Bone-peg grafting for osteochondritis dissecans of the elbow.
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In the treatment of osteochondritis dissecans involving the elbow, we have used a bone-peg graft taken from the proximal part of the ulna and inserted into the defect. Thirty-two patients were followed from 2 to 10.5 years. The graft was utilised in 20 elbows, and 6 of these also had concomitant removal of a loose body. Another 6 elbows had removal of a loose body only. Ten elbows were treated conservatively in 5 of these the outcome was unsatisfactory, including 4 in which a bone-peg graft was later necessary. The bone-peg graft gave the best short-term results. Bony union of the dissecans site and reconstitution of subchondral bone required an average of 6.5 months. In 15 patients followed for a minimum of 5 years, the bone-peg graft was effective in limiting the development of osteoarthritis. Bone-peg grafting is a reliable method for treating osteochondritis dissecans of the elbow. (+info)
Osteochondritis dissecans: a diagnosis not to miss.
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Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. Because clinical findings are often subtle, diagnosis requires a high index of suspicion. Limited range of motion may be the only notable clinical sign. The diagnosis is made by radiographic examination, and magnetic resonance imaging has a key role in determining the stability of the lesion. Conservative management is the mainstay of treatment for stable lesions. While the majority of patients respond to conservative treatment, those with unstable lesions require arthroscopic management. (+info)
Treatment of severe osteochondritis dissecans of the elbow using osteochondral grafts from a rib.
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We treated a patient with extensive osteochondritis dissecans of the elbow by an osteochondral graft from a rib. It had consolidated seven months after operation. When seen at follow-up, after seven years and eight months, the elbow was free from pain with an improvement in the range of movement of 24 degrees. (+info)
Treatment of cartilage defects of the talus by autologous osteochondral grafts.
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We reviewed retrospectively 11 patients who had been treated surgically by open autologous osteochondral grafting for symptomatic chondral or osteochondral defects of the dome of the talus between 1996 and 1999. The mean ages of the eight men and three women were 34.2 and 25.9 years, respectively, with a mean time to follow-up of 24 months. The results of functional outcome were prospectively obtained using the MODEMS AAOS foot and ankle follow-up questionnaire, the AOFAS ankle-hindfoot scale and the Hannover scores for the ankle. The grafts were harvested from the ipsilateral knee. Good to excellent results were obtained for the ankle without adverse effects on the knee. We believe that autologous osteochondral grafting should be considered for the patient with a symptomatic osteochondral defect of the talus. (+info)
Osteochondritis dissecans of the knee in children. A comparison of MRI and arthroscopic findings.
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The treatment of osteochondritis dissecans (OCD) in children and adolescents is determined by the stability of the lesion and the state of the overlying cartilage. MRI has been advocated as an accurate way of assessing and staging such lesions. Our aim was to determine if MRI scans accurately predicted the subsequent arthroscopic findings in adolescents with OCD of the knee. Some authors have suggested that a high signal line behind a fragment on the T2-weighted image indicates the presence of synovial fluid and is a sign of an unstable lesion. More recent reports have suggested that this high signal line is due to the presence of vascular granulation tissue and may represent a healing reaction. We were able to improve the accuracy of MRI for staging the OCD lesion from 45% to 85% by interpreting the high signal T2 line as a predictor of instability only when it was accompanied by a breach in the cartilage on the T1-weighted image. We conclude that MRI can be used to stage OCD lesions accurately and that a high signal line behind the OCD fragment does not always indicate instability. We recommend the use of an MRI classification system which correlates with the arthroscopic findings. (+info)
Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years.
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We reviewed 38 patients who had been treated for an osteochondral defect of the talus by arthroscopic curettage and drilling. The indication for surgical treatment was persistent symptoms after conservative treatment for at least six months. A total of 22 patients had received primary surgical treatment (primary group) and 16 had had failed previous surgery (revision group). The mean follow-up was 4.8 years (2 to 11). Good or excellent results, as assessed by the Ogilvie-Harris score, were found in 86% in the primary group and in 75% in the revision group. Two further procedures were required, one in each group. Radiological degenerative changes were seen in one ankle in the revision group after ten years. Arthroscopic curettage and drilling are recommended for both primary and revision treatment of an osteochondral defect of the talus. (+info)
Fixation of osteochondral lesions of the talus using cortical bone pegs.
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We have treated osteochondral lesions of the talus using cortical bone pegs. We examined 27 ankles (27 patients) after a mean follow-up of 7.0 years (2 to 18.8). The mean age of the patients was 27.8 years (12 to 62). An unstable osteochondral fragment or osteosclerotic changes in the bed of the talus were regarded as indications for the procedure. The clinical results were good in 24 ankles (89%) and fair in three (11%); none had a poor result. There was also radiological improvement in 24 ankles. Repair of the articular surface and stability of the lesion can be achieved even in unstable chronic lesions. (+info)
Biomarkers of joint tissue metabolism in canine osteoarthritic and arthritic joint disorders.
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OBJECTIVE: To explore the levels of matrix metalloprotease-3 (MMP-3), tissue inhibitor of metalloproteases-1 (TIMP-1), 5D4 keratan sulfate, and two 3B3 chondroitin-sulfate epitopes in several canine osteoarthritic and inflammatory arthropathies. METHODS: Blood and synovial fluid were obtained from 103 dogs with rupture of the anterior cruciate ligament (ACLR), osteochondritis dissecans (OCD), fragmented coronoid process (FPC), patella luxation (PL), hip dysplasia (HD) or infectious arthritis. Dogs with non-musculosceletal disorders were used as controls. The biomarkers were measured by immunoassays. RESULTS: Median levels of synovial MMP-3, TIMP-1 and molar ratios of MMP/TIMP-1 were significantly higher in the arthritis than in the control group. The release of 5D4 keratan sulfate epitope and serum 3B3 neoepitope was reduced in arthritis patients. Increases in synovial TIMP-1 in OA were less pronounced and the molar ratio of MMP-3/TIMP-1 remained far below 1.0, demonstrating a surplus of the protease inhibitor. In osteoarthritic patients median levels of synovial 5D4 keratan sulfate were up-regulated after ACLR and PL and were inversely correlated with increasing duration of lameness. Serum TIMP-1 levels were significantly reduced in the joint disorder group when compared with the control group. CONCLUSION: Our observations present the TIMP-1 serum level as a potential marker for the detection of degenerative changes in cartilage and also indicate that in canine OA, the MMP-3 mediated matrix destruction is not of major importance. However MMP-3 seems to be a sensitive marker for the local inflammation in canine arthritis. (+info)