1/11. osteochondritis dissecans: a diagnosis not to miss.osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. Because clinical findings are often subtle, diagnosis requires a high index of suspicion. Limited range of motion may be the only notable clinical sign. The diagnosis is made by radiographic examination, and magnetic resonance imaging has a key role in determining the stability of the lesion. Conservative management is the mainstay of treatment for stable lesions. While the majority of patients respond to conservative treatment, those with unstable lesions require arthroscopic management.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/11. A novel surgical procedure for osteochondritis dissecans of the lateral femoral condyle: Exchanging osteochondral plugs taken from donor and recipient sites.We treated a 16-year-old boy who had a large symptomatic osteochondritis dissecans (OCD) lesion of the lateral femoral condyle by exchanging osteochondral plugs taken from the donor site with plugs taken from the recipient site. At final inspection 36 months after surgery, he had full range of motion and no symptoms in his knees. Our methods can be used to treat grade 2 or 3 OCD lesions, as classified by Clanton and DeLee.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/11. Autologous osteochondral grafting for talar cartilage defects.The purpose of this study was to evaluate the clinical results of Osteochondral Autograft Transfer System (OATS) for the treatment of symptomatic osteochondral defects of the talus using standardized outcome analysis. Nineteen patients with symptomatic osteochondral defect (OCD) of the talus were treated with autologous osteochondral grafting. There were six men and 13 women. The average age was 32 years (range, 18 to 48 years). The average duration of symptoms prior to surgery was 4.2 years (range, three months to 12 years). All patients had failed nonoperative treatment, and 13 (68%) patients had failed prior excision, curettage and/or drilling of the lesion. The average size of the lesion prior to autografting was 12 mm x 10 mm (range, 10 x 5 mm to 20 x 20 mm). Donor plugs were harvested from the trochlear border of the ipsilateral femoral condyle. ankle exposure was obtained with a medial malleolar osteotomy in 13 patients, arthrotomy in five patients and lateral malleolar osteotomy in one patient. Clinical evaluations were performed for both the recipient ankle and donor knee using the AOFAS ankle/Hindfoot Scale and Lysholm knee scale, respectively. The average follow-up time was 16 months (range, 12 to 30 months). The average postoperative AOFAS ankle score was 88 (range, 60 to 100). Most patients had occasional mild pain, but excellent function, range of motion, stability and alignment. The average postoperative ankle score for the 13 patients who failed prior surgery was 91 (range, 84 to 100). The average postoperative Lysholm knee score was 97 (range, 87 to 100). Only two patients had mild knee pain. Postoperative radiographs were available for 13 patients. There was no evidence of graft subsidence and all grafts healed. All malleolar osteotomies united. Seventeen (89%) patients said that they would undergo the procedure again. The results of osteochondral autograft transplant for OCD lesions of the talus demonstrate excellent postoperative ankle scores including improvement of pain and function with minimal knee donor site morbidity. Also, our results indicate that this is an effective salvage procedure following failed previous procedures and for patients with longstanding symptoms.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/11. Arthroscopic treatment of osteochondritis dissecans of the capitellum: Report of 5 female athletes.The management of osteochondritis dissecans of the capitellum of the adolescent elbow is still controversial. We report on 5 cases of female high-level athletes aged from 10 to 19 years (4 gymnasts, 1 waterpolo player). All these athletes had a symptomatic osteochondritis dissecans of the capitellum, which was treated arthroscopically in all cases. Follow-up time averaged 5 months (1 to 6.5 months). During the arthroscopy, loose osteochondral fragments of the capitellum and radial head were removed, and the defect was debrided. Thorough evaluation of the anterior and posterior joint including the olecranon fossa was performed. One of the 5 patients had a loose body requiring arthroscopic removal. Within 6 months after surgery, all except 1 elbow, the elbow with a loose body, regained maximum range of motion. Two patients returned to a high level of gymnastics and 1 was considering return. The short-term results of this treatment suggest that arthroscopic debridement of the loose osteochondral fragments provides a good result.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/11. Osteochondral autograft transfer of the first metatarsal head: a case report.A case of an osteochondral autograft transfer performed at the head of the first metatarsal for an acute incidence of traumatic osteochondritis dissecans was presented. The donor site for the osteochondral graft was from the medial and plantar aspect of the talar head, which was found to be composed entirely of articular hyaline cartilage, yet was not part of the functional talonavicular articulation. Six months postoperatively, the graft was well seated at the head of the first metatarsal, as confirmed by magnetic resonance imaging, and the graft donor site was asymptomatic. At 12 months' follow-up, the patient had a functional metatarsophalangeal joint range of motion. Details from the case study as well as a review of the literature are presented.