Osteochondritis dissecans of the hip in legg-calvé-perthes disease: case report and review / Osteocondrite dissecante do quadril na doença de legg-calvé-perthes: relato de caso e revisão

ABSTRACT Introduction: 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. Case report: 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. Discussion: 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.

RESUMO Introdução: 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. Relato de caso: 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. Discussão: 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.

Outcome of Arthroscopic Bone Marrow Stimulation in Osteochondritis Dissecans of the Talus in a Tertiary Care Hospital

Introduction: Osteochondritis dissecans of the talus is a rarecondition that can create challenges for both the patient andthe treating surgeon. Arthroscopic bone marrow stimulation(i.e. microfracture, drilling) is a well-accepted and proventechnique to allow fibrocartilage differentiation and therebyprovide infill at the site of a cartilage defect in several joints,including the ankle. The aim of our study was to examine therole of arthroscopic bone marrow stimulation techniques as ameans of treatment for osteochondral lesions of the talus.Material and methods: Thirty two ankles were identifiedbetween January 2012 and January 2020 with talus OCD thatunderwent arthroscopic bone marrow stimulation. Each lesionwas classified according to the Berndt and Harty classification.Study patients were evaluated at 6 weeks, 3 months, 6 months,12 months, and annually after surgery. Assessments via avisual analogue scale (VAS) for pain during daily activitiesand sport activity and the American Orthopaedic Foot & AnkleSociety (AOFAS) scoring system were obtained at each visit.Result: There were 25 men and 4 women of average age 35years (range 17–50) and mean body mass index (BMI) 22 kg/m2 (range 20–34) at the time of surgery. Quantitative MRImeasurements on 3D FSPGR Sequence showed that meanarea of the lesions were 0.801 ± 0.505 cm2. Mean AOFASscores improved from 66 points (range 53–77) preoperativelyto 90 points (range 83–100) at final follow-up (p<0.05) andmean Visual Analogue Scale (VAS) scores from 6 points(range 5–8) to 2 points (range 0–5) with p value <0.05 whichis statistically significant.Conclusion: Arthroscopic management of osteochondrallesions of the talus has the advantages of better cosmeticresults, less pain, and less surgical trauma. This techniqueis technically demanding and should be reserved for theexperienced foot and ankle arthroscopist.

Osteochondritis Dissecans of the Lateral Femoral Trochlea Healing after Isolated Medial Patellofemoral Ligament Reconstruction: A Case Report

@#We report on a 12 years old female patient who had been diagnosed with patellofemoral instability – recurrent dislocation and anterior knee pain. Radiologic evaluation further revealed osteochondritis dissecans (OCD) of the lateral femoral trochlea. She underwent surgical procedure with isolated medial patellofemoral ligament reconstruction, no surgical procedure was done to the OCD lesion. Postoperatively, there was clinical improvement of patellofemoral instability, with radiological evidence of healing of the OCD lesion. Isolated realignment procedures such as medial patellofemoral ligament reconstruction may be associated with spontaneous healing of osteochondritis dissecans of the lateral femoral trochlea.

Treatment of Osteochondritis Dissecans of the Knee with Autologous Iliac Bone Graft and Hyaluronic Acid Scaffold

Osteochondritis dissecans (OCD) is a condition that corresponds to an idiopathic focal lesion affecting the subchondral bone with possible compromise of the stability of the adjacent cartilage. Treatment depends on the size of the lesion, cartilage stability, and the physeal status. The case reported is about an 18-year-old male patient who complained of suffering from knee pain for a period of ten months. Magnetic resonance imaging (MRI) revealed a lesion of 2 cm² in the medial femoral condyle that compromised the subchondral bone, compatible with OCD. He underwent surgery that consisted of filling the subchonral defect with an iliac crest autograft and sealing the defect with a hyaluronic acid scaffold. At the 12-month follow-up, the MRI shows complete healing and the patient has resumed sports activities. Management with autologous iliac crest graft and hyaluronic acid scaffold represents an effective alternative treatment for OCD.

