Osteochondrosis dissecans is a particularly common developmental orthopaedic disorder in equines. Among its causes, the hereditary component is no longer a matter of debate, and, for several decades, the various studbooks for sport horses have been selecting stallions in order to limit the prevalence of this condition in the population. However, to our knowledge, no study has evaluated changes in the prevalence of osteochondrosis dissecans over time through longitudinal monitoring of a population of sport horses. The study presented here is part of a large screening programme for developmental orthopaedic pathologies in Wallonia (Belgium) and assessed the presence of these lesions over a period of 19 years in the Walloon sport horse population according to constant and standardised sampling and diagnostic criteria. The effects of breeding conditions and infection in foals were also assessed by means of questionnaires. The results showed no significant change in the prevalence of osteochondrosis dissecans in a population of 1099 individuals born between 2004 and 2022. Furthermore, individuals who had suffered from sepsis during their growing period were very significantly predisposed (p < 0.001) to the development of osteochondrosis dissecans compared to a control group, with respectively 14/21 (67%) and 103/364 (28%) of individuals affected. This study suggests that the selection programmes applied to the population studied are not sufficiently strong or adapted to reduce the prevalence of osteochondrosis dissecans in the population over a period of 19 years. Moreover, this study confirms that foals with sepsis and concurrent osteochondrosis dissecans lesions should not necessarily be excluded from breeding programmes on this basis.

BACKGROUND: Juvenile osteochondritis dissecans of the knee joint is the most common osteochondral lesion during growth, usually occurring between the 10th and 14th year of age.
METHODS: Repetitive microtraumata lead to a subchondral osseus lesion, which is commonly located at the medial aspect of the femoral condyle. Sport activities are considered to be the main cause, although genetic and hereditary factors as well as vitamin D3 deficiency also play a role. Current classification systems distinguish between stable and unstable osteochondral lesions, which is decisive for further treatment.
METHODS: Stable lesions may heal through conservative treatment by avoiding weight bearing and sport. Unstable lesions, on the other hand, can lead to a complete defect of the joint surface with the formation of a free joint body. In such cases, various surgical techniques aim at reconstructing the surface of the joint, in order to reduce the risk of secondary arthritis.
UNASSIGNED: HINTERGRUND: Die juvenile Osteochondrosis dissecans des Kniegelenkes ist die häufigste osteochondrale Läsion des Wachstumsalters und tritt am häufigsten zwischen dem 10. und 14. Lebensjahr auf.
UNASSIGNED: Sie entsteht durch repetitive Mikrotraumata und ist typischerweise im subchondralen Knochen des medialen Femurkondylus lokalisiert. Während die sportliche Aktivität als die Hauptursache betrachtet wird, scheinen genetische und hereditäre Faktoren sowie ein Vitamin‑D3-Mangel ebenfalls eine Rolle zu spielen. Etablierte Klassifikationen dienen der Unterscheidung zwischen stabilen und instabilen osteochondralen Läsionen, die maßgebend für die weitere Behandlung sind.
UNASSIGNED: Stabile Läsionen können in der Regel konservativ durch konsequente Schonung vollständig ausheilen. Instabile Läsionen können hingegen zu einem vollständigen Defekt der Gelenkoberfläche mit Entstehung eines freien Gelenkkörpers führen. In diesen Fällen stehen unterschiedliche operative Techniken zur Verfügung, die auf die Wiederherstellung der Kontinuität der Gelenkoberfläche abzielen, um das Risiko einer sekundären Arthrose zu reduzieren.

