Osteochondritis dissecans

699: 749: 722: 1351: 183: 462: 43: 992: 1097: 1083: 1069: 1055: 239:) of both cartilage and bone, and the free movement of these bone and cartilage fragments within the joint space, causing pain, blockage and further damage. OCD has a typical anamnesis with pain during and after sports without any history of trauma. Some symptoms of late stages of osteochondritis dissecans are found with other diseases like rheumatoid disease of children and meniscal ruptures. The disease can be confirmed by 1215:), which are precursors to both bone and cartilaginous tissue. As a result, open growth plates allow for more of the stem cells necessary for repair in the affected joint. Unstable, large, full-thickness lesions (stage III and IV) or lesions of any stage found in the skeletally mature are more likely to fail non-operative treatment. These lesions offer a worse prognosis and surgery is required in most cases. 235:

subchondral bone. There it will show as bone defect area under articular cartilage. The bone will then possibly heal to the surrounding condylar bone in 50% of the cases. Or it will develop into a pseudarthrosis between condylar bone core and osteochondritis flake leaving the articular cartilage it supports prone to damage. The damage is executed by ongoing sport overload. The result is fragmentation (

274:. Because their bones are still growing, adolescents are more likely than adults to recover from OCD; recovery in adolescents can be attributed to the bone's ability to repair damaged or dead bone tissue and cartilage in a process called bone remodeling. While OCD may affect any joint, the knee tends to be the most commonly affected, and constitutes 75% of all cases. 620:, and times with limited range of motion. Some with loose body lesions may report catching, locking, or both. The possibility of microtrauma emphasizes a need for evaluation of biomechanical forces at the knee in a physical examination. As a result, the alignment and rotation of all major joints in the affected extremity is common, as are 1207:

skeletal maturity. The juvenile form of the disease occurs in open growth plates, usually affecting children between the ages of 5 and 15 years. The adult form commonly occurs between ages 16 to 50, although it is unclear whether these adults developed the disease after skeletal maturity or were undiagnosed as children.

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5 and 15 years and occurs more commonly in males than females, with a ratio between 2:1 and 3:1. OCD has become more common among adolescent females as they become more active in sports. The adult form, which occurs in those who have reached skeletal maturity, is most commonly found in people 16 to 50 years old.

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found OCD to be the cause of articular cartilage defects in 2% of cases in a study of 25,124 knee arthroscopies. Although rare, OCD is noted as an important cause of joint pain in active adolescents. The juvenile form of the disease occurs in children with open growth plates, usually between the ages

481:, which is primarily an articular surface problem. Instead, OCD is a problem of the bone underlying the cartilage, which may secondarily affect the articular cartilage. Left untreated, OCD can lead to the development of degenerative arthritis secondary to joint incongruity and abnormal wear patterns. 1210:

The prognosis is good for stable lesions (stage I and II) in juveniles with open growth plates; treated conservatively—typically without surgery—50% of cases will heal. Recovery in juveniles can be attributed to the bone's ability to repair damaged or dead bone tissue and cartilage in a process

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Continuous passive motion (CPM) has been used to improve healing of the articular surface during the postoperative period for people with full-thickness lesions. It has been shown to promote articular cartilage healing for small (< 3 mm in diameter) lesions in rabbits. Similarly, Rodrigo and

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in young athletes is on the rise and accounts for a significant number of visits to primary care; this reinforces the theory that OCD may be associated with increased participation in sports and subsequent trauma. High-impact sports such as gymnastics, soccer, basketball, lacrosse, football, tennis,

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Non-surgical treatment is successful in 50% of the cases. If in late stages the lesion is unstable and the cartilage is damaged, surgical intervention is an option as the ability for articular cartilage to heal is limited. When possible, non-operative forms of management such as protected reduced or

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According to the Columbia Animal Hospital the frequency of affected animals is dogs, humans, pigs, horses, cattle, chickens, and turkeys, and in dogs the most commonly affected breeds include the German Shepherd, Golden and Labrador Retriever, Rottweiler, Great Dane, Bernese Mountain Dog, and Saint

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and formation of granulation (scar) tissue, absorption of necrotic fragments, intertrabecular osteoid deposition, and remodeling of new bone. With delay in the revascularization stage, an OCD lesion develops. A lesion can lead to articular-surface irregularities, which in turn may cause progressive

