Osteochondritis dissecans of the elbow: Histopathological assessment of the articular cartilage and subchondral bone with emphasis on their damage and repair

Abstract

Osteochondritis dissecans (OCD) of the elbow is a localized injury of the articular cartilage and subchondral bone that is commonly seen in the young athlete. In the present study, the extent of damage and repair on the articular cartilage and subchondral bone was examined histologically using specimens of 25 osteochondral cylinders and seven loose bodies obtained from 25 young athletes who had undergone osteochondral autograft surgery. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) assays for detecting apoptotic cells and immunohistochemistry of matrix metalloproteinases (MMP) were performed on the osteochondral cylinder specimens. The histological findings of the OCD of the elbow showed that the articular cartilage exhibited degenerative change, mimicking osteoarthritis, and was markedly damaged as the lesion progressed. TUNEL-positive cells and MMP-3- and -13-expressing cells were distributed in the degenerative articular cartilage and reparative fibrocartilage tissue. Separation occurred at either the deep articular cartilage or the subchondral bone, with the former being dominant in the early OCD lesions. The present results suggest that the primary pathological changes in OCD of the elbow were due to damage of articular cartilage induced by repeated stress following degenerative and reparative process of articular cartilage and subchondral fracturing, and separation subsequently occurred on the cartilage and developed onto the subchondral bone in its advanced stages.

Focal Defects of the Knee Articular Surface: Evidence of a Regenerative Potential Pattern in Osteochondritis Dissecans and Degenerative Lesions

“…However, the OCD group showed a significantly higher percentage of TRAP-positive cells. These data are in line with studies by Krause et al [3] and Yonetani et al [26] who also showed viable subchondral trabeculae in juvenile OCD lesions arthroscopically classified according to the International Cartilage Repair Society (ICRS) OCD as ICRS OCD I/II [27]. A recent paper described a greater presence of TRAP-positive cells in sclerotic bone than in nonsclerotic bone areas, which is a typical feature in advanced OA [28], suggesting that the presence of TRAP-positive cells in bone focal lesion may contribute to a sclerotic bone evolution.…”

Transection of vessels in epiphyseal cartilage canals leads to osteochondrosis and osteochondrosis dissecans in the femoro-patellar joint of foals; a potential model of juvenile osteochondritis dissecans

“…Needle core biopsies and chondro-osseous cylinders collected during the treatment of JOCD lesions in the knees or elbows of children from 10 to 16 years old have been examined histologically 45,46 . On histological examination, changes apparently representing chondrocyte necrosis 46 , alterations in matrix staining 45,46 , proliferation of viable, adjacent chondrocytes 45,46 , granulation tissue 45,46 and focal cartilage thickening, i.e., delayed ossification 45 have been described. The same changes were observed from 42 days following vascular transection in the current study, and in previously examined naturally occurring chronic lesions in foals 21,31 .…”

An Update on the Pathogenesis of Osteochondrosis

“…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 …”