UNASSIGNED: Capitellar osteochondritis dissecans (OCD) lesions are common in athletes. Osteochondral autograft transfer (OAT) is one possible treatment option, though outcomes including return to sport (RTS) data are limited to small series. The purpose of this study was to systematically review RTS following OAT for capitellar OCD lesions. Our secondary objectives were to evaluate patient-reported outcomes (PROs), range of motion (ROM), and complications after OAT.
UNASSIGNED: PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched for peer-reviewed articles on \"osteochondral autograft transfer\" and related terms for capitellar OCD lesions. Articles were included if they reported an RTS rate and had a follow-up time point of at least 12 months. Data on RTS rates, PRO measures, complications, and ROM were extracted. Articles were assessed for methodological quality using the Methodological Index for Non-randomized Studies criteria.
UNASSIGNED: Six hundred sixty-six articles were retrieved, and 24 articles (470 patients) met the inclusion criteria. In total, 454/470 patients (97%) returned to sports following OAT for OCD. The RTS rate ranged from 79% to 100%. Return to previous level of performance ranged from 10% to 100%. Timmerman-Andrews postoperative scores (range = 169-193) were most often reported, with 87% of patients showing scores within the excellent range. Disabilities of the Arm, Shoulder, and Hand and Japanese Orthopedic Association scores were also excellent postoperatively for all studies reporting, with higher scores among centralized lesions vs. lateral.
UNASSIGNED: Following OAT for capitellar OCD lesions, RTS rates are high; however, athletes should be counseled on the potential of a return to lower performance or the need to change positions. Lateral lesion location may negatively impact outcomes. PRO scores are typically excellent and postoperative ROM consistently improves. This information helps counsel patients regarding expectations and outcomes of OAT for OCD of the capitellum.

UNASSIGNED: Osteochondritis dissecans (OCD) of the humeral capitellum is a rare and challenging condition to treat. Several surgical options exist, but in the last few years, the pendulum has swung from debridement and microfracture to restoration of the articular surface. Osteochondral autografts from the rib and knee have been described, but donor-site morbidity is a concern.
UNASSIGNED: To expand the results of fresh osteochondral allograft transplantation (FOCAT) in a previously published report with inclusion of additional patients and a longer follow-up period.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: After institutional review board approval, the charts of patients who underwent FOCAT for OCD of the capitellum between 2006 and 2022 by a single surgeon were reviewed. The majority of cases (94%) had unstable lesions (Minami grades 2 and 3). A trial of nonoperative treatment had failed in all. All patients underwent diagnostic arthroscopy, followed by a mini-open, ligament-sparing approach with grafting using commercially available guides and instruments.
UNASSIGNED: A total of 35 patients were identified, of whom 25 were male. The mean age was 16 ± 3.9 years (range, 11-32 years). There were 24 baseball players (19 pitchers and 5 position players), 5 gymnasts, 3 cheerleaders/tumblers, 1 tennis player, 1 student (who did not participate in athletics), and 1 patient with avascular necrosis from chemotherapy. Eighteen patients had a mean flexion contracture of 14.1°± 11.9°. A single osteochondral allograft plug was used in 23 patients (mean diameter, 11.3 ± 2.8 mm), and 12 patients required 2 plugs (Mastercard technique). The mean follow-up was 92.6 ± 54.5 months (range, 24-204 months). There was significant improvement in Oxford (from 25.5 ± 4.9 to 46.7 ± 3.5; P < .00001) and visual analog scale for pain (from 7.5 ± 2 to 0.3 ± 1.0; P < .0001) scores. The mean Single Assessment Numeric Evaluation score at the time of follow-up was 90.6 ± 10.8 (range, 60-100). In overhead athletes, there was significant improvement in the Kerlan-Jobe Orthopaedic Clinic score (from 40.8 ± 11.8 to 90.6 ± 10.8; P < .00001). A postoperative magnetic resonance imaging scan was obtained in 16 (46%) patients at a mean of 32.6 months. In all cases, the graft was incorporated. All overhead athletes were able to return to their sport and perform at the same level or higher for >2 years. Two elbows required a subsequent arthroscopy for loose-body removal; otherwise, there were no other complications.
UNASSIGNED: FOCAT is an excellent option for treating OCD lesions of the humeral capitellum. Excellent outcomes and high return-to-sport rates were observed, with midterm follow-up showing no graft failures. FOCAT eliminates donor-site morbidity.

