Treatment of Osteochondritis Dissecans

Smillie, Ian

doi:10.1302/0301-620x.39b2.248

Cited by 203 publications

(109 citation statements)

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“…It is unlikely that a single implant is ideal in all circumstances. Based on our observations and outcomes reported from clinical studies, 3,[8][9][10]12 an osteochondral fragment seated within its bed might require the least stiff fixation device. However, in the context of a mismatch between the defect site and its corresponding fragment, OCD might be more amenable to rigid fixation with a compression screw system.…”

Section: Discussionmentioning

confidence: 80%

“…A 4-month trial of protected weightbearing is recommended in this group. 3,[8][9][10][11][12] Surgical treatment is reserved for the patient with JOCD that has failed conservative measures and for those who are skeletally mature at the time of presentation. A variety of fixation methods have been used successfully in achieving fracture healing, including Kirschner wire (K-wire) fixation, 3,9 cannulated screws, 10 Herbert screws, 13 compression screws, 14 biodegradable rods, 15 biologic fixation with autogenous osteochondral plugs, 16 and nonabsorbable sutures.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the stability of various internal fixators used in the treatment of osteochondritis dissecans—a mechanical model

Morelli

Poitras

Grimes

et al. 2007

Journal Orthopaedic Research

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The purpose of this study was to determine what characteristics of fixation devices used in the treatment of osteochondritis dissecans (OCD) contribute to improved stability to resist shear loading. An OCD model was designed using rigid polyurethane foam. Each specimen consisted of two components, an osteochondral fragment and a corresponding defect. A total of 40 specimens were prepared and assigned to one of four groups: control (no extrinsic stabilizer); two 2-mm-diameter Kirschner wires (K-wires), 40 mm in length; one threaded washer and a 28-mm screw; and one threaded washer and a 38 mm screw. Each specimen was mounted onto an Iosipescu shear test fixture and subjected to shear loads at a pseudo-static displacement rate of 0.075 mm/s. All groups demonstrated some stability; controls were significantly less stable than all other groups. The group with the threaded washer and 38-mm screw demonstrated the greatest stability ( p < 0.001), and no difference was noted between the K-wire and 28-mm screw groups. These results suggest that, in this OCD model, friction conferred some intrinsic stability to resist loads in shear. However, stability was improved with the use of long implants that compressed the fragments together. ß

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Comparison of the stability of various internal fixators used in the treatment of osteochondritis dissecans—a mechanical model

Morelli

Poitras

Grimes

et al. 2007

Journal Orthopaedic Research

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“…Arthroscopic drilling was used first by Smillie and Dundee in 1957 [48]. It was popularised later by Pridie in 1959 [46].…”

Section: Subchondral Drillingmentioning

confidence: 99%

Treatment of articular cartilage lesions of the knee

Falah

Nierenberg

Soudry

et al. 2010

International Orthopaedics (SICOT)

193

155

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Treatment of articular cartilage lesions in the knee remains a challenge for the practising orthopaedic surgeon. A wide range of options are currently practised, ranging from conservative measures through various types of operations and, recently, use of growth factors and emerging gene therapy techniques. The end result of these methods is usually a fibrous repair tissue (fibrocartilage), which lacks the biomechanical characteristics of hyaline cartilage that are necessary to withstand the compressive forces distributed across the knee. The fibrocartilage generally deteriorates over time, resulting in a return of the original symptoms and occasionally reported progression to osteoarthritis. Our purpose in this study was to review the aetiology, pathogenesis and treatment options for articular cartilage lesions of the knee. At present, autologous cell therapies, growth factor techniques and biomaterials offer more promising avenues of research to find clinical answers.

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“…Although the cause of Freiberg disease remains unclear, injury, continued stress, and vascular insufficiency have been reported [1]. Treatments for this disease consist primarily of conservative therapy, such as activity restriction and using orthoses or casts.…”

Section: Introductionmentioning

confidence: 99%

Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results

Ikoma

Maki

Kido

et al. 2014

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the clinical outcomes regarding the dorsal wedge osteotomy fixed using a polyblend suture and describe the usefulness of this fixation method for the treatment of Freiberg disease. Methods The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease that underwent extra-articular dorsal closing-wedge osteotomy using a polyblend suture. The average age was 31.7 (range 13-72) years. The average followup period was 17 (range 14-24) months. Regarding image findings, time to bone union and metatarsal shortening was reviewed. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), and Japanese Society of the Surgery of Foot lesser toe scale (JSSF score) in the MTP joint before surgery and at the latest follow-up. Results Calluses under the metatarsal head were not observed in any cases. The mean metatarsal shortening was 2.33± 2.07 mm at follow-up. The bone union required an average of 8.4±0.8 weeks. The average ROM of dorsal flexion improved from 37.2±5.3°before surgery to 73.6±9.9°at latest follow-up (p<0.0001). The average ROM of plantar flexion improved from 16.0±10.1°before surgery to 19.5±8.6°at latest follow-up (p=0.35). The average VAS significantly improved from 75.3±8.5 before surgery to 4.9±4.2 at latest follow-up (p<0.0001). The average JSSF score significantly improved from 67.3±9.4 points before surgery to 98.8±3.0 points at the latest follow-up (p<0.0001). Conclusion Extra-articular dorsal closing-wedge osteotomy using a polyblend suture was carried out to treat Freiberg disease. The bone union was observed in all cases with improved clinical results. Fixation using a polyblend suture was considered to be useful.

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Treatment of Osteochondritis Dissecans

Cited by 203 publications

References 0 publications

Comparison of the stability of various internal fixators used in the treatment of osteochondritis dissecans—a mechanical model

Comparison of the stability of various internal fixators used in the treatment of osteochondritis dissecans—a mechanical model

Treatment of articular cartilage lesions of the knee

Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results

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