tailieunhanh - Knee surgery for pediatric and adolescent: Part 2

(BQ) Continued part 1, part 2 of the document Knee surgery for pediatric and adolescent has contents: Retroarticular drilling of osteochondritis dissecans, meniscal allograft transplantation, patella sleeve fractures, growth plate anatomy, and other contents. Invite you to refer. | SECTION 3 Osteochondritis Dissecans CHAPTER Eric W. Edmonds Henry G. Chambers 21 Osteochondritis Dissecans Overview Epidemiology Etiology Classification Assessment INTRODUCTION Although loose bodies within a joint were first described by Paget 1 Konig later suggested three methods by which loose bodies could be created 1 direct trauma with acute fracture 2 minimal trauma that develops into osteonecrosis and subsequent fragmentation or 3 no trauma with spontaneous fragmentation. The latter variety he coined osteochondritis dissecans OCD .2 3 Although it should be pointed out that the exact pathophysiology remains unknown it is agreed that OCD is likely an acquired lesion of subchondral bone. Beyond this characterization it is less clear. There are degrees of osseous resorption collapse and sequestrum formation with possible involvement of the articular cartilage through delamination unrelated to an acute osteochondral fracture of normal cartilage Fig. .4 5 This understanding of the end point of the disease process has led to many etiologies of OCD being postulated particularly concerning the knee including trauma 6 7 inflammation 2 8 genetics 9 vascular abnormalities 10 11 and constitutional However the etiology remains unknown even though our veterinary medicine colleagues have made some leaps in understanding over recent 14 Historically there has been a distinction between juvenile-onset OCD and adult-onset OCD. Many surgeons have suggested that skeletally immature patients juvenile onset have a better prognosis that has been inconsistently defined in the literature as either radiographic healing or merely resolution of 5 9 11 12 15 Despite the lack of an open physis at the time of diagnosis in an adult OCD however many authors suggest that the only true difference between juvenile- and adult-onset OCD is purely a reflection of patient age at the time of diagnosis. A recent definition of human OCD lesions proposed by the Research in