Aims. To explore the efficacy of extracorporeal shockwave therapy (ESWT) in the treatment of osteochondral defect (OCD), and its effects on the levels of transforming growth factor (TGF)-β, bone morphogenetic protein (BMP)-2, -3, -4, -5, and -7 in terms of cartilage and bone regeneration. Methods. The OCD lesion was created on the trochlear groove of left articular cartilage of femur per rat (40 rats in total). The experimental groups were Sham, OCD, and ESWT (0.25 mJ/mm. 2. , 800 impulses, 4 Hz). The animals were euthanized at 2, 4, 8, and 12 weeks post-treatment, and histopathological analysis, micro-CT scanning, and immunohistochemical staining were performed for the specimens. Results. In the histopathological analysis, the macro-morphological grading scale showed a significant increase, while the histological score and cartilage repair scale of ESWT exhibited a significant decrease compared to OCD at the 8- and 12-week timepoints. At the 12-week follow-up, ESWT exhibited a significant improvement in the volume of damaged bone compared to OCD. Furthermore, immunohistochemistry analysis revealed a significant decrease in type I collagen and a significant increase in type II collagen within the newly formed hyaline cartilage following ESWT, compared to OCD. Finally, SRY-box transcription factor 9 (SOX9), aggrecan, and TGF-β, BMP-2, -3, -4, -5, and -7 were significantly higher in ESWT than in OCD at 12 weeks. Conclusion. ESWT promoted the effect of TGF-β/BMPs, thereby modulating the production of extracellular matrix proteins and transcription factor involved in the regeneration of articular cartilage and subchondral bone in an OCD rat model. Cite this article: Bone Joint Res 2024;13(7):342–352

Abstract. Introduction. Symptomatic osteochondritis dissecans (OCD) and traumatic osteochondral fractures (OCF) are treated with fixation with either metal or bioabsorbable device. We performed a comparative review of patients with OCD and traumatic OCF stabilised with Bio-Compression screws which are headless absorbable compression screws. Our aim was to determine whether there was a difference in outcomes between presentations. Methods. Retrospective single-centre cohort study of all patients with OCD and OCF treated with Bio-Compression screw between July 2017 and September 2022. All patients followed up until discharge with satisfactory clinical outcome. Primary outcome was return to theatre for ongoing pain or mechanical symptoms. Secondary outcome was evidence of fixation failure on follow-up MRI scan. Results. 20 patients included; 8 OCF and 12 OCD. Average age 21 (OCF), 24 (OCD). The most common location was patella (58%) in OCF or the medial femoral condyle (75%) in OCD. Traumatic defects were smaller (2.6cm2 vs 3.3cm2) although this was not statistically significant (p=0.28). In the OCF group one patient went on to have further surgery. There were no re-operations in the OCD group. Both groups had good outcomes and similar times to discharge. There was no evidence of fixation failure of Bio-Compression screws on MRI scans. Conclusions. Within the limits of this relatively small cohort there is no significant difference between outcomes for OCD or traumatic OCF fixation with Bio-Compression screws. Both groups demonstrate good outcomes irrespective of the location or the aetiology of the fragment

This study aimed to evaluate the clinical outcomes of paediatric patients who underwent a retrograde drilling treatment for their osteochondritis dissecans (OCD) of the talus. The secondary purpose was to identify factors that are predictive of a failure of the treatment. A retrospective study was done. All patients treated for talar OCD between 2014 and 2017 were reviewed to extract clinical and demographic information (age, sex, BMI, OCD size and stability, number of drilling, etc). Inclusion criteria were: (1) talar OCD treated with retrograde drilling, (2) less than 18 years, (3) at least one available follow up (4) stable lesion. Exclusion criteria was another type of treatment for a the talar OCD. Additionally, all pre-operative and post-operative medical imaging was reviewed. Outcome was classified based on the last follow-up appointment in two ways, first a score was attributed following the Berndt and Harty treatment outcome grading and second according to the necessity of a second surgery which was the failure group. Chi-square and Mann-Whitney tests were used to compared the success and failure group. Seventeen patients (16 girls and 1 boy, average age: 14.8±2.1 years) were included in our study group. The mean follow up duration was 11.5 (±12) months. Among this population, 4/17 (24%) had a failure of the treatment because they required a second surgery. The treatment result grading according to Berndt and Harty outcome scale identified good results in 8/17 (47%) patients, fair results in 4/17(24%) patients and poor results in 5/17 (29%) patients. The comparisons for various patient variables taken from the medical charts between patients who had a success of the treatment and those who failed did not find any significant differences. At a mean follow-up duration of 11.5 months, 76% of patients in this study had a successful outcome after talar OCD retrograde drilling. No statistically significant difference was identified between the success and failure group. Talar OCD in a paediatric population is uncommon, and this study reviewed the outcome of retrograde drilling with the largest sample size of the literature. Retrograde drilling achieved a successful outcome in 76% of the cases and represents a good option for the treatment of stable talar OCD

