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Ultrasound Arthroscopy of Hip in Treatment of Osteochondritis Dissecans.

ABSTRACT: An ultrasound arthroscopy (UA) technique is a promising tool for the evaluation of the articular cartilage during arthroscopic examination. However, the applicability of UA for the evaluation of the hip joint is unknown. We describe a UA assessment of a patient with osteochondritis dissecans at the femoral head. An ultrasound catheter designed for intravascular imaging was inserted into the hip joint by use of conventional arthroscopic portals, and the cartilage surfaces of the femoral head and acetabulum were investigated with ultrasound. UA provided essential quantitative information on the integrity of the articular cartilage and the condition of the subchondral plate not assessable with conventional arthroscopy. Furthermore, the UA technique provided the possibility to monitor arthroscopy-assisted retrograde drilling and bone transplantation in the hip joint.

SUBMITTER: Joukainen A

PROVIDER: S-EPMC5621660 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Ultrasound Arthroscopy of Hip in Treatment of Osteochondritis Dissecans.

Joukainen Antti A Virén Tuomas T Penttilä Pekko P Liukkonen Jukka J Puhakka Pia Henriikka PH Kröger Heikki H Töyräs Juha J

Arthroscopy techniques 20170717 4

An ultrasound arthroscopy (UA) technique is a promising tool for the evaluation of the articular cartilage during arthroscopic examination. However, the applicability of UA for the evaluation of the hip joint is unknown. We describe a UA assessment of a patient with osteochondritis dissecans at the femoral head. An ultrasound catheter designed for intravascular imaging was inserted into the hip joint by use of conventional arthroscopic portals, and the cartilage surfaces of the femoral head and ...[more]

PMID: 28970993

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Ultrasound-assisted hip arthroscopy.

Project description:We describe the use of intraoperative ultrasound for the safe development of arthroscopic portals during hip arthroscopy without the requirement for fluoroscopy. We find this technique consistently accurate, allowing the safe introduction of arthroscopic instruments into the hip with a very low rate of iatrogenic injury. We have further developed the technique for application to both central- and peripheral-compartment procedures. We now have a total experience of more than 700 procedures to date. With the described technique of ultrasound guidance for portal placement, fluoroscopy is required in fewer than 2% of hip arthroscopy procedures at our institution.

| S-EPMC4044512 | biostudies-literature

Hip Arthroscopic Osteochondral Autologous Transplantation for Treating Osteochondritis Dissecans of the Femoral Head.

Project description:Osteochondritis dissecans (OCD) of the femoral head is not a common source of hip pain. Hip arthroscopy is becoming a more frequent indication for intra-articular pathologies of the hip. Osteochondral autologous transplantation is a promising technique that theoretically can reconstruct osteochondral lesions of the femoral head. We describe our technique for arthroscopic antegrade osteochondral autologous transplantation for the treatment of OCD of the femoral head. The advantages of this technique include that it is a less invasive method with the ability to assess and treat intra-articular pathologies associated with OCD of the femoral head at same time. Case series and outcomes after this technique are not currently reported in the literature; however, it could be a less invasive method and provide favorable clinical outcomes for patients with OCD lesions of the femoral head.

| S-EPMC4738504 | biostudies-literature

Impaction Bone Grafting for Treatment of Unstable Osteochondritis Dissecans (OCD) Lesions.

Project description:Although treatment options for unstable and unsalvageable large osteochondral lesions have largely been limited to autologous chondrocyte implantation (ACI) and osteochondral allografts, isolated impaction bone grafting represents a cost-friendly alternative, with predictable outcomes comparable to other options. Furthermore, the procedure can be completed in a single stage on an elective basis. We present our technique for impaction bone grafting of unstable osteochondritis dissecans (OCD) using either cancellous autograft or allograft.

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Arthroscopic Management for Acetabular Rim Stress Fracture and Osteochondritis Dissecans in the Athlete With Hip Dysplasia.

Project description:Intra-articular lesions are common in patients with acetabular hip dysplasia. Rim stress fractures (RSFs) have also been described in patients with acetabular hip dysplasia. This lesion is believed to be a result of an unfused secondary ossification center or a stress fracture that could be caused by repetitive impingement of an abnormal-shaped femoral head-neck junction. In addition, osteochondritis dissecans of the acetabulum is a rare condition that can also result from impingement and has been described in patients with hip dysplasia. Here, we describe an arthroscopic technique for internal fixation of osteochondritis dissecans of the acetabulum and concomitant RSF associated with hip dysplasia in a rhythmic gymnast.

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Ultrasound-Guided Portal Placement for Hip Arthroscopy.

Project description:Over the past 2 decades, hip arthroscopy has developed as a surgical technique, with more orthopaedic surgeons attempting to become proficient in performing this surgical procedure as indications and surgical skills evolve. The hip joint presents unique arthroscopic challenges because of its anatomic location, and it can be challenging to safely and confidently establish portal sites. Ultrasound-guided hip arthroscopy portal placement is not yet common practice for orthopaedic surgeons. The potential advantages of ultrasound-guided hip arthroscopy portal placement are the lack of radiation exposure to the patient and operating room personnel, direct visualization of the hip joint and surrounding soft-tissue structures, and lack of bulky fluoroscopic equipment in the operative field. We describe a detailed technique incorporating video examples using ultrasound guidance to establish appropriate portal sites for hip arthroscopy with the aim to improve safety and overall operator competence.

