Osteochondritis dissecants of the femur in children. Treatment. Modern tendencess
- Authors: Yeltsin A.G.1, Ivanov I.A.1, Mininkov D.S.1, Gushchina D.A.1
-
Affiliations:
- Priorov National Medical Research Center of Traumatology and Orthopedics
- Issue: Vol 30, No 4 (2023)
- Pages: 501-512
- Section: SCIENTIFIC REVIEWS
- Submitted: 20.09.2023
- Accepted: 14.11.2023
- Published: 15.12.2023
- URL: https://journals.eco-vector.com/0869-8678/article/view/585205
- DOI: https://doi.org/10.17816/vto585205
- ID: 585205
Cite item
Abstract
Osteochondritis dissecants is a pathological condition characterized by the manifestation of subchondral osteonecrosis, which subsequently leads to the separation of the cartilage plate from the femoral condyle. It is a serious condition that can significantly affect patients' quality of life. Despite a significant amount of research, there is still a need to better understand this pathology and to develop effective diagnostic and treatment strategies to achieve optimal clinical outcomes. The aim of this work was to analyze the literature on osteochondritis dissecants of the knee joint and to substantiate modern treatment methods for this disease, as well as to find out the preferred treatment options depending on the age group of patients. Literature sources were analyzed. The search was carried out in the databases RSCI, NCBI Pubmed, Medline for the last 10 years. Osteochondritis dissecants is a disease requiring a modern approach to treatment. With the advent of new technologies and techniques, various therapeutic options have emerged, such as collagen membrane replacement of the defect, mosaic chondroplasty, etc. However, the question of the preferred treatment method remains relevant, especially in view of the age-related characteristics of patients. An individualized approach, taking into account their age, stage of injury and clinical features, is an important aspect for effective treatment of osteochondritis dissecants. Further research and clinical follow-up are needed to better define the most effective treatment strategies and prevent complications.
Keywords
Full Text
About the authors
Alexander G. Yeltsin
Priorov National Medical Research Center of Traumatology and Orthopedics
Email: Agyeltsin@mail.ru
ORCID iD: 0000-0002-7736-9493
SPIN-code: 6411-2484
MD, Cand. Sci. (Med.)
Russian Federation, MoscowIaroslav A. Ivanov
Priorov National Medical Research Center of Traumatology and Orthopedics
Author for correspondence.
Email: docyaroslav@gmail.com
ORCID iD: 0000-0002-6352-2784
SPIN-code: 5575-4630
MD, Cand. Sci. (Med.)
Russian Federation, MoscowDmitry S. Mininkov
Priorov National Medical Research Center of Traumatology and Orthopedics
Email: 4504311@mail.ru
ORCID iD: 0000-0002-9490-6932
SPIN-code: 1494-3179
MD, Cand. Sci. (Med.)
Russian Federation, MoscowDaria A. Gushchina
Priorov National Medical Research Center of Traumatology and Orthopedics
Email: gushchina-DA@yandex.ru
ORCID iD: 0000-0003-1877-3557
Russian Federation, Moscow
References
- Konig F. The classic: on loose bodies in the joint. 1887. Clin Orthop Relat Res. 2013;471(4):1107–15. doi: 10.1007/s11999-013-2824-y
- Olstad K, Shea KG, Cannamela PC, Polousky JD, Ekman S, Ytrehus B, Carlson CS. Juvenile osteochondritis dissecans of the knee is a result of failure of the blood supply to growth cartilage and osteochondrosis. Osteoarthritis and cartilage. 2018;26(12):1691–1698. doi: 10.1016/j.joca.2018.06.019
- Kessler JI, Nikizad H, Shea KG, Jacobs Jr JC, Bebchuk JD, Weiss JM. The demographics and epidemiology of osteochondritis dissecans of the knee in children and adolescents. Am J Sports Med. 2014;42(2):320–6. doi: 10.1177/0363546513510390
- Hefti F, Beguiristain J, Krauspe R, Moller-Madsen B, Riccio V, Tschauner C, et al. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop Part B. 1999;8(4):231–45.
- Andriolo L, Crawford DC, Reale D, Zaffagnini S, Candrian C, Cavicchioli A, Filardo G. Osteochondritis dissecans of the knee: etiology and pathogenetic mechanisms. A systematic review. Cartilage. 2020;11(3):273–90. doi: 10.1177/1947603518786557
- Pareek A, Sanders TL, Wu IT, Larson DR, Saris DBF, Krych AJ. Incidence of symptomatic osteochondritis dissecans lesions of the knee: a population-based study in Olmsted County. Osteoarthritis Cartilage. 2017;25(10):1663–71. doi: 10.1016/j.joca.2017.07.005
- Crawford DC, Safran MR. Osteochondritis dissecans of the knee. J Am Acad Orthop Surg. 2006;14(2):90–100. doi: 10.5435/00124635-200602000-00004
- Wechter JF, Sikka RS, Alwan M, Nelson BJ, Tompkins M. Proximal tibial morphology and its correlation with osteochondritis dissecans of the knee. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3717–22. doi: 10.1007/s00167-014-3289-6
- Cahuzac JP, Mansat C, Clement JL, Pasquie M, Gaubert J. The natural history of osteochondritis dissecans of the knee in children. Rev Chir Orthop Reparatrice Appar Mot. 1988;74(suppl 2):121–4.