UNASSIGNED: Although the incidence of osteochondritis dissecans (OCD) of the knee may be low, an overview and comparison of sports-related outcomes with current surgical management techniques are needed.
UNASSIGNED: To summarize the available evidence regarding outcomes for different surgical treatment options for unstable OCD of the knee in both skeletally mature and immature patients by calculating the return to sports (RTS) rate, the mean RTS time, and other sports-related postoperative outcome measures.
UNASSIGNED: Systematic review; Level of evidence, 4.
UNASSIGNED: A systematic review of studies on RTS after surgical correction of unstable OCD within the knee was conducted utilizing PubMed, Embase, and the Cochrane databases. Included were studies discussing the treatment of unstable OCD with minimum 1-year follow-up outcomes. Multivariate analysis was used to compare studies grouped together based on RTS and skeletal maturity.
UNASSIGNED: Of 2229 articles, 6 studies (197 patients; 198 knees) met the inclusion criteria and were included in our analysis. The percentage of patients who returned to the previous level of sport ranged from 52% to 100%; those returning to any level of sport ranged from 87% to 100%. Clinical outcomes did not differ between patients with open versus closed physes. Osteochondral Autograft Transfer System (OATS) procedures had a 100% RTS rate across several studies with skeletally mature and mixed cohorts, and microfracture had the lowest overall RTS rate (52%). For skeletally immature patients, all examined studies that utilized either open or arthroscopic reduction and internal fixation, 77% and 78%, respectively, had acceptable RTS rates. Arthroscopic fixation had a higher rate of revision surgery in both skeletally mature and immature patients.
UNASSIGNED: Our analysis indicated that the treatment of unstable OCD lesions using the OATS technique demonstrated high RTS rates across several studies, while microfracture alone exhibited the lowest RTS rate. Both arthroscopic and open internal fixation utilizing bioabsorbable screws yielded satisfactory RTS rates for juvenile patients with OCD.

Ostechondritis dissecans (OCD) is an orthopaedic disease characterized by formation of osteochondral defects in developing joints. Epiphyseal cartilage necrosis (osteochondrosis [OC]) caused by focal failure of vascular supply is the known precursor lesion of OCD, but it remains to be established how the severity of vascular failure drives lesion healing or progression. In the current study we have implemented a novel piglet model of induced osteochondrosis of the lateral trochlear ridge of the femur to determine the role that the extent of ischemia plays in the development and progression of OC/OCD lesions. Ten 4-week-old Yorkshire piglets underwent surgical interruption of the vascular supply to the entirety (n = 4 pigs) or the distal half (n = 6 pigs) of the lateral trochlear ridge of the femur. At 2, 6, and 12 weeks postoperatively, distal femora were evaluated by magnetic resonance imaging (MRI) to determine the fate of induced OC lesions. At 12 weeks, piglets were euthanized, and the surgical sites were examined histologically. After complete devascularization, lesion size increased between the 6- and 12-week MRI by an average of 24.8 mm2 (95% CI: [-2.2, 51.7]; p = 0.071). During the same period, lesion size decreased by an average of 7.6 mm2 (95% CI: [-24.5, 19.4]; p = 0.83) in piglets receiving partial devascularization. At 12 weeks, average ± SD lesion size was larger (p<0.001) in piglets undergoing complete (73.5 ± 17.6 mm2) vs. partial (16.5 ± 9.8 mm2) devascularization. Our study demonstrates how the degree of vascular interruption determines lesion size and likelihood of healing in a large animal model of trochlear OC.