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König named the disease "osteochondritis dissecans", describing it as a subchondral inflammatory process of the knee, resulting in a loose fragment of cartilage from the femoral condyle. In 1922, Kappis described this process in the ankle joint. On review of all literature describing transchondral

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of the articular surface. The chondrocytes are grown and injected into the defect under a periosteal patch. ACI surgery has reported good to excellent results for reduced swelling, pain and locking in clinical follow-up examinations. Some physicians preferred to use undifferentiated pluripotential

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Candidates for non-operative treatment are limited to skeletally immature teenagers with a relatively small, intact lesion and the absence of loose bodies. Non-operative management may include activity modification, protected weight bearing (partial or non-weight bearing), and immobilization. The

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The articular cartilage's capacity for repair is limited: partial-thickness defects in the articular cartilage do not heal spontaneously, and injuries of the articular cartilage that fail to penetrate subchondral bone tend to lead to deterioration of the articular surface. As a result, surgery is

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Similar to OATS, arthroscopic articular cartilage paste grafting is a surgical procedure offering cost-effective, long-lasting results for stage IV lesions. A bone and cartilage paste derived from crushed plugs of the non-weight-bearing intercondylar notch can achieve pain relief, repair damaged

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to remove shear stress from the involved area. They are permitted to walk with weight bearing as tolerated. X-rays are usually taken three months after the start of non-operative therapy; if they reveal that the lesion has healed, a gradual return to activities is instituted. Those demonstrating

357:. The tenderness may initially spread, but often reverts to a well-defined focal point as the lesion progresses. Just as OCD shares symptoms with common maladies, acute osteochondral fracture has a similar presentation with tenderness in the affected joint, but is usually associated with a fatty 337:

People with OCD report activity-related pain that develops gradually. Individual complaints usually consist of mechanical symptoms including pain, swelling, catching, locking, popping noises, and buckling / giving way; the primary presenting symptom may be a restriction in the range of movement.

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While the arthroscopic classification of bone and cartilage lesions is considered standard, the Anderson MRI staging is the main form of staging used in this article. Stages I and II are stable lesions. Stages III and IV describe unstable lesions in which a lesion of the cartilage has

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drilling may be performed by using an antegrade (from the front) approach from the joint space through the articular cartilage, or by using a retrograde (from behind) approach through the bone outside of the joint to avoid penetration of the articular cartilage. This has proven successful with

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The prognosis after different treatments varies and is based on several factors that include the age of the patient, the affected joint, the stage of the lesion and, most importantly, the state of the growth plate. It follows that the two main forms of osteochondritis dissecans are defined by

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program is usually instituted once the immobilization period has ended, incorporating range of motion, stretching, progressive strengthening, and functional or sport-specific training. During this time, patients are advised to avoid running and jumping, but are permitted to perform low impact

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The choice of surgical versus non-surgical treatments for osteochondritis dissecans is controversial. Consequently, the type and extent of surgery necessary varies based on patient age, severity of the lesion, and personal bias of the treating surgeon—entailing an exhaustive list of suggested

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OCD is caused by blood deprivation of the secondary physes around the bone core of the femoral condyle. This happens to the epiphyseal vessels under the influence of repetitive overloading of the joint during running and jumping sports. During growth such chondronecrotic areas grow into the

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Symptoms typically present within the initial weeks of stage I. The onset of stage II occurs within months and offers little time for diagnosis. The disease progresses rapidly beyond stage II, as OCD lesions quickly move from stable cysts or fissures to unstable fragments.

1301:, Berndt and Harty developed a classification system for staging of osteochondral lesions of the talus (OLTs). The term osteochondritis dissecans has persisted, and has since been broadened to describe a similar process occurring in many other joints, including the knee, hip, elbow, and 267:, such as straight leg raises, are commonly used to restore muscle loss without disturbing the cartilage of the affected joint. Once the immobilization period has ended, physical therapy involves continuous passive motion (CPM) and/or low impact activities, such as walking or swimming. 1164:

or pins made of stainless steel or materials that can be absorbed by the body. If loose bodies are found, they are removed. Although each case is unique and treatment is chosen on an individual basis, ACI is generally performed on large defects in skeletally mature people.

