Osteochondritis dissecans
Etiologia i przyczyny
Osteochondritis dissecans (OCD) to schorzenie stawowe charakteryzujące się aseptycznym oddzieleniem fragmentu podchrzęstnej kości wraz z chrząstką, wynikającym z zaburzenia miejscowego ukrwienia. Etiologia OCD jest wieloczynnikowa, z dominującą rolą powtarzających się mikrourazów, szczególnie u młodych sportowców, które prowadzą do niedokrwienia i martwicy kości podchrzęstnej. Najczęstszą lokalizacją zmian jest przyśrodkowy kłykieć kości udowej, gdzie mechaniczne przeciążenia i rotacje wewnętrzne piszczeli sprzyjają rozwojowi choroby. Czynniki genetyczne, takie jak mutacje genu ACAN kodującego agrekan, oraz zaburzenia endokrynne i metaboliczne (np. niedobór witaminy D, zaburzenia wapniowo-fosforanowe) również zwiększają podatność na OCD. Nieprawidłowości anatomiczne, w tym dyskoidalne łąkotki, koślawość kolan i uszkodzenia więzadeł, modyfikują biomechanikę stawu, co sprzyja powstawaniu zmian. OCD występuje najczęściej u dzieci i młodzieży w wieku 10-20 lat, z częstością 15-29/100 000, częściej u chłopców, choć wzrasta u dziewcząt.
Etiologia Osteochondritis dissecans
Osteochondritis dissecans (OCD) to schorzenie stawowe, które charakteryzuje się aseptycznym oddzieleniem fragmentu podchrzęstnej kości wraz z pokrywającą ją chrząstką w wyniku zaburzenia miejscowego ukrwienia. Dokładna etiologia tej choroby pozostaje niejasna, jednak badacze wskazują na wieloczynnikowe pochodzenie, w którym istotną rolę odgrywają czynniki mechaniczne, naczyniowe, genetyczne oraz biologiczne.123
Czynniki mechaniczne
Teorie mechaniczne były historycznie najczęściej badane jako główne przyczyny OCD. Urazy mechaniczne wydają się odgrywać kluczową rolę, szczególnie w przypadku młodych sportowców. Powtarzające się mikrourazy stawu mogą doprowadzić do zaburzenia ukrwienia podchrzęstnej kości.12
Najczęstszą lokalizacją zmian OCD jest przyśrodkowa kłykieć kości udowej od strony tylno-przyśrodkowej, co może wskazywać na pośredni mechanizm urazowy. Powtarzający się nacisk na niedojrzałe stawy kolanowe oraz na kolec piszczelowy na bocznej części przyśrodkowego kłykcia kości udowej podczas rotacji wewnętrznej piszczeli może przyczyniać się do rozwoju OCD.12
Teoria mikrourazowa dotycząca OCD ma największy poziom dowodów naukowych. Początkowym czynnikiem jest uderzenie między przyśrodkowym kłykciem kości udowej a przednim kolcem piszczelowym. Kolejne badania potwierdziły, że powtarzające się urazy lub mikrourazy, szczególnie podczas uprawiania sportu, są jedną z głównych przyczyn OCD.12
Niezależnie od tego, czy mamy do czynienia z pojedynczym znaczącym urazem, czy wieloma mniejszymi, niewykrytymi epizodami urazowymi, mechaniczne uszkodzenie kości wydaje się być istotnym czynnikiem w patogenezie OCD.12
Czynniki naczyniowe
Zaburzenia ukrwienia i miejscowe niedokrwienie są uważane za potencjalną przyczynę OCD. Ograniczony dopływ krwi do kości podchrzęstnej prowadzi do jej martwicy (avascular necrosis), co skutkuje osłabieniem i oddzieleniem fragmentu kostno-chrzęstnego.12
Anatomia naczyniowa kości podchrzęstnej charakteryzuje się niskimi anastomozami tętniczymi, co predysponuje do urazu niedokrwiennego. Niedokrwienie może być spowodowane skurczem naczyniowym, zatorami tłuszczowymi, zakażeniem lub zakrzepicą.12
W OCD dochodzi do zaburzenia dopływu krwi do określonego obszaru kości, co prowadzi do jej martwicy i w konsekwencji do oddzielenia fragmentu kostno-chrzęstnego. Niedokrwienie zwykle występuje w połączeniu z urazami, co wskazuje na współzależność czynników mechanicznych i naczyniowych.12
Czynniki genetyczne
Coraz więcej dowodów wskazuje na rolę czynników genetycznych w rozwoju OCD. Występowanie przypadków rodzinnych oraz zwiększone ryzyko OCD u bliźniąt jednojajowych sugeruje, że predyspozycje dziedziczne są istotne w etiologii tej choroby.12
Rodzinna osteochondritis dissecans jest związana z mutacją genu ACAN, który koduje agrekan – białko budujące chrząstkę. Mutacja ta powoduje, że powstająca chrząstka jest słaba lub zdezorganizowana.12
Rodziny z OCD mogą mieć mutacje w genie agrekanu, co skutkuje nieprawidłowym przyłączaniem się białka do innych składników chrząstki. Osoby z rodzinną postacią OCD często charakteryzują się niskim wzrostem i wczesnym początkiem choroby zwyrodnieniowej stawów.12
Liczne warianty genu ACAN z dziedziczeniem autosomalnym dominującym, wpływające na powtórzenie lektyny typu C agrekanu (gen 15q), powodują rzadką formę dziedzicznej osteochondritis dissecans.1
