The classic: On loose bodies in the joint. 1887.

This Classic Article is a translation of the original work by Franz König, "Ueber freie Körper in den Gelenken" [On loose bodies in the joint]. Dtsch Z Chir. 1887;27: 90-109. available at DOI 10.1007/s11999-013-2824-y (Translated by Drs. Richard A. Brand and Christian-Dominik Peterlein). An accompanying biographical sketch of F. König is available at DOI 10.1007/s11999-013-2823-z . A PDF of the original German is available as supplemental material. (ED Note: An attempt has been made to preserve some of the original wording while placing the material in a contemporary context. In some cases the author's original intent was obscure.).

Osteochondritis dissecans of the patella in a XVII century player of the Florentine historic kickball.

We report a case of osteochondritis dissecans in the patella of Francesco de' Medici, Prince of Capistrano, who lived from 1594 to 1614. He was known to play Florentine kick ball, a precursor of Rugby and American football, and speculate that trauma from this activity may have led to the lesion.

[History of meniscus surgery. From excision of joint loose bodies to meniscus suture]. / Die Geschichte der Meniskuschirurgie. Von der Exzision des freien Gelenkkörpers bis zur Meniskusnaht.

In comparison with other operative procedures, the history of meniscal-surgery offers some particular differences. Over a long period of time injuries of the semilunar-cartilages of the knee-joint were not generally recognised. In the 18th century only was the clinical picture roughly outlined. There is evidence, that parts of the meniscus were removed much earlier than we have historic proof of. These meniscal fragments were generally mistaken for "loose bodies" in the joints, not knowing the exact etiology. Operative interference with joints was afflicted with a very high incidence of infections and thus complications. Due to this reliable standards of sterility were imperative to obtain reproductive and satisfactory results in surgery of the knee-joint and this is why the discovery and implementation of antiseptic and aseptic principles play such an important role in joint- and, in particular, in meniscal-surgery. The development of meniscal-surgery is dominated by a lengthy discussion about the way in which the injuries of the semilunar cartilages should be dealt with operatively. Fundamental techniques such as fixation of the cartilage by sutures, limited or total removal of the meniscus were established as early as 1895. Over a long period they existed concurrently and their adequate application remained cause for a highly controversial discussion until the end of the 20th century. Not before more detailed knowledge was gained about the exact morphology of the meniscus and the rising of arthroscopic surgery offered new surgical perspectives, it was possible to establish a widely accepted standard of meniscal surgery.

Osteochondritis dissecans of the knee: a historical review of etiology and treatment.

Osteochondritis dissecans (OCD) is a common entity in both the juvenile and adult populations, with an incidence of 3 to 6/10,000 in adults. Much of the early literature grouped juvenile and adult osteochondritis dissecans, osteochondral fracture, and accessory ossification into the same category. Conclusions were then drawn on the combined group. Nonetheless, this is a diverse group. This review discusses only OCD. There have been multiple etiological theories of OCD, ranging from trauma to ischemia to accessory centers of ossification and to genetics. It is evident that the true etiology is probably multifactorial. Bone scan, computed tomographic scan, and magnetic resonance imaging advances have enhanced the physician's ability to make the diagnosis of osteochondritis dissecans as well as to stage operative intervention. There is a vast difference between juvenile and adult OCD, as seen in the natural history, prognosis, and treatment options. In general, the juvenile patients have better results overall. The indications for operative intervention for these juvenile patients are a nonhealing attached fragment, fully or partially detached lesions of the articular surface, and loose bodies. Nonoperative treatment in the adult patient has been shown to accelerate degenerative arthritis, which involves all 3 compartments of the knee. Therefore, symptomatic lesions and loose bodies comprise the surgical indications for adult OCD. An understanding of this disease process will help the physician optimize the patient's results.

Osteochondritis dissecans 1887-1987. A centennial look at König's memorable phrase.

In 1887, König claimed that loose bodies in the knee joints of young persons had three causes: (1) very severe trauma; (2) lesser trauma causing contusion and necrosis; and (3) minimal trauma acting on an underlying lesion-for which he suggested the name osteochondritis dissecans. His thesis has stood the test of time. We still confuse the second and third categories but osteochondritis dissecans has been identified as an ossification defect.