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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1986 and 1991, a total of 18 patients (11 men and 7 women) with osteochondritis dissecans of the knee were treated with periosteal transplantation. Median patient age was 19 years (range: 16-45 years). Eight patients were reoperated up to 8 years postoperatively, due to reduced range of motion, synovitis, or formation of an exostosis in the transplanted area. Of 14 patients who were available for follow-up after 8 years (range: 5-10), 2 were completely pain free. Six patients had reduced range of motion, knee instability, or quadriceps muscle atrophy. The number of reoperations and the presence of continued knee pain in most patients does not justify the extensive procedure of periosteal transplantation.
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PMID:Long-term results of periosteal transplantation in osteochondritis dissecans of the knee. 1074 66

Since the advent of operative ankle arthroscopy and magnetic resonance imaging (MRI) specific treatment of osteochondritis dissecans of the talus has progressed rapidly. Drilling is still the treatment of choice in early stages of osteochondritis dissecans of the talus. Rear-entry guides and preoperative planning with MRI have led to better results with this kind of treatment. Within 5 years, 42 patients (26 male and 16 female) underwent arthroscopic treatment of osteochondritis dissecans of the talus, 22 underwent percutaneous drilling, 13 cancellous bone grafting, 4 refixation, and 3 curettage. The average age of the patients was 28 years (range, 11 to 53 years). A clinical score system was used in a clinical and MRI follow-up of 19 of the patients with K-wire drilling. Up to 100 points are given in the categories pain, stability/insecurity, efficiency/pain-free walking distance, gait, differences in circumference, range of motion, and power. There was a history of trauma in 31 of the 42 patients. The majority of lesions (24 cases) were localized at the lateral talus, and these patients all had trauma. In 11 of the 18 lesions at the medial talus, there was no evidence of trauma. The 19 patients in the follow-up achieved an average of 87 points. K-wire drilling represents the chief component of early stages with intact or partially fractured cartilage surface, whereas arthroscopically controlled cancellous bone grafts after curettage are used in grade II stages only. Results of K-wire drilling are not worse than those of cancellous bone grafts; this is attributable to a generous perforation of the sclerosis. This has contributed to an improved preoperative diagnosis with MRI.
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PMID:Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment. 1075 10

The 3 cases presented describe loosening or failure of bioabsorbable screws in the treatment of osteochondritis dissecans (OCD). In case 1, a 17-year-old boy with OCD of the medial femoral condyle was treated with bioabsorbable screw fixation. Six months after surgery, the patient had an acute episode of pain with effusion. Arthroscopic examination revealed 2 of the 4 screws backed out, causing cartilage damage to the corresponding tibial plateau. The shafts of the remaining 2 screws had completely absorbed, leaving the unabsorbed screw heads as intra-articular loose bodies in the knee. Unpredictable and inconsistent degradation of the screws is believed to be the mechanism for screw back-out and cartilage damage.
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PMID:Potential complication of bioabsorbable screw fixation for osteochondritis dissecans of the knee. 1117 59

We treated a patient with extensive osteochondritis dissecans of the elbow by an osteochondral graft from a rib. It had consolidated seven months after operation. When seen at follow-up, after seven years and eight months, the elbow was free from pain with an improvement in the range of movement of 24 degrees.
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PMID:Treatment of severe osteochondritis dissecans of the elbow using osteochondral grafts from a rib. 1147 16

To attain bony union of the fragment in osteochondritis dissecans of the humeral capitellum, fragment fixation was performed with a bone graft and dynamic staples in 4 patients. The staples were inserted not from the articular surface but from the lateral aspect of the capitellum. All patients achieved bony union without complication, and 3 of them returned to playing competitive baseball. At final follow-up after surgery (mean, 7.5 years [range, 2.1-11 years]), 3 patients were able to throw a ball without pain and the remaining patient felt elbow dullness after he played recreational-level baseball as a pitcher. These results suggest that the procedure of fragment fixation with a bone graft and dynamic staples can provide satisfactory results for osteochondritis dissecans of the humeral capitellum with a large osteochondral fragment.
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PMID:Fragment fixation with a bone graft and dynamic staples for osteochondritis dissecans of the humeral capitellum. 1219 55

Over 25 million children participate in school-sponsored sports, and an additional 20 million participate in extracurricular organized sports. Over the past decade, increased intensity of training, more pressure for success, new opportunities for structured play, and more organized advanced leagues and traveling teams have led to a corresponding increase in overuse injuries in the skeletally immature athlete. Perhaps the classic sports model for overuse injuries of the upper extremity is baseball. Throwing sports contribute to an increased incidence of elbow and shoulder injuries that might be related to intensity of training, throwing mechanics, and poor conditioning, including core strength. Specific areas of concern regarding overuse injuries in young athletes include such diagnoses as little leaguer's shoulder, little leaguer's elbow, osteochondritis dissecans of the elbow, tennis elbow, and distal radial epiphysitis. Ultimately, overuse injuries, and particularly physeal injuries, should be suspected in any young athlete who has pain in the upper extremity. Comparative bilateral radiographs are the rule in workup.
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PMID:Overuse and throwing injuries in the skeletally immature athlete. 1269 Aug 38