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Fresh Precut Osteochondral Allograft Core Transplantation for the Treatment of Capitellum Osteochondritis Dissecans.

Project description:Osteochondritis dissecans (OCD) of the elbow is a disease of unclear etiology that affects young children and adolescents, particularly overhead athletes and gymnasts. Common surgical options include fixation, debridement, loose body removal, and marrow stimulation (microfracture/drilling). For large, deep, and/or uncontained defects, osteochondral autograft transplantation (OAT) has been advocated. However, there are some drawbacks to OAT, particularly related to donor-site morbidity. Fresh osteochondral allograft (OCA) transplantation avoids the donor-site morbidity associated with OAT and has been shown to be effective for treating capitellar OCD. This Technical Note details a surgical technique of OCA transplantation of the capitellum in an adolescent patient using a fresh precut OCA core. This procedure addresses the cartilage defect and loss of subchondral bone associated with OCD without the drawbacks associated with harvesting an autograft. Furthermore, as the graft is readily available, it avoids delays related to the donor-recipient matching process.

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Top 50 Most-Cited Studies about Osteochondritis Dissecans.

Project description:PurposeTo determine the 50 most frequently cited studies on osteochondritis dissecans (OCD) and to conduct a bibliometric analysis of these studies.MethodsWe performed a search within the Clarivate Web of Science database, identifying articles published before December 2022 that encompass topics related to OCD. The search was conducted using the keywords "Osteochondritis Dissecans OR Osteochondritis OR Dissecans."Search results were then filtered using predetermined guidelines and criteria, and the 50 most-cited articles were selected for analysis. Extracted data included title, journal, design, main topic, joint, citations, year, country of origin, and level of evidence.ResultsThe search yielded 3,865 articles. The 50 most-cited articles were published between 1957 and 2018, with the greatest proportion published from 2000 to 2009 (60%). The most frequently studied topic was treatment (68%), followed by etiology (14%) and imaging (8%). The majority of articles had Level IV evidence (36%) and the largest proportion focused on the knee joint (36%), followed by the ankle (32%), and elbow (6%). The mean citation count per article was 287 (range: 157-1,050), with the most-cited articles primarily published from 2000 to 2003. The leading country of origin was the United States, accounting for 19 publications.ConclusionsMost of the top 50 most-cited articles regarding OCD are about treatment, and the knee is the most-studied joint. The majority of the articles were Level IV evidence and were published in the United States between 2000 and 2009.Clinical relevanceThe top 50 most-cited studies list will provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions regarding osteochondritis dissecans (OCD).

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All-Arthroscopic Suture Fixation of Patellar Osteochondritis Dissecans.

Project description:Osteochondritis dissecans of the knee, despite its cause, is characterized by the impairment of the subchondral bone. Failure of its spontaneous healing makes surgical fixation often necessary. The patella is less affected than other locations in the knee. Its surgical treatment remains a challenge due to the thickness of the lesion and the complex approach of the retropatellar cartilage. Arthroscopy has the theoretical advantage to avoid a possible arthrotomy; however, the retrograde application of fixation materials does not guarantee good fragment compression and may lead to cartilage penetration and damage. The purpose of this Technical Note is to present a reproducible, full arthroscopic suture fixation technique for patellar osteochondritis dissecans lesions. By using the posterior cruciate tibial drill guide, absorbable sutures are passed through the center and the peripheral borders of the lesion resulting in a "spider-parachute-type" fixation with direct fragment compression.

| S-EPMC5621503 | biostudies-literature

Arthroscopic Treatment of Capitellum Osteochondritis Dissecans With Micronized Allogeneic Cartilage Scaffold.

Project description:Osteochondritis dissecans (OCD) of the capitellum is a common disorder that causes pain and functional limitation in the adolescent elbow. Although conservative management is the first line of treatment, surgical intervention is usually recommended for patients with persistent mechanical symptoms, loose bodies, or unstable lesions. Elbow arthroscopy has become the gold standard to evaluate and treat symptomatic OCD lesions. Arthroscopic debridement and bone marrow stimulation have been shown to yield good short-term results. Unfortunately, long-term follow-up has shown less favorable outcomes, with degenerative changes frequently documented. Current marrow stimulation techniques promote the formation of fibrocartilage, which is known to be less durable than hyaline cartilage. We describe an arthroscopic technique of debridement and drilling supplemented with a micronized allogeneic cartilage scaffold to address OCD lesions of the capitellum in an effort to promote hyaline cartilage formation.

| S-EPMC5496118 | biostudies-other

Arthroscopic Microfracture for Osteochondritis Dissecans Lesions of the Capitellum.

Project description:Capitellar osteochondritis dissecans (OCD) is one of the most common causes of elbow pain and dysfunction in adolescent athletes. It typically occurs in gymnasts and overhead throwers and presents along a wide spectrum of severity. Stable lesions can typically be treated with conservative therapy; however, those presenting with instability, fragmentation, or loose bodies generally require surgical intervention. Although there are a number of described surgical options used to treat capitellar OCD lesions, microfracture is one of the most commonly performed and well studied. Patients who are candidates for microfracture generally have favorable outcomes with high rates of return to athletic activity after postoperative rehabilitation. In this work, we present our preferred arthroscopic technique for microfracture of OCD lesions of the capitellum. This technique is most suitable for patients with unstable or fragmented OCD lesions that are less than 1 cm in diameter and do not violate the lateral-most articular margin of the capitellum.

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