OBJECTIVE: Osteochondritis dissecans (OCD) can lead to detrimental effects in the affected joints. Osteochondral autologous transplantation (OAT) allows to restore the articular surface with an autologous osteochondral unit. While short-term results are documented, there is a lack of long-term data. Aim of this study was to analyze the long-term clinical results of single-plug OAT for the treatment of knee OCD.
METHODS: Twenty patients (14 men, 6 women) were treated with single plug-OAT. Mean age was 23.6 ± 9.9 years and BMI was 23.3 ± 3.6 kg/m2. Lesion size was 2.3 ± 1.6 cm2 and defects included 14 medial femoral condyles (MFC) and 6 lateral femoral condyles (LFC). Patients were followed up prospectively at baseline, 24 months, 60 months, and at minimum ten years (12.6 ± 2.0 years) using the IKDC subjective score and through an overall judgment on treatment satisfaction. The activity level was evaluated with the Tegner score and adverse events and failures were also recorded. Factors influencing the clinical outcomes, including age, sex, BMI, lesions size, and lesion location were also investigated.
RESULTS: No severe adverse events and no surgical failures were reported and 85.0% of patients were satisfied at a minimum ten year follow-up. Subjective IKDC showed a significant and stable improvement at all follow-ups, passing from 45.3 ± 16.5 at baseline to 73.7 ± 16.6 at 24 months (p < 0.0005), to 72.9 ± 16.6 at 60 months (p < 0.0005), and to 74.1 ± 20.8 at long-term follow-up (p < 0.0005). Patients with OCD lesions localized on the LFC obtained lower results compared to those with MFC lesions at two years and five years (p = 0.034 and p = 0.023). The highest long-term scores were obtained in patients with lesion size lower than 2 cm2 (89.1 ± 8.8) compared to patients with lesion size between 2 and 4 cm2 (69.2 ± 15.7), and patients with lesion size larger than 4 cm2 (63.8 ± 34.6).
CONCLUSIONS: OAT is a suitable technique to treat knee OCD in young patients and offers a high patient satisfaction and a significant improvement in terms of clinical subjective scores, with results remaining stable over time, although without reaching the pre-injury activity level. No severe adverse events and no surgical failures have been documented confirming OAT as a valid treatment option, although the best long-term results for lesions smaller than 2 cm2 and for MFC lesions should be considered when choosing this procedure to address knee OCD lesions.

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.

OBJECTIVE: To evaluate the efficacy of surgical treatment of the discoid lateral meniscus with osteochondritis dissecans (OCD) through clinical and radiological evaluations, focusing on recurrent or postoperative OCD occurrence.
METHODS: This retrospective study included patients with symptomatic discoid lateral meniscus with OCD (pre-OCD group) and without OCD (non-OCD group) who had undergone arthroscopic surgery with >5 years of follow-up. Age, sex, Lysholm score, Tegner activity scale, surgical procedure, and recurrent or postoperative OCD lesions were compared. The association between patient variables and postoperative OCD was determined using multivariate logistic regression analysis.
RESULTS: Of the 95 knees, 15 (15%) were in the pre-OCD group. Healing was observed in 14/15 (93%) knees. Recurrent and postoperative OCDs were reported in 4/15 (28.5%) knees in the pre-OCD and 7/80 (8.8%) knees in the non-OCD groups at a mean of 3.2 ± 1.1 and 3.7 ± 1.2 years, respectively. Pre- and postoperative Tegner activity scale and Lysholm scores were higher in the pre-OCD group but similar to those in the non-OCD group. The incidence of recurrent OCD in the pre-OCD group was significantly higher than that of postoperative OCD in the non-OCD group. Younger patients (odds ratio, 0.49; p = 0.003) had an increased risk of experiencing recurrent or postoperative OCD in multivariate analysis. The optimal cutoff age for distinguishing recurrent or postoperative OCD was 9 years.
CONCLUSIONS: Surgical procedures for OCD lesions in the pre-OCD group were successful. Multivariate analysis identified age as a risk factor for recurrent or postoperative OCD; therefore, conservative treatment is recommended for patients with discoid lateral meniscus before preadolescence to prevent postoperative OCD occurrence.
METHODS: Level III.