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/11. arthroscopy and microfracture technique in the treatment of osteochondritis dissecans of the humeral capitellum: report of three adolescent gymnasts.The aim of this paper is to report on three cases of symptomatic osteochondritis dissecans of the humeral capitellum in adolescent gymnasts, two females and one male. In all the cases arthroscopic surgery was performed. During arthroscopy, loose osteochondral fragments were removed, the defect was debrided and microfractures were performed. All the three patients regained the full range of motion of the affected elbow, and returned to the high-level gymnastics within a period of 5 months. At 12 months follow-up, all the three patients remained symptomless and were participating in high-level gymnastics. A combination of arthroscopy and the microfracture technique is a reliable method with excellent short-term results in the treatment of the osteochondritis dissecans of the elbow.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/11. The use of fresh allografts in osteochondrosis dissecans of the lateral femoral condyle.OBJECTIVE: Reconstruction of joint surface by using allografts to fill extensive bone-cartilage defects. INDICATIONS: Bone-cartilage defects ranging from a diagonal length of at least 3 cm and a depth of minimum 1 cm to maximum the entire lateral femoral condyle, e. g., following trauma, in the case of osteochondrosis dissecans, or following the resection of benign tumors. CONTRAINDICATIONS: Arthrosis. Minor or superficial cartilage defects. Bipolar defects. SURGICAL TECHNIQUE: The transplant bed is reamed precisely into the recipient's knee, the donor knee is opened, the block required for transplantation is measured, prepared and press-fit inserted. A straight leg axis is required for a good surgical result. POSTOPERATIVE MANAGEMENT: No weight bearing on the operated leg, two underarm crutches for 10 weeks, then partial weight bearing and further increase in weight bearing depending on postoperative allograft healing. CT follow-ups to assess postoperative healing of the transplant after 3 and after 8-12 months. Sporting activities that put pressure on the knee joint should not be undertaken until at least 1 year after surgery; cycling and swimming-depending on the CT-from the 6th postoperative month onward. RESULTS: Three male patients aged 21 (n = 2) and 28 (n = 1) were operated on for osteochondrosis dissecans of the lateral femoral condyle and observed for an average of 26 months. Postoperative healing of the transplanted tissue was confirmed in all patients by means of CT. For two of them, the vitality of the transplant was confirmed by means of MRT and contrast agents, and good postoperative healing of the transplant was also represented arthroscopically. All patients were subjectively satisfied, without complaints, and had improved range of motion in the operated knee.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/11. osteochondritis dissecans of the distal radioulnar joint.To our knowledge there has been no report of osteochondritis dissecans of the distal radioulnar joint. This patient was seen with episodes of painful motion in the left wrist. At operation two free bodies were removed from the distal radioulnar joint. From the clinical, radiographic, operative, and histologic findings, the diagnosis was osteochondritis dissecans of the distal radioulnar joint.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/11. Compressive fixation of osteochondritis dissecans fragments with Herbert screws.Current methods of fixation of femoral osteochondritic fragments do not provide rigid enough stabilization to allow early postoperative motion. We describe a technique using Herbert screws in a patient to secure a large unstable medial condylar fragment. A second procedure for removal of the screws was not required, and the patient had an excellent clinical result. The Herbert differential pitch bone screw is able to provide compressive fixation, allow early motion, and minimize the potential for complications.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
10/11. Spontaneous osteonecrosis of the knee.Spontaneous osteonecrosis is a common cause of knee pain in older patients, but the diagnosis is often overlooked. Sudden knee pain in older women, with marked joint line tenderness and a decreased range of motion, should alert the physician to the diagnosis. Two to three weeks after the onset of symptoms, plain radiographs will usually be normal but bone scan will be markedly positive. Treatment is initially conservative. Surgical intervention (either osteotomy or arthroplasty) is reserved for patients who develop a large radiolucent lesion in the subchondral femoral condyle.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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