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are also sometimes used to monitor the progress of treatment. Unlike plain radiographs (X-rays), CT scans and MRI scans can show the exact location and extent of the lesion. Technetium bone scans can detect regional blood flow and the amount of

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Moriya T, Wada Y, Watanabe A, Sasho T, Nakagawa K, Mainil-Varlet P, Moriya H (May 2007). "Evaluation of reparative cartilage after autologous chondrocyte implantation for osteochondritis dissecans: histology, biochemistry, and MR imaging".

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positive results at one-year follow-up with antegrade drilling in nine out of eleven teenagers with the juvenile form of OCD, and in 18 of 20 skeletally immature people (follow-up of five years) who had failed prior conservative programs.

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In attempts to address the weaker structure of the reparative fibrocartilage, new techniques have been designed to fill the defect with tissue that more closely simulates normal hyaline articular cartilage. One such technique is

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LaPrade RF, Bursch LS, Olson EJ, Havlas V, Carlson CS (February 2008). "Histologic and immunohistochemical characteristics of failed articular cartilage resurfacing procedures for osteochondritis of the knee: a case series".

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Kish G, Módis L, Hangody L (January 1999). "Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results".

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non-weight bearing and immobilization are used. Surgical treatment includes arthroscopic drilling of intact lesions, securing of cartilage flap lesions with pins or screws, drilling and replacement of cartilage plugs,

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treatments. A variety of surgical options exist for the treatment of persistently symptomatic, intact, partially detached, and completely detached OCD lesions. Post-surgery reparative cartilage is inferior to healthy

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Once candidates for treatment have been screened, treatment proceeds according to the lesion's location. For example, those with OCD of the knee are immobilized for four to six weeks or even up to six months in

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Osteochondritis dissecans is difficult to diagnose clinically as the animal may only exhibit an unusual gait. Consequently, OCD may be masked by, or misdiagnosed as, other skeletal and joint conditions such as

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Hefti F, Beguiristain J, Krauspe R, Möller-Madsen B, Riccio V, Tschauner C, Wetzel R, Zeller R (October 1999). "Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society".

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The problem develops in puppyhood although often subclinically, and there may be pain or stiffness, discomfort on extension, or other compensating characteristics. Diagnosis generally depends on X-rays,

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De Smet AA, Fisher DR, Graf BK, Lange RH (September 1990). "Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects".

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surface integrity, and fragment displacement. A low T1 and high T2 signal at the fragment interface is seen in active lesions. This indicates an unstable lesion or recent microfractures. While MRI and

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and must be protected for 6 to 12 months. Results for large lesions tend to diminish over time; this can be attributed to the decreased resilience and poor wear characteristics of the fibrocartilage.

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Pins and screws can be used to secure flap (sometimes referred to as hinged) lesions. Bone pegs, metallic pins and screws, and other bioresorbable screws may be used to secure these types of lesions.

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cells, such as periosteal cells and bone marrow stem cells, as opposed to chondrocytes. These too have demonstrated the ability to regenerate both the cartilage and the underlying subchondral bone.

361:. Although there is no significant pathologic gait or characteristic alignment abnormality associated with OCD, the patient may walk with the involved leg externally rotated in an attempt to avoid 1198:

activities, such as walking or swimming. If patients return to activity before the cartilage has become firm, they will typically complain of pain during maneuvers such as squatting or jumping.

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A rehabilitation program often involves protection of the compromised articular surface and underlying subchondral bone combined with maintenance of strength and range of motion. Post-operative

2397:"Associations between candidate gene markers at a quantitative trait locus on equine chromosome 4 responsible for osteochondrosis dissecans in fetlock joints of South German Coldblood horses" 3745:

Stone KR, Walgenbach AW, Freyer A, Turek TJ, Speer DP (March 2006). "Articular cartilage paste grafting to full-thickness articular cartilage knee joint lesions: a 2- to 12-year follow-up".

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has formed within the cartilage layer itself, giving rise to secondary inflammation. OCD most commonly affects the knee, although it can affect other joints such as the ankle or the elbow.

