Akkawi Ibrahim, Zmerly Hassan, Draghetti Maurizio, Felli Lamberto
Orthopedics, Casa di Cura Villa Erbosa, Bologna, ITA.
Orthopedics, Villa Erbosa Hospital, Bologna, ITA.
Cureus. 2024 Jul 27;16(7):e65496. doi: 10.7759/cureus.65496. eCollection 2024 Jul.
Osteochondritis dissecans (OCD) primarily damages the subchondral bone, leading to damage to the articular cartilage. Juvenile OCD (JOCD) of the knee is limited to skeletally immature and young patients with open growth plates on radiographs. We conducted a review of PubMed articles up until March 16, 2024, using a combination of the following keywords: knee, juvenile, and osteochondritis dissecans. This narrative review included a total of 56 relevant articles that investigated the etiology, incidence, clinical presentation, imaging, classification, and treatment of JOCD of the knee in patients less than 20 years of age. The exact etiology is controversial. Most authors believe that the disease involves multiple theories, such as ischemia, recurrent trauma, and genetic predisposition. Radiographs, the first imaging study in this patient group, cannot determine the stability or instability of the surface cartilage of the OCD lesion. As a result, MRI has become a recommended diagnostic method for determining OCD stability and providing important information for determining a treatment plan. For stable JOCD lesions, nonsurgical treatment is often advised. For unstable and stable lesions that do not respond to nonsurgical treatment, several surgical techniques with good healing rates are available.
剥脱性骨软骨炎(OCD)主要损害软骨下骨,导致关节软骨损伤。膝关节青少年OCD(JOCD)仅限于骨骼未成熟且X线片显示生长板开放的年轻患者。我们使用以下关键词组合对截至2024年3月16日的PubMed文章进行了综述:膝关节、青少年和剥脱性骨软骨炎。这篇叙述性综述共纳入了56篇相关文章,这些文章研究了20岁以下患者膝关节JOCD的病因、发病率、临床表现、影像学、分类和治疗。确切病因存在争议。大多数作者认为该疾病涉及多种理论,如缺血、反复创伤和遗传易感性。X线片是该患者群体的首选影像学检查,但无法确定OCD病变表面软骨的稳定性或不稳定性。因此,MRI已成为确定OCD稳定性并为制定治疗方案提供重要信息的推荐诊断方法。对于稳定的JOCD病变,通常建议采用非手术治疗。对于不稳定和对非手术治疗无反应的稳定病变,有几种愈合率良好的手术技术可供选择。