Czynniki endokrynne i metaboliczne
Badacze wskazują również na rolę czynników endokrynnych i metabolicznych w rozwoju OCD. Niedobór witaminy D został powiązany ze zmianami osteochondritis dissecans w stawie kolanowym wśród młodych dorosłych.12
Zaburzenia równowagi wapniowo-fosforanowej oraz nieprawidłowe procesy kostnienia mogą również przyczyniać się do rozwoju OCD. Niedobory żywieniowe i zaburzenia metaboliczne mogą wpływać na integralność tkanki kostnej i chrzęstnej.12
Zwiększony wskaźnik masy ciała (BMI) jest związany z cięższymi zmianami: obrzękiem podchrzęstnym i zmianami w przyśrodkowo-przedniej części kłykcia kolana.1
Czynniki rozwojowe
OCD często występuje w okresie intensywnego wzrostu u dzieci i młodzieży, co sugeruje, że procesy związane z rozwojem kości mogą mieć wpływ na podatność na tę chorobę.12
Nieprawidłowe ośrodki kostnienia, powszechne u dzieci w okresach szybkiego wzrostu, zostały wskazane jako potencjalne czynniki predysponujące do rozwoju zmian OCD. Postuluje się, że dodatkowa wyspa kostna częściowo przyłącza się z czasem.1
Inna teoria sugeruje zaangażowanie endochondralnej nasadowej płytki wzrostu, która może zostać uszkodzona ostro lub powtarzalnie w czasie. Podczas gdy niezraniony region endochondralnej nasadowej płytki wzrostu kontynuuje kostnienie, uszkodzony region, tymczasowo lub trwale, przestaje ulec kostnieniu, prowadząc do rozwoju OCD.1
Czynniki anatomiczne
Nieprawidłowości anatomiczne mogą również przyczyniać się do rozwoju OCD. Dyskoidalne łąkotki i ustawienie koślawe zostały wskazane jako czynniki ryzyka OCD kłykcia bocznego kości udowej.1
Inne czynniki anatomiczne obejmują osłabienie więzadeł oraz koślawość/szpotawość kolan (genu valgum/varum), które mogą zmieniać rozkład obciążeń w stawie i zwiększać ryzyko mikrourazów.1
Uszkodzenia łąkotek w stawie kolanowym również mogą przyczyniać się do rozwoju OCD poprzez zmianę biomechaniki stawu i zwiększenie nacisku na określone obszary powierzchni stawowej.1
Związek z aktywnością sportową
OCD jest często obserwowana u młodych sportowców, szczególnie tych uprawiających sporty o wysokim obciążeniu stawów.12
Rzucanie, czynności wykonywane z obciążeniem kończyny górnej nad głową są związane z OCD stawu łokciowego, co obserwuje się u miotaczy baseballowych, softballowych, krykieta, cheerleaderek i gimnastyczek.12
Zmiany w obrębie przyśrodkowej części bloczka kości skokowej są często wynikiem chorób naczyniowych i przewlekłej niestabilności kostki, natomiast zmiany po stronie bocznej bloczka są związane z ostrym urazem i uszkodzeniem więzadeł bocznych kostki.1
Zwiększona częstość występowania urazów przeciążeniowych u młodych sportowców rośnie i odpowiada za znaczną liczbę wizyt w podstawowej opiece zdrowotnej, co wzmacnia teorię, że OCD może być związana ze zwiększonym udziałem w sporcie i późniejszymi urazami.1
Wieloczynnikowa natura OCD
Aktualny stan wiedzy wskazuje, że etiologia OCD jest wieloczynnikowa, a różne mechanizmy mogą prowadzić do tego samego obrazu klinicznego.123
Prawdopodobnie najczęstszą przyczyną jest powtarzający się mikrouraz, szczególnie u młodych sportowców, który prowadzi do zaburzenia ukrwienia kości podchrzęstnej. To zaburzenie ukrwienia skutkuje martwicą obszaru kości i w konsekwencji oddzieleniem fragmentu kostno-chrzęstnego.12
Czynniki genetyczne, endokrynne i rozwojowe mogą zwiększać podatność na rozwój OCD, szczególnie w przypadku rodzinnej postaci choroby. Nieprawidłowości anatomiczne i biomechaniczne mogą dodatkowo przyczyniać się do powstania zmian OCD poprzez zmianę rozkładu obciążeń w stawie.12
Ostatecznie, teoria mikrourazowa odgrywa centralną rolę w etiopatogenezie OCD, pomimo jej wieloczynnikowej natury. Zrozumienie złożonej interakcji między czynnikami mechanicznymi, naczyniowymi, genetycznymi i biologicznymi jest kluczowe dla opracowania skutecznych strategii profilaktycznych i terapeutycznych.1
Różnice między postacią młodzieńczą i dorosłą
Etiologia OCD może różnić się w zależności od wieku pacjenta. U młodzieży przyczyny upatruje się bardziej w urazach niż w martwicy naczyniowej.1
U dorosłych uważa się, że główną lub być może jedyną przyczyną jest uraz, który może być endogenny, egzogenny lub oba. Wielu badaczy uważa, że postać dorosła jest niezdiagnozowaną, przetrwałą młodzieńczą postacią OCD.12
Zmiany OCD u pacjentów z zamkniętymi płytkami wzrostowymi mają gorsze rokowanie i są mniej podatne na wyleczenie w porównaniu do zmian u pacjentów z otwartymi płytkami wzrostowymi.1