Introduction and purpose: Femoral osteochondritis dissecans (OCD) is a process of unpredictable clinical course and uncertain aetiology (vascular, post-traumatic or microtraumatic). Its prognosis is based on diagnostic imaging (MRI and scintillation scanning) and age (Multicentre EPOS OCD Study). In our study we analysed the influence of the alignment of the lower limbs in femoral OCD. Materials and methods: From 2000–2004 we studied 22 cases in 19 patients with femoral OCD. We carried out a tele-radiographic study of the lower limbs with weight-bearing, recording the location of the OCD according to Cahill, the femorotibial angle (n=87.5° ±2°) and the mechanical axis of the limb, which was considered normal when it went through the two tibial spines (Cahill zone 3). Results: The mean age was 13.4 years (r: 10–28). The OCD was located in the medial condyle in 16 cases and the lateral in 6. We found changes in the femorotibial angle in 12/22 (55%) and of the mechanical axis in 18/22 (82%). In the cases with worst prognosis and loose bodies (7 cases), 100% showed changes in the mechanical axis. Conclusions: There is a strong relation between OCD and changes in the lower limb alignment. The most sensitive radiological measurement is the mechanical or weight-bearing axis. This finding confirms the good prognosis of the lesion in children, since they undergo physiological changes in the femorotibial angle and constant changes of the mechanical axis until growth is complete

The purpose of this study was to describe a clinical evaluation of the etiological factors in osteochondritis dissecans (OCD) of the knee from radiographic and arthroscopic findings. Twenty-two knees of 20 patients (16 male and 4 female, 16.1 years old in average at surgery) with symptomatic OCD of the femoral condyle were studied. The medial femoral condyles were affected in 16 knees of 14 patients (medial group) and the lateral femoral condyle in 6 knees of 6 patients (lateral group). These two groups were compared using radiological location and arthroscopic findings. In radiography, the location of OCD was classified in accordance with Cahill et al. (1989). On the anteroposterior view, five zones were numbered 1 to 5 from medial to lateral. On the lateral view, three zones were labeled A,B and C from anterior to posterior. In the medial group, the locations of OCD were 23BC(12), 2BC(1), 23ABC(1) and 23C(2); 14(88%) of 16 knees involved in non-meniscal area. In the lateral group, the locations of OCD were 45C(4), 5C(1) and 4BC(1); 5(83%) of 6 knees involved in meniscal area. In arthroscopy the medial group did not have medial meniscal tear, while the lateral group had 5 lateral meniscal lesions of 6 knees; 3 discoid meniscus (2 with tear and 1 without tear), 2 bucket-handle type tear and one no meniscal lesion. Lateral meniscal lesions (with or without discoid) might cause OCD of the lateral femoral condyle. In the medial femoral condyle, we thought that OCD did not relate to meniscal lesions