- Gerasimenko MA, Beletskii AV, Chernyavskii KS, Zhuk EV. Konig’s disease of the knee joint in children: clinical picture, diagnosis, treatment. Meditsinskii zhurnal. 2007;(2):28–30. (In Russ).
- Green WT, Banks HH. Osteochondritis dissecans in children. J Bone Joint Surg Am. 1953;35-А(1):26–47; passim.
- Axhausen G. Die Aetiologie der Kohler’schen Erkrankung der Metatarsalköpfchen. Beitr Klin Chir. 1922;(126):451–476. (In German).
- Rieger H. Zur Pathogenese von Gelenkmausen. Munchener Medizinische Wochenschrift. 1920;(67):719–720. (In German).
- Watson-Jones SR, editor. Fractures and joint injuries. 4th edition. Vol. 1. Edinburgh (United Kingdom), London: E & S Livingston; 1952.
- Barrie HJ. Hypertrophy and laminar calcification of cartilage in loose bodies as probable evidence of an ossification abnormality. The Journal of pathology. 1980;132(2):161–168. doi: 10.1002/path.1711320206
- Barrie HJ. Hypothesis ― a diagram of the form and origin of loose bodies in osteochondritis dissecans. Journal of rheumatology. 1984;11(4):512–513.
- Stattin EL, Wiklund F, Lindblom K, Önnerfjord P, Jonsson BA, Tegner Y, et al. A missense mutation in the aggrecan C-type lectin domain disrupts extracellular matrix interactions and causes dominant familial osteochondritis dissecans. The American Journal of Human Genetics. 2010;86(2):126–137. doi: 10.1016/j.ajhg.2009.12.018
- Ribbing S. The Hereditary Multjple Epiphyseal Disturbance and its Consequences for the Aetiogenesis of Locai, Malacjas-Particularly the Osteochondrosis Dissecans. Acta Orthopaedica Scandinavica. 1954;24(1–4):286-299. doi: 10.3109/17453675408988571
- Mubarak SJ, Carroll NC. Juvenile osteochondritis dissecans of the knee: etiology. Clin Orthop Relat Res. 1981;(157):200–11.
- Bruns J, Werner M, Soyka M. Is vitamin D insufficiency or deficiency related to the development of osteochondritis dissecans? Knee Surg Sports Traumatol Arthrosc. 2014;24(5):1575–9. doi: 10.1007/s00167-014-3413-7
- Mine T, Ihara K, Kawamura H, Date R, Chagawa K. Unusual appearance of an osteochondral lesion accompanying medial meniscus injury. Arthrosc Tech. 2014;3(1):e111–e114. doi: 10.1016/j.eats.2013.09.003
- Maruyama Y, Kaneko K, Baba T. A case of osteochondritis dissecans of the lateral femoral condyle and patellofemoral joint surface occurring in the same knee. Eur Orthop Traumatol. 2014;5(2):171–4. doi: 10.1007/s12570-013-0227-x
- Deie M, Ochi M, Sumen Y, Kawasaki K, Adachi N, Yasunaga Y, et al. Relationship between osteochondritis dissecans of the lateral femoral condyle and lateral menisci types. J Pediatr Orthop. 2006;26(1):79–82. doi: 10.1097/01. bpo.0000191554.34197.fd
- Hashimoto Y, Yoshida G, Tomihara T, Matsuura T, Satake S, Kaneda K, et al. Bilateral osteochondritis dissecans of the lateral femoral condyle following bilateral total removal of lateral discoid meniscus: a case report. Arch Orthop Trauma Surg. 2008;128(11):1265–8. doi: 10.1007/s00402-007-0499-0
- Bramer JA, Maas M, Dallinga RJ, te Slaa RL, Vergroesen DA. Increased external tibial torsion and osteochondritis dissecans of the knee. Clin Orthop Relat Res. 2004;(422):175–9. doi: 10.1097/01.blo.0000126310.02631.f2
- Camathias C, Hirschmann MT, Vavken P, Rutz E, Brunner R, Gaston MS. Meniscal suturing versus screw fixation for treatment of osteochondritis dissecans: clinical and magnetic resonance imaging results. Arthroscopy. 2014;30(10):1269–79. doi: 10.1016/j.arthro.2014.05.010
- Campbell CJ, Ranawat CS. Osteochondritis dissecans: the question of etiology. J Trauma. 1966;6(2):201–21.
