Osteochondritis dissecans: Definition, etiology, epidemiology
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1 5 th course of advanced surgery of the knee Val d Isère, Osteochondritis dissecans: Definition, etiology, epidemiology Prof. Romain Seil, MD, PhD Orthopaedic Surgery Sports Medicine Research Laboratory Centre Hospitalier de Luxembourg Centre de Recherche Public Santé, Luxembourg
2 crp-sante.lu 2 chl.lu Definition Disorder of the subchondral bone that can secondarily affect the overlying articular cartilage and may, in some cases, lead to cartilage separation and fragmentation. Ganley TJ, Flynn JM 2006
3 crp-sante.lu 3 Definition chl.lu In 1558, Ambroïse Paré removed loose bodies from a knee joint. In 1870, Paget described quiet necrosis within the knee. In 1888, König created the term "osteochondritis dissecans." He proposed this condition was caused by spontaneous necrosis due to trauma.
4 crp-sante.lu 4 Definition chl.lu Juvenile form Open growth plates 5 15 years Adult form years Localization Size Stability Fragmentation
5 Definition Non fragmented & repairable OCD, 15 y., basketball crp-sante.lu 5 chl.lu
6 Definition Fragmented & non-repairable OCD, 18 y., basketball crp-sante.lu 6 chl.lu
7 crp-sante.lu 7 Differential Fragmentrefixation diagnosis Traumatic (osteo)chondral lesion
8 crp-sante.lu 8 Differential Fragmentrefixation diagnosis Traumatic (osteo)chondral lesion
9 crp-sante.lu 9 Differential Fragmentrefixation diagnosis Traumatic (osteo)chondral lesion
10 Behandlung der akuten Differential Patellaluxation diagnosis Traumatic (osteo)chondral lesion crp-sante.lu 10 Stanitski CL, 1998
11 Behandlung der akuten Differential Patellaluxation diagnosis Traumatic (osteo)chondral lesion crp-sante.lu 11 Stanitski CL, 1998
12 Differential diagnosis crp-sante.lu 12 chl.lu Osteonecrosis
13 crp-sante.lu 13 Differential diagnosis Synovial chondromatosis
14 Differential diagnosis Normal variants of ossification in children DD of stage 1 OCD Ossification defects posterior condyles w. intact cartilage Accessory ossification centers Spiculation Lack of bone marrow edema crp-sante.lu 14 Gebarski K, Ramirez R, Pediatr Radiol 2005
15 crp-sante.lu 15 chl.lu Epidemiology From: Keenan OJF, Knee 2014 Males > females 2:1 3:1 Schenk R, Goodnight JM, JBJS-A, 1996 Prevalence: 3-6 / Federico DJ, Arthroscopy nd-3d decade 10 % bilateral
16 Etiology Repetitive microtrauma Ischemia Genetic factors Endocrine factors Anomalies of ossification It is NOT an inflammation absence of inflammatory cells in histological sections From: Uozumi H, Am J Sports Med 2009 crp-sante.lu 16 Shea KG, Clin Orthop Relat Res 2013 chl.lu
17 crp-sante.lu 17 chl.lu Epidemiology 2 brothers 18 y. 16 y.
18 crp-sante.lu 18 chl.lu Pathomechanism Repetitive microtrauma: focal ischemia reduced support of subchondral bone cartilage softening crater formation/fragment separation
19 crp-sante.lu 19 chl.lu From: Uozumi H, Am J Sports Med 2009 Fibrillated cartilage Active bone remodelling Necrotic bone Present in 8 of 11 histologic studies
20 crp-sante.lu 20 chl.lu Localisation > 50 anatomic OCD sites have been identified 1. Knee lateral aspect MFC patella trochlea 2. Ankle medial talar dome 3. Elbow capitulum humeri
21 Localisation 2010: drilling y. crp-sante.lu 21 chl.lu
22 crp-sante.lu 22 chl.lu Localisation, 13 y., gymnast OD of the capitulum humeri
23 crp-sante.lu 23 chl.lu Prognosis Affects present / future activity levels May contribute to degenerative joint disease FU over 34 y.: 32 % of moderate to severe OA Twyman RS, JBJS-B, 1991 Juvenile form: Depends on status of the growth plate
24 crp-sante.lu 24 chl.lu Prognosis The younger the patient, the higher the probability of spontaneous resorption! , 13 y., 15 y.
25 Prognosis Schuss, 45 PA AP 66 y. crp-sante.lu 25 chl.lu
26 crp-sante.lu 26 chl.lu Prognosis: cartilage regeneration potential 13 y.
27 Prognosis: regeneration potential crp-sante.lu 27 chl.lu
28 13 y. crp-sante.lu 28
29 crp-sante.lu 29 chl.lu Prognosis: cartilage regeneration potential 6 w. postop. 4,5 mo. postop. 12 mo. postop. 2 y. postop. 13 y. 2 y. postop.
30 AMSTERDAM / THE NETHERLANDS 16th ESSKA Congress May 14-17, 2014 CONGRESS PRESIDENT C. Niek van Dijk ESSKA PRESIDENT João Espregueira-Mendes SCIENTIFIC CHAIRMEN Stefano Zaffagnini Roland Becker Gino Kerkhoffs ORGANISER esska@intercongress.de crp-sante.lu 30
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