Młodsi pacjenci z małymi, stabilnymi zmianami w przyśrodkowym kłykciu kości udowej mają najlepsze rokowanie. Natomiast niestabilne zmiany mogą się goić po stabilizacji, jednak długoterminowe rokowanie nie jest jasne.1
Przewlekłe luźne fragmenty mogą być trudne do naprawy i mają tendencję do słabego gojenia. Usunięcie dużych zmian ze stref obciążenia również daje słabe wyniki.1
Różnice w występowaniu i rozpowszechnieniu
OCD występuje najczęściej u dzieci i młodzieży w wieku od 10 do 20 lat, ze szczególnym nasileniem w okresie dojrzewania.12
Choroba dotyka częściej chłopców niż dziewczęta, choć częstość występowania wzrasta u kobiet i dziewcząt.12
Osteochondritis dissecans jest stosunkowo rzadkim schorzeniem, występującym u 15-29 osób na 100 000. Jest to najczęstsza przyczyna ciała wolnego w przestrzeni stawowej u pacjentów w wieku młodzieńczym.12
OCD może wystąpić w każdym stawie, ale najczęściej dotyczy stawu kolanowego, łokciowego i skokowego. W stawie kolanowym najczęściej zajmuje przyśrodkowy kłykieć kości udowej.12
W 10% przypadków obserwuje się rodzinne występowanie OCD, co wspiera teorię o genetycznym podłożu choroby.1
Podsumowanie etiologii OCD
Osteochondritis dissecans to złożona choroba o wieloczynnikowej etiologii, w której kluczową rolę odgrywają zaburzenia ukrwienia kości podchrzęstnej prowadzące do jej martwicy i oddzielenia fragmentu kostno-chrzęstnego.12
Najczęściej przyjmowaną teorią jest powtarzający się mikrouraz stawu, który w połączeniu z innymi czynnikami, takimi jak predyspozycje genetyczne, zaburzenia endokrynne, nieprawidłowości anatomiczne oraz czynniki rozwojowe, prowadzi do rozwoju zmian OCD.12
Zrozumienie złożonej interakcji między różnymi czynnikami etiologicznymi jest kluczowe dla opracowania skutecznych strategii profilaktycznych i terapeutycznych, które mogą zapobiegać długoterminowym konsekwencjom OCD, takim jak wczesne zmiany zwyrodnieniowe stawu.12
Dalsze badania są niezbędne do pełnego wyjaśnienia etiologii OCD i opracowania ukierunkowanych interwencji, które mogą zapobiegać rozwojowi tej choroby u osób z grupy ryzyka, szczególnie młodych sportowców.12
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Materiały źródłowe
- #1 Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint – PMC Lockhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6139592/
Osteochondritis dissecans (OCD) is a common cause of knee disorder among skeletally immature and adult patients and it occurs when a small piece of subchondral bone begins to separate from its surrounding area due to a disturbance of the local blood supply. […] The etiology of OCD lesions remains unclear and is characterized by an aseptic necrosis in the subchondral bone area. Mechanical factors seem to play an important role. […] One may divide the OCD etiology into 4 different possible causes; traumatic, ischemic, hereditary, and idiopathic. However, etiology of multifactorial origin is the most probable cause. […] Trauma: Probably caused by indirect trauma as seen on the most common OCD lesion, the posteromedial medial femoral condylar position. Repetitive stress to immature knees and on the tibial spine on the lateral aspect of the medial femoral condyle during internal rotation of the tibia may contribute to the development of human OCD. […] Ischemia: Poor vascularity and induced ischemia have been described as a potential cause of OCD. […] Genetics: Several authors have investigated a potential genetic link for OCD but still genetic and developmental factors in the development of OCD remain relatively unstudied.
- #1 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviewshttps://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee
Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis. […] According to the most recent literature, the etiology appears to be multifactorial and includes biological factors (eg. genetic predisposition, deficiency of ossification centers, disorders in blood supply and endocrine disorders such as vitamin D deficiency) and mechanical factors (eg. repetitive microtrauma, discoid meniscus, meniscus anterior horn instability, anterior tibial spine impingment). […] The microtraumatic theory of OCD is the one with the highest level of evidence. […] The initial factor is the impingment between the medial femoral condyle and anterior tibial spine. […] Subsequent studies have demonstrated the idea of the repetitive trauma or microtrauma, especially during sports as one of the principal underlying cause of OCD.
