Over time, OCD lesions can lead to further degenerative changes in the elbow. The exact etiology of JOCD remains unknown.111 Various authors suggest repetitive trauma,14,47,51,64,123 ischemia,36,51,93 and genetics5,65,86,98,99,115,117 as the 3 most likely causes. 6, The Journal of Medical Investigation, Vol. Juvenile osteochondritis dissecans lesions are a unique articular joint pathology, initially involving the subchondral bone below the articular cartilage rather than the joint surface.14 Specifically, the portion of the bone supporting the surface cartilage of the knee transforms into fibrous tissue, leaving the overlying joint articular cartilage susceptible to injury due to compromised bony support.127 The presence of open growth plates distinguishes JOCD from the adult form of osteochondritis dissecans (OCD).2,14,71 Though JOCD occurs most often in the knee joint, primarily in the medial and lateral femoral condyles, a few cases have been reported in the trochlear groove, patella, and tibial plateau.57 The most common location of JOCD is on the lateral border of the medial femoral condyle, adjacent to the intercondylar notch (FIGURE 1).47 The incidence of JOCD of the knee has been reported to be 8.7 per 100 000 in children (6–11 years of age) and 21.8 per 100 000 in adolescents (12–19 years of age), with higher incidence for boys than for girls.57 The incidence in children under age 10 has been reported to have increased over the last 40 years from 2 per 100 000.70, Described as early as 1870,3,36,93 the underlying mechanism and prognosis for JOCD remain unclear. Several validated outcome questionnaires exist for children with knee conditions and may be useful tools for health care professionals to evaluate, compare, and advance the different treatment and rehabilitation approaches to JOCD. Can fresh osteochondral allografts restore function in juveniles with osteochondritis dissecans of the knee? She received physical therapy intervention that included iontophoresis with DEX-P, strengthening and ROM exercises that were modified to limit stress to the lesion, and patient education on joint protection strategies. CC
A home exercise program was initiated to address the decreased muscle performance of the right lower extremity. It can also affect other joints, such as elbows and ankles. Her home exercise program was modified to include strengthening exercises for the muscles about the hip, knee, and ankle that required movement of the tibiofemoral joint. Recent studies44,45 have shown an absence of DEX-P in the synovium and local venous blood after the application of iontophoresis delivered at a 4.0-mA current. , Jensen MP, Karoly P. Finch
A prospective study, Osteochondritis of the femoral condyles in children and adolescents: our experience over the last 28 years, American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis and treatment of osteochondritis dissecans, AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans, MR grading system of osteochondritis dissecans lesions: comparison with arthroscopy, Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair, Osteochondritis dissecans: a histologic and microradiographic analysis of surgically excised lesions, Osteochondritis dissecans: Wilson's sign revisited, Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle, Untreated osteochondritis dissecans of the femoral condyles: prediction of patient outcome using radiographic and MR findings, Evaluation and treatment of osteochondritis dissecans lesions of the knee, Internal fixation of undisplaced lesions of osteochondritis dissecans in the knee, Characterizing osteochondral lesions by magnetic resonance imaging, Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee, Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee, Surgical management of osteochondritis dissecans of the knee, Load moments about the hip and knee joints during ergometer cycling, Arthroscopic surgical management of osteochondritis dissecans of the knee, Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes, A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children, Arthroscopic treatment of osteochondritis dissecans. The intervention for this visit remained iontophoresis with DEX-P to the right knee, monitoring of her home exercise program (with an increase to 3 sets of 15 repetitions for all exercises as tolerated), and consultation regarding continued importance of joint protection. The interventions, other than iontophoresis, utilized with this patient were based on clinical decisions that used the formula stress=force/area as their foundation.30 Interventions were chosen primarily in an effort to decrease the amount of force applied to the tibiofemoral joint (ie, change in footwear, avoidance of knee extension during first week of treatment, patient education regarding modification of standing time at work, effects of increased body weight and strengthening exercises for muscles crossing the joint). 43, No. In some cases, you or your doctor will be able to feel a loose fragment inside your joint. Drilling is typically followed by a period of non-weight bearing, rehabilitation, and return to sports after 3 to 4 months if healing is evident on radiographs.18, Microfracture, which uses an awl to create tiny fractures in the subchondral bone, has also been suggested to facilitate the influx of stem cells and growth factors for cartilage resurfacing.37,38,53 Microfracture is typically performed on lesions with complete discontinuity down to the subchondral bone, a loose fragment, or a displaced fragment.38 The remaining unstable or necrotic bone in the lesion is removed prior to microfracture.38 One study identified good to excellent results in 86% of JOCD lesions treated with microfracture at 1 year that reduced to 63% by 4 years38 and 62% by 10 years.37 This finding highlights the importance of long-term follow-up, as short-term outcomes may regress over time. De Smet et al26 provided the first system for assessing stability of a JOCD lesion using T2-weighted MRI. , Lysholm J. 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