UNASSIGNED: Wilson\'s disease (WD) is a rare genetic disorder characterized by copper accumulation in the body, leading to a spectrum of health issues, such as liver disease, neurological disturbances, and psychiatric disorders. In recent years, there has been increasing recognition that WD can also result in osteoarticular defects. Research has shed light on the potential of WD to cause these findings, which in some instances, can progress to osteoarthritis and persistent pain. However, the exact pathophysiological process through which WD leads to osteochondral defects remains unclear.
UNASSIGNED: We present a case of a 30-year-old male diagnosed with WD exhibiting musculoskeletal symptoms. The patient\'s medical history revealed chronic intermittent knee pain. Radiographic and magnetic resonance imaging (MRI) studies revealed a substantial osteochondral lesion with high-grade chondral fissuring. This report reviews the proposed pathophysiology of orthopedic pathology in WD, offers an updated literature review, and provides clinical recommendations for management. Treatment options including nonsurgical options and surgery are discussed.
UNASSIGNED: This case underscores the significance of identifying the orthopedic manifestations of WD, even in the absence of classic signs and symptoms. Any WD patient suspected of having osteoarticular defects should be thoroughly evaluated, with a low threshold for initiating imaging studies. Moreover, treatment plans should be tailored to the patient\'s specific presentation, emphasizing the importance of individualized patient care. This case highlights key findings in WD and provides important insights, particularly on the clinical relevance of osteoarticular defects in WD, the potential application of nonsurgical and surgical treatments, and the importance of individualized patient care in the management of WD.

METHODS: A 27-year-old woman developed capitellar osteonecrosis after long-term corticosteroid use to treat non-Hodgkin lymphoma. She underwent an osteochondral reconstruction using a lateral femoral condyle (LFC) allograft. This graft was selected because it has a similar radius of curvature to the capitellum. The patient had osseous integration, painless, near full range of motion of her elbow 6 months postoperatively and good shoulder function 1.0 year postoperatively.
CONCLUSIONS: The LFC allograft should be considered a viable option in treating capitellar osteonecrosis.

BACKGROUND: The etiology of osteochondrosis dissecans (OCD), a chondropathy associated with detachment of the subchondral bone and the overlaying cartilage, is not yet fully understood. While repetitive physical exercise-related stress is usually assumed to be the main risk factor for the occurrence of OCD, genetic predisposition could have an underestimated influence on the development of the disease.
METHODS: We report a case of monozygotic twins with almost identical stages of bilateral osteochondrosis dissecans of the knee joint. In both patients, initially, a unilateral lesion occurred; despite restricted physical exercise, in the further course of the disease a lesion also developed on the contralateral side. While the lesion found most recently demonstrated an ongoing healing process at a 6-month follow-up, the other three lesions showed a natural course of healing under conservative treatment with significant clinical as well as radiological improvements after one year and complete consolidation in magnetic resonance imaging (MRI) after 2 years.
CONCLUSIONS: There could be a genetic component to the development of OCD, although this has not yet been proven. Based on a two-year MRI follow-up, we were able to show the self-limiting characteristics of juvenile osteochondrosis dissecans.