- #1 Osteochondritis dissecans – Symptoms and causes – Mayo Clinichttps://www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/symptoms-causes/syc-20375887
Osteochondritis dissecans occurs most often in children and adolescents. […] The cause of osteochondritis dissecans is unknown. The reduced blood flow to the end of the affected bone might result from repetitive trauma small, multiple episodes of minor, unrecognized injury that damage the bone. There might be a genetic component, making some people more inclined to develop the disorder.
- #1https://pmc.ncbi.nlm.nih.gov/articles/PMC9900014/
Osteochondritis dissecans (OCD) is a disease of unknown etiology involving the osteochondral unit of the joint. […] The precise cause of OCD remains unclear, although a number of etiological theories have been proposed. […] Mechanical, biological, hereditary, and anatomical factors are all speculated to play a role in the development of this disease, whose origin can therefore be considered multifactorial. […] Mechanical factors have historically been investigated as primarily responsible for the occurrence of OCD of the knee. […] This theory predicts a single major traumatic event or multiple smaller but repeated micro-traumatic events as the main cause. […] Local ischemia has been proposed as another causative factor for OCD. […] The vascular anatomy of subchondral bone is characterized by low arteriole anastomoses predisposing to ischemic insult.
- #1 Osteochondritis dissecans: Causes, symptoms, and treatmenthttps://www.medicalnewstoday.com/articles/166764
Osteochondritis dissecans occurs when a fragment of bone in a joint separates from the rest of the bone because its blood supply is faulty, and there is not enough blood to maintain it. […] The exact cause is not fully understood. However, healthcare professionals believe the condition to have a variety of causes, that may include: […] Repeated stress to the bone or joint: Osteochondritis dissecans is common in young athletes, which implies that repetitive trauma is a possible cause. […] Ischemia: A restriction of blood supply starves the bone of essential nutrients. The restricted blood supply is usually caused by some problem with blood vessels, or vascular problems. The bone undergoes avascular necrosis, a deterioration caused by lack of blood supply. Ischemia usually occurs in conjunction with a history of trauma. […] Genetic factors: Osteochondritis dissecans sometimes affects more than one family member. This may indicate an inherited genetic susceptibility.
- #1https://pmc.ncbi.nlm.nih.gov/articles/PMC9900014/
Mechanical and vascular factors therefore play an important role in the etiopathogenesis of OCD; however, the presence of family cases with high risk of OCD in monozygotic twins suggests that hereditary factors are likewise crucial. […] Other biological theories refer to endocrine factors, but the effective role of the intra-articular biochemical environment and endocrine patterns is not still defined.
- #1 Osteochondritis Dissecans (OCD): Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/21073-osteochondritis-dissecans
Osteochondritis dissecans (OCD) happens when a section of bone and cartilage in one of your joints loses its blood supply. This makes that piece soft and weak. Eventually, the affected section of bone might break loose. […] Osteochondritis dissecans affects the end of one bone in a joint. It cuts off blood supply to a section of the bone which makes it soften and weaken. Eventually, the affected section of bone dies and separates from the rest of your bone. […] Researchers are still studying sporadic osteochondritis dissecans and haven’t been able to find or prove one single cause. Because it’s more common in athletes, experts think repeated stress on a joint may cause OCD. […] Familial osteochondritis dissecans is caused by a genetic change. A change in the ACAN gene causes familial OCD. The ACAN gene carries the code for your body to make a cartilage-building protein called aggrecan. The mutation causes your aggrecan to build weak or disorganized cartilage.
- #1 Osteochondritis dissecans – Wikipediahttps://en.wikipedia.org/wiki/Osteochondritis_dissecans
In adults, trauma is thought to be the main or perhaps the sole cause, and may be endogenous, exogenous or both. […] The incidence of repetitive strain injury in young athletes is on the rise and accounts for a significant number of visits to primary care; this reinforces the theory that OCD may be associated with increased participation in sports and subsequent trauma. […] Recent case reports suggest that some people may be genetically predisposed to OCD. […] Families with OCD may have mutations in the aggrecan gene.
- #1 Osteochondritis Dissecans | PM&R KnowledgeNowhttps://now.aapmr.org/osteochondritis-dessicans/
Multiple missense ACAN gene variants with autosomal dominant inheritance, affect the C-type lectin repeat of aggrecan (15q gene) and cause a rare form of hereditary osteochondritis dissecans. ACAN missense gene variants are often demonstrate short stature and early osteoarthritis. […] Recent studies have shown that Vitamin D deficiency was associated with knee osteochondritis dissecans lesions among the young adult population. […] Increased BMI is associated with more severe lesions: subchondral edema, anteromedial condylar lesions of the knee. […] Discoid menisci and valgus alignment have been shown to be a risk factor for lateral femoral condyle OCD. […] Overhead throwing and upper limb weightbearing is associated with OCD of the elbow, as seen in baseball pitches, softball pitchers, cheerleaders, cricket bowlers, cheerleaders, female gymnastics. […] Medial talar dome lesions are often the result of vascular disease and chronic ankle instability lesions, lateral talar dome is associated with acute trauma and lateral ankle ligament injury.
