Bilateral osteochondral defects of the patellae in an 11-year-old girl

Ruiz, Miguel Rodríguez; Igah, Ibidumo; Iranpour, Farhad; Patel, Akash

doi:10.1136/bcr-2020-240790

Cited by 3 publications

(4 citation statements)

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“…During skeletal growth, this can result in an osteochondral fragment embedded in the talus or an area of the talus that is more susceptible to injury. As the result of a traumatic event (e.g., an ankle sprain), repetitive overloading, or suboptimal loading in a patient with chronic ankle instability, the embedded fragment could become destabilized or the high-risk area could be injured, resulting in symptoms 9,10 . Through osteolytic changes, the morphology of these lesions may change over time as fragments can dissolve, potentially developing into a crater (see Appendix).…”

Section: Discussionmentioning

confidence: 99%

“…Although most patients with OLT have unilateral symptoms, OLT can also present bilaterally 8 . Early discovery of bilateral OLT is important as the symptomatology may change over time—from asymptomatic to symptomatic—because of factors such as trauma to the ankle joint, high body mass index (BMI), or ankle microinstability 9,10 . Furthermore, it can be hypothesized that early diagnosis may prevent further damage through lifestyle changes and may increase the chance of successful conservative or surgical treatment, thereby limiting the progression on the incremental cascade toward end-stage osteoarthritis 1,4,11 .…”

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confidence: 99%

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15% of Talar Osteochondral Lesions Are Present Bilaterally While Only 1 in 3 Bilateral Lesions Are Bilaterally Symptomatic

Rikken

Wolsink

Dahmen

et al. 2022

Journal of Bone and Joint Surgery

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Background:The primary aim of the present study was to determine the prevalence of osteochondral lesions of the contralateral talus in patients with computed tomography (CT)-confirmed osteochondral lesions of the talus (OLT). The secondary aims were to determine if the contralateral lesions were symptomatic and to describe the demographic characteristics and radiographic presentation of patients with bilateral OLT.Methods:To identify patients with bilateral OLT, we utilized a cross-sectional database of consecutive patients with a CT-proven OLT who had undergone bilateral CT scanning at our hospital between January 1989 and June 2021. The primary outcome was the prevalence of bilateral OLT. Patients with bilateral OLT were grouped into a unilaterally symptomatic group and a bilaterally symptomatic group. Patient and lesion characteristics were compared between these groups as well as between the symptomatic and asymptomatic ankles in the unilaterally symptomatic group. Radiographic examination included lesion volume, location, and morphology.Results:Of 1,062 patients with OLT, 161 (15%) had bilateral OLT. Of the patients with bilateral OLT, 53 (33%) were bilaterally symptomatic. Patients who were bilaterally symptomatic were younger (p = 0.03) and more likely to present with a non-traumatic etiology (p < 0.01) in comparison with those who were unilaterally symptomatic. No differences were observed between the unilaterally and bilaterally symptomatic groups in terms of lesion morphology, volume, or location. In the unilaterally symptomatic group, lesion volume was significantly larger in symptomatic ankles in comparison with the contralateral, asymptomatic ankles (p < 0.01), but no significant differences were observed in terms of lesion morphology or location.Conclusions:In patients presenting with symptomatic OLT, the prevalence of bilateral OLT was 15%, and 1 in 3 patients with bilateral OLT were symptomatic on both sides. Larger lesion volume was associated with the presence of symptoms in patients with bilateral OLT. For patients with bilateral OLT, the treating team should be aware that younger patients and patients without a history of trauma are at a higher risk for having bilateral symptoms.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

15% of Talar Osteochondral Lesions Are Present Bilaterally While Only 1 in 3 Bilateral Lesions Are Bilaterally Symptomatic

Rikken

Wolsink

Dahmen

et al. 2022

Journal of Bone and Joint Surgery

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“…4 Previous research on treatment outcomes has been limited by small sample sizes, with prior case reports and series reviewing small numbers of pediatric and adolescent knees-ranging from 1 to 34 patients. 1,3,[5][6][7][8][9][10][11][12] In an effort to address gaps in the literature, this study aims to describe the presentation of patients with OCD lesions of the patella and trochlear groove and characterize the common clinical and functional results of operative and nonoperative treatments to help guide management.…”

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confidence: 99%

“…A recent multicenter prospective study from the “Research in Osteochondritis Dissecans of the Knee” group found that only 9.5% of OCD lesions of the knee were found in the trochlea and 6.0% were in the patella 4 . Previous research on treatment outcomes has been limited by small sample sizes, with prior case reports and series reviewing small numbers of pediatric and adolescent knees—ranging from 1 to 34 patients 1,3,5–12 …”

mentioning

confidence: 99%

Patella and Trochlea Osteochondritis Dissecans: Demographics and Treatment Paradigms