To determine if there are osteochondritis dissecans (OCD) lesions of the knee that are so unstable on MRI that they are incapable of healing without operative intervention. A secondary objective was to determine the ability of orthopaedic residents to accurately grade OCD lesions according to the Kijowski criteria of stable and unstable. A retrospective review was performed of patients who had femoral condyle OCD lesions from 2009-present. Only patients with open growth plates and serial MRIs were included. Each MRI was classified according to the Kijowski classification by a junior orthopaedic surgery resident as well as an MSK trained radiologist. A weighted kappa value was used to assess the inter-rater agreement. The final analysis included 16 patients (17 knees) with 49 MRI's. The weighted kappa agreement between reviewers for overall lesion stability was moderate (0.570 [95% CI 0.237–0.757]). The initial MRI lesion was graded as stable in 59% (10/17) of the knees. Two of these 10 knees became unstable during the study period, however, both stabilised again on subsequent MRIs, one with surgery and the other without surgery. The initial MRI was graded as unstable in 41% (7/17) of the knees. Two of the seven knees (29%) later demonstrated MRI evidence of lesion stability without surgical intervention. The most important finding in this study was the ability of unstable OCD lesions on MRI to heal without operative intervention. The ability of an orthopaedic surgery resident to grade these lesions on MRI was moderate

The purpose of this study is to describe a surgical procedure for unstable osteochondritis dissecans (OCD) of the capitellum and its results. Between 1992 and 1997, 11 elbows of 11 patients with OCD of the capitellum were treated in our institution. The average age at surgery was 14.7 years and the ages ranged from 12 to 16 years. All patients were male baseball players affected in the throwing side. The follow-up period was from 31 to 95 months (average: 57 months). All patients underwent internal fixation using the pull out wiring method and bone graft (this procedure was established by Kondo in 1989). All lesions of OCD were not only softening or cracked but also unstable with early separation or partially detached fragment. After surgery, a long arm cast was applied for 3 weeks. After confirming bony union of OCD by X-ray, the wires were removed ranged from 15 to 21 weeks (average 17 weeks) postoperatively. Throwing activity was allowed 6 months after surgery. At the follow-up, all patients were relieved pain and all except one returned to previous throwing levels. Radiographs showed good healing of OCD and minimum degenerative changes were found in only a few joints. We concluded that this surgical procedure was an effective treatment for adolescent baseball players with unstable OCD of the capitellum

To assess the use of autogenous osteochondral graft fixation (mosaicplasty) in unstable osteochondritis dissecans (OCD) lesions (Clanton type 2 and 3) of the knee. Eleven patients with x-ray and N4R1 confirmed OCD lesion in their femoral condyle, that had remained symptomatic despite adequate conservative treatment, underwent arthroscopic mosaicplasty plug fixation of the lesion. The OCD lesions were all loose at operation and were all fixed rigidly in situ. using a number of autogenous 4. 5min osteochondral plugs harvested from the edge of the trochlear groove. The patients were prospectively assessed both clinically and by MRI scan at 3, 6 and 12 months and then six monthly. Average follow up was 2. 7 years (2 – 4. 1). Prior to operation all patients had joint effusions and were experiencing pain limiting their activities. By 6 months post-operation the IKDC score had returned to normal in all cases and none of the patients had joint effusions or pain. Serial NHU scans documented healing of the osteochondral plugs and a continuous articular cartilage surface layer in all cases by 9 months. Using mosaicplasty plug fixation we were able to obtain healing in all 1 1 unstable OCD lesions. The benefits of this technique are the ability to obtain rigid stabilization of the fragment using multiple plugs, stimulation of the subchondral blood supply and autogenous cancellous bone grafting. We conclude that mosaic-plasty plug fixation of unstable OCD lesions in the knee is a good technique and recommend its use. Eleven patients with an unstable osteochondritis dissecans lesion (OCD) in their femoral condyle underwent in situ arthroscopic osteochondral graft fixation (mosaicplasty) of the lesion using a number of 4. 5min plugs harvested from the trochlear groove. By 6 months follow-up all of the patients were pain free with no joint effusion and by 9 months all had NW evidence of plug healing and continuous articular cartilage coverage. The benefits of this technique are the ability to obtain rigid stabilization, stimulation of the subchondral blood supply and cancellous bone grafting. We conclude that mosaic-plasty fixation of OCD lesions is a useful technique

