Ebook Pediatric and adolescent knee surgery (1st): Part 2
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Ebook Pediatric and adolescent knee surgery (1st): Part 2
SECTION3Osteochondritis DissecansCHAPTEREric w. Edmonds Henry G. Chambers21Osteochondritis Dissecans: Overview,Epidemiology, Etiology,Classification, Ebook Pediatric and adolescent knee surgery (1st): Part 2 AssessmentINTRODUCTIONAlthough loose bodies within a joint were first described by Paget,1 Kõnig later suggested three methods by which loose bodies could be created: (1) direct trauma with acute fracture, (2) minimal trauma that develops into osteonecrosis and subsequent fragmentation, or (3) no t Ebook Pediatric and adolescent knee surgery (1st): Part 2rauma with spontaneous fragmentation. The latter variety he coined osteochondritis dissecans (OCD).2,3 Although it should be pointed out that the exacEbook Pediatric and adolescent knee surgery (1st): Part 2
t pathophysiology remains unknown, it is agreed that OCD is likely an acquired lesion of subchondral bone.Beyond this characterization, it is less cleSECTION3Osteochondritis DissecansCHAPTEREric w. Edmonds Henry G. Chambers21Osteochondritis Dissecans: Overview,Epidemiology, Etiology,Classification, Ebook Pediatric and adolescent knee surgery (1st): Part 2ion unrelated to an acute osteochondral fracture of normal cartilage (Fig. 21.1).4’5 This understanding of the end point of the disease process has led to many etiologies of OCD being postulated (particularly concerning the knee) including trauma,6,7 inflammation,2,8 genetics,9 vascular abnormalitie Ebook Pediatric and adolescent knee surgery (1st): Part 2s,10’11 and constitutional factors.12 However, the etiology remains unknown, even though our veterinary medicine colleagues have made some leaps in unEbook Pediatric and adolescent knee surgery (1st): Part 2
derstanding over recent years.13,14Historically, there has been a distinction between juvenile-onset OCD and adult-onset OCD. Many surgeons have suggeSECTION3Osteochondritis DissecansCHAPTEREric w. Edmonds Henry G. Chambers21Osteochondritis Dissecans: Overview,Epidemiology, Etiology,Classification, Ebook Pediatric and adolescent knee surgery (1st): Part 2ographic healing or merely resolution of pain.4'5’9’11’12*15 Despite the lack of an open physis at the time of diagnosis in an adult OCD, however, many authors suggest that the only true difference between juvenile- and adult-onset OCD is purely a reflection of patient age at the time of diagnosis.A Ebook Pediatric and adolescent knee surgery (1st): Part 2 recent definition of human OCD lesions, proposed by the Research in Osteochondritis of the Knee (ROCK) study group, highlights the fact that these arEbook Pediatric and adolescent knee surgery (1st): Part 2
c (I) focal, (2) idiopathic, (3) involve subchondral bone, and (4) risk instability and disruption of articular cartilage with potential long-term conSECTION3Osteochondritis DissecansCHAPTEREric w. Edmonds Henry G. Chambers21Osteochondritis Dissecans: Overview,Epidemiology, Etiology,Classification, Ebook Pediatric and adolescent knee surgery (1st): Part 2LOGYThere are only three true epidemiology papers regarding knee OCD.10'17’18 The first was performed by Marsden and Wiernik18 in a review of 18,405 radiographs at a military hospital. They found an incidence of symptomatic OCD of 2.3% of the radiographs and an overall incidence (including incidenta Ebook Pediatric and adolescent knee surgery (1st): Part 2l discovery) of 4% OCD in their cohort.A classic study by Linden10 in 1977 from Malmo, Sweden demonstrated an incidence of 29 per 100,000 boys and 19Ebook Pediatric and adolescent knee surgery (1st): Part 2
per 100,000 girls. More importantly, after he reviewed radiographs and obtained follow-up with many of these patients 33 years later, he discovered thSECTION3Osteochondritis DissecansCHAPTEREric w. Edmonds Henry G. Chambers21Osteochondritis Dissecans: Overview,Epidemiology, Etiology,Classification, Ebook Pediatric and adolescent knee surgery (1st): Part 2ritis to be 0% at the start of life, this was unchanged at age 40 years with an OCD; but the risk increased to 70% at age 48 years and continued to increase to 95% at 70 years of age. However, in those initially discovered with juvenile-onset OCD, he could not directly correlate any pathology such a Ebook Pediatric and adolescent knee surgery (1st): Part 2s gonarthritis with their OCD directly.The only other study was published in 2014 and included a review of just over1 million children aged 2 to 19 yeEbook Pediatric and adolescent knee surgery (1st): Part 2
ars within a closed health system.* 1 These authors found 192 children with 206 OCD lesions of the knee. The majority (64%) of the lesions involved thSECTION3Osteochondritis DissecansCHAPTEREric w. Edmonds Henry G. Chambers21Osteochondritis Dissecans: Overview,Epidemiology, Etiology,Classification, Ebook Pediatric and adolescent knee surgery (1st): Part 2varied by ethnicity: non-Hispanic white was 10.3 per 100,000 overall (17.3 and 3.0 per 100,000 for boys and girls, respectively), non-Hispanic black was 10.3 per 100,000 overall (17.3 and 3.0 per 100,000 for boys and girls, respectively), Hispanic was 8.6 per 100.000 overall (14.3 and 2.8 per 100.00 Ebook Pediatric and adolescent knee surgery (1st): Part 20 for boys and girls, respectively), and Asian was 4.7 per 100,000 overall (9.1 and 0.0 per 100,000 for boys and girls, respectively). These authors pEbook Pediatric and adolescent knee surgery (1st): Part 2
erformed multivariable logistic regression analysis that revealed a 3.3-fold increased risk of OCD of the knee in children aged 12 to 19 years compareSECTION3Osteochondritis DissecansCHAPTEREric w. Edmonds Henry G. Chambers21Osteochondritis Dissecans: Overview,Epidemiology, Etiology,Classification, Ebook Pediatric and adolescent knee surgery (1st): Part 2may occur in both knees. In the literature, there is a relatively wide range of bilaterality noted with about a 3% to 30% chance of discovering it in both knees by x-ray.5 * * *’18-23ETIOLOGYNo definitive etiology has yet been determined for the origin of knee OCD.There are, of course, many hypothes Ebook Pediatric and adolescent knee surgery (1st): Part 2es that have been presented and testedprimarily via ex vivo histology. The potential etiologies include inflammation,spontaneous osteonecrosis and vasEbook Pediatric and adolescent knee surgery (1st): Part 2
cular deficiency, genetic predisposition, andrepetitive trauma. Each of these will be discussed.As suggested by the name "osteochondritis,” the first SECTION3Osteochondritis DissecansCHAPTEREric w. Edmonds Henry G. Chambers21Osteochondritis Dissecans: Overview,Epidemiology, Etiology,Classification, Ebook Pediatric and adolescent knee surgery (1st): Part 2upported this etiology ’24;instead, these works appear to highlight findings of necrosis within the OCDlesions rather (han inflammation.Based on their histology findings, Green and Banks12 * * * * * *’19 * * proposed thatischemia was the primary etiology, and Milgram,22 identifying revascularization Ebook Pediatric and adolescent knee surgery (1st): Part 2SECTION3Osteochondritis DissecansCHAPTEREric w. Edmonds Henry G. Chambers21Osteochondritis Dissecans: Overview,Epidemiology, Etiology,Classification,Gọi ngay
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