- Jans L, Jaremko J, Ditchfield M, De Coninck T, Huysse W, Moon A, et al. Ossification variants of the femoral condyles are not associated with osteochondritis dissecans. Eur J Radiol. 2012;81(11):3384–9. doi: 10.1016/j.ejrad.2012.01.009
- Shea KG, Jacobs JC Jr, Grimm NL, Pfeiffer RP. Osteochondritis dissecans development after bone contusion of the knee in the skeletally immature: a case series. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):403–7. doi: 10.1007/s00167-012-1983-9
- Chow RM, Guzman MS, Dao Q. Intercondylar notch width as a risk factor for medial femoral condyle osteochondritis dissecans in skeletally immature patients. J Pediatr Orthop. 2016;36(6):640–4. doi: 10.1097/BPO.0000000000000511
- Hughes JA, Cook JV, Churchill MA, Warren ME. Juvenile osteochondritis dissecans: a 5-year review of the natural history using clinical and MRI evaluation. Pediatr Radiol. 2003;33(6):410–7. doi: 10.1007/s00247-003-0876-y
- Jans L, Jaremko J, Ditchfield M, De Coninck T, Huysse, W, Moon A, Verstraete K. Ossification variants of the femoral condyles are not associated with osteochondritis dissecans. European Journal of Radiology. 2012;81(11):3384–3389. doi: 10.1016/j.ejrad.2012.01.009
- Jans LB, Jaremko JL, Ditchfield M, Huysse WC, Verstraete KL. MRI differentiates femoral condylar ossification evolution from osteochondritis dissecans. A new sign. European Radiology. 2011;21(6):1170–1179. doi: 10.1007/s00330-011-2058-x
- Lefort G, Moyen B, Beaufils P, De Billy B, Breda R, Cadilhac C, et al. L’ostéochondrite disséquante des condyles fémoraux: analyse de 892 cas. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur. 2006;92(5):97–141.
- Accadbled F, Vial J, de Gauzy JS. Osteochondritis dissecans of the knee. Orthopaedics & Traumatology: Surgery & Research. 2018;104(1):S97–S105. doi: 10.1016/j.otsr.2017.02.016
- Masquijo J, Kothari A. Juvenile osteochondritis dissecans (JOCD) of the knee: current concepts review. EFORT open reviews. 2019;4(5):201–212. doi: 10.1302/2058-5241.4.180079
- Tepolt FA, Kalish LA, Heyworth BE, Kocher MS. Nonoperative treatment of stable juvenile osteochondritis dissecans of the knee: effectiveness of unloader bracing. Journal of Pediatric Orthopaedics B. 2020;29(1):81–89. doi: 10.1097/BPB.0000000000000617
- LeBrun DG, DeFrancesco CJ, Fabricant PD, Lawrence JT. Cost-effectiveness analysis of nonoperative management versus early drilling for stable osteochondritis dissecans lesions of the knee in skeletally immature patients. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021;37(2):624–634. doi: 10.1016/j.arthro.2020.09.020
- Sanders TL, Pareek A, Johnson NR, Carey JL, Maak TG, Stuart MJ, Krych AJ. Nonoperative management of osteochondritis dissecans of the knee: progression to osteoarthritis and arthroplasty at mean 13-year follow-up. Orthopaedic journal of sports medicine. 2017;5(7):2325967117704644. doi: 10.1177/2325967117704644
- Tan SHS, Tan BSW, Tham WYW, et al. The incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knees: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2021;29(9):3096–3104. doi: 10.1007/s00167-020-06365-y
- Ross BJ, Hermanns CA, Xu S, Baker J, Vopat B, Miskimin C, Mulcahey MK. Males and females exhibit comparable outcomes following treatment of osteochondritis dissecans lesions of the knee: a systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022;38(10):2919–2929. doi: 10.1016/j.arthro.2022.03.015
- Andriolo L, Candrian C, Papio T, Cavicchioli A, Perdisa F, Filardo G. Osteochondritis dissecans of the knee-conservative treatment strategies: a systematic review. Cartilage. 2019;10(3):267–77. doi: 10.1177/1947603518758435
- Merkulov VN, Avakian AP, Yeltsin AG, Mininkov DS. Dissecting osteochondritis of femoral condyles in children and adolescents. N.N. Priorov Journal of Traumatology and Orthopedics. 2012;19(2):48–55. (In Russ). doi: 10.17816/vto20120248-55
- Eismont OL. Long-term results of treatment of dissecting osteochondritis of the femoral condyles with the use of osteoperforations of the subchondral bone. Journal of Grodno State Medical University. 2020;18(5):532–537. (In Russ). doi: 10.25298/2221-8785-2020-18-5-532-537
- Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. New england journal of medicine. 1994;331(14):889–895. doi: 10.1056/NEJM199410063311401
- Peterson L, Minas T, Brittberg M, Lindahl A. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. JBJS. 2003;85-А(suppl 2):17–24. doi: 10.2106/00004623-200300002-00003
- Carey JL, Shea KG, Lindahl A, Vasiliadis HS, Lindahl C, Peterson L. Autologous chondrocyte implantation as treatment for unsalvageable osteochondritis dissecans: 10- to 25-year follow-up. The American journal of sports medicine. 2020;48(5):1134–1140. doi: 10.1177/0363546520908588
- Lazishvili GD, Egiazaryan KA, Ratyev AP, Gordienko DI, Bug-Gusaim AB, et al. Hybrid bone-cartilage transplantation is an innovative technology for surgical treatment of extensive bone — cartilage defects of the knee joint. Surgical practice. 2020;(4):10–17. (In Russ). doi: 10.38181/issn2223-2427.2019.4.10-17
- Patent RUS № № 2692228/21.06.19. Egiazaryan KA, Lazishvili GD, Gordienko DI, Khramenkova IV, Shpak MA. Method of surgical treatment of bone-cartilaginous defects of femoral condyles. Available from: https://yandex.ru/patents/doc/RU2692228C1_20190621?ysclid=lozuoczf4s560836704 (In Russ).