1394:. Osteochondritis itself signifies the disturbance of the usual growth process of cartilage, and OCD is the term used when this affects joint cartilage causing a fragment to become loose. 775:

OCD is classified by the progression of the disease in stages. There are two main staging classifications used; one is determined by MRI diagnostic imaging while the other is determined

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signal at the articular surfaces of the lateral aspect of the medial femoral condyle confirms the presence of OCD. Diffuse increase in T2 signal at the medial femoral condyle indicates

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Bui-Mansfield LT, Kline M, Chew FS, Rogers LF, Lenchik L (November 2000). "Osteochondritis dissecans of the tibial plafond: imaging characteristics and a review of the literature".

658:(MRI) is useful for staging OCD lesions, evaluating the integrity of the joint surface, and distinguishing normal variants of bone formation from OCD by showing bone and cartilage 427:, which leads to microfractures and sometimes an interruption of blood supply to the subchondral bone, may cause subsequent localized loss of blood supply or alteration of growth. 1414:

scans. While cases of OCD of the stifle go undetected and heal spontaneously, others are exhibited in acute lameness. Surgery is recommended once the animal has been deemed lame.

433:, rather than avascular necrosis, is thought to cause osteochondritis dissecans in juveniles. In adults, trauma is thought to be the main or perhaps the sole cause, and may be 3030:

Takahara M, Ogino T, Takagi M, Tsuchida H, Orui H, Nambu T (July 2000). "Natural progression of osteochondritis dissecans of the humeral capitellum: initial observations".

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Peterson L, Minas T, Brittberg M, Nilsson A, Sjögren-Jansson E, Lindahl A (May 2000). "Two- to 9-year outcome after autologous chondrocyte transplantation of the knee".

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OCD occurs in 15 to 30 people per 100,000 in the general population each year. Although rare, it is an important cause of joint pain in physically active children and

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goal of non-operative intervention is to promote healing in the subchondral bone and prevent potential chondral collapse, subsequent fracture, and crater formation.

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Cahill BR, Berg BC (1983). "99m-Technetium phosphate compound joint scintigraphy in the management of juvenile osteochondritis dissecans of the femoral condyles".

256: 3825:"The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit" 1124:

and rarely form hyaline cartilage. While small lesions can be resurfaced using this form of surgery, the repair tissue tends to have less strength than normal

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interface. Many other conditions were once confused with OCD when attempting to describe how the disease affected the joint, including osteochondral fracture,

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Tunnel or notch view X-ray of the right knee from a patient with osteochondritis dissecans—cystic changes and irregular border are indicated by arrows on the

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in the subchondral region, or those whose lesions are unchanged, are candidates to repeat the above described three-month protocol until healing is noted.

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OCD occurs when a loose piece of bone or cartilage partially (or fully) separates from the end of the bone, often because of a loss of blood supply (

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Johnson LL, Uitvlugt G, Austin MD, Detrisac DA, Johnson C (1990). "Osteochondritis dissecans of the knee: arthroscopic compression screw fixation".

263:. Most rehabilitation programs combine efforts to protect the joint with muscle strengthening and range of motion. During an immobilization period, 2041:

Milgram JW (February 1978). "Radiological and pathological manifestations of osteochondritis dissecans of the distal femur. A study of 50 cases".

946:; removal or reattachment of loose bodies; mosaicplasty and osteoarticular transfer system (OATS) procedures. The primary goals of treatment are: 4773: 4900: 3780:

Kocher MS, Czarnecki JJ, Andersen JS, Micheli LJ (May 2007). "Internal fixation of juvenile osteochondritis dissecans lesions of the knee".

3276: 259:, and in very difficult situation in adults joint replacement. After surgery rehabilitation is usually a two-stage process of unloading and 5287: 4873: 4425: 2219:

Kenniston JA, Beredjiklian PK, Bozentka DJ (October 2008). "Osteochondritis dissecans of the capitellum in fraternal twins: case report".

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Bernard. Although any joint may be affected, those commonly affected by OCD in the dog are: shoulder (often bilaterally), elbow, knee and

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Mandelbaum BR, Browne JE, Fu F, Micheli L, Mosely JB, Erggelet C, Minas T, Peterson L (1998). "Articular cartilage lesions of the knee".

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Langer F, Percy EC (May 1971). "Osteochondritis dissecans and anomalous centres of ossification: a review of 80 lesions in 61 patients".

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Detterline AJ, Goldstein JL, Rue JP, Bach BR (April 2008). "Evaluation and treatment of osteochondritis dissecans lesions of the knee".

