Osteochondritis dissecans剥脱性骨软骨炎

Sub-articular,post-traumatic necrosis Occurs only on convex surfaees of bone Medial condyle of femur Capitellum Proximal surface of talus Head of 1st metatarsal Most patients are athletic Direct blow is more common cause than a rotational injury 医学词汇注释与简要讲解Medial condyle内侧髁Capitellum肱骨小头胫骨近端关节面 metatarsal

Esophagitis dissecans superficialis and autoimmune bullous dermatoses: A review

Esophagitis dissecans superficialis(EDS)is a rare and severe endoscopic finding characterized by sloughing of large fragments of esophageal mucosal lining.Although EDS has been reported in association with serious illnesses and certain medications,the pathophysiological association of autoimmune bullous dermatoses with EDS has gained remarkable attention.Among these dermatoses,pemphigus vulgaris and pemphigoid frequently present with various types of esophageal involvement including EDS.We review the pathophysiology and clinical features of this involvement with the presentation of our experiences.The importance of endoscopic evaluation of this entity is discussed.

Osteochondritis dissecans of the capitellum in adolescents

Osteochondritis dissecans(OCD)is a disorder of articular cartilage and subchondral bone.In the elbow,an OCD is localized most commonly at the humeral capitellum.Teenagers engaged in sports that involve repetitive stress on the elbow are at risk.A high index of suspicion is warranted to prevent delay in the diagnosis.Plain radiographs may disclose the lesion but computed tomography and magnetic resonance imaging are more accurate in the detection of OCD.To determine the best treatment option it is important to differentiate between stable and unstable OCD lesions.Stable lesions can be initially treated nonoperatively with elbow rest or activity modification and physical therapy.Unstable lesions and stable lesions not responding to conservative therapy require a surgical approach.Arthroscopic debridement and microfracturing has become the standard initial procedure for treatment of capitellar OCD.Numerous other surgical options have been reported,including internal fixation of large fragments and osteochondral autograft transfer.The aim of this article is to provide a current concepts review of the etiology,clinical presentation,diagnosis,treatment,and outcomes of elbow OCD.

Subchondral bone as a novel target for regenerative therapy of osteochondritis dissecans:A case report

BACKGROUND Osteochondritis dissecans(OCD)is a rare disease of unclear cause characterized by subchondral bone damage and overlying cartilage defects.The current report presents the results of subchondral bone as a novel target for implantation of peripheral blood stem cells(PBSCs)in the treatment of OCD.CASE SUMMARY A 16-year-old patient diagnosed with OCD underwent subchondral bone implantation of PBSCs.Four months later,the patient's visual analog scale scores,Western Ontario and McMaster University osteoarthritis index,and whole-organ magnetic resonance imaging score improved significantly,and regeneration of cartilage and subchondral bone was observed on magnetic resonance imaging.CONCLUSION This is the first case of OCD treated with subchondral bone as an implantation target of PBSCs,which highlights the importance of subchondral bone for cartilage repair.This treatment could be a potential option for articular cartilage and subchondral bone recovery in OCD.

Treatment of knee osteochondritis dissecans with autologous tendon transplantation:Clinical and radiological results