- #1 Osteochondritis dissecans – Wikipediahttps://en.wikipedia.org/wiki/Osteochondritis_dissecans
Osteochondritis dissecans (OCD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. […] OCD is caused by blood deprivation of the secondary physes around the bone core of the femoral condyle. This happens to the epiphyseal vessels under the influence of repetitive overloading of the joint during running and jumping sports. […] Despite much research, the causes remain unclear but include repetitive physical trauma, ischemia (restriction of blood flow), hereditary and endocrine factors, avascular necrosis (loss of blood flow), rapid growth, deficiencies and imbalances in the ratio of calcium to phosphorus, and problems of bone formation. […] Trauma, rather than avascular necrosis, is thought to cause osteochondritis dissecans in juveniles.
- #1 Osteochondritis Dissecans (OCD) | Boston Children’s Hspitalhttps://www.childrenshospital.org/conditions/osteochondritis-dissecans
Osteochondritis dissecans is often caused by sports that put repeated stress on the joint. Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. Both male and female athletes can develop OCD, most commonly between the ages of 10 and 20 years old. […] Young athletes involved in high-impact sports can sustain an osteochondritis dissecans injury from motions that put repetitive stress on the joint.
- #1 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFPhttps://www.aafp.org/pubs/afp/issues/2000/0101/p151.html
Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. […] OCD is a relatively rare disorder, characterized by a focal area of subchondral bone that undergoes necrosis. […] Many researchers believe that the adult form is undiagnosed persistent juvenile OCD. […] Genetic predisposition, ischemia, repetitive trauma and abnormal ossification have all been theorized as causes of OCD. […] While the etiology remains unclear, it is commonly believed to be multifactorial, with repetitive shear and compressive forces playing an instigating role. […] Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role. […] Abnormal ossification centers, common in children during rapid periods of growth, have been implicated as precursors to the development of OCD lesions. […] It is postulated that an accessory bony island partially reattaches over time.
- #1 Osteochondritis Dissecans | PM&R KnowledgeNowhttps://now.aapmr.org/osteochondritis-dessicans/
In 1888, Knig first described OCD and at the time suggested inflammation as the cause of these lesions. The exact pathophysiology is unknown; however, a disruption of blood supply to subchondral bone is thought to be the underlying mechanism for OCD. Proposed causes include localized avascular necrosis, ossification center deficit, chronic microtrauma or acute trauma, joint malalignment (genu varum), and genetic predisposition, among other causes. Other considerations include systemic vasculopathies, inflammation, endocrine or metabolic factors, and degenerative joint disease. The most commonly accepted cause of osteochondritis dissecans is repetitive trauma. […] Another explanation is involvement of the endochondral epiphyseal growth plate, which can be injured either acutely or repetitively over time. While the uninjured region of the endochondral epiphyseal growth plate continues to ossify, the injured region, either temporarily or permanently, ceases ossification, leading to development of OCD.
- #1 Osteochondritis Dissecans (Causes, Symptoms, and Treatment)https://patient.info/doctor/osteochondritis-dissecans
Osteochondritis dissecans may lead to secondary effects on joint cartilage, such as pain, oedema, possible formation of free bodies and mechanical symptoms, including joint locking. OCD may lead to degenerative changes if left untreated. […] The cause of osteochondritis dissecans is unknown. […] Trauma (about half of cases). […] Male sex (although incidence is increasing in women and girls). […] Overuse due to sporting activity. […] Familial pattern in about 10% of cases. […] Ligamentous weakness. […] Genu valgum/varum. […] Meniscal lesions in the knee. […] Osteochondritis dissecans prognosis depends on the age of the patient, the affected joint and the stage of the lesion at presentation. […] Younger patients with small, stable medial femoral condylar lesions have the best prognosis. […] Unstable lesions can heal after stabilisation; however, long-term prognosis is not clear. Chronic loose fragments can be difficult to fix and tend to heal poorly. […] Excision of large lesions from weight-bearing zones also tend to give poor results.
- #1 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviewshttps://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee
Other theories proposed are local ischemia: in fact, the subchondral bone has a vascularization susceptible to ischemia that is responsible of bone necrosis. […] Endocrine theories see vitamin D deficiency implicated in the etiopathogenesis of OCD. […] Some authors have suggested a familial inheritance in the etiology of OCD with reports of familial case and increased incidence in monozygotic twins, suggesting implication of genetic loci involved in cartilage turnover. […] Ultimately, the microtraumatic theory plays a central role in the etiopathogenesis of the OCD, despite being a multifactorial pathology.
- #1 Osteochondritis Dissecans of the Knee : Wheeless’ Textbook of Orthopaedicshttps://www.wheelessonline.com/joints/osteochondritis-dissecans-of-the-knee/
– etiology: repetitive overloading causing fragmention and separation of bony fragment; […] – skeletally immature patients have better prognosis and will frequently heal w/ non-op treatment if frag has not detached; […] – lesions occurring after growth plate closure have worse prognosis are not likely to heal; […] – bad prognosis if frag detaches, leaving defect in wt bearing region; […] – juvenile osteochondritis dissecans of the knee: etiology.