Kiani,

Yellin,

Huffman

et al. 2023

Journal of Pediatric Orthopaedics

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Objective: Previous research on patellar and trochlear groove osteochondritis dissecans (OCD) is limited by small sample sizes. This study aims to describe the presentation of patients with OCD lesions of the patella and trochlea and characterize the outcomes of operative and nonoperative treatments. Methods: This retrospective cohort study identified all patients from a single institution from 2008 to 2021 with patellar and/or trochlear OCD lesions. Patients were excluded from the study if surgical records were unavailable or if the patient had knee surgery for a different injury at index surgery or in the 12 months postoperative. Minimum follow-up was 12 months. Outcomes included a return to sports (RTS), pain resolution, radiographic healing, and treatment “success” (defined as full RTS, complete pain resolution, and full healing on imaging). Results: A total of 68 patients (75 knees) were included—45 (60%) with patellar OCD and 30 (40%) with trochlear. Of the patients, 69% were males. The median age at knee OCD diagnosis was 14 years. At the final follow-up, 62% of knees (n = 44) recovered sufficiently to allow a full RTS and 54% of knees (n = 39) had full pain resolution. Of the 46 knees with radiographic imaging at least 1 year apart, 63% had full healing of the lesion. There was no significant difference in RTS, pain resolution, radiographic healing, or overall success when comparing treatments. Conclusions: This study provides valuable epidemiologic demographic and outcome data regarding the scarcely reported patellar and trochlear OCD. While over half of patients fully returned to sports and reported full pain resolution, a large proportion continued to experience symptoms over a year after presentation. Future research should aim to better define the treatment algorithms for these OCD subtypes. Level of Evidence: Level III.

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Lesion Size Location Dependency on Maximum Pressure in Osteochondral Defects: Experiments and Finite-Element Analysis

Kim,

Koh,

Bedi

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Osteochondral defects (OCDs) in the knee joint have significant clinical implications, particularly regarding contact pressures and pressure distribution. Understanding how these factors are influenced by defect size and location is crucial for developing effective therapeutic strategies. Purpose/Hypothesis: The purpose of this study was to investigate the impact of defect size and location on contact pressures and pressure distribution in the knee joint. It was hypothesized that an increase in defect size would result in elevated contact pressures and alterations in pressure distribution, with specific variations related to defect location. Study Design: Descriptive laboratory study. Methods: The study utilized 6 cadaveric knees, including the patella and fibula, subjected to controlled compressive loading for measuring contact pressures. Simultaneously, computed tomography-based models were created for finite-element analysis (FEA) to investigate the impact of varying defect sizes and locations on contact pressures and pressure distribution in the knee joint, excluding the patellofemoral joint. The study employed analysis of variance to assess contact pressure and defect size association. Comparison between medial and lateral femoral condyles at full extension and 30° flexion angle was performed, followed by post hoc testing. Fisher exact test analyzed peak pressure point location and defect size, categorizing them into medial and lateral. Results: An increase in defect size corresponded with heightened contact pressures on both medial and lateral femoral condyles at full extension ( P = .013 for medial and P = .024 for lateral). However, this correlation did not yield significant differences at 30° of flexion ( P = .674 for medial and P = .333 for lateral). During mechanical testing, the highest pressures occurred near 5 mm defect dimensions. FEAs showed a significant increase in pressure and circumferential-edge stress with 7-mm defects. Peak contact pressure points shifted laterally with more significant defects. Conclusion: Our study demonstrated the impact of defect size, location, and alignment on knee joint contact pressures. Intervening promptly with defects exceeding 3 mm is crucial, as significant stress levels manifest beyond this threshold. Significant increases in contact pressures were noted with larger defect sizes, particularly between 3 and 10 mm at full extension. Peak pressure points shifted with defect size increments, and alignment variations showed minimal stress variation at 30° compared with 0°. FEA validated increasing contact pressures up to 7 mm defect size, beyond which pressures stabilized or slightly decreased. A concentrated pressure distribution on the medial side was observed. These findings inform our understanding of the biomechanical implications of OCDs. Clinical Relevance: In the field of sports medicine, this research offers valuable insights to clinicians and researchers, elucidating key factors influencing knee joint health and the potential consequences of OCDs.

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Bilateral osteochondral defects of the patellae in an 11-year-old girl

Cited by 3 publications

References 46 publications

15% of Talar Osteochondral Lesions Are Present Bilaterally While Only 1 in 3 Bilateral Lesions Are Bilaterally Symptomatic

15% of Talar Osteochondral Lesions Are Present Bilaterally While Only 1 in 3 Bilateral Lesions Are Bilaterally Symptomatic

Patella and Trochlea Osteochondritis Dissecans: Demographics and Treatment Paradigms

Lesion Size Location Dependency on Maximum Pressure in Osteochondral Defects: Experiments and Finite-Element Analysis

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