Histologic Findings and Possible Causes of Osteochondritis Dissecans of the Knee

Uozumi, Hiroaki; Sugita, Takehiko; Aizawa, Tadanori; Takahashi, Atsushi; Ohnuma, Masahiro; Itoi, Eiji

doi:10.1177/0363546509346542

Cited by 110 publications

(120 citation statements)

References 26 publications

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“…However, Yonetani et al [84] found no osseous necrosis on microscopic examination in biopsy samples obtained from intact OCD lesions. Furthermore, Uozumi et al [78] demonstrated an absence of subchondral bone in six of 11 biopsy samples and of the remaining five specimens with an osseous component, only two demonstrated no viable osteocytes. Therefore, it seems the necrosis found in OCD may be secondary to the actual detachment of the lesion rather than the underlying etiology of formation.…”

Section: Etiologymentioning

confidence: 99%

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

Edmonds

Polousky

2013

Clinical Orthopaedics &Amp; Related Research

215

223

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Background Osteochondritis dissecans (OCD) was first described to provide an explanation for the nontraumatic development of loose bodies within a joint. Despite many reports on the subject, there remains no clear understanding of the etiology, natural history, or treatment. Questions/purposes This review was undertaken to delineate (1) the etiology of OCD; (2) the presentation and locations; (3) the most appropriate imaging modalities; and (4) the most effective treatment strategies. Methods We reviewed the English literature using a database compiled from a Medline search for ''osteochondritis dissecans''. We identified 1716 publications, 1246 of which were in English. After exclusions, we reviewed 748 articles and of these cited 85. The observations of each study were then synthesized into this report. Results There appears to be no consensus concerning the etiology of OCD lesions. The presentations and locations are variable, but the knee, ankle, and elbow are most commonly involved. Although plain film assessment is important in OCD, there appears to be a trend toward the use of MRI, but the preferred sequences are in evolution. We found no consensus on the treatment of these lesions, related in part to the lack of agreement of methods for assessing outcomes. Conclusions Despite more than a century of study, we have made little advancement in our understanding of OCD. A study group has been formed to address this issue and actively seeks to answer these unknown issues regarding OCD.

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Section: Etiologymentioning

confidence: 99%

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

Edmonds

Polousky

2013

Clinical Orthopaedics &Amp; Related Research

215

223

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“…The form that is most similar to osteochondrosis dissecans in animals is the juvenile form. 23,58,67 Degenerated chondrocytes were found in excised cylinders and fragments from the elbow joint of 10-to 16-year-old patients 56 Retained cartilage a found in excised cylinders and fragments from the medial femoral condyle of 12-to 22-year-old patients 112 Retained cartilage a found in excised cylinders from the medial femoral condyle of 12-to 15-year-old patients 128 …”

Section: Causes Of Vascular Failurementioning

confidence: 99%

An Update on the Pathogenesis of Osteochondrosis

2015

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Osteochondrosis is defined as a focal disturbance in endochondral ossification. The cartilage superficial to an osteochondrosis lesion can fracture, giving rise to fragments in joints known as osteochondrosis dissecans (OCD). In pigs and horses, it has been confirmed that the disturbance in ossification is the result of failure of the blood supply to epiphyseal growth cartilage and associated ischemic chondronecrosis. The earliest lesion following vascular failure is an area of ischemic chondronecrosis at an intermediate depth of the growth cartilage (osteochondrosis latens) that is detectable ex vivo, indirectly using contrast-enhanced micro-and conventional computed tomography (CT) or directly using adiabatic T1r magnetic resonance imaging. More chronic lesions of ischemic chondronecrosis within the ossification front (osteochondrosis manifesta) are detectable by the same techniques and have also been followed longitudinally in pigs using plain CT. The results confirm that lesions sometimes undergo spontaneous resolution, and in combination, CT and histology observations indicate that this occurs by filling of radiolucent defects with bone from separate centers of endochondral ossification that form superficial to lesions and by phagocytosis and intramembranous ossification of granulation tissue that forms deep to lesions. Research is currently aimed at discovering the cause of the vascular failure in osteochondrosis, and studies of spontaneous lesions suggest that failure is associated with the process of incorporating blood vessels into the advancing ossification front during growth. Experimental studies also show that bacteremia can lead to vascular occlusion. Future challenges are to differentiate between causes of vascular failure and to discover the nature of the heritable predisposition for osteochondrosis.

