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COMMENTARY
Year : 2014  |  Volume : 7  |  Issue : 5  |  Page : 638  

Osteochondritis dissecans: A diagnosis not to miss


Department of Ortopaedics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

Date of Web Publication10-Sep-2014

Correspondence Address:
Lars Peterson
Department of Ortopaedics, Sahlgrenska Academy, Gothenburg University, Gothenburg
Sweden
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Peterson L. Osteochondritis dissecans: A diagnosis not to miss. Med J DY Patil Univ 2014;7:638

How to cite this URL:
Peterson L. Osteochondritis dissecans: A diagnosis not to miss. Med J DY Patil Univ [serial online] 2014 [cited 2022 Aug 11];7:638. Available from: https://www.mjdrdypu.org/text.asp?2014/7/5/638/140475

"I have been asked to comment on the above article. I feel honored by the invitation and stimulated by the subject Osteochondritis dissecans, a diagnosis that has intrigued me for more than 50 years."

This article is a case report of a 26-year-old woman who presented with a history of trauma to her right knee 12 months earlier, followed by pain and swelling, and also locking and a palpable loose body for the last 4 months.

The article gives the reader important information about osteochondritis dissecans (OCD), the most common cause of a loose body in adolescence with a prevalence estimated to 15-21 per 100,000. [1]

The article gives the reader useful information of the importance of a careful history, physical examination, results of X-ray, magnetic resonance imaging (MRI) and laboratory tests necessary for a correct diagnosis verified by arthroscopic assessment. This gives the background for the choice of surgical treatment in this actual case - arthroscopic removal of a loose body, debridement of the osteochondral defect and microfracture of the exposed bone. In the short-term follow-up, improvement is reported. Furthermore, the discussion gives a good overview of the present knowledge of this disease, including etiological factors and treatment options in juvenile and adult forms.

This classical approach to present a case in a well-examined, documented and summarized report is the highlight of this article.

Some remarks in this case. The loose body was removed during arthroscopy at the age of 26 years, and was quite acceptable with short-term good results. In a juvenile case with a loose and "fresh" fragment, it could be considered to fresh up the bony surfaces and fix the fragment. The initial prognosis for the 26-year-old woman is good, especially if she is not active in sports or hard work. However, the risk for progress into osteoarthritis is very high within 20-30 years. [2]

In the case of an osteochondral defect, not only should the surface area be measured but also the depth of the bone defect, which can be done during arthroscopy or from X-rays and MRI. However, the extent of OCD pathologic changes, including sclerotic, necrotic bone and cyst formations, have to be estimated and can also be measured using X-rays and MRI. This information is important when autologous osteochondral grafts or autologous chondrocyte transplantation with or without autologous bone graft are indicated and the depth of the defect and the extent of the pathologic bone and cysts may need bone grafting.

The options for OCD treatment are important information, and this article would improve if a treatment algorithm could be included to guide the reader in different clinical situations.

In case of varus or valgus deformities, correcting osteotomies to unload the affected compartment should be performed as a concomitant or a staged procedure, but not too late. To evaluate the need for unloading osteotomies, long-standing hip-knee ankle X-rays are recommended.

 
  References Top

1.Hughston JC, Hergenroeder PT, Courtenay BG. Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 1984;66:1340-8.  Back to cited text no. 1
[PUBMED]    
2.Linden B. Osteochondritis of the femoral condyles: A long term follow-up study. J Bone Joint Surg Am 1977;59:769-76.  Back to cited text no. 2
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