Materiały źródłowe

• #1 Osteochondritis Dissecans – OrthoInfo – AAOS

  https://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. […] There are different surgical techniques for treating OCD, depending on the individual case: Drilling into the lesion to create pathways for new blood vessels to nourish the affected area. This will encourage healing of the surrounding bone.

• #2 Osteochondritis dissecans – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/symptoms-causes/syc-20375887

  Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion. […] 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.

• #3 Osteochondritis Dissecans of the Knee: Pathophysiology and Treatment | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4939-7587-7_10

  Osteochondritis dissecans (OCD) involves injury to the subchondral bone, which can progress to involve the overlying articular cartilage. […] Despite being a known clinical entity for more than 120 years, there is no consensus as to the etiology. […] Furthermore, there is a paucity of high level literature on this topic and not one paper on the natural history of OCD. […] Treatment for OCD lesions is dictated by many factors; however physeal status, lesion stability, and lesion size are the most important to consider when contemplating surgery. […] While considerable progress has been made in the treatment of this condition, current treatment options lack uniform success, and future research is required. […] Andriolo L, Crawford DC, Reale D, Zaffagnini S, Candrian C, Cavicchioli A, Filardo G. Osteochondritis dissecans of the knee: etiology and pathogenetic mechanisms. A systematic review. Cartilage. 2018 July 1:1947603518786557. https://doi.org/10.1177/1947603518786557. (Epub ahead of print).

• #4 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0101/p151.html

  OCD refers to a focal area of subchondral bone that undergoes necrosis. The overlying cartilage remains intact to variable degrees, receiving nourishment from the synovial fluid. As the necrotic bone is resorbed, the cartilage loses its supporting structure. Subsequently, the bony fragment may be displaced into the joint space. There are two main types of OCD: the adult form, which occurs after the physis closes, and the juvenile form, which occurs in patients with an open epiphyseal plate. Many researchers believe that the adult form is undiagnosed persistent juvenile OCD. […] Our understanding of the pathophysiology of OCD has not advanced much over the past 100 years. 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.

• #5 Osteochondritis Dissecans – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526091/

  Osteochondritis dissecans (OCD), also known as an osteochondral lesion, is not a fully understood process, though it is believed to be multi-factorial in etiology. […] Although the etiology of osteochondritis dissecans is not fully elucidated, it is believed to be multi-factorial in nature. Postulated etiologies include genetic predisposition, inflammation, spontaneous avascular necrosis, and repetitive microtrauma. […] Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. […] The higher prevalence of OCD in young athletes also suggests a repetitive microtrauma etiology.

• #6 Osteochondritis dissecans – Wikipedia

  https://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. […] It is thought that repetitive microtrauma, which leads to microfractures and sometimes an interruption of blood supply to the subchondral bone, may cause subsequent localized loss of blood supply or alteration of growth. […] In skeletally immature individuals, the blood supply to the epiphyseal bone is good, supporting both osteogenesis and chondrogenesis. With disruption of the epiphyseal plate vessels, varying degrees and depth of necrosis occur, resulting in a cessation of growth to both osteocytes and chondrocytes.

• #7

  https://link.springer.com/article/10.1007/s12015-019-09875-6

  During epiphyseal and metaphyseal growth plates development, OC causes a disturbance of endochondral ossification, and a subsequent failure of cartilage maturation resulting from the absence of penetrating capillaries into the hypertrophic growth plate zone. […] An interruption of endochondral ossification then occurs, leading to the retention of a thickened layer of cartilage. […] The cartilaginous complex of the growth plate is weakened due to avascular necrosis of the basal layers and the appearance of lesions manifesting as subchondral fractures, subchondral cysts and fractures of the cartilage flaps in case of OCD, binding link to detachments of joints cartilage fragments over time. […] Despite the exact origin of the disease seems to be of great complexity, a diagram of four main stages for OCD pathophysiological development can clearly be distinguished.

