Osteochondritis Dissecans: Ten Years After Autologous Chondrocyte Transplantation

Osteochondritis dissecans is defined as a necrosis that affects the bone and cartilage of the joints. It is located in a segment of the bone tissue adjacent to the joint. The joint fragment may not consolidate correctly, resulting in a free fragment that can lead to premature osteoarthritis. It most often occurs in the knee, elbow, or ankle of the school-age child or adolescent. It usually presents with pain that worsens with exercise. There may be crepitus, contracture, or locking of the joint in advanced cases, especially if there is a loose piece of bone or cartilage in the joint. This article presents a clinical case of a 32-year-old male patient who underwent autologous chondrocyte auto transplantation 10 years ago and currently presents with pain and functional limitation of the knee.

Ostoechondritis dissecan (OCD) is defined as osteonecrosis of the subchondral bone. Specifically, it is a localized injury in which a segment of subchondral bone and articular cartilage separates from the underlying bone, leaving a stable or unstable fragment that can lead to early osteoarthritis. The cause is often unknown. Proposed etiologies include repetitive microtrauma, vascular insufficiency around cartilage, local ischemia after focal injury, and genetic predisposition. The juvenile type is associated with a high level of activity in children and adolescents of school age, favoring repetitive trauma as the main mechanism. With the initial trauma, a focal area of bone necrosis and collapse develops, which can lead to cartilage damage. As the injury progresses, areas of demineralization and repeated loading forces cause detachment of adjacent tissue.

 It can also develop after an isolated injury, such as inversion of the ankle or a direct blow to the knee or elbow. OCD injuries of the elbow are thought to be due, at least in part, to chronic valgus strain of the elbow that compromises the tenuous blood supply to the capitellum and chronic compressive microtrauma during overhead activities like throwing, gymnastics. OCD injuries are a rare cause of joint pain. Depending on age, men are two to four times more likely to be affected than women. In children, the global prevalence of OCD lesions, especially in the knee, is estimated to be 15 to 29 per 100,000 patients. According to a large observational study, the overall incidence of the pediatric disease is 9.5 per 100,000, with the highest incidence in patients 12 to 19 years of age. In adults 20 to 45 years of age, the incidence of OCD is approximately 3.4 per 100,000 perso.

https://www.stephypublishers.com/sojor/pdf/SOJOR.MS.ID.000504.pdf

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