BACKGROUND Defect treatment with tendon autograft in osteochondral lesions has been published in the literature with an experimental study in dogs.To demonstrate that it is possible to treat knee osteochondral lesions with the technique of autologous tendon transplantation.AIM To evaluate the clinical and radiological results of patients with knee osteochondral lesions who were treated with autologous tendon transplantation.METHODS Twenty patients(22 knees)with osteochondritis dissecans(OCD)lesions involving the knee were treated with autologous tendon transplantation between 2005-2018.All lesions were International Cartilage Repair Society grade IV.All patients were evaluated clinically at final follow-up with knee injury and osteoarthritis outcome score(KOOS);and radiologically with magnetic resonance observation and cartilage repair tissue(MOCART)and Kellgren-Lawrence(KL)classification.RESULTS A total of 20 patients(22 knees)with a mean age of 25.5±6.8 years were included.The average defect size was 4.2±2.1 cm^(2),and the average defect depth was 0.9±0.4 cm.Total KOOS score was preoperatively 29.4±5.5 and was later found to be 81.5±5.9 after an average of 68.7±37.7 mo follow-up.The mean MOCART score was 56.2±10.7.Preoperatively,all of the patients had KL grades of 0-1;during the follow-up period,80% of the patients showed no radiological progress of osteoarthritis.Patients with less than 4 cm^(2) lesion had statistically significantly better overall KOOS than patients whose more than 4 cm^(2) lesion,particularly in sport and quality of life subscales.CONCLUSION The autologous tendon transplantation is a single-step,safe,simple,cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes,particularly in patients with less than 4 cm^(2) lesion.

Abnormal Femoral Origin of the Anterior Cruciate Ligament Associated with Osteochondritis Dissecans of the Medial Femoral Condyle

We report a case of abnormal meniscal-like anterior cruciate ligament (ACL), inserting at the 9 o’clock position just beside the cartilage of the lateral femoral condyle, in a stable knee associated with osteochondritis dissecans (OCD) of the medial femoral condyle.

3D printing of patient-specific implants for osteochondral defects: workflow for an MRI-guided zonal design

Magnetic resonance imaging(MRI)is a common clinical practice to visualize defects and to distinguish different tissue types and pathologies in the human body.So far,MRI data have not been used to model and generate a patient-specific design of multilayered tissue substitutes in the case of interfacial defects.For orthopedic cases that require highly individual surgical treatment,implant fabrication by additive manufacturing holds great potential.Extrusion-based techniques like 3D plot-ting allow the spatially defined application of several materials,as well as implementation of bioprinting strategies.With the example of a typical multi-zonal osteochondral defect in an osteochondritis dissecans(OCD)patient,this study aimed to close the technological gap between MRI analysis and the additive manufacturing process of an implant based on dif-ferent biomaterial inks.A workflow was developed which covers the processing steps of MRI-based defect identification,segmentation,modeling,implant design adjustment,and implant generation.A model implant was fabricated based on two biomaterial inks with clinically relevant properties that would allow for bioprinting,the direct embedding of a patient’s own cells in the printing process.As demonstrated by the geometric compatibility of the designed and fabricated model implant in a stereolithography(SLA)model of lesioned femoral condyles,a novel versatile CAD/CAM workflow was successfully established that opens up new perspectives for the treatment of multi-zonal(osteochondral)defects.

Fabella Syndrome: A Typical Case of Misdiagnosis and Discussion

Background: Fabella is a natural occurring sesamoid bone, cartilage or a mixture of both that is usually located at the posterolateral corner (PLC) of the knee [1]. Recently the PLC of the knee has been extensively investigated because it is a common site of injuries and diseases [2] [3]. The complexity of PLC anatomy needs to be fully understood because the fabella could be missed diagnosis as an osteochondral defect, osteochondritis dissecans (OCD), calcific tendinitis, or foreign body. We present a case report of fabella syndrome triggered by trauma and also performed a review of literature for the various diagnoses that might be confused with fabella syndrome. Case presentation: A 29-year-old, Sudanese male presented to the trauma center in King Khalid Hospital in KSA, complaining of pain and partial swelling in his left knee joint due to trauma. Fabella was detected in the posterior lateral corner (PLC) of the knee joint embedded in the lateral head of the gastrocnemius muscle. All other pathological conditions were excluded. Conclusion: Fabella is sesamoid bone with variable size, found in the PLC. Commonly if present it causes periodic pain especially in the fully extended knee or it remains asymptomatic. Trauma, surgery, sports or heavy extreme activities may trigger the pain of asymptomatic fabella. Clinicians should consider that pain in the PLC of the knee can result from the presence of the fabella in a condition called fabella syndrome.