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Rodrigo JJ, Steadman JR, Syftestad G, Benton H, Silliman J (1995). "Effects of human knee synovial fluid on chondrogenesis in vitro".

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Kocher MS, Tucker R, Ganley TJ, Flynn JM (July 2006). "Management of osteochondritis dissecans of the knee: current concepts review".

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Harding WG (March–April 1977). "Diagnosis of ostechondritis dissecans of the femoral condyles: the value of the lateral x-ray view".

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often required in even moderate cases where the osteochondral fragment has not detached from the bone (Anderson Stage II, III).

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Thomson NL (November 1987). "Osteochondritis dissecans and osteochondral fragments managed by Herbert compression screw fixation".

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The three methods most commonly used in treating full thickness lesions are arthroscopic drilling, abrasion, and microfracturing.

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Tuite MJ, DeSmet AA (October 1994). "MRI of selected sports injuries: muscle tears, groin pain, and osteochondritis dissecans".

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Recent case reports suggest that some people may be genetically predisposed to OCD. Families with OCD may have mutations in the

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squash, baseball and weight lifting may put participants at a higher risk of OCD in stressed joints (knees, ankles and elbows).

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in 75–85% of knee cases—tends to be the most commonly affected, and constitutes 75% of all cases. The elbow (specifically the

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Anderson AF, Richards DB, Pagnani MJ, Hovis WD (June 1997). "Antegrade drilling for osteochondritis dissecans of the knee".

2298: 1813: 2639: 939: 605:. The test is performed by slowly extending the knee from 90 degrees, maintaining internal rotation. Pain at 30 degrees of 5205: 4148:

Widuchowski W, Widuchowski J, Trzaska T (June 2007). "Articular cartilage defects: study of 25,124 knee arthroscopies".

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Clanton TO, DeLee JC (July 1982). "Osteochondritis dissecans. History, pathophysiology and current treatment concepts".

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Livesley PJ, Milligan GF (29 November 2004). "Osteochondritis dissecans patellae. Is there a genetic predisposition?".

1740: 929: 411:(loss of blood flow), rapid growth, deficiencies and imbalances in the ratio of calcium to phosphorus, and problems of 3328: 5031: 4756: 4723: 3964: 3937: 1968: 1371:

OCD also is found in animals, and is of particular concern in horses, as there may be a hereditary component in some

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on the anterior aspect of the knee in juvenile patients. In older people, the lesion typically appears as an area of

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Williamson LR, Albright JP (November 1996). "Bilateral osteochondritis dissecans of the elbow in a female pitcher".

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In some cases, the absence of notable trauma made it likely that there existed some spontaneous cause of separation.

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called bone remodeling. Open growth plates are characterized by increased numbers of undifferentiated chondrocytes (

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If non-surgical measures are unsuccessful, drilling may be considered to stimulate healing of the subchondral bone.

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Kadakia AP, Sarkar J (2007). "Osteochondritis dissecans of the talus involving the subtalar joint: a case report".

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In animals, OCD is considered a developmental and metabolic disorder related to cartilage growth and endochondral

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Steadman reported that CPM for six hours per day for eight weeks produced an improved clinical outcome in humans.

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Dipaola JD, Nelson DW, Colville MR (1991). "Characterizing osteochondral lesions by magnetic resonance imaging".

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Kappis M (1922). "Weitere beitrage zur traumatisch-mechanischen entstehung der "spontanen" knorpela biosungen".

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stiff and unstable. OCD in humans most commonly affects the knees, ankles, and elbow but can affect any joint.

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can be performed to show necrosis of subchondral bone, formation of loose fragments, or both. Occasionally a

2601:"Osteochondritis dissecans: analysis of mechanical stability with radiography, scintigraphy, and MR imaging" 1379:

for increased size are also factors. OCD has also been studied in other animals—mainly dogs, especially the

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Livesley PJ, Milligan GF (1992). "Osteochondritis dissecans patellae. Is there a genetic predisposition?".

1144: 735: 470: 466: 1787: 4426:"Qafzeh 9 mandible (ca 90-100 kyrs BP, Israel) revisited: μ-CT and 3D reveal new pathological conditions" 5474: 5301: 3980:

Cahill BR (July 1995). "Osteochondritis Dissecans of the Knee: Treatment of Juvenile and Adult Forms".

