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41.
Objective The purpose of this study was to characterize the variety of osteochondral abnormalities of the humeral trochlea in the pediatric
athlete.
Materials and methods Patients with trochlear abnormalities were identified through keyword search of radiology dictations from 1999 to 2007. The
patient’s medical record, imaging studies, and surgical reports were reviewed. The osteochondral lesions were categorized
based on the imaging appearance. Surgical results were reviewed in conjunction with the imaging findings.
Results Eighteen patients were identified. Trochlear lesions were stratified into two imaging groups: Osteochondral injury/osteochondritis
dissecans (OCD) vs. avascular necrosis (AVN). The osteochondral injury group was stratified into medial and lateral trochlear
abnormalities. The medial lesions (n = 3) were small (<6 mm) and were located on the posterior articular surface of the medial trochlea. The lateral lesions (n = 10) were larger (10–14 mm), circumscribed, and were located on the posterior inferior aspect of the lateral trochlea. Trochlear
AVN (n = 5) affected development of the lateral trochlea (type A) or both the medial and lateral aspects of the trochlea (type B).
AVN occurred exclusively in athletes with history of remote distal humeral fracture. Seven of the 18 patients underwent elbow
arthroscopy. Surgical findings and treatment regimens are summarized.
Conclusion Trochlear lesions should be considered in throwing athletes presenting with medial elbow pain and flexion contracture/extension
block. Medial trochlear osteochondral injuries may result from posteromedial olecranon abutment. Lateral OCD lesions occur
in a characteristic vascular watershed zone resulting from the unique blood supply of the trochlea. Trochlear AVN may be unmasked
years following treated distal humeral fracture when the athletic demands upon the adolescent elbow increase, revealing the
altered growth and biomechanics. 相似文献
42.
《The Foot》2021
BackgroundThere has been no consensus regarding the treatment of osteochondral lesions of the talus, there has been many attempts to formulate a treatment pathway, with multiple proposed modalities and adjuncts used.ObjectivesThe aim of this paper was to investigate the evidence published in the recent history, identify the relevant papers, review and summarize the findings, to help clarify the available operative treatment options and their respective efficacies based on the level of evidence provided.Study design & methodsA literature search through electronic databases MEDLINE and EMBASE was done, these databases were screened for publications and papers form June 2004 to June 2019. Key words were utilised in the search ‘talus, talar, tibia, cartilage, osteochondral, ankle, osteochondritis dissecans, articular cartilage’. Studies on adults aged 18–60 years were included. Exclusion criteria were studies with less than 10 patients, or no clear outcome was recorded. Papers were reviewed by the authors and data extracted as per a pre-defined proforma.ResultsFollowing screening, 28 published articles were included and reviewed. Of these publications 5 were level I, 7 level II, 4 level III and 12 level IV. The total number of patients was 1061 patients. Treatment modalities included arthroscopic microfracture, drilling, hyaluronic acid injection, platelet rich plasma, osteochondral autologous transplantation (OAT), vascularised free bone graft among others. The most common functional measures used to assess efficacy were the Visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle (AOFAS) score. Follow up ranged from 26 weeks upto 4 years.ConclusionsDespite the abundance of treatment options, high level evidence (level I) remains limited and does not conclude a definitive treatment modality as superior to others. Further research, in the form highly organised randomised clinical trials, is needed to help improve the efficacy and develop new treatment modalities in the future. 相似文献
43.
Treatment of osteochondral defects of the distal femur with fresh osteochondral allografts: A preliminary report 总被引:2,自引:0,他引:2
Twenty-four patients with osteochondral defects of a femoral condyle who failed to respond adequately to arthroscopic arthroplasty underwent osteochondral grafting with fresh allografts. Grafts were obtained from young donors and were matched according to skeletal size as measured by standard x-rays. Transplantation was performed within 12 h of harvesting. Follow-up extends from 2 to 4 years in 10 cases and is 1-2 years in the remaining 14. All ten patients with follow-up greater than 2 years were improved when evaluated in terms of pain, buckling, and swelling. Of the 24 patients, 11 have been evaluated arthroscopically following transplantation. In all 11 cases, the graft appeared viable. Fraying, if present, was limited to the margins of the graft in all except two cases. Collapse was not observed. 相似文献
44.