UNASSIGNED: Legg-Calvé-Perthes disease (LCPD) is the idiopathic osteonecrosis of the capital femoral epiphysis in children. It is a self-healing condition, and the morphology of the hip may vary according to the severity of the disease, among several other factors. The treatment focuses on attempts to prevent femoral head collapse, obtain functional hip motion recovery, and reduce pain. Osteochondritis Dissecans (OCD) of the femoral head has been reported in 2% to 7% of patients diagnosed with healed LCPD. Although OCD may remain asymptomatic, the osteochondral fragment has the potential to become unstable, evolving into symptoms of pain, locking, catching, and snapping.
UNASSIGNED: We present a case report of a ten-year-old boy with an OCD lesion following LCPD who underwent effective osteochondral fixation through the surgical hip dislocation approach. The patient evolved to excellent functional recovery at 1 year post-operatively.
UNASSIGNED: The surgical hip dislocation approach allows anatomical fixation of the OCD fragment, as well as improvement of hip biomechanics, decreasing pain, improving range of motion and joint congruency, and preserving the native articular cartilage. It also gives the surgeon the opportunity to assess hip stability, femoroacetabular impingement and labral tears, allowing a wide variety of options for the treatment of the healed LCPD. Level of Evidence IV; Type of study Case Report.
UNASSIGNED: A Doença de Legg-Calvé-Perthes (DLCP) é a osteonecrose idiopática da epífise femoral proximal em crianças. É uma condição auto resolutiva, porém a morfologia final do quadril pode variar de acordo com a gravidade da doença. O tratamento concentra-se na tentativa de prevenir o colapso da cabeça femoral, obtendo recuperação funcional do movimento do quadril e redução da dor. A osteocondrite dissecante (OCD) da cabeça femoral foi relatada em 2% a 7% dos pacientes diagnosticados com DLCP já curada. Embora a OCD possa permanecer assintomática, o fragmento osteocondral tem potencial para se tornar instável, evoluindo para sintomas de dor, bloqueio, impacto e estalido.
UNASSIGNED: Apresentamos o relato de caso de um menino de 10 anos com OCD da cabeça femoral após DLCP, submetido à fixação osteocondral do fragmento por meio da abordagem cirúrgica de luxação do quadril. O paciente evoluiu com excelente recuperação funcional 1 ano após a cirurgia.
UNASSIGNED: A abordagem cirúrgica da luxação do quadril permite a fixação anatômica do fragmento da OCD, bem como a melhora da biomecânica do quadril, diminuindo a dor, melhorando a amplitude de movimento e a congruência articular e preservando a cartilagem articular nativa. Também dá ao cirurgião a oportunidade de avaliar a estabilidade do quadril, impacto femoroacetabular e lesões labrais, permitindo uma ampla variedade de opções para o tratamento das sequelas da DLCP. Nível de evidência IV; tipo de estudo Relato de Casos.

We report the case of a 17-year-old climber presenting a rare case of osteochondritis dissecans of a proximal interphalangeal finger joint. A thorough bibliographic search confirmed the rarity of this pathology. The diagnosis and treatment choice are discussed in view of the literature findings.

Injury to the chondral surface and subchondral bone can be due to osteochondritis dissecans or traumatic injury. These lesions can lead to pain, swelling, and mechanical symptoms causing functional impairments for patients. Treatment can include nonoperative management or surgical intervention including internal fixation. Internal fixation can be performed through multiple methods including the use of bioabsorbable screw fixation, though there is concern for potential early failure of this method. We present three cases of osteochondral lesions treated with internal fixation with bioabsorbable screws, which experienced early failure of the bioabsorbable screws, leading to failure of fixation and requiring revision surgery with advanced cartilage restoration procedures. All patients had resolution of their symptoms and improved function postoperatively. While the use of bioabsorbable screw fixation can potentially decrease cost and morbidity, their mechanical properties may increase the risk of failure before lesion healing. We advocate caution with the use of these screws for the treatment of unstable osteochondritis dissecans lesion and recommend careful patient selection and meticulous surgical technique to avoid failure of fixation of these lesions.

We encountered a case of an 18-year-old woman with persisting ankle pain after a healed Weber-B fracture. Additional imaging through a computed tomography (CT) scan revealed a fully united fragmentous osteochondral lesion of the talus (OLT) (17 ​mm ​× ​9 ​mm ​× ​8 ​mm) of the right ankle-as opposed to a non-united OLT when the fracture was diagnosed 19 months prior to the presentation. Our proven hypothesis is that the fragmented OLT was non-symptomatic for many years, based on an osteochondritis dissecans. The ipsilateral ankle trauma induced a fresh fracture in the interface between the talus and the fragmented OLT, and consequently the destabilized fragmented OLT became symptomatic. The ankle trauma initiated fracture healing that resulted in a complete union of the OLT without clinical symptoms. The existing symptoms were established to be based on anterior osseous ankle impingement, due to the presence of osseous fragments in the medial gutter of the ankle joint. Therefore, a nettoyage of the medial gutter including a resection of the corpora libera from the medial gutter with the shaver was performed. Intraoperative macroscopic assessment of the medial osteochondritis dissecans was performed and showed union with completely intact hyaline cartilage at the level of the surrounding articular cartilage requiring no interventions. An increased range of motion was achieved. The patient recovered well with and experienced no more recognizable pain. In this article, the unstable fragmentous lesion of the patient reached spontaneous union within 19 months after destabilization. Although this is not common for an unstable fragmentous OLT, this could be a stepping stone toward an increased role of conservative treatment for fragmentary OLTs.