- Shevtsov VI, Karaseva TYu, Karasev AG. Chondroplasty in treatment of a patient with König disease (early experience). Genij Ortopedii. 2006;(2):100–102.
- Hangody L, Kish G, Kárpáti Z, Udvarhelyi I, Szigeti I, Bély M. Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. Orthopedics. 1998;21(7):751–6. doi: 10.3928/0147-7447-19980701-04
- Malanin DA. Plasty of full-layer defects of hyaline cartilage in the knee joint: experimental and clinical aspects of reparative chondrogenesis [dissertation]. Volgograd; 2002. Available from: https://search.rsl.ru/ru/record/01002307324?ysclid=lozv4nsjjn746979552 (In Russ).
- Antipov AV. Arthroscopic replacement of articular surface defects with bone-cartilage grafts in dissecting osteochondritis (experimental clinical study) [dissertation]. Kurgan; 2003. Available from: https://search.rsl.ru/ru/record/01002321781?ysclid=lozv7oat9m60670050 (In Russ).
- Mohamed H, Besar MM, Zayed ME. Systemic review of management of knee osteochondritis dissecans by mosaicplasty. Al-Azhar Medical Journal. 2021;50(3):1683–92.
- Frank RM, Lee S, Levy D, et al. Osteochondral allograft transplantation of the knee. Am J Sports Med. 2017;45:864–874.
- McCulloch PC, Kang RW, Sobhy MH, Hayden JK, Cole BJ. Prospective evaluation of prolonged fresh osteochondral allograft transplantation of the femoral condyle: Minimum 2-year follow-up. Am J Sports Med. 2007;35(3):411–420. doi: 10.1177/0363546506295178
- Cotter EJ, Frank RM, Wang KC, Totlis T, Poland S, Meyer MA, Cole BJ. Clinical outcomes of osteochondral allograft transplantation for secondary treatment of osteochondritis dissecans of the knee in skeletally mature patients. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018;34(4):1105–1112. doi: 10.1016/j.arthro.2017.10.043
- Bourebaba L, Röcken M, Marycz K. Osteochondritis dissecans (OCD) in Horses — Molecular Background of its Pathogenesis and Perspectives for Progenitor Stem Cell Therapy. Stem Cell Rev and Rep. 2019;15(3):374–390. doi: 10.1007/s12015-019-09875-6
- Russo A, Coco V, Zaffagnini S. The effect of autologous adipose derived mesenchymal stem cell therapy on juvenile osteochondritis dissecans of the patella: a case study. Journal of Surgical Case Reports. 2020;2020(8):rjaa274. doi: 10.1093/jscr/rjaa274
- Logli AL, Bernard CD, O’Driscoll SW, et al. Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm. Curr Rev Musculoskelet Med. 2019;12(1):1–12 doi: 10.1007/s12178-019-09528-8
- Vapniarsky N, Moncada L, Garrity C., et al. Tissue Engineering of Canine Cartilage from Surgically Debrided Osteochondritis Dissecans Fragments. Ann Biomed Eng. 2022;50(1):56–77. doi: 10.1007/s10439-021-02897-7
- Ai C, Lee YH, Tan XH, Tan SH, Hui JH, Goh JC. Osteochondral tissue engineering: perspectives for clinical application and preclinical development. Journal of Orthopaedic Translation. 2021;30:93–102. doi: 10.1016/j.jot.2021.07.008