Untreated osteochondritis dissecans of the femoral condyles: prediction of patient outcome using radiographic and MR findings 总被引:5,自引:0,他引:5
Objective. We investigated the usefulness of plain film and MR findings in predicting the outcome of conservatively treated patients
with femoral osteochondritis dissecans. Design. Without knowledge of the clinical outcome, we retrospectively reviewed the initial plain films and MR examinations. Each MR
examination was evaluated for the four MR findings of instability. Patients. Fourteen patients were studied in whom osteochondritis dissecans of a femoral condyle had been treated conservatively for
periods ranging from 1.2 to 8.5 years. Results and conclusion. Three of five patients with an open femoral growth plate and one of nine patients with a closed growth plate had a good clinical
outcome. Both patients with lesions smaller than 160 mm2 in area had a good outcome and ten of 12 patients with larger lesions had a poor outcome. Both patients with stable lesions
by MR imaging had a good outcome while ten of 12 patients with a lesion unstable by MR imaging had poor outcomes. All six
patients with a cartilage fracture or articular defect had poor outcomes. The results of this study should be considered preliminary
since only 14 patients were followed. However, it appears that a good clinical outcome is likely when the femoral growth plate
is open, when the osteochondritis dissecans is small, and when the lesion is stable by MR imaging. When a cartilage fracture
or articular defect is found on MR imaging, the patient is likely to have a poor outcome. 相似文献
45.
K. Bohndorf 《European radiology》1998,8(1):103-112
Osteochondritis (osteochondrosis) dissecans (OCD) is a common condition in children, adolescents, and young adults. Describing
OCD together with osteochondral fractures and epiphyseal ossification disturbances and considering these three conditions
as one entity has caused much confusion. Age distribution and localization combined with the radiologic and surgical presentation
distinguishes these conditions. Osteochondritis dissecans represents an osseous lesion with secondary involvement of the overlying
cartilage. Beginning as avascular osteonecrosis, OCD forms a transitional zone that harbors the potential of restoration with
complete healing or progression to an osseous defect. Mechanical and traumatic factors are etiologically dominant in OCD,
but a predisposition seems to be a contributing factor in some patients. Osteochondritis dissecans is generally diagnosed
by conventional radiology. Its therapy is determined by the stage of the lesion and MRI will become the method of choice for
staging. Intact cartilage, contrast enhancement of the lesion, and absent “cystic” defects are findings of MRI stage I and
justify conservative therapy, obviating arthroscopy. Cartilage defect with or without incomplete separation of the fragment,
fluid around an undetached fragment, and a dislodged fragment are MRI findings observed in stage II and require arthroscopy
with possible intervention. Thus, MRI can noninvasively separate non-surgical from possibly surgical lesions and should replace
diagnostic arthroscopy.
Received 27 January 1997; Revision received 1 April 1997; Accepted 3 April 1997 相似文献
46.
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49.
《The Foot》2021
An osteochondral lesion of the talus (OLT) is an idiopathic acquired lesion of the subchondral bone that can lead to debilitating sequelae. The causes of OLT’s are still debatable, however, most agree that the etiology is repetitive microtrauma associated with vascular impairment. OLTs are most commonly described in the medial portion of the talus, while lateral involvement is less frequent. If not properly recognized and treated, an OLT may lead to numerous secondary conditions including premature osteoarthritis and functional limitations of the ankle joint. Multiple surgical and non-surgical treatment modalities have been described with varying results. Treatments are usually guided by the patients age, onset of symptoms, severity, and the disease stage according to the Berndt and Harty classification. Recent literature recommends curettage, drilling, or microfracture techniques for lesions which are no larger than 15 mm in diameter and no deeper than 7 mm. On the other hand, for large lesions or lesions that failed from primary bone marrow stimulation, surgery should be considered for autologous chondrocyte implantation (ACI), osteochondral autograft transplantation (OATs or mosaicplasty), or osteochondral allograft transplantation [1]. This case study examines surgical treatment of an extensive OLT in a 53 year old man who suffered with continuous ankle pain for over 10 years, misdiagnosed as ankle joint arthritis.Level of clinical evidence: Level of evidence 4. 相似文献
50.