Osteochondritis dissecans of the trochlea: case report / Osteocondrite dissecante da tróclea: relato de caso

ABSTRACT The authors report a rare case of osteochondritis dissecans of the trochlea. The treatment of these lesions, in which the osteochondral fragment is not viable, is difficult and often limited in Brazil. A clinical case is presented with functional and radiological outcomes after treatment with microfracture technique, bone graft, and collagen membrane coverage.

RESUMO Os autores relatam um caso raro de osteocondrite dissecante de tróclea. O tratamento dessas lesões com inviabilidade do fragmento osteocondral é difícil e muitas vezes limitado no nosso meio. Os autores apresentam resultados clínicos e radiológicos após o tratamento com a técnica de microfratura, enxertia óssea e cobertura com membrana de colágeno.

Early Lateral Compartment Physeal Closure of the Elbow in Osteochondritis Dissecans of the Adolescent Baseball Players / 대한스포츠의학회지

PURPOSE: The purpose of this study is to identify bilateral differences of physeal closure of the lateral compartment of the elbow in osteochondritis dissecans (OCD) and related factors with premature physeal closure. METHODS: Initial radiographs of the bilateral elbows in 40 baseball players with OCD (group I) were reviewed for the status of physeal closure of the lateral compartment; capitellum, radial head, lateral epicondyle. Forty baseball players with medial epicondylar apophysitis (group II) were enrolled as a control. Relative status of physeal closure of dominant elbow was defined as early, same, and delayed. Bilateral differences of the status of physeal closure were analyzed between groups, and according to the radiographic stages, extent of the lesions and demographic factors in group I. RESULTS: Significant early physeal closures of dominant elbows were identified in group I in capitellum (group I, 55%; group II, 3%), radial head (group I, 53%; group II, 3%), and lateral epicondyle (group I 37%; group II, 5%). In group I, advanced stage and extended lesion showed early lateral compartment physeal closure especially in capitellum and radial head, and players with longer career length and limitation of motion showed early closure. CONCLUSION: Over the half of the adolescent baseball players with OCD demonstrated early radiocapitellar physeal closures of dominant elbow in initial presentation. Because premature physeal closure contributes to the development of arthritis without appropriate radiocapitellar remodeling, early detection of OCD is essential for prevention of arthritis and successful conservative management.

Mosaicoplastia / Mosaicplasty

movimiento articular. El tratamiento de esta afección es variado, de estas modalidades la mosaicoplastia es muy empleada por sus diferentes ventajas. Objetivo: actualizar los conocimientos sobre el injerto osteocondral autólogo en la modalidad de mosaicoplastia. Métodos: la búsqueda de la información se realizó en el mes de octubre de 2016, a partir de la información obtenida se realizó una revisión bibliográfica de un total de 654 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 52 citas seleccionadas para realizar la revisión, 47 de ellas de los últimos cinco años, donde se incluyeron cuatro libros. Desarrollo: se describen los elementos necesarios para el diagnóstico clínico e imaginológico, en relación a estos últimos se hace énfasis en la imagen de resonancia magnética y la artroscopia. Se hace referencia a la clasificación de la sociedad internacional para la reparación de los cartílagos. Se describen las indicaciones quirúrgicas generales de las lesiones de cartílago y las específicas de la mosaicoplastia con sus principales ventajas y desventajas. Se plasman las principales complicaciones relacionadas con el procedimiento y los resultados de un grupo de investigaciones. Conclusiones: la mosaicoplastia es una variedad de injerto autólogo osteocondral empleada con buenos resultados en la actualidad, tiene ventajas, desventajas e indicaciones específicas.

Background: cartilage lesions are common nowadays. Their main symptoms and signs are pain and limited joint range of motion. There are many ways to treat them. Mosaicplasty is very used because of its several advantages. Objective: to update knowledge of autogenous osteochondral transplantation in mosaicplasty modality. Methods: a search in the databases PubMed, Hinari, SciELO and Medline was conducted through the information locator EndNote in October 2016. From the information obtained, a bibliographic review was carried out with 654 articles. Among them, 52 citations were used and 47 of them from the last five years, including four books. Development: fundamental elements for clinical and imaging diagnosis were described. With regard to the latter, it is emphasized on magnetic resonance imaging and arthroscopy. The international cartilage repair society classification system was pointed out. General surgical indications for cartilage lesions were described as well as specific ones for mosaicplasty and its main advantages and disadvantages. Complications were highlighted as well as the results of a group of researchers. Conclusions: mosaicplasty is a modality of autogenous osteochondral transplantation with good results because of its many advantages and disadvantages and specific indications to do it.

Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus / 대한정형외과학회잡지

PURPOSE: We compared the results between conservative and surgical treatment methods in a group of children and adolescents with osteochondritis dissecans of the talus. MATERIALS AND METHODS: A total of 24 patients (31 ankles), who were younger than 18 years old, were included in this study. Group 1 consisted of 14 ankles (mean age at the time of treatment was 13.0 years) treated conservatively. Group 2 consisted 17 ankles (mean age at the time of treatment was 15.1 years) treated surgically. According to the Berndt and Harty classification, there were 6 ankles in class I, 4 in class II, 3 in class III, and 1 in class IV in group 1; 1 ankle in class I, 9 in class II, and 7 in class III in group 2. In group 1, there were 13 medial lesions and 1 lateral lesion; and in group 2, there were 14 medial lesions and 3 lateral lesions. The mean follow-up period was 31.9 months for group 1 and 28.9 months for group 2. Clinical and radiologic results were analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the classification by Higuera et al. RESULTS: The mean AOFAS clinical score was 91.4 in group 1 and 87.5 in group 2. According to the classification by Higuera et al., regarding clinical results, there were 6 excellent, 7 good, and 1 fair in group 1, and 5 excellent, 2 good, and 10 fair in group 2. As for radiological results, there were 13 good and 1 fair in group 1, and 10 good and 7 fair in group 2. There was no statistical difference between the two groups. CONCLUSION: Conservative treatment provided satisfactory results for osteochondritis dissecans of the talus in children and adolescents.

Is Antegrade Transmalleolar Drilling Method for Osteochondral Lesion of Talus Necessary? Iatrogenic Cystic Formation at the Tibia: A Report of Five Cases

Antegrade transmalleolar drilling method is one of the options for the treatment of osteochondral lesion of talus (OLT). We present five patients who underwent tibial drilling for treatment of OLT and later developed distal tibial cystic formation induced by cartilage opening or heat necrosis during drilling. Antegrade transmalleolar drilling can be a possible option for the treatment of OLT if the lesion is not easily reachable; however, other viable treatment should be considered due to its possibility of distal tibial pathologic change.

Arthroscopic Bioabsorbable Screw Fixation of Unstable Osteochondritis Dissecans in Adolescents: Clinical Results, Magnetic Resonance Imaging, and Second-Look Arthroscopic Findings

BACKGROUND: This study aimed to evaluate the clinical and radiological outcomes of arthroscopic bioabsorbable screw fixation in osteochondritis dissecans (OCD) in adolescent patients with unstable lesions causing pain. METHODS: The study included 11 patients (10 males and 1 female) with OCD who underwent arthroscopic bioabsorbable screw fixation between July 2007 and February 2014 and were available for follow-up for more than 12 months. The mean age at diagnosis was 16.3 years (range, 11 to 19 years), and the average follow-up period was 51 months (range, 12 to 91 months). Clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, and International Knee Documentation Committee (IKDC) score measured before surgery and at follow-up. Functional evaluation was made using the Tegner activity scale. Magnetic resonance imaging (MRI) and second-look arthroscopy were performed at the 12-month follow-up. RESULTS: Between the preoperative assessment and follow-up, improvements were seen in the KOOS (range, 44.9 to 88.1), Lysholm knee score (range, 32.6 to 82.8), and IKDC score (range, 40.8 to 85.6). The Tegner activity scale also improved from 2.8 to 6.1. Based on postoperative MRI, there were eight Dipaola grade I cases and three grade II cases. No complications due to fixation failure developed in any case. Second-look arthroscopy at 12 months postoperatively revealed that the lesion was covered with cartilage in all cases. CONCLUSIONS: For unstable OCD lesions causing pain in adolescents, arthroscopic bioabsorbable screw fixation provided favorable outcomes with reduced pain and restoration of movement. Therefore, it should be considered as an effective treatment for OCD.