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Mesgarzadeh M, Sapega AA, Bonakdarpour A, Revesz G, Moyer RA, Maurer AH, Alburger PD (December 1987).

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are encouraged during the post-operative or immobilization period. A six to eight-week home or formal

578:. In OCD of the knee, people may walk with the involved leg externally rotated in an attempt to avoid 5568: 5502: 4777: 4748: 4327:

Lindén B (December 1976). "The incidence of osteochondritis dissecans in the condyles of the femur".

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Powers R (May 2008). "An ice hockey player with an unusual elbow injury. Osteochondritis dissecans".

616:, and diffuse or localized tenderness. Examination often reveals symptoms of generalized joint pain, 4679:

Berndt AL, Harty M (June 2004). "Transchondral fractures (osteochondritis dissecans) of the talus".

5804: 5664: 5536: 5363: 5216: 1314: 1271: 1240: 1224: 708: 602: 442: 182: 5829: 5037: 4948: 1279: 1189:, are usually required to control pain, inflammation and swelling. Straight leg raising and other 837:

The articular cartilage is breached; high signal behind the fragment indicates loss of attachment

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uptake. Both of these seem to be closely correlated to the potential for healing in the fragment.

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published a paper on the cause of loose bodies in the joint. In his paper, König concluded that:

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defects in younger people. In this surgery, chondrocytes are arthroscopically extracted from the

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The articular cartilage is breached; low signal behind the fragment indicates fibrous attachment

779:. Both stagings represent the pathological conditions associated with OCD's natural progression. 739: 587: 370: 215:. OCD usually causes pain during and after sports. In later stages of the disorder there will be 1289:

Less severe trauma might contuse the bone to cause an area of necrosis that might then separate.

523:. In turn, this pattern leads to disordered ossification of cartilage, resulting in subchondral 5892: 5887: 5439: 5352: 1444: 1419: 1262:

The oldest case of OCD was identified on the temporo-mandibular joint of the Qafzeh 9 fossil.

5680: 5457: 3614:"Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation" 1212: 943: 652:

used. Harding described the lateral X-ray as a method to identify the site of an OCD lesion.

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Treatment options include modified activity with or without weight bearing; immobilization;

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Replace damaged bone and cartilage with implanted tissues or cells that can grow cartilage.

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Physical examination of a patient with ankle OCD often returns symptoms of joint effusion,

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Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND (December 1980).

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American Academy of Orthopaedic Surgeons Symposium on Upper Extremity Injuries in Athletes

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Berzon JL (October 1979). "Osteochondritis dissecans in the dog: diagnosis and therapy".

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Some methods of fixation for unstable lesions include countersunk compression screws and

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appearance. As a result, surgery is often avoided if non-operative treatment is viable.

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have a close correlation, X-ray films tend to be less inductive of similar MRI results.

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typical of late stage Osteochondritis dissecans. In this case, the lesion was caused by

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Conrad JM, Stanitski CL (2003). "Osteochondritis dissecans: Wilson's sign revisited".

2600: 1857:"Osteochondritis dissecans of the knee: a historical review of etiology and treatment" 1582: 1565: 223:

in the early stages does only show pain as symptom, in later stages there could be an

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Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (October 1994).

3586: 3551: 3547: 3516: 3512: 3481: 3446: 3397: 3353: 3186: 3143: 3098: 3047: 2971: 2936: 2901: 2863: 2859: 2820: 2816: 2777: 2704: 2662: 2658: 2620: 2582: 2574: 2499: 2453: 2418: 2377: 2321: 2317: 2271: 2236: 2161: 2123: 2119: 2058: 2008: 1964: 1941: 1914: 1910: 1878: 1873: 1856: 1833: 1829: 1752: 1714: 1710: 1636: 1587: 1541: 1518: 1514: 1483: 1479: 1125: 1009: 583: 531: 461: 366: 171: 5773: 5256: 4665: 4627: 4597:"Osteochondritis dissecans 1887-1987. A centennial look at König's memorable phrase" 4581: 4310: 4134: 4009: 3809: 3682: 3598: 3365: 3198: 3151: 2983: 2832: 2789: 2716: 2616: 2283: 2173: 2020: 1607:"Bilateral osteochondritis dissecans of the elbow treated by Herbert screw fixation" 662:

in the area of the irregularity. MRI provides information regarding features of the