Objectives. Surgical treatment is standard for advanced osteochondritis dissecans (OCD) of the humeral capitellum. When cartilage is seen to be separated or completely detached, this fragment fixation is not usually applied. There have been reports of cases in which advanced OCD of the humeral capitellum progressed to osteoarthritis (Fig), particularly in cases which involved the lateral wall. In these cases, every attempt should be made to reconstruct the lateral wall to avoid osteoarthritis. In this study, we followed up cases with rib osteochondral autograft transplantation technique. Methods. Subjects were 20 cases who were followed up until after they started pitching. The mean age was 13.8 years old and the mean observation period was 2 years and 6 months (from 7 months to 6 year 3 months). Kocher's approach was used to give a good access to the aspect of the radiohumeral joint. The majority of cases suffered from extensive OCD of the elbow. Detached fragment was removed (Fig. 2a) and graft from 5. th. or 6. th. rib with screw fixation was performed on 12 patients and 8 received fixation with no material (Fig. 2b). Follow-up assessment included the range of motion, start time of playing catch and throwing a ball with full power, sports activity, evaluation of radiography, a subjective (including Pain, Swelling, Locking/Catching and Sport activity) and objective (Flexion contracture, Pronation/Supination and sagittal arc of motion) modified elbow rating system by Timmeman et al. We also investigated the details of the arthroscopy observations and the 2nd arthroscopy findings for 4 cases. Results. Preoperative elbow extension increased from −13.5 to −10 degrees and elbow flexion increased from 117 to 123 degrees, but no significant differences were found. All but one patient resumed baseball sporting activity. Catching was started at an average of 3.5 (2 to 5.5 months) months postoperatively and pitching the ball with full power was achieved at 6.7 months. One case was found to have degenerative changes on plain X-ray, and two cases were found to have deviated screws. The mean elbow rating system subjective score improved significantly from 63.9.5 to 89.5 points, as did the overall rating, increasing from 131.6 to 164.8 points. The 2. nd. arthroscopy observations for 4 patients showed that 2 experienced pain due to the loose body, 1 had a limitation in range of motion due to spur formation, and 1 had a screw deviation. Graft survival was observed in two out of four cases. Partial detachment was observed in two cases. Conclusion. Recovery of articular facets with hyaline cartilage were possible using this surgical technique, and in addition, the costal-costochondral grafts, comprising cortical and cancellous bone, were simultaneously transplanted en bloc. This indicates that it is adequate treatment for extensive OCD. All the patients started pitching 3 months postoperatively and returned to full baseball activities after 6 months. Even in cases with extensive OCD, with large osseous and cartilaginous deficits, the surgical technique was useful and showed favorable results

Introduction. Osteochondritis dissecans (OCD) is a localised disorder of subchondral bone and the overlying articular cartilage. The most commonly used classification systems involve arthroscopy and MRI. Aim. To investigate the correlation between arthroscopic and MR findings in patients with OCD of the talus. Methods. 16 ankles in 14 patients with radiographically proven OCD were reviewed. Nine were male and five female. Mean age was 35yrs (range 18–64yrs). The lesions were staged independently using the Guhl. 1. arthroscopic and Dipaola. 2. MR classification systems. Results. Arthroscopically there were eight stable and eight unstable lesions. Of the eight stable lesions, MRI staged five as stable and three as unstable. Of the eight unstable lesions, MRI staged six as unstable and two as stable. This gives a sensitivity of diagnosing unstable lesions as 0.75, with a specificity of 0.63. Conclusions. This small study demonstrates that MR scans may have some limitations in classifying OCD lesions of the talus. Possible explanations are discussed. We propose that MRI findings, of OCD of the talus, should not be taken in isolation, but correlated with the patients symptoms and signs to avoid unnecessary arthroscopy

The June 2012 Foot & Ankle Roundup. 360. looks at: the Achilles tendon Total Rupture Score (ATRS); endoscopic treatment of Haglund’s syndrome; whether it is worth removing metalwork; hyaluronic acid injection; thromboembolic events after fracture fixation in the ankle; whether surgeons are as good as CT scans for OCD of the talus; proximal fractures of the fifth metatarsal; nerve blocks for hallux valgus surgery; chronic osteomyelitis in the non-diabetic patient; Charcot arthropathy

Although osteochondral defects (OCD) following trauma, sport or degenerative diseases occur frequently, healing remains an unresolved clinical problem. These defects seem to appear more often in convex surfaces than in concave ones. In vivo studies have demonstrated the influence of mechanical conditions on osteochondral repair[. 1. ]. However, the influence of the local joint curvature on the mechanical environment as well as the effect of defect fillings on healing remained unknown. We hypothesize that healing of OCD is strongly affected by the local mechanical environment generated after variations in the joint geometry specifically on concave and convex joint surfaces. To study spontaneous repair, OCD (mm, 1.5mm depth) in 18 minipigs were created. Based on this knowledge, a predictive biphasic finite element model for tissue differentiation was created to simulate osteochondral healing. The model was validated by comparison of simulated healing with histological and histomorphometrical outcomes. Differentiation was regulated by the combination of a mechanical stimulus with a factor for differentiation defined for each tissue. The mechanical conditions arising from different predesigned defect fillings have been evaluated: Grafts with 100% (P1) and 50% (P2) of the native subchondral bone stiffness were analyzed. The healing pattern was in general qualitatively comparable to the findings of a gross examination of the histological sections. Generally, the pattern appears to be almost independent of the joint curvature. More hyaline cartilage (HC) was formed in the concave model during simulated healing. The maximum percentage of HC during the simulations was smaller and occurred earlier in the one (27 vs. 40%). In vivo 33% of HC was registered in the 12th week[. 2. ]. Defect filling restoring sub-chondral bone quality (P1) allowed a larger amount of hyaline cartilage formation than a less rigid filling (P2). Until today the more frequent occurrence of OCD at convex joint surfaces reported in the clinical practice has not been related to the local mechanical environment. This study is the first to demonstrate that this may be related to the mechanical stimulus for healing. In fact, during healing simulation HC formation was affected by changes in the joint surface curvature. A continuity of material properties in the layers under an OCD, which operates as basis for the newly formed cartilage, is important for the development of a tissue with adequate mechanical quality for load transmission. Indeed hyaline cartilage formation occurs earlier when P1 as when P2 was used. The use of a predictive tissue differentiation model allows a better understanding of the mechanical aspects of healing. Further analysis is however required before such algorithm may be applied in clinical cases. To consider mechanical factors affecting healing, appear to be of importance

Purpose of the study: Conservative surgical treatment of osteochondritis dissecans (OCD) in adults raises the problem of integration of the sequestered bone. Mechanical techniques using screw fixation are often insufficient to achieve healing. Adjunction of a biological fixation with osteochondral graft tissue for a mosaicplasty might favour integration of the fragment. The purpose of this study was to assess the short-term outcomes in an initial series using a technique called fixation plus where screw fixation is associated with mosaiplasty. Material and methods: This was a retrospective analysis of eight adults who underwent surgery from 2003 to 2008 for stage IIB or III (Bedouelle) OCD of the medial condyle. Loss of subchondral tissue could be filled with a cancellous graft. Clinical and radiographic (Hugston) parameters were noted. At three months, the screws were removed arthroscopically. The ICRS-OCD score was noted. At six months, five patients had an arthroMRI to evaluate fragment integration, determine its signal and vitality. Results: Mean follow-up was 17.4 months (range 3–36). The Hugston score improved from 1.6 (0–3) preoperatively to 3.4 (2–4) postoperatively and the radiological score from 2.5 (2–4) to 3.2 (3–4). The arthroscopy performed to remove the screws revealed integration of the OCD fragment. The ICRS-OCD score was I in two cases, II in five and III in one. The postoperative arthroMRI confirmed continuity with the cartilage at the periphery of the fragment, with no passage of contrast agent into the defect. Discussion: Screw fixation of OCD fragments is often followed by nonunion and thus failure. Moasaicplasty is an alternative but does not preserve quality cartilage cover (curvature, thickness, cover). The technique proposed here ensures osseous integration of he fragment, complete cartilage cover, and a smaller number of osteochondral pits. Fixation Plus associates mechanical and biological fixation with good preliminary clinical results. Comparative longer term assessment is needed to confirm its pertinence