- #1 Osteochondritis Dissecans Treatment at Children’s Mercy | Children’s Mercy Kansas Cityhttps://www.childrensmercy.org/departments-and-clinics/orthopedics/sports-medicine/injury-management/osteochondritis-dissecans/
Osteochondritis dissecans, or OCD, is an articular cartilage defect that develops most often in adolescents. […] No one knows exactly what causes OCD. Some think it may be the result of trauma to the joint, while others suspect it may be a genetic defect. The resulting damage is believed to be caused by an interruption in blood flow to a portion of bone. […] In the case of OCD, tissue samples from more than 500 patients will be sequenced to determine if there is a possible genetic connection that may one day identify the defect and better inform treatment options.
- #2https://pmc.ncbi.nlm.nih.gov/articles/PMC9900014/
Osteochondritis dissecans (OCD) is a disease of unknown etiology involving the osteochondral unit of the joint. […] The precise cause of OCD remains unclear, although a number of etiological theories have been proposed. […] Mechanical, biological, hereditary, and anatomical factors are all speculated to play a role in the development of this disease, whose origin can therefore be considered multifactorial. […] Mechanical factors have historically been investigated as primarily responsible for the occurrence of OCD of the knee. […] This theory predicts a single major traumatic event or multiple smaller but repeated micro-traumatic events as the main cause. […] Local ischemia has been proposed as another causative factor for OCD. […] The vascular anatomy of subchondral bone is characterized by low arteriole anastomoses predisposing to ischemic insult.
- #2 Osteochondritis dissecans – Wikipediahttps://en.wikipedia.org/wiki/Osteochondritis_dissecans
Osteochondritis dissecans (OCD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. […] OCD is caused by blood deprivation of the secondary physes around the bone core of the femoral condyle. This happens to the epiphyseal vessels under the influence of repetitive overloading of the joint during running and jumping sports. […] Despite much research, the causes remain unclear but include repetitive physical trauma, ischemia (restriction of blood flow), hereditary and endocrine factors, avascular necrosis (loss of blood flow), rapid growth, deficiencies and imbalances in the ratio of calcium to phosphorus, and problems of bone formation. […] Trauma, rather than avascular necrosis, is thought to cause osteochondritis dissecans in juveniles.
- #2 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviewshttps://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee
Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis. […] According to the most recent literature, the etiology appears to be multifactorial and includes biological factors (eg. genetic predisposition, deficiency of ossification centers, disorders in blood supply and endocrine disorders such as vitamin D deficiency) and mechanical factors (eg. repetitive microtrauma, discoid meniscus, meniscus anterior horn instability, anterior tibial spine impingment). […] The microtraumatic theory of OCD is the one with the highest level of evidence. […] The initial factor is the impingment between the medial femoral condyle and anterior tibial spine. […] Subsequent studies have demonstrated the idea of the repetitive trauma or microtrauma, especially during sports as one of the principal underlying cause of OCD.
- #2 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviewshttps://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee
Other theories proposed are local ischemia: in fact, the subchondral bone has a vascularization susceptible to ischemia that is responsible of bone necrosis. […] Endocrine theories see vitamin D deficiency implicated in the etiopathogenesis of OCD. […] Some authors have suggested a familial inheritance in the etiology of OCD with reports of familial case and increased incidence in monozygotic twins, suggesting implication of genetic loci involved in cartilage turnover. […] Ultimately, the microtraumatic theory plays a central role in the etiopathogenesis of the OCD, despite being a multifactorial pathology.
- #2 Osteochondritis Dissecans (OCD): Symptoms & Treatmenthttps://my.clevelandclinic.org/health/diseases/21073-osteochondritis-dissecans
Osteochondritis dissecans (OCD) happens when a section of bone and cartilage in one of your joints loses its blood supply. This makes that piece soft and weak. Eventually, the affected section of bone might break loose. […] Osteochondritis dissecans affects the end of one bone in a joint. It cuts off blood supply to a section of the bone which makes it soften and weaken. Eventually, the affected section of bone dies and separates from the rest of your bone. […] Researchers are still studying sporadic osteochondritis dissecans and haven’t been able to find or prove one single cause. Because it’s more common in athletes, experts think repeated stress on a joint may cause OCD. […] Familial osteochondritis dissecans is caused by a genetic change. A change in the ACAN gene causes familial OCD. The ACAN gene carries the code for your body to make a cartilage-building protein called aggrecan. The mutation causes your aggrecan to build weak or disorganized cartilage.
- #2 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFPhttps://www.aafp.org/pubs/afp/issues/2000/0101/p151.html
Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. […] OCD is a relatively rare disorder, characterized by a focal area of subchondral bone that undergoes necrosis. […] Many researchers believe that the adult form is undiagnosed persistent juvenile OCD. […] Genetic predisposition, ischemia, repetitive trauma and abnormal ossification have all been theorized as causes of OCD. […] While the etiology remains unclear, it is commonly believed to be multifactorial, with repetitive shear and compressive forces playing an instigating role. […] Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role. […] Abnormal ossification centers, common in children during rapid periods of growth, have been implicated as precursors to the development of OCD lesions. […] It is postulated that an accessory bony island partially reattaches over time.