5792: 5479: 5262: 4688: 4653: 4615: 4611: 4569: 4530: 4493: 4440: 4398: 4336: 4294: 4245: 4157: 4114: 4082: 4077: 4065: 3989: 3839: 3789: 3754: 3712: 3662: 3625: 3578: 3543: 3508: 3473: 3441: 3436: 3424: 3409: 3389: 3343: 3178: 3135: 3090: 3039: 2963: 2928: 2893: 2855: 2812: 2769: 2696: 2654: 2612: 2566: 2491: 2465: 2445: 2408: 2367: 2359: 2313: 2263: 2228: 2153: 2115: 2085: 2050: 2000: 1906: 1868: 1825: 1706: 1626: 1618: 1577: 1510: 1475: 1320: 1194: 755: 731: 560: 500: 260: 212: 75: 42: 3728: 3329:"Clinical outcome of fragment fixation for osteochondritis dissecans of the elbow" 1668: 5724: 5706: 5685: 5659: 5628: 5563: 5489: 5221: 4363: 4261: 4028: 3855: 3758: 3582: 2734: 2700: 2329: 1841: 1384: 1345: 1278:

described the disease process for the first time, but it was not until 1887 that

1161: 648:. The visibility of the lesion depends on its location and on the amount of knee 489: 430: 392: 382: 347: 327: 291: 5259: 3630: 3613: 2670: 597:. This examination may reveal fluid in the joint, tenderness, and crepitus. The 511:. With disruption of the epiphyseal plate vessels, varying degrees and depth of 5839: 5621: 5616: 5558: 5415: 4445: 4298: 4161: 3139: 2967: 2495: 2232: 2089: 1399: 1326: 1121: 784: 727: 681: 637: 508: 478: 224: 5232: 5184: 4340: 4118: 3182: 2932: 2897: 2570: 2363: 2188: 5866: 5393: 4468:

Munro A (1738). "Part of the cartilage of the joint separated and ossified".

3793: 3393: 3213: 2157: 624:

and intrinsic abnormalities concerning the affected joint, including laxity.

485: 423:

examination suggests a non-inflammatory cause. It is thought that repetitive

287: 2413: 2396: 1760: 666:

and bone under the cartilage, including edema, fractures, fluid interfaces,

326:. These fragments are sometimes referred to as joint mice. OCD is a type of 5642: 5604: 5469: 5452: 5447: 5410: 5332: 4700: 4507: 4454: 4424:

Coutinho Nogueira D, Dutour O, Coqueugniot H, Tillier AM (September 2019).

4169: 4126: 4001: 3801: 3766: 3674: 3401: 3357: 3190: 3147: 3102: 3051: 2940: 2708: 2578: 2503: 2457: 2449: 2422: 2381: 2325: 2240: 2165: 2127: 2012: 1918: 1756: 1391: 1360: 1029: 980: 641: 633: 575: 520: 504: 416: 412: 358: 353:

Physical examination typically reveals fluid in the joint, tenderness, and

323: 279: 4623: 4542: 4410: 4348: 4306: 4257: 4215: 4105:

Lützner J, Mettelsiefen J, Günther KP, Thielemann F (September 2007). "".

4091: 3885: 3851: 3724: 3639: 3590: 3555: 3520: 3485: 3450: 3348: 2975: 2905: 2867: 2781: 2666: 2624: 2275: 1945: 1882: 1837: 1718: 1640: 1622: 1591: 1522: 1487: 991: 530:

Four minor stages of OCD have been identified after trauma. These include

5420: 5368: 5293: 5109: 4423: 3305: 3069:. Annual Meeting of the Academy of Orthopaedic Surgeons. New Orleans, LA. 2824: 2062: 1501:

Woodward AH, Bianco AJ (1975). "Osteochondritis dissecans of the elbow".