A prospective case control study analysed clinical and radiographic results in patients operated on with the periosteum autologous chondrocyte implantation (ACI) due to cartilage lesions on the femoral condyles over 10 years ago. 31 out of the 45 patients (3 failures, 9 non-responders, 2 others) were available for a continuous clinical (Lyshom/Tegner, IKDC, KOOS) and radiographic (Kellgren-Lawrence) follow-up at 0, 2, 5, and 10 years after the ACI procedure. The patients were sub-grouped into focal cartilage lesions (FL) – 10, osteochondritis dissecans (OCD) – 12, and cartilage lesions with simultaneous ACL reconstruction (ACL) – 9 subgroups. Lysholm, Tegner, and IKCD subjective scores revealed stable results over the period from 2 to 10 years with a significant improvement toward the pre-operative levels, but the patients had not reached their pre-injury Tegner levels. KOOS profile at 10 years was: Pain 78.6, Symptoms 78.1, Activities of daily living 82.5, Sports 56.9, and Quality of life 55.1. A 10-year IKDC knee examination classified operated knees as: 14 normal, 10 nearly normal, 5 abnormal and 2 severely abnormal. Kellgren-Lawrence scores of 2 and above were found in 10 patients (FL 5, OCD 0, and ACL 5). Seven patients in the group required an arthroscopic re-intervention (3 ACI related, 4 ACI unrelated). ACI provided safe and stable performance of operated knees over ten years. High incidence of knee osteoarthritis in FL and ACL subgroups, and low incidence in OCD patients indicate that best long performance is expected in localised low-impact cartilage lesions of young patients

Purpose: Osteochondritis dissecans (OCD) of the capitellum most commonly affects adolescent pitchers and gymnasts, and presents with pain and mechanical symptoms. Fragment excision is the most commonly employed surgical treatment; however, patients with larger lesions have been reported to have poorer outcomes. It’s not clear whether this is due to increased contact pressures on the surrounding articular surface, or if fragment excision causes instability of the elbow. The purpose of this study was to determine if fragment excision of simulated OCD lesions of the capitellum alters kinematics and stability of the elbow. Method: Nine fresh-frozen cadaveric arms were mounted in an upper extremity joint motion simulator, with cables attaching the tendons of the major muscle tendons to motors and pneumatic actuators. Electromagnetic receivers attached to the radius and ulna enabled quantification of the kinematics of both bones with respect to the humerus. Three-dimensional CT scans were used to plan lesions of 12.5% (mean 0.8cm2), 25%, 37.5%, 50%, and 100% (mean 6.2cm2) of the capitellar surface, which were marked on the capitellum using navigation. Lesions were created by burring through cartilage and subchondral bone. The arms were subjected to active and passive flexion in both the vertical and valgus-loaded positions, and passive forearm rotation in the vertical position. Results: No significant differences in varus-valgus or rotational ulnohumeral kinematics were found between any of the simulated OCD lesions and the elbows with an intact articulation with active and passive flexion, regardless of forearm rotation and the orientation of the arm (p> 0.7). Radiocapitellar kinematics were not significantly affected during passive forearm rotation with the arm in the vertical position (p=0.07–0.6). Conclusion: In this in-vitro biomechanical study even large simulated OCD lesions of the capitellum did not alter the kinematics or laxity of the elbow at either the radiocapitellar or ulnohumeral joints. These data suggest that excision of capitellar fragments not amenable to fixation can be considered without altering elbow kinematics or decreasing stability. Further study is required to examine other factors, such as altered contact stresses on the remaining articulation, that are thought to contribute to poorer outcomes in patients with larger lesions