- #2 Osteochondritis Dissecans Brigham City, UT | Knee Joint Instability Tremonton, UThttps://www.orthoutah.org/osteochondritis-dissecans-of-the-knee-orthopaedic-surgeon-brigham-city-farr-west-malad-tremonton-ut/
Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. […] The exact cause for osteochondritis dissecans remains unknown and certain factors such as trauma, fractures, sprains or injury to the joint can increase the risk of developing the condition. Osteochondritis dissecans may be caused by restricted blood supply to the end of the affected bone that usually occurs in conjunction with repetitive trauma. […] The appearance of osteochondritis dissecans in several family members may indicate that the condition is inherited.
- #2 Osteochondritis dissecans – Wikipediahttps://en.wikipedia.org/wiki/Osteochondritis_dissecans
In adults, trauma is thought to be the main or perhaps the sole cause, and may be endogenous, exogenous or both. […] The incidence of repetitive strain injury in young athletes is on the rise and accounts for a significant number of visits to primary care; this reinforces the theory that OCD may be associated with increased participation in sports and subsequent trauma. […] Recent case reports suggest that some people may be genetically predisposed to OCD. […] Families with OCD may have mutations in the aggrecan gene.
- #2 Familial osteochondritis dissecans: MedlinePlus GeneticsLockhttps://medlineplus.gov/genetics/condition/familial-osteochondritis-dissecans/
Familial osteochondritis dissecans is a condition that affects the joints and is associated with abnormal cartilage. […] Mutation of the ACAN gene can cause familial osteochondritis dissecans. […] The ACAN gene mutation associated with familial osteochondritis dissecans results in an abnormal protein that is unable to attach to the other components of cartilage. […] Sporadic osteochondritis dissecans is not caused by genetic changes and is not inherited.
- #2 Osteochondritis Dissecans: Symptoms, Causes, Risk Factors, Treatmenthttps://www.healthline.com/health/osteochondritis
Osteochondritis dissecans (OCD) is a joint condition that occurs when bone separates from cartilage and starts to die. Its usually due to a lack of blood flow to the bone. […] Experts arent sure what causes OCD. However, it might be related to repeated, small injuries to the joint from high-impact activities. […] Some cases of OCD also have a genetic component. This is known as familial osteochondritis dissecans, which tends to affect multiple joints. People with familial osteochondritis dissecans are usually short and have early-onset osteoarthritis.
- #2https://pmc.ncbi.nlm.nih.gov/articles/PMC9900014/
Mechanical and vascular factors therefore play an important role in the etiopathogenesis of OCD; however, the presence of family cases with high risk of OCD in monozygotic twins suggests that hereditary factors are likewise crucial. […] Other biological theories refer to endocrine factors, but the effective role of the intra-articular biochemical environment and endocrine patterns is not still defined.
- #2 Osteochondritis dissecans – the development, causes and treatments of OCD | Trainer Magazine | European Trainer Article Indexhttps://trainermagazine.com/european-trainer-articles/2013/4/29/osteochondritis-dissecans-the-development-causes-and-treatments-of-ocd
Osteochondritis dissecans (OCD) is caused by a disruption of the normal growth process of bone. […] Many different parameters have been described as having an affect on the development of OCD. There is no apparent common denominator in OCD formation and the disease is multifactorial. Nutritional imbalances, trauma, rate of growth, biomechanical influences as well as genetic predisposition have all been documented as potential causes. […] Recent research on the relationship between nutrition and development of OCD have found multiple correlations. […] It is thought that a high mechanical load in areas of thickened cartilage where the blood supply is tenuous can lead to OCD due to traumatic causes. […] Research investigating a possible link between genetics and OCD development is ongoing. […] This again supports the claim that OCD is a multifactoral disease.
- #2 Osteochondritis Dissecans – OrthoInfo – AAOShttps://orthoinfo.aaos.org/en/diseases–conditions/osteochondritis-dissecans/
Osteochondritis dissecans (OCD) is a condition that develops in joints in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. […] It is not known exactly what causes the disruption to the blood supply and the resulting OCD. Doctors think it probably involves repetitive trauma or stresses to the bone over time.
- #2 Osteochondritis Dissecans (OCD)https://www.nationwidechildrens.org/conditions/osteochondritis-dissecans-ocd
The cause of Osteochondritis Dissecans is largely unknown but is thought to be caused by repetitive stress to the bone. […] There is a possible genetic (runs in families) link, but this has not been proven. […] OCD occurs in children, especially in pediatric athletes such as gymnasts and pitchers, who do repetitive motions, and those who participate in contact activities.
- #2 Osteochondritis Dissecans | St. Charles Healthhttps://www.thecenteroregon.com/pain-injury-services-elbow-pain-osteochondritis-dissecans-of-the-elbow/
Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. […] Repetitive high stress forces on the joint can result in a series of minor injuries on the elbow that can eventually lead to bony fragmentation and ultimately detachment of the bony fragment from the bone. Commonly seen in the adolescent sporting population; who partake in repetitive throwing or overhead activities such as baseball and gymnastics. More frequently seen in males (ages 10-14) than females and often affecting the dominant arm.