• #8 Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139592/

  This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an analysis of and outcomes of the treatments available. […] 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. […] Although the etiology is not fully clear, the pathogenesis of OCD is relatively well understood. Independent from the etiology, at least 4 stages can be described. […] OCD lesions start in the subchondral bone with intraosseous subchondral osteopenia, which is only detectable with magnetic resonance imaging (MRI) or bone scans. […] The lesions are associated with an intraosseous edema of the subchondral bone. A bone bruise is probably the initial stage and subchondral trabecular microfractures might be the morphological correlate of the bone marrow edema.

• #9 Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139592/

  This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an analysis of and outcomes of the treatments available. […] 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. […] Although the etiology is not fully clear, the pathogenesis of OCD is relatively well understood. Independent from the etiology, at least 4 stages can be described. […] OCD lesions start in the subchondral bone with intraosseous subchondral osteopenia, which is only detectable with magnetic resonance imaging (MRI) or bone scans. […] The lesions are associated with an intraosseous edema of the subchondral bone. A bone bruise is probably the initial stage and subchondral trabecular microfractures might be the morphological correlate of the bone marrow edema.

• #10 Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6139592/

  The continuing, natural course is characterized by a radiologically detectable sclerotic ring, which demarcates the lesions from the surrounding healthy bone. The center of the lesions is thought to be an osteonecrosis. […] A „softening phenomenon and alteration in the mechanical properties of cartilage” promotes a reaction of the bone at the border of the necrosis toward the healthy surrounding bone. […] There are several biomechanically orientated analyses concerning the suggestion of a biomechanical etiology. […] Bone bruises following a bone contusion of the knee are assumed to be primary lesions of the subchondral trabecular bone, which probably initiates an OCD.

• #11 (Fig 5-B.20) Pathogenesis of Osteochondritis Dissecans

  https://mskmri.tistory.com/1078

  Osteochondritis Dissecans […] The disturbed segment, known as „a progeny,” may develop laminar calcifications or ossify partially/completely. […] Detachment starts at the deep, basal portion of the lesion, creating a cleft and causing fragment instability. […] This instability disrupts the bone plate and overlying articular cartilage, leading to fragment separation. […] Disturbance of Epiphyseal Growth Plate […] An unknown insult disturbs a small area of the epiphyseal growth plate. […] This leads to localized delay or cessation of normal ossification. […] The affected segment remains cartilaginous while the rest of the epiphysis continues to ossify. […] A radiolucent crater forms in the area of hindered cartilage ossification. […] Chronic Osteochondral Lesion […] Osteochondritis dissecans is a chronic lesion occurring in young adults and children. […] It involves progressive separation of articular cartilage and underlying subchondral bone. […] The cleavage plane is situated in the subchondral bone, eventually affecting the full thickness of the overlying articular cartilage.

• #12 Basic Science and Pathology Overview of Osteochondritis Dissecans – Osteochondritis Dissecans

  https://kneeocd.org/patient-education/basic-science-and-pathology-overview-of-osteochondritis-dissecans/

  OCD, also known as osteochondrosis/osteochondritis dissecans, is a disease of the developing joints that is most often seen in young, growing patients. […] The details of the development of OCD remain incompletely understood, but recent studies performed in human and animal patients indicate that the development of OCD lesions starts well before the appearance of clinical signs, such as pain. […] It is believed that the development of OCD starts with a disturbance of the blood supply to the epiphyseal growth cartilage which results in an area of the epiphyseal growth cartilage dying. This prevents replacement of the epiphyseal growth cartilage with bone via endochondral ossification. […] Although the pathogenesis is not yet completely understood, current knowledge indicates that, in most patients, the initial event occurring in OCD is an injury to blood vessels supplying the epiphyseal growth cartilage. This results in the epiphyseal growth cartilage dying and a focal failure of the normal endochondral ossification process.

• #13 Basic Science and Pathology Overview of Osteochondritis Dissecans – Osteochondritis Dissecans

  https://kneeocd.org/patient-education/basic-science-and-pathology-overview-of-osteochondritis-dissecans/

  OCD, also known as osteochondrosis/osteochondritis dissecans, is a disease of the developing joints that is most often seen in young, growing patients. […] The details of the development of OCD remain incompletely understood, but recent studies performed in human and animal patients indicate that the development of OCD lesions starts well before the appearance of clinical signs, such as pain. […] It is believed that the development of OCD starts with a disturbance of the blood supply to the epiphyseal growth cartilage which results in an area of the epiphyseal growth cartilage dying. This prevents replacement of the epiphyseal growth cartilage with bone via endochondral ossification. […] Although the pathogenesis is not yet completely understood, current knowledge indicates that, in most patients, the initial event occurring in OCD is an injury to blood vessels supplying the epiphyseal growth cartilage. This results in the epiphyseal growth cartilage dying and a focal failure of the normal endochondral ossification process.

• #14 Osteochondritis dissecans (OCD) – Manchester Veterinary Specialists

  https://www.mvsvets.co.uk/pet-owners/osteochondritis-dissecans-ocd/

  In a young growing animal, the skeleton starts off as almost all cartilage. As the animal grows, the cartilage will eventually turn into bone, with cartilage only present on the bone ends to form the joints. If there is a failure of the bone to form normally, a process called osteochondrosis or OC, a thicker than normal layer of cartilage develops. The joint cartilage receives nutrients from joint fluid but when the layer is thicker than normal, the nutrients cannot reach the deepest cartilage cells, which causes them to die. The adhesion of the cartilage to the bone is lost and a flap of cartilage, an OCD flap, elevates. […] The exact cause of this condition is not fully understood but could relate to genetics, nutritional imbalance, trauma etc. […] When the cartilage flap elevates and the underlying bony tissue is exposed, an inflammatory process will start to develop (osteoarthritis). This will progress with time but the rate can depend on the individual and also on the joint affected. Some joints tolerate the changes better than others and the location of the cartilage defect may also limit the progression.

• #15 Osteochondritis dissecans (OCD) – Manchester Veterinary Specialists

  https://www.mvsvets.co.uk/pet-owners/osteochondritis-dissecans-ocd/

  In a young growing animal, the skeleton starts off as almost all cartilage. As the animal grows, the cartilage will eventually turn into bone, with cartilage only present on the bone ends to form the joints. If there is a failure of the bone to form normally, a process called osteochondrosis or OC, a thicker than normal layer of cartilage develops. The joint cartilage receives nutrients from joint fluid but when the layer is thicker than normal, the nutrients cannot reach the deepest cartilage cells, which causes them to die. The adhesion of the cartilage to the bone is lost and a flap of cartilage, an OCD flap, elevates. […] The exact cause of this condition is not fully understood but could relate to genetics, nutritional imbalance, trauma etc. […] When the cartilage flap elevates and the underlying bony tissue is exposed, an inflammatory process will start to develop (osteoarthritis). This will progress with time but the rate can depend on the individual and also on the joint affected. Some joints tolerate the changes better than others and the location of the cartilage defect may also limit the progression.

• #16

  https://link.springer.com/article/10.1007/s12015-019-09875-6

  The final phase of the endochondral ossification process is characterized by the invasion of the mineralized cartilaginous matrix layer by capillary buds and osteoblasts, leading to the gradual disappearance of chondrocytes, leaving room for osteoblasts that will form the mature bone tissue. […] It has been reported that during the course of osteochondrosis, blood capillaries are no longer able to penetrate the distal region of the hypertrophic zone, implying a consequent delay and a pathological modification of the cartilage maturation and the surrounding matrix; retention and thickening of the cartilage then occur, thereby weakening the entire cartilaginous articular / epiphyseal complex. […] The emergence of microRNAs appeared to be potentially new biomarkers for the study of OC/OCD.

• #17

  https://link.springer.com/article/10.1007/s12015-019-09875-6

  The final phase of the endochondral ossification process is characterized by the invasion of the mineralized cartilaginous matrix layer by capillary buds and osteoblasts, leading to the gradual disappearance of chondrocytes, leaving room for osteoblasts that will form the mature bone tissue. […] It has been reported that during the course of osteochondrosis, blood capillaries are no longer able to penetrate the distal region of the hypertrophic zone, implying a consequent delay and a pathological modification of the cartilage maturation and the surrounding matrix; retention and thickening of the cartilage then occur, thereby weakening the entire cartilaginous articular / epiphyseal complex. […] The emergence of microRNAs appeared to be potentially new biomarkers for the study of OC/OCD.

• #18 Osteochondritis Dissecans – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526091/

  The theory of spontaneous osteonecrosis is thought to occur during the maturation of the overlying cartilage during adolescence. At this time, the vascular supply to the subchondral bone transitions from a juvenile perichondrial supply to the mature supply from the medullary cavity. It is thought that during this transition period, the epiphyseal bone is predisposed to avascular necrosis. […] The most commonly accepted etiology is that of repetitive microtrauma, with or without an inciting event, that results in the patients initial presentation.

• #19 Osteochondritis Dissecans and Avascular Necrosis | Musculoskeletal Key

  https://musculoskeletalkey.com/osteochondritis-dissecans-and-avascular-necrosis/

  The definitive cause of OCD lesions remains elusive. Several theories exist, including trauma, ischemia, abnormal ossification involving the physes, genetic predisposition, and combinations of these. Prominent theories are further discussed in the following paragraphs, with most authors suspecting that repetitive stress plays a central role. […] Repetitive microtrauma may create a stress fracture within subchondral bone. If the microtrauma continues and overwhelms the ability of the subchondral bone to heal, necrosis may occur, leading to separation and nonunion of the segment. […] The alteration of subchondral vascularity is precipitated by insult at a vulnerable point. […] In most situations, however, healing is inadequate, and persistent avascularity of the fragment, along with mechanical forces at the subchondral region, leads to articular surface fracture. […] Synovial fluid pumped into the bone around the fragment via knee motion limits healing by preventing fibrin clot formation. The pressurized fluid can even erode bone and create a cystic defect. Loss of fragment stability results in loose body formation.

• #20 Osteochondritis Dissecans and Avascular Necrosis | Musculoskeletal Key

  https://musculoskeletalkey.com/osteochondritis-dissecans-and-avascular-necrosis/

  The definitive cause of OCD lesions remains elusive. Several theories exist, including trauma, ischemia, abnormal ossification involving the physes, genetic predisposition, and combinations of these. Prominent theories are further discussed in the following paragraphs, with most authors suspecting that repetitive stress plays a central role. […] Repetitive microtrauma may create a stress fracture within subchondral bone. If the microtrauma continues and overwhelms the ability of the subchondral bone to heal, necrosis may occur, leading to separation and nonunion of the segment. […] The alteration of subchondral vascularity is precipitated by insult at a vulnerable point. […] In most situations, however, healing is inadequate, and persistent avascularity of the fragment, along with mechanical forces at the subchondral region, leads to articular surface fracture. […] Synovial fluid pumped into the bone around the fragment via knee motion limits healing by preventing fibrin clot formation. The pressurized fluid can even erode bone and create a cystic defect. Loss of fragment stability results in loose body formation.

• #21 Osteochondritis Dissecans – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526091/

  Osteochondritis dissecans (OCD), also known as an osteochondral lesion, is not a fully understood process, though it is believed to be multi-factorial in etiology. […] Although the etiology of osteochondritis dissecans is not fully elucidated, it is believed to be multi-factorial in nature. Postulated etiologies include genetic predisposition, inflammation, spontaneous avascular necrosis, and repetitive microtrauma. […] Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. […] The higher prevalence of OCD in young athletes also suggests a repetitive microtrauma etiology.

• #22 Osteochondritis Dissecans (OCD) | Boston Children’s Hspital

  https://www.childrenshospital.org/conditions/osteochondritis-dissecans

  Osteochondritis dissecans (OCD) is a joint disorder in which a segment of bone and cartilage starts to separate from the rest of the bone after repeated stress or trauma. The fragment may stay in place or fall into the joint space. This causes pain and a sense that the joint is “catching” or “giving way.” These loose pieces are sometimes called “joint mice” or “loose bodies.” […] 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. […] Young athletes involved in high-impact sports can sustain an osteochondritis dissecans injury from motions that put repetitive stress on the joint.

• #23 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0101/p151.html

  Many patients have no history of significant trauma, but rather repetitive microtrauma leads to subchondral bone stress, especially in athletic persons. For OCD of the knee, impaction or impingement of the tibial spine and patella on fragments of the femoral condyle has been implicated. Because of the high incidence of bilaterality and nonweight-bearing areas affected, nontraumatic etiologies may be more likely. Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role. […] Pediatric patients may have a greater likelihood of injuries with less severe trauma associated with growth plates, more porous bone and susceptibility to injury during adolescent growth spurts. 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. Genetic predisposition is a less likely factor, although inherited bone disorders may be mistaken for OCD.