Aims: This study aimed to assess the outcome of arthroscopic debridement and removal of loose bodies from the elbows of patients with OCD of the capitellum who had previously failed non-operative treatment. Methods: Patients who had been treated arthroscopically for symptomatic OCD of the capitellum after failing non-operative management for 6 months were invited for review. They were assessed clinically, by an independent examiner using a modern elbow outcome score, and radiologically. In addition details of sporting involvement and satisfaction of outcome were ascertained. Results: 29 patients/elbows (91% follow up rate) were assessed at a mean follow up period of 77 months. There were 20 males and 9 females with an average age at operation of 22 years. There were no operative complications. 26 patients had none or mild pain and were able to complete activities of daily living with minimal impairment. 27 patients had been regularly involved in sports (Olympic and professional to recreational levels) only 4 of whom had to give up the sport because of ongoing problems. 5 of 6 elite gymnasts and 10 of 11 rugby players were able to fully resume their sport. 11 patients (38%) had recurrence of locking episodes. There was an average 5û loss of ßexion and a 10û loss of extension while the grip strength remained normal. Radiographs demonstrated that most of the capitella had not remodelled. 28 (97%) patients had a good or excellent outcome. Conclusions: This study has demonstrated that arthroscopic treatment of recalcitrant OCD of the capitellum is a safe procedure resulting in satisþed patients most of whom can return their previous level of sports but there is a risk of recurrent locking symptom

Background: Seven cases of osteochondritis dissecans (OCD) of the tarsal navicular bone have been described mainly radiologically. Aims: We report our experience with additional 6 patients which represent the largest series described, and conclude about the treatment modalities in this unique type of OCD. Methods: All patients who had OCD of the tarsal navicular bone during the years 1993 and 1998 were evaluated. The parameters which were examined were the age and sex of the patients, the location of pain, duration of symptoms, and any trigger mechanism if this was noted. The various treatments used for these patients as well as their outcome were recorded. Results: Six patients were treated by us between 1993 and 1998 (follow up 3–7 years). There were 4 males and 2 females aged between 14 and 35 years (mean 21 years). All patients had pain in the dorsal aspect of the midfoot, and painful limitation in midfoot movements. Duration of symptoms varied between 4 months and 1 year. In 3 patients basic training in army service and in one running short distances triggered the pain. In 3 patients an accompanying stress fracture of the navicular bone was developed. Three patients were managed conservatively. Two patients underwent excision, curettage and drilling, and one patient underwent excision and fusion. All patients, whether treated conservatively or surgically, still suffer form pain in activities and painful limitation of midfoot motion. Conclusions: OCD of tarsal navicular bone affects mainly young patients. Physical efforts are the trigger mechanism for the symptoms. The clinical presentation includes painful limitation in midfoot motion. The outcome is reserved both for conservative or operative treatment

Osteocondritis dissecans (OCD) is a relatively common cause of knee pain. Ideal treatment is still controversial. Aim of this exhibit is to describe the outcomes of 5 different surgical techniques in a series of 63 patients. 63patients (age 22.5±7.4 years) affected by OCD of the femoral condyle (45 medial and 17 lateral) were treated by either osteochondral autologous transplantation, autologous chondrocyte implantation with bone graft, biomimetic nanostructured osteochondral scaffold (Maioregen) implantation, bone-cartilage paste graft or bone marrow derived cells transplantation “one-step” technique. Patient evaluation included IKDC score, eq-vas score, X-Rays and MRI preoperatively and at follow-up. Global mean IKDC improved from pre-operative 40.1±14.6 to 77.2±21.3 (p<0.0005) at mean 5.3±4.7 years follow-up, while eq-vas improved from 51.7±17.0 to 83.5±18.3(p<0.0005). No influence of age, size of the lesion, length of follow-up and associated surgeries on the result was found. No differences were found between the results obtained with different surgeries except a slight tendency of better improvement in the result following autologous chondrocyte implantation (p<0.01). Control MRI evidenced a satisfactory repair of cartilaginous layer and subchondral bone. The techniques described were effective in providing good clinical and radiographic results in the treatment of OCD and confirmed the validity of autologous chondrocyte implantation over time. Newer techniques such as Maioregen implantation and “one-step” base on different rationales, the first relying on the characteristics of the scaffold and the second on the regenerative potential of mesenchymal cells. Both of them have the advantages to be minimally invasive surgeries and to require a single operation