A 12 1/2-year-old white girl presented with a 3-year history of bilateral knee and bilateral elbow pain. Radiographs showed osteochondritis dissecans (OCD) lesions of both patellas and bilateral intra-articular bodies within the elbows--consistent with previous OCD lesions. After unsuccessful conservative management, an arthroscopy was performed on the right knee; the lesion was removed, and a chondroplasty was performed on the patella. There were no operative complications, and the patient did well postoperatively. At 12-week follow-up, a 2+ effusion was found in the right knee. Locking and pain in the left elbow were treated with arthroscopy/arthrotomy, and the 3 loose osteochondral bodies were removed. The patient regained full, painless range of motion of the left elbow. This is the first report of OCD lesions located on both patellas and elbows in an adolescent.
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PMID:Bilateral knee and bilateral elbow osteochondritis dissecans. 1277 74

For years, OCD of the talus has been known as a symptomatic lesion that causes pain, recurrent synovitis, altered joint mechanism, and obstruction from loose bodies. It is a probable precursor of ankle osteoarthritis because of altered joint mechanics and recurrent synovitis. With the notable advance of diagnostic imaging and the advent of ankle arthroscopy, classification of the lesion has become standardized, which allowed for the comparison of treatment options. Arthroscopic procedures (eg, debridement, retrograde drilling, bone grafting, by nature of their minimally invasive approach, have a great advantage in treating small defects and stable OCD lesions compared with open methods. For larger osteochondral defects and unstable OCD lesions, the optimal treatment is the long-term replacement and integration of type-specific hyaline cartilage. In principle, mosaicplasty autogenous osteochondral transplantation fills these criteria. The early- and medium-term results are encouraging, complete with confirmatory radiographs and histology, and hold promise for this procedure to provide lasting relief of symptoms and the prevention of ankle arthrosis. Under the current dichotomy of nonoperative and operative treatments giving satisfactory results, and few comparative studies, there is a need for a randomized, prospective study in the treatment of talar OCD to define a reproducible treatment algorithm.
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PMID:The mosaicplasty technique for osteochondral lesions of the talus. 1291 Dec 40

Anterior knee pain is a common symptom, which may have a large variety of causes including patellofemoral pathologies. Patellofemoral maltracking refers to dynamic abnormality of patellofemoral alignment and has been measured using plain film, computed tomography (CT) and magnetic resonance imaging (MRI) using static and kinematic techniques. Patellar dislocation is usually transient, but specific conventional radiographic and MRI features may provide evidence of prior acute or chronic dislocation. In addition, chondromalacia patellae, osteochondritis dissecans, patellofemoral osteoarthritis, excessive lateral pressure syndrome, and bipartite patella have all been implicated in causing patellofemoral pain. The imaging and clinical features of these processes are reviewed, highlighting the specific diagnostic features of each condition.
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PMID:Imaging of patellofemoral disorders. 1520 60

Lesions of articular cartilage have a large variety of causes among which traumatic damage, osteoarthritis and osteochondritis dissecans are the most frequent. Replacement of articular defects in joints has assumed greater importance in recent years. This interest results in large part because cartilage defects cannot adequately heal themselves. Many techniques have been suggested over the last 30 years, but none allows the regeneration of the damaged cartilage, i.e. its replacement by a strictly identical tissue. In the first generation of techniques, relief of pain was the main concern, which could be provided by techniques in which cartilage was replaced by fibrocartilage. Disappointing results led investigators to focus on more appropriate bioregenerative approaches using transplantation of autologous cells into the lesion. Unfortunately, none of these approaches has provided a perfect final solution to the problem. The latest generation of techniques, currently in the developmental or preclinical stages, involve biomaterials for the repair of chondral or osteochondral lesions. Many of these scaffolds are designed to be seeded with chondrocytes or progenitor cells. Among natural and synthetic polymers, collagen- and polysaccharide-based biomaterials have been extensively used. For both these supports, studies have shown that chondrocytes maintain their phenotype when cultured in three dimensions. In both types of culture, a glycosaminoglycan-rich deposit is formed on the surface and in the inner region of the cultured cartilage, and type II collagen synthesis is also observed. Dynamic conditions can also improve the composition of such three-dimensional constructs. Many improvements are still required, however, in a number of key aspects that so far have received only scant attention. These aspects include: adhesion/integration of the graft with the adjacent native cartilage, cell-seeding with genetically-modified cell populations, biomaterials that can be implanted without open joint surgery and combined therapies, aimed at disease modification, pain relief and reduction of inflammation.
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PMID:Cartilage repair: surgical techniques and tissue engineering using polysaccharide- and collagen-based biomaterials. 1529 75


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