Concomitant Osteochondral Autograft Transplantation and Fixation of Osteochondral Fragment for Treatment of a Massive Osteochondritis Dissecans: A Report of 8-Year Follow-up Results

Numerous procedures exist to treat osteochondritis dissecans (OCD); however, it remains a topic of debate which procedure is most ideal. When restoring a massive osteochondral defect, the use of only one procedure may not always allow complete filling of the defect. This case report presents a massive OCD with displaced osteochondral fragment and loose body in the knee joint that occupied almost all of the weight bearing area of the medial femoral condyle and was treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. To our knowledge, this is a rare report on OCD treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. At 8 years after surgery, the clinical outcome was excellent, and radiographs revealed congruence of the medial femoral condyle. The patient returned to sports activities. In massive and complex OCD lesions, individual techniques have limitations. Two or more techniques are needed to increase the rate of success.

Osteochondritis dissecans in bilateral lateral femoral condyle in knees / Osteocondrite dissecante em côndilo femural lateral bilateral nos joelhos

The osteochondritis dissecans (OCD) is a disease of unknown cause that classically affects the knee lateral border of the medial femoral condyle. We present a rare case of OCD in bilateral lateral femoral condyle.

A osteocondrite dissecante (OCD) é uma patologia de causa desconhecida, que classicamente acomete no joelho a borda lateral do côndilo femural medial. Apresentamos um raro caso de OCD no côndilo femural lateral bilateral.

Outcomes of Operative Management of Juvenile Osteochondritis Dissecans of the Knee in Athletes / 대한스포츠의학회지

The purpose of this study was to investigate clinical and radiological outcomes of multiple drilling in case of failed conservative treatment of juvenile osteochondritis dissecans in athletes. We treated 37 lesions from 30 athletic patients who failed conservative treatment for juvenile osteochondritis dissecans. Multiple drillings were done for 32 lesions and multiple drilling and bioabsorbable pin fixations were done for 5 lesions. Lysholm score, Hughston clinical scale were used for clinical evaluation before and last follow up of treatment. For radiologic evaluation we used magnetic resonance imaging at 3 months and 12 months after operation. Of all 37 lesions, 11 lesions were located on medial femoral condyle, 2 lesions on lateral femoral condyle and 24 lesions on trochlear groove. There were clinical and radiological improvement from Hughston scale after operative treatment. Twenty-five patients among 30 returned to the sports activity. There were no specific complications after operation. Multiple drilling and bio-absorbable pin fixation of juvenile athletic osteochondritis dissecans patients after failure of conservative treatment showed good clinical and radiologic results. So it would be helpful for juvenile athletic patients to return to sports activities.

Searching for Hidden, Painful Osteochondral Lesions of the Ankle in Patients with Chronic Lower Limb Pain: Two Case Reports

It is easy to overlook osteochondral lesions (OCLs) of the ankle in patients with chronic lower limb pain, such as complex regional pain syndrome (CRPS) or thromboangiitis obliterans (TAO, Buerger's disease). A 57-year-old woman diagnosed with type 1 CRPS, and a 58-year-old man, diagnosed with TAO, complained of tactile and cold allodynia in their lower legs. After neurolytic lumbar sympathethic ganglion block and titration of medications for neuropathic pain, each subject could walk without the aid of crutches. However, they both complained of constant pain on the left ankle during walking. Focal tenderness was noted; subsequent imaging studies revealed OCLs of her talus and his distal tibia, respectively. Immediately after percutaneous osteoplasties, the patients could walk without ankle pain. It is important to consider the presence of a hidden OCL in chronic pain patients that develop weight-bearing pain and complain of localized tenderness on the ankle.