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“…Of the 11 studies, four used formalin (varying concentrations) [10,14,28,31], one study each used formaldehyde 10% [4] or alcohol [20], and five did not report a fixation agent [3,8,9,16,30]. Decalcification agents used among the studies varied: one study used 5% nitric acid and 70% alcohol [4], one study used 40% formic acid and 20% sodium citrate [14], one study used EDTA [28], one study reported that no decalcification was used [20], and seven did not report on decalcification [3, 8-10, 16, 30, 31]. For histological analysis, six separate stains/analyses were used with varying frequency (Table 1).…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…For histological analysis, six separate stains/analyses were used with varying frequency (Table 1). Six studies used hematoxylin and eosin [4,14,16,28,30,31], two used Safranin-O (one in combination with Fast-Green) [14,31], one used toluidine blue [14], one used Alcian blue [10], one study used von Kossa stain [10], one study used Gomori trichrome stain [10], and one study used Goldner stain [14]. Two studies preoperatively labeled with tetracycline [14,20] and three studies did not use any staining techniques and only observed crosssections through photomicrographs [3,8,9].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Fairbank's [6] theory, later advocated by Smillie [24], was that repetitive microtrauma caused OCD of the knee. Trauma, either acute or repetitive microtrauma, has become a more accepted cause of OCD as a result of the high incidence of this disorder in the athletic population [2,4,6,7,10,13,14,16,28]. Despite the current consensus, the etiology of OCD remains unknown, and it may be multifactorial.…”

Section: Introductionmentioning

confidence: 99%

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Osteochondritis Dissecans Knee Histology Studies Have Variable Findings and Theories of Etiology

Shea

Jacobs

Carey

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although many etiological theories have been proposed for osteochondritis dissecans (OCD), its etiology remains unclear. Histological analysis of the articular cartilage and subchondral bone tissues of OCD lesions can provide useful information about the cellular changes and progression of OCD. Previous research is predominantly comprised of retrospective clinical studies from which limited conclusions can be drawn. Questions/purposes The purposes of this study were threefold: (1) Is osteonecrosis a consistent finding in OCD biopsy specimens? (2) Is normal articular cartilage a consistent finding in OCD biopsy specimens? (3) Do histological studies propose an etiology for OCD based on the tissue findings? Methods We searched the PubMed, Embase, and CI-NAHL databases for studies that conducted histological analyses of OCD lesions of the knee and identified 1560 articles. Of these, 11 met our inclusion criteria: a study of OCD lesions about the knee, published in the English language, and performed a histological analysis of subchondral bone and articular cartilage. These 11 studies were assessed for an etiology proposed in the study based on the study findings. Results Seven of 11 studies reported subchondral bone necrosis. Four studies reported normal articular cartilage, two studies reported degenerated or irregular articular cartilage, and five studies found a combination of normal and degenerated or irregular articular cartilage. Five studies proposed trauma or repetitive stress and two studies proposed poor blood supply as possible etiologies. Conclusions We found limited research on histological analysis of OCD lesions of the knee. Future studies with consistent methodology are necessary to draw major conclusions about the histology and progression of OCD lesions. Inconsistent histologic findings have resulted in a lack of consensus regarding the presence of osteonecrosis, whether the necrosis is primary or secondary, the association of cartilage degeneration, and the etiology of OCD. Such studies could use a standardized grading system to allow better comparison of findings.

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Histologic Findings and Possible Causes of Osteochondritis Dissecans of the Knee

Abstract: The results of this histologic study provide readers with several insights about the causes and treatment options of osteochondritis dissecans.

Cited by 110 publications

References 26 publications

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

An Update on the Pathogenesis of Osteochondrosis

Osteochondritis Dissecans Knee Histology Studies Have Variable Findings and Theories of Etiology

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