OBJECTIVE: Treatment of focal cartilage defects of the humeral capitellum with autologous bone-cartilage cylinders to prevent development of arthritis of the elbow joint.
METHODS: High-grade, unstable lesions (> 50% of the capitellum, grade III-IV according to Dipaola), including those involving the lateral edge of the capitellum and with a depth of up to 15 mm.
METHODS: Stable lesions and generalized osteochondritis of the capitellum (including Panner\'s disease), as well as a relative contraindication for lesions > 10 mm, as the largest punch has a maximum diameter of 10 mm.
METHODS: Arthroscopy of the elbow joint, transition to open surgery. First, the size of the cartilage defect in the capitellum is determined. Then, one (or several) osteochondral cylinders (OATS Arthex) are removed, which as far as possible completely encompass the defect zone. Corresponding intact bone-cartilage cylinders are obtained from the ipsilateral proximal lateral femoral condyle, each with a 0.3 mm larger diameter via an additive miniarthrotomy. The \"healthy\" cylinders are then inserted into the defect zone in a \"press fit\" technique.
METHODS: An upper arm cast in neutral position of the hand for 10-14 days, simultaneously beginning physiotherapy (active-assisted movements) and lymphatic drainage. As soon as painless range of motion (ROM) is restored (goal: by week 6), isometric training can be started. Resistance training starts from week 12. Competitive sports are only recommended after 6(-8) months.
RESULTS: The current state of research on the surgical treatment of OCD of the humeral capitellum using autologous osteochondral grafts shows mostly promising results. A recent meta-analysis of 24 studies reports a significantly higher (p < 0.01) rate of return to sports (94%) compared to fragment fixation (64%) or microfracture and debridement (71%) [41]. However, the increased donor-site morbidity must be taken into account (ca. 7.8%).
UNASSIGNED: OPERATIONSZIEL: Therapie fokaler Knorpeldefekte des Capitulum humeri mittels autologer Knorpel-Knochen-Zylinder zur Verhinderung der Ausbildung einer Arthrose des Ellenbogengelenks.
UNASSIGNED: Hochgradige, instabile Läsionen (> 50 % des Capitulums, Grad III–IV nach Dipaola), v. a. bei Beteiligung des lateralen Rands des Capitulums und mit einer Tiefenausdehnung bis zu 15 mm.
UNASSIGNED: Stabile Läsionen und generalisierte Osteochondrosen des Capitulums (u. a. Morbus Panner) sowie relative Kontraindikation bei Läsionen > 10 mm, da die größte Entnahmestanze einen maximalen Durchmesser von 10 mm aufweist.
UNASSIGNED: Arthroskopie des Ellenbogengelenks, Übergang zum offenen Vorgehen. Zunächst Größenbestimmung des Knorpeldefekts am Capitulum. Dann Entnahme eines (oder mehrerer) Stanzzylinders (OATS®, Fa. Arthex, Naples, FL, USA), der die Defektzone möglichst vollständig umfasst. Gewinnung entsprechender intakter Knochen-Knorpel-Zylinder aus dem ipsilateralen proximalen lateralen Femurkondylus von jeweils ca. 0,3 mm größerem Durchmesser über eine additive Miniarthrotomie. Einsetzen des gesunden Zylinders in die Defektzone in Press-fit-Technik.
UNASSIGNED: Oberarmgipsschiene in Neutralstellung der Hand für 10 bis 14 Tage, gleichzeitig Beginn der Physiotherapie (aktiv-assistierte Bewegungen) und Lymphdrainage. Sobald eine schmerzfreie ROM wiederhergestellt ist (Ziel: bis zur 6. Woche), kann mit isometrischen Training begonnen werden. Beginn Widerstandstraining ab der 12. Woche. Wettkampfsport erst nach 6(bis 8) Monaten empfohlen.
UNASSIGNED: Die aktuelle Studienlage zur operativen Behandlung der OCD des Capitulum humeri mithilfe von Knorpel-Knochen-Zylindern zeigt größtenteils vielversprechende Ergebnisse. Eine aktuelle Metaanalyse von 24 Studien berichtet dabei, dass eine signifikant höhere Rate der Rückkehr zum Sport (94 %) im Vergleich zu Fragmentrefixation (64 %) oder Mikrofrakturierung und Débridement (71 %) erreicht werden kann [41]. Allerdings muss dabei die erhöhte Entnahmemorbidität (ca. 7,8 %) berücksichtigt werden.