Histological and MR quantitative analysis of repaired tissue following microfracture treatment for knee joint osteochondritis dissecans in rabbit models / 中华放射学杂志

Objective To quantitatively analyze the histological and MR images of repaired tissue (RT) following microfracture for knee joint osteochondritis dissecans (OCD) in rabbit models at different time points,make comparisons with the RT performances of joint debribement,explore the efficiency of the microfracture treatment for OCD.Methods Twenty-seven New Zealand rabbits were randomly assigned into 3 groups (sacrificed at the end of 3,5 and 7 weeks post-operation respectively),with 9 in each group.For each rabbit,one knee joint was made into an OCD model.In each group,6 were for microfracture treatment,and the other 3 were for joint debridement as control.MR scan,which mainly included sequences of 3D double echo steady state sequence (3D-DESS) and T2-mapping,was taken at 3,5 and 7 weeks postoperation.The thickness index and T2 value index of RT were calculated and T2-mapping of repaired region was drafted.Then the operation sites were removed to make histological sections of HE and Masson staining.The modified O' Driscoll score system was employed to make semi-quantitative evaluation for the histological performance of RT.Comparisons were made with respect to MR and histological findings between two treatments at each time point using unpaired Student t test.Effects of two treatments were evaluated longitudinally by comparing the results of three time points using one-way ANOVA.Results The post-operation thickness indexes of two groups increased gradually (F =33.940,28.841,P ＜ 0.05),T2 value indexes decreased (F =80.183,206.206,P ＜ 0.05),and O'driscoll scores increased gradually (F =29.867,17.167,P ＜ 0.05).At each time point,the thickness index of microfracture was higher than that of debridement group(3-week:0.743 ±0.048 vs 0.624 ±0.013,t =4.077 ;5-week:0.813 ±0.031 vs 0.734 ±0.015,t =4.107 ; 7-week: 0.972 ± 0.064 vs 0.777 ± 0.039,t =4.782 ; P ＜ 0.05),and the defects of microfracture in 7-week group were almost fully recovered while the defects of the debridement in 7-week group were not.The T2 value index of microfracture group was lower than that of debridement group at 3-week point(1.338 ±0.043 vs 1.510 ± 0.009,t =6.583,P ＜ 0.05),but it was higher than that of debridement group at 5-week and 7-week points (5-week: 1.284 ± 0.097 vs 1.116 ± 0.068,t =2.663 ; 7-week: 0.916 ± 0.036 vs 0.843 ± 0.016,t =3.283 ; P ＜ 0.05).The O'Driscoll score of microfracture group was higher than that of joint debridement at every time point(3-week:7.167 ±0.753 vs 4.667 ±0.577,t =5.000;5-week: 9.833 ± 1.169 vs 7.667 ± 0.577,t =2.960 ; 7-week: 11.167 ± 0.753 vs 8.333 ± 1.155,t =4.520 ; P ＜ 0.05).For microfracture group,the RT was mainly repaired by fibrocartilage and got matured gradually with more production of well-distributed collagen fibrils ; while for joint debridement group,the RT was mainly repaired by fibrous and scar tissue.Conclusions The post-operation repairing thickness and tissue composition of microfracture for OCD are superior to that of joint debridement.MR 3D-DESS and T2-mapping can show the thickness and tissue composition of the RT after OCD treatments,provide effective evaluation of repairing conditions,and they are of great importance on the OCD post-op follow-up.

Multiple Osteochondritis Dissecans of Knee Joint in a Patient with Wilson Disease, Focusing on Magnetic Resonance Findings

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.

Bilateral Osteochondritis Dissecans of the Femoral Condyles in Both Knees: A Report of Two Sibling Cases

Osteochondritis dissecans (OCD) of both femoral condyles is very rare, with no previously reported cases of bilateral OCD of both knees in two siblings. We report on a brother and sister with both femoral condyle OCD with a description of surgical technique and clinical results. Fixation using headless compressive screws, osteochondral autologous transplantation and autologous chondrocyte implantation were all successful.