1407: 1372: 1275: 1247:

of the ankle represents 4% of cases. Less frequent locations include the

1136: 1117: 1113: 857: 776: 759: 671: 598: 424: 240: 3425:"Results of drilling osteochondritis dissecans before skeletal maturity" 2552:"MR imaging features of osteochondritis dissecans of the femoral sulcus" 2004: 1354:

Pathological specimen from a sow— the arrow points to a fracture in the

1096: 1082: 1068: 1054: 877:

Articular cartilage is smooth and intact but may be soft or ballottable

5651: 5497: 5464: 5403: 5398: 5268: 4657: 4573: 3067:

Osteochondral lesion of the talus: A radiologic and surgical comparison

2773: 2550:

Boutin RD, Januario JA, Newberg AH, Gundry CR, Newman JS (March 2003).

2267: 1364: 1332: 1298: 1244: 1178: 1133: 712: 711:

of a case of osteochondritis dissecans of parts of the superior-medial

594: 516: 434: 400: 278:

coined the term osteochondritis dissecans in 1887, describing it as an

271: 207:

disorder primarily of the subchondral bone in which cracks form in the

55: 5167: 4976:"Osteochondritis Dissecans in Thoroughbreds. Weanlings: A Field Study" 2054: 5591: 5251: 4183:

Nagura S (1960). "The so-called osteochondritis dissecans of Konig".

4066:"Osteochondritis dissecans and other lesions of the femoral condyles" 2193: 1895: 1286:

Trauma had to be very severe to break off parts of the joint surface.

1252: 1013: 684: 645: 621: 563: 536: 438: 420: 404: 319: 295: 283: 4557: 4104: 574:

Physical examination often begins with examination of the patient's

477:

Osteochondritis dissecans differs from "wear and tear" degenerative

5341: 3926:

Fleisher GR, Ludwig S, Henretig FM, Ruddy RM, Silverman BK (2005).

2598: 2198: 613: 556: 512: 450: 396: 388: 354: 228: 453:

gene. Studies in horses have implicated specific genetic defects.

1256: 1248: 1182: 1005: 704: 689: 649: 606: 552: 307: 5210: 3327:

Nobuta S, Ogawa K, Sato K, Nakagawa T, Hatori M, Itoi E (2008).

492:. The loose piece may stay in place or slide around, making the 5507: 5179: 2299:"Familial osteochondritis dissecans with associated tibia vara" 1186: 609:

and relief with tibial external rotation is indicative of OCD.

343: 331: 3871: 3779: 3611: 1227:

of 15 to 30 cases per 100,000 persons per year. Widuchowski W

219:

of the affected joint that catches and locks during movement.

5753: 4228: 4147: 3652: 3498: 2218: 1140: 953:

Fix unstable fragments while maintaining joint congruity; and

762: 659: 579: 548: 493: 362: 204: 4229:

Hughston JC, Hergenroeder PT, Courtenay BG (December 1984).

3901:"Knee Osteochondritis dissecans: treatment & medication" 3463: 3275:. Société Française d'Orthopédie Pédiatrique. Archived from 2918: 2640:"A diagnostic sign in osteochondritis DISSECANS OF THE KNEE" 593:

Next, the examining physician may check for weakness of the

566:

is used to assess the degree of loosening within the joint.

499:

In skeletally immature individuals, the blood supply to the

4949:"Seo In-guk returns after controversial military exemption" 3982:

The Journal of the American Academy of Orthopaedic Surgeons

3925: 3822: 3029: 2549: 2395:

Wittwer C, Dierks C, Hamann H, Distl O (March–April 2008).

1566:"Osteochondritis dissecans of the distal femur and patella" 1120:

of an OCD lesion. These cells typically differentiate into

117: 96: 90: 4280:"Osteochondritis dissecans of the knee. A clinical survey" 3744: 2435: 1243:) is the second most affected joint with 6% of cases; the 1235:

While OCD may affect any joint, the knee—specifically the

1112:

In 1946, Magnusson established the use of stem cells from

102: 81: 3952: 3568: 1411: 322:

or bone become loose within a joint, leading to pain and

149: 143: 137: 123: 3378: 2394: 1139:

implantation (ACI), which is useful for large, isolated

4923:"Seo In Guk exempt from his mandatory military service" 4033:(2 ed.). Cambridge University Press. p. 102. 3899:

Jacobs B, Ertl JP, Kovacs G, Jacobs JA (28 July 2006).

3326: 3167: 2143: 5098:

Journal of the American Veterinary Medical Association

4681: