Osteochondritis Dissecans in a Female Soccer Player
Osteochondritis Dissecans in a Female Soccer Player
The adolescent patient in this study had a 6-year history of OCD involving 5 joints. She had a history of recurrent trauma during soccer practice, and this may have been a cause of OCD in this patient. Although cases with multiple OCD lesions have been previously reported, it is unknown why some patients develop OCD at multiple locations.
Surgical treatment frequently is indicated for OCD, depending on the age of the patient, stage of the lesion, size of the defect, and quality of the articular cartilage. In a retrospective multicenter study that evaluated different therapies for OCD at the knee joint, early diagnosis of OCD and treatment with temporary non–weight-bearing and transchondral perforation (microfracture, drilling, and abrasion arthroplasty) gave good results in children. The OCD fragment may be left in place and a loose body may be reattached. If this is impossible, osteochondral grafting may be preferred, but autologous chondrocyte transplantation and other less invasive cartilage regenerative methods may be considered.
In the present case, the first metatarsal head epiphysis was closed and the OCD fragment was small and not attached. Although nonoperative treatment had been considered, the patient had requested surgical treatment of the first MP joint because of previous satisfactory results with surgery at the knees and elbows. Cartilage transplantation methods also have been reported for the first MP joint, but further study is necessary to clarify the indications for this procedure. Further investigation to clarify the pathogenesis of OCD may lead to the development of less invasive therapies that may decrease the risk of degenerative arthritis resulting from this condition.
Discussion
The adolescent patient in this study had a 6-year history of OCD involving 5 joints. She had a history of recurrent trauma during soccer practice, and this may have been a cause of OCD in this patient. Although cases with multiple OCD lesions have been previously reported, it is unknown why some patients develop OCD at multiple locations.
Surgical treatment frequently is indicated for OCD, depending on the age of the patient, stage of the lesion, size of the defect, and quality of the articular cartilage. In a retrospective multicenter study that evaluated different therapies for OCD at the knee joint, early diagnosis of OCD and treatment with temporary non–weight-bearing and transchondral perforation (microfracture, drilling, and abrasion arthroplasty) gave good results in children. The OCD fragment may be left in place and a loose body may be reattached. If this is impossible, osteochondral grafting may be preferred, but autologous chondrocyte transplantation and other less invasive cartilage regenerative methods may be considered.
In the present case, the first metatarsal head epiphysis was closed and the OCD fragment was small and not attached. Although nonoperative treatment had been considered, the patient had requested surgical treatment of the first MP joint because of previous satisfactory results with surgery at the knees and elbows. Cartilage transplantation methods also have been reported for the first MP joint, but further study is necessary to clarify the indications for this procedure. Further investigation to clarify the pathogenesis of OCD may lead to the development of less invasive therapies that may decrease the risk of degenerative arthritis resulting from this condition.
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