The purpose of this report is to demonstrate that radiographic evaluation of the canine shoulder joint alone is not sensitive enough to detect migrated osteochondral fragments within the biceps tendon sheath, as a sequela to osteochondrosis dissecans of the caudal humeral head. A 6-months-old, male, 35 kg Hovawart was referred due to chronic intermittent lameness on the left forelimb. Survey radiographs revealed a semilunar radiolucency surrounded by a moderately sclerotic rim at the caudal aspect of the left humeral head, referred to as osteochondrosis dissecans. However, only computed tomography combined with ultrasonography could clearly confirm a dislodged osteochondral fragment within the left biceps tendon sheath and a consequent tenosynovitis. Arthroscopic treatment on the clinically affected left forelimb followed by an additional approach over the left biceps tendon sheath to remove the migrated fragment resulted in a complete remission of the lameness until the last follow-up one year after surgery. In our opinion, computed tomography should be applied in the medical work up of canine shoulder osteochondrosis (OC) as standard. Combined with ultrasonography, it can further aid in complete evaluation of the shoulder joint and reliable exclusion of displaced osteochondral fragments, which might also be missed during arthroscopy when located too far distally.
Ziel dieses Fallberichts ist es, zu zeigen, dass die Röntgenuntersuchung des Schultergelenks allein nicht sensitiv genug ist, um dislozierte Fragmente in die Bizepssehnenscheide als Folge einer Osteochondrosis dissecans (OCD) Läsion am kaudalen Humeruskopf bei Hunden zu diagnostizieren. Ein 6 Monate alter, 35 kg schwerer, männlicher Hovawart wurde aufgrund einer chronisch intermittierenden Lahmheit an der linken Vordergliedmaße überwiesen. Auf den Röntgenaufnahmen zeigte sich eine semilunare Radioluzenz mit sklerotischem Randsaum am linken kaudalen Humeruskopf, typisch für eine osteochondrale Läsion. Jedoch konnte nur durch die Kombination von Computertomografie und Sonografie ein disloziertes osteochondrales Fragment in der linken Bizepssehnenscheide und die daraus resultierende Tenosynovitis eindeutig bestätigt werden. Eine chirurgische Versorgung mittels Arthroskopie, gefolgt von einem Zugang über der linken Bizepssehnenscheide zur Entfernung des migrierten Fragments, führte zu einer vollständigen Remission der Lahmheit bis zur letzten Nachuntersuchung ein Jahr postoperativ. Unserer Meinung nach sollte die Computertomografie als Standard in der Abklärung einer OCD des Schultergelenks bei Hunden eingesetzt werden. In Kombination mit einer Sonografie kann sie zur vollständigen Beurteilung des Schultergelenks und zum zuverlässigen Ausschluss dislozierter osteochondraler Fragmente beitragen, welche auch in der Arthroskopie übersehen werden können.

BACKGROUND: Osteochondrosis dissecans (OCD) is common in the femoropatellar joint in Thoroughbred yearlings for sale at auction and there is no consensus on the effect on racing outcomes.
OBJECTIVE: Describe femoropatellar OCD in juvenile Thoroughbreds and compare the racing performance of affected Thoroughbred horses to siblings and unaffected horses from the same sale.
METHODS: Retrospective case-control study of juvenile horses born 2010-2016.
METHODS: Radiographic reports from 27 Thoroughbred auctions of weanling (5-11 months of age) and yearling (12-22 months of age) horses were reviewed to identify femoropatellar OCD. Age and sex of cases and controls were obtained from the sales catalogue. Racing performance was obtained from an online database. Correlation between lesion characteristics and racing performance were assessed using Pearson and Spearman correlations for continuous and ordinal/categorical variables respectively. Racing performance was compared between cases and sibling controls and age- and sex-matched sale number controls from the same sale with Poisson distribution and log link. Significance level of alpha = 0.05 was used.
RESULTS: Femoropatellar OCD was identified in 429 horses with North American race records. OCD was present on 519 lateral trochlear ridges and 54 medial trochlear ridges. There were more males in the case group (70%) than in the sibling control group (47%). Case racing performance was compared to 1042 sibling and 757 hip controls. There were significant but small decreases in racing metrics of cases and increases in males for years raced, total starts, starts for 2-5 years of age, total placings, and placings at 2-4 years of age. Analysis of specific lesion metrics revealed weak correlations for performance outcomes (positive and negative) resulting in an inability to draw firm conclusions.
CONCLUSIONS: Retrospective study where case management was unknown.
CONCLUSIONS: Femoropatellar OCD in juvenile Thoroughbreds for sale at auction decreases some racing outcomes.
背景: 在纯血马周岁拍卖会的中，股髌关节骨软骨分离症(OCD)很常见，其对比赛结果的影响尚无共识。 目的: 描述幼年纯血马的股髌关节骨软骨分离症，并将有病症的纯血马与其兄弟姐妹马匹和同一场拍卖会无病症的马匹的比赛表现进行比较。 研究设计: 对2010-2016年出生的幼马进行回顾性病例对照研究。 方法: 回顾27场纯血马拍卖会的马匹X线影像报告，分别是断奶驹(5-11个月)和周岁驹(12-22个月)，确定股髌关节骨软骨分离症。病例组和对照组马匹的年龄和性别从拍卖销售目录中获得。出赛成绩从在线数据库中取得。病变特征与赛马表现之间的相关性分别采用Pearson和Spearman法，对连续变量和顺序/分类变量进行评估。用泊松分布和对数连接比较病例组和其兄弟姐妹对照组以及来自同一批次拍卖的年龄和性别匹配臀部对照组的赛马表现。显著性水平α = 0.05。 结果: 在北美比赛记录中，429匹的马发现了股髌关节骨软骨分离症(OCD)。OCD存在于519个外侧滑车(LTR)和54个内侧滑车(MTR)。病例组的公马(70%)比兄弟姐妹对照组(47%)多。病例组赛马表现与1042匹兄弟姐妹组和757匹臀部对照组进行了比较。病例组的比赛指标有微小但显著的下降，而公马在比赛年限，总出赛次数，2-5岁出赛次数，总排名次数和2-4岁排名次数方面的下降更明显。对特定病变指标的分析显示，表现结果(阳性和阴性)呈弱相关性导致无法得出确切的结论。 主要局限性: 回顾性研究，病例后续管理未知。 结论: 拍卖会中出售的幼年纯血马的股髌关节骨软骨分离症会降低比赛成绩预期.

