A Review of Arthroscopic Classification Systems for Osteochondritis Dissecans of the Knee

Jacobs, John C.; Archibald-Seiffer, Noah; Grimm, Nathan L.; Carey, James L.; Shea, Kevin G.

doi:10.1016/j.csm.2013.11.005

Cited by 23 publications

(18 citation statements)

References 21 publications

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“…Multiple systems have been described for classifying OCD lesions of the knee on MRI and during arthroscopy (17), with varying levels of agreement and overlap among the existing classification systems. The ICRS provided a specific classification system to OCD of the knee for more standardized and universally accepted criteria with the option to transfer the arthroscopic grading into an imaging classification (18).…”

Section: Discussionmentioning

confidence: 99%

“…Although the choice of the grading system was based on the recommendation of an expert team consensus, many other parameters have been discussed in the literature, and to this date there is no common recommendation that is considered standard of care. Additionally, the study is limited by the inherent reliance on arthroscopy to determine stability, as even the gold standard of arthroscopy has some shortcomings in that it only allows superficial visualization of the lesion (17). Particularly in grade II and grade III lesions, stability is not always readily apparent on arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…There are several arthroscopic classification systems that have been used (17). The International Cartilage Repair Society (ICRS) has attempted to create a more standardized and universally accepted system (17,18). As higher grades are more likely to be unstable and need intervention, there is a utility to using a corresponding grading system in preoperative MR imaging (19).…”

Section: Introductionmentioning

confidence: 99%

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Magnetic Resonance Imaging of Osteochondritis Dissecans

et al. 2016

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In this paper, we utilize arthroscopy as the gold standard to determine if MRI can predict OCD lesion stability, the most important information to guide patient treatment decisions. To our surprise, the analysis of the existing radiology reports that addressed stability revealed an overall accuracy in defining OCD lesion stability of about 53%. The classification system of the ICRS, created by an international multidisciplinary, multi-expert consortium, did markedly improve the accuracy, but consistency among different readers was lacking. This retrospective study on OCD reporting and classification highlights the inadequacy of existing classification schemes, and emphasizes the critical need for improved diagnostic MRI protocols in musculoskeletal radiology in order to propel it toward evidence-based medicine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Magnetic Resonance Imaging of Osteochondritis Dissecans

et al. 2016

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“… 9 , 28 , 37 , 43 Furthermore, while we used several clinically relevant outcomes, we did not employ the common clinical procedure in which the lesion is probed for stability by placing a hook in the cleft and trying to open the gap. 20 This was not performed as further evaluation of the sample by micro-CT and histology would have been at risk. An additional limitation of the study was the age of the animals used.…”

Section: Discussionmentioning

confidence: 99%

Development of a Large Animal Model of Osteochondritis Dissecans of the Knee

Pfeifer

Kinsella

Milby

et al. 2015

Orthopaedic Journal of Sports Medicine

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Background:Treatment of osteochondritis dissecans (OCD) of the knee is challenging, and evidence for stage-dependent treatment options is lacking. Basic science approaches utilizing animal models have provided insight into the etiology of OCD but have yet to produce a reliable and reproducible large animal model of the disease on which to test new surgical strategies.Purpose/Hypotheses:The purpose of this study was to develop an animal model featuring an OCD-like lesion in terms of size, location, and International Cartilage Repair Society (ICRS) grading. The hypothesis was that surgical creation of an osteochondral defect followed by placement of a barrier between parent bone and progeny fragment would generate a reproducible OCD-like lesion.Study Design:Controlled laboratory study.Methods:Bilateral osteochondral lesions were created in the medial femoral condyles of 9 Yucatan minipigs. After lesion creation, a biodegradable membrane was interposed between the progeny and parent bone. Five different treatment groups were evaluated at 2 weeks: a control with no membrane (ctrl group; n = 4), a slowly degrading nanofibrous poly(∊-caprolactone) membrane (PCL group; n = 4), a fenestrated PCL membrane with 1.5-mm holes covering 25% of surface area (fenPCL group; n = 4), a collagen membrane (Bio-Gide) (CM group; n = 3), and a fenestrated CM (fenCM group; n = 3). Five unperturbed lateral condyles (1 from each treatment group) served as sham controls. After euthanasia on day 14, the lesion was evaluated by gross inspection, fluoroscopy, micro–computed tomography (micro-CT), and histology. To quantify changes between groups, a scoring system based on gross appearance (0-2), fluoroscopy (0-2), and micro-CT (0-6) was established. Micro-CT was used to quantify bone volume per total volume (BV/TV) in a defined region surrounding and inclusive of the defect.Results:The no scaffold group showed healing of the subchondral bone at 2 weeks, with continuity of subchondral bone elements. Conversely, condyles treated with PCL or CM showed substantial remodeling, with loss of bone in both the progeny fragment and surrounding parent bone. When these membranes were fenestrated (fenPCL and fenCM groups), bone loss was less severe. Histological analysis showed no integration in the cartilage layer in any treatment group, while fibrous tissue formed between the parent and progeny fragments. Micro-CT showed significant differences in mean BV/TV between the PCL (27.4% ± 2.3%) and the sham (47.7% ± 1.4%) or no scaffold (54.9% ± 15.1%) groups (P < .01 and P < .05, respectively). In addition, a significant difference in bone loss was evident between the PCL and fenPCL groups (mean BV/TV, 46.6% ± 15.2%; P < .05), as well as between the PCL and fenCM (mean BV/TV, 50.9% ± 3.5%) and fenPCL groups (P < .01). Grading by 6 blinded reviewers using an OCD scoring system with 3 subcategories showed a significant difference between control and PCL groups.Conclusion:This study successfully developed a large animal model of OCD-like lesions in the knee join...

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