There is no optimal treatment for osteochondral defects of the talus after failed primary surgical treatment. To treat these patients, a 15-mm diameter metal implant was developed for the medial talar dome. The present study was undertaken to evaluate the clinical effectiveness of the metal implantation technique for osteochondral lesions of the medial talar dome. This is a prospective case series. The inclusion criteria were the combination of a large OCD (ϕ >12 mm) of the medial talar dome, persistent complaints >1 year after treatment, and clinically relevant pain levels. The exclusion criteria were: age <18 years, OCD size >20 mm, ankle osteoarthritis grade 2 or 3, concomitant ankle pathology, and diabetes. The primary outcome measure was the Numeric Rating Scale pain (NRS) rest, walking, running, and stair climbing. Secondary outcome measures were: Foot Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and clinical and radiographic complications. The Wilcoxon signed ranks test was used to calculate p-values. Between October 2007 and March 2009 10 patients were included. The median follow-up was 2 years (range, 2–3 years). On preoperative CT scanning, the median lesion size was 15 (range, 12–20) × 11 (range, 8–14) mm. The NRS rest improved from a median of 3 (0–7) preoperatively to 0.5 (0–2) at final follow-up (p = 0.017), NRS walking from 6.5 (4–8) to 1 (0–4) (p = 0.005), NRS running from 9 (6–10) to 3 (0–10) (p = 0.024), and NRS stair climbing from 6 (4–8) to 1 (0–7) (p = 0.012). The FAOS improved significantly on four of five subscales. The AOFAS improved from a median of 70 (47–75) before surgery to 89 (69–100) at final follow-up (p = 0.008). There were three temporary complications: hyposensibility about the scar in two and a superficial wound infection in one. There were no radiographic complications

PURPOSE. Osteochondral talar defects (OCDs) are sometimes located so far posteriorly that they may not be accessible by anterior arthroscopy, even with the ankle joint in full plantar flexion, because the talar dome is covered by the tibial plafond. It was hypothesized that computed tomography (CT) of the ankle in full plantar flexion could be useful for preoperative planning. The dual purpose of this study was, firstly, to test whether CT of the ankle joint in full plantar flexion is a reliable tool for the preoperative planning of anterior ankle arthroscopy for OCDs, and, secondly, to determine the area of the talar dome that can be reached by anterior ankle arthroscopy. METHODS. In this prospective study, CT-scans with sagittal reconstructions were made of 46 consecutive patients with their affected ankle in full plantar flexion. In the first 20, the distance between the anterior border of the OCD and the anterior tibial plafond was measured both on the scans and during anterior ankle arthroscopy as the gold standard. Intra- and interobserver reliability of CT as well as agreement between CT and arthroscopy were assessed by intraclass correlation coefficients (ICCs) and a Bland and Altman graph. Next, the anterior and posterior borders of the talar dome as well as the anterior tibial plafond were marked on all 46 scans. Using a specially written computer routine, the anterior proportion of the talar dome not covered by the tibial plafond was calculated, both lateral and medial, indicating the accessible area. RESULTS. The distance between the anterior border of the OCD and the anterior tibial plafond ranged from −3.1 to 9.1 mm on CT and from −3.0 to 8.5 on arthroscopy. The intra- and interobserver reliability of the measurements made on CT-scans were excellent (ICC > 0.99, p < 0.001). Likewise, agreement between CT and arthroscopy was excellent (ICC=0.97; p < 0.001); only one patient showed a difference of more than 2.0 mm. The anterior 47.3 ± 6.8% (95%CI, 45.2–49.3) of the lateral talar dome, and 47.7 ± 7.0% (95%CI, 45.7–49.8) of the medial talar dome was not covered by the tibial plafond. CONCLUSIONS. Computed tomography of the ankle joint in full plantar flexion is an accurate preoperative planning method to determine the arthroscopic approach for treatment of OCDs of the talus. Almost half of the talar dome is directly accessible by anterior ankle arthroscopy