- #2 Osteochondritis Dissecans (OCD) | Boston Children’s Hspitalhttps://www.childrenshospital.org/conditions/osteochondritis-dissecans
Osteochondritis dissecans is often caused by sports that put repeated stress on the joint. Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. Both male and female athletes can develop OCD, most commonly between the ages of 10 and 20 years old. […] Young athletes involved in high-impact sports can sustain an osteochondritis dissecans injury from motions that put repetitive stress on the joint.
- #2 Osteochondritis dissecans | Children’s Wisconsinhttps://childrenswi.org/medical-care/orthopedics/conditions/osteochondritis-dissecans
Osteochondritis dissecans (OCD) occurs when a small piece of bone and cartilage in a part of a joint separates from the bone around it. […] It is not entirely known why some children develop OCD. What is known: The separation of bone from the joint may be due to loss of blood supply to that piece of bone. Overuse of the joint and repeated stress (from jumping or running, for example) make a child more likely to develop OCD. […] The most common patient with OCD is a boy between the ages of 10-16.
- #2 Osteochondritis Dissecans | Symptoms, Diagnosis & Treatmenthttps://www.cincinnatichildrens.org/health/o/osteochondritis-dissecans
Osteochondritis dissecans (OCD), also called an osteochondral lesion, refers to damage to the end of the bone that forms a joint. […] Medical experts dont know the specific cause of osteochondritis dissecans. Genetics may play a role. Some think that a lack of blood flow and oxygen to a joint leads to this condition. Others agree that repetitive stress to a joint (for example, repeated stress fractures) may result in osteochondritis dissecans. […] Because the cause of osteochondritis dissecans isnt known, theres no clear way to prevent it. Only 15 to 29 people out of 100,000 get osteochondritis dissecans. The condition is most common in children and adolescents who play regular, highly competitive sports. It can affect adults if they had undiagnosed or untreated osteochondritis dissecans as a child.
- #2 Osteochondritis dissecans (OCD): Clinical manifestations, evaluation, and diagnosis – UpToDatehttps://www.uptodate.com/contents/osteochondritis-dissecans-ocd-clinical-manifestations-evaluation-and-diagnosis
Osteochondritis dissecans (OCD) most often occurs in the knee, elbow, or ankle of the school-age or adolescent child where it causes pain. […] Initial treatment consists of rest, nonsteroidal anti-inflammatory medicines, avoidance of high-intensity activities, and physical therapy. […] Patients with large lesions or in whom intra-articular foreign bodies develop usually need surgery.
- #2 Osteochondritis Dissecans (Causes, Symptoms, and Treatment)https://patient.info/doctor/osteochondritis-dissecans
Osteochondritis dissecans may lead to secondary effects on joint cartilage, such as pain, oedema, possible formation of free bodies and mechanical symptoms, including joint locking. OCD may lead to degenerative changes if left untreated. […] The cause of osteochondritis dissecans is unknown. […] Trauma (about half of cases). […] Male sex (although incidence is increasing in women and girls). […] Overuse due to sporting activity. […] Familial pattern in about 10% of cases. […] Ligamentous weakness. […] Genu valgum/varum. […] Meniscal lesions in the knee. […] Osteochondritis dissecans prognosis depends on the age of the patient, the affected joint and the stage of the lesion at presentation. […] Younger patients with small, stable medial femoral condylar lesions have the best prognosis. […] Unstable lesions can heal after stabilisation; however, long-term prognosis is not clear. Chronic loose fragments can be difficult to fix and tend to heal poorly. […] Excision of large lesions from weight-bearing zones also tend to give poor results.
- #3 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFPhttps://www.aafp.org/pubs/afp/issues/2000/0101/p151.html
Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. […] OCD is a relatively rare disorder, characterized by a focal area of subchondral bone that undergoes necrosis. […] Many researchers believe that the adult form is undiagnosed persistent juvenile OCD. […] Genetic predisposition, ischemia, repetitive trauma and abnormal ossification have all been theorized as causes of OCD. […] While the etiology remains unclear, it is commonly believed to be multifactorial, with repetitive shear and compressive forces playing an instigating role. […] Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role. […] Abnormal ossification centers, common in children during rapid periods of growth, have been implicated as precursors to the development of OCD lesions. […] It is postulated that an accessory bony island partially reattaches over time.
- #3 Osteochondritis dissecans – the development, causes and treatments of OCD | Trainer Magazine | European Trainer Article Indexhttps://trainermagazine.com/european-trainer-articles/2013/4/29/osteochondritis-dissecans-the-development-causes-and-treatments-of-ocd
Osteochondritis dissecans (OCD) is caused by a disruption of the normal growth process of bone. […] Many different parameters have been described as having an affect on the development of OCD. There is no apparent common denominator in OCD formation and the disease is multifactorial. Nutritional imbalances, trauma, rate of growth, biomechanical influences as well as genetic predisposition have all been documented as potential causes. […] Recent research on the relationship between nutrition and development of OCD have found multiple correlations. […] It is thought that a high mechanical load in areas of thickened cartilage where the blood supply is tenuous can lead to OCD due to traumatic causes. […] Research investigating a possible link between genetics and OCD development is ongoing. […] This again supports the claim that OCD is a multifactoral disease.