UNASSIGNED: Following sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in pediatric athletic trauma, particularly during the pre-puberty through adolescent years of rapid skeletal growth. This paper presents the diagnosis and management of osteochondritis dissecans in its third most common location, the elbow, a presentation of which chiropractors should be aware, including the importance of timely diagnosis and appropriate treatment.
UNASSIGNED: A 9-year-old elite gymnast presented at a chiropractic clinic with elbow pain and restricted range of motion after a fall during training. Following multidisciplinary involvement, the diagnosis was eventually made as osteochondritis dissecans.
UNASSIGNED: The patient underwent successful arthroscopic surgery in order to remove the osteochondral fragment, followed by a specific regimen of rehabilitation exercises, which helped to enhance and accelerate optimal healing for her return to athletic activity.
UNASSIGNED: This case reminds the practicing chiropractor of the valuable role he/she can play in a multidisciplinary management of pediatric sports trauma, particularly in diagnosis and post-surgical care. A literature review presents a synopsis of the reported clinical presentations, diagnostic assessment and therapeutic options for capitellar osteochondritis dissecans.
UNASSIGNED: À la suite d’une blessure liée au sport, il est important de poser un diagnostic précis rapide, afin d’entreprendre les soins appropriés le plus tôt possible. Ceci revêt peut-être encore une plus grande importance dans le cas d’un traumatisme sportif chez les jeunes, surtout pendant les années de croissance rapide du squelette, de la prépuberté à l’adolescence. Cet article présente le diagnostic et la gestion de l’ostéochondrite disséquante dans sa troisième localisation la plus fréquente, le coude, un cas que les chiropraticiens devraient connaître, y compris l’importance d’un diagnostic rapide et d’un traitement approprié.
UNASSIGNED: Une gymnaste d’élite de 9 ans s’est présentée dans une clinique chiropratique avec une douleur au coude et une limitation de l’amplitude des mouvements après une chute pendant l’entraînement. Après une intervention multidisciplinaire, le diagnostic a finalement été posé comme étant une ostéochondrite disséquante.
UNASSIGNED: La patiente a subi avec succès une chirurgie arthroscopique afin de retirer le fragment ostéochondral, suivie d’un régime spécifique d’exercices de réadaptation, qui a contribué à améliorer et à accélérer la guérison optimale pour son retour à l’activité sportive.
UNASSIGNED: Ce cas rappelle au chiropraticien en exercice le rôle précieux qu’il peut jouer dans une prise en charge multidisciplinaire des traumatismes sportifs chez les jeunes, notamment dans le diagnostic et les soins postchirurgicaux. Un examen des documents scientifiques présente un synopsis des tableaux cliniques signalés, de l’évaluation diagnostique et des options thérapeutiques de l’ostéochondrite disséquante du capitulum.