Osteocondrite dissecante do joelho: diagnóstico e tratamento / Osteochondritis dissecans of the knee: diagnosis and treatment

A osteocondrite dissecante (OCD) é um processo patológico que atinge o osso subcondral do joelho em criança e adolescente (OCDJ) e adultos jovens (OCDA) com efeitos secundários sobre a cartilagem articular com dor, edema, possível formação de corpos livres e sintomas mecânicos, inclusive bloqueio articular. A OCD pode levar a alterações degenerativas precoces da articulação, quando não tratada. Este artigo apresenta uma revisão e atualização sobre o problema com ênfase especial no diagnóstico e tratamento. Este pode incluir os métodos conservadores que mostram resultados mais satisfatórios para a OCDJ e os vários métodos cirúrgicos que incluem: técnicas reparativas como a remoção isolada do fragmento, as perfurações ósseas e a fixação do fragmento osteocondral e as técnicas restaurativas como as microfraturas, o transplante osteocondral autólogo (mosaicoplastia), o implante autólogo de condrócitos e o aloenxerto osteocondral fresco, considerando a lesão estável ou instável e sua viabilidade, bem como a maturidade esquelética e localização do processo. Estudos recentes para a avaliação dos resultados dos vários tipos de tratamento demonstram a falta de estudos com níveis de evidência confiáveis e sugere-se maior número de análises multicêntricas, prospectivas, randomizadas e controladas para estabelecer melhores diretrizes para o manuseio da doença.

Osteochondritis dissecans (OCD) is a pathological process affecting the subchondral bone of the knee in children and adolescents with open growth plates (juvenile OCD) and young adults with closed growth plates (adult OCD). It may lead to secondary effects on joint cartilage, such as pain, edema, possible formation of free bodies and mechanical symptoms, including joint locking. OCD may lead to degenerative changes may develop if left untreated. This article presents a review and update on this problem, with special emphasis on diagnosis and treatment. The latter may include either conservative methods, which show more predictable results for juvenile OCD, or various surgical methods, which include reparative techniques like isolated removal of the fragment, bone drilling and fixation of the osteochondral fragments, and restorative techniques like microfractures, autologous osteochondral transplantation (mosaicplasty), autologous chondrocyte implantation and fresh osteochondral allograft, depending on lesion stability, lesion viability, skeletal maturity and OCD process location. Recent assessments on the results from several types of treatment have shown that there is a lack of studies with reliable levels of evidence and have suggested that further multicenter prospective randomized and controlled studies on management of this disease should be conducted.

Osteocondrite dissecante bilateral de joelho em jogador de basquetebol: relato de caso / Bilateral osteochondritis dissecans of the knee in a basketball player: case report

Os autores relatam um caso de osteocondrite dissecante em joelho bilateral de um jogador de basquetebol de 17 anos que foi diagnosticado e tratado conforme a literatura.

The authors report a case of bilateral osteochondritis dissecans in a 17-year-old basketball player who was diagnosed and treated as shown in the literature.

Osteonecrosis de la rodilla: enfoque actual / Knee osteonecrosis: current approach

Fundamento: la Osteonecrosis de la Rodilla se describió por primera vez por Ahlback citado por Adriaensen en el año 1968. Aunque esta enfermedad afecta fundamentalmente al condilo medial, también puede observarse en el cóndilo lateral y los paltillos tibiales. Desarrollo: se realizó una revisión bibliográfica sobre la Osteonecrosis de la Rodilla, con especial énfasis en las teorías involucradas en su fisiopatología, exponemos los distintos estadios de esta enfermedad así como las características radiológicas de cada uno, se realizó el diagnóstico diferencial de esta enfermedad con otras, relacionadas o no con la Osteonecrosis. Conclusiones: se brindó un breve enfoque terapéutico basado fundamentalmente en la edad y extensión de la lesión.

Background: knee osteonecrosis was described for the first time by Ahlback mentioned by Adriaensen in 1968. Although this disease affects fundamentally to the medial condyle, it may also be observed in the lateral condyle and tibial saucers. Development: a bibliographical review was carried out on knee osteonecrosis, with special emphasis in the theories involved in its physiopathology, different stages of this disease as well as the radiological characteristics of each are exposed, differential diagnosis of this disease with other, related or not with osteonecrosis was carried out. Conclusions: it was offered a brief therapeutic approach based fundamentally on the age and extension of the lesion.