• #24 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0101/p151.html

  Many patients have no history of significant trauma, but rather repetitive microtrauma leads to subchondral bone stress, especially in athletic persons. For OCD of the knee, impaction or impingement of the tibial spine and patella on fragments of the femoral condyle has been implicated. Because of the high incidence of bilaterality and nonweight-bearing areas affected, nontraumatic etiologies may be more likely. Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role. […] Pediatric patients may have a greater likelihood of injuries with less severe trauma associated with growth plates, more porous bone and susceptibility to injury during adolescent growth spurts. 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. Genetic predisposition is a less likely factor, although inherited bone disorders may be mistaken for OCD.

• #25 Osteochondritis Dissecans (OCD): Symptoms & Treatment

  https://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. This can pull some cartilage with it. […] 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.

• #26 Osteochondritis Dissecans (OCD): Symptoms & Treatment

  https://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. This can pull some cartilage with it. […] 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.

• #27

  https://link.springer.com/article/10.1007/s12015-019-09875-6

  Many microRNAs have been identified in recent years as playing a crucial role in the regulation of various processes during osteochondral ossification. […] The oxidative phorphorylation provided by the mitochondria is seen to be significantly reduced during ischemia, this leads to a decrease in the level of produced cellular ATP. […] The Wnt signalling pathway, which comprises numerous proteins, receptors and inhibitors, takes part in various physiological processes and in particular, in the regulation of proliferation, maturation, differentiation and endochondral ossification of chondrocytes. […] It has been postulated that disturbance of the Wnt signalling pathway, a key regulator of mitochondrial function, typically characteristic of OC equine cartilage may be partly responsible for mitochondrial dysfunction. […] The ultimate consequence of this damage lies in the development of an abnormally structured cartilaginous ECM.

• #28

  https://link.springer.com/article/10.1007/s12015-019-09875-6

  Many microRNAs have been identified in recent years as playing a crucial role in the regulation of various processes during osteochondral ossification. […] The oxidative phorphorylation provided by the mitochondria is seen to be significantly reduced during ischemia, this leads to a decrease in the level of produced cellular ATP. […] The Wnt signalling pathway, which comprises numerous proteins, receptors and inhibitors, takes part in various physiological processes and in particular, in the regulation of proliferation, maturation, differentiation and endochondral ossification of chondrocytes. […] It has been postulated that disturbance of the Wnt signalling pathway, a key regulator of mitochondrial function, typically characteristic of OC equine cartilage may be partly responsible for mitochondrial dysfunction. […] The ultimate consequence of this damage lies in the development of an abnormally structured cartilaginous ECM.

• #29 Osteochondritis dissecans (OCD) in Horses – Molecular Background of its Pathogenesis and Perspectives for Progenitor Stem Cell Therapy. | Research Bank

  https://madbarn.com/research/osteochondritis-dissecans-ocd-in-horses-molecular-background-of-its-pathogenesis-and-perspectives-for-progenitor-stem-cell-therapy/?srsltid=AfmBOoq8z283tJx0jSJc9Dyv8KfFRgNPkBidr0f7UtPKLn6sTgMW5eF-

  Osteochondrosis (osteochondrosis dissecans; OCD) is a disease syndrome of growing cartilage related to different clinical entities such as epiphysitis, subchondral cysts and angular carpal deformities, which occurs in growing animals of all species, including horses. […] As a complex multifactorial disease, OCD is initiated when failure in cartilage canals because of existing ischemia, chondrocyte biogenesis impairment as well as biochemical and genetic disruptions occur. […] Recently, particular attention have been accorded to the definition of possible relations between OCD and some metabolic disorders; in this way, implication of mitochondrial dysfunctions, endoplasmic reticulum disruptions, oxidative stress or endocrinological affections are among the most considered axes for future researches.

• #30

  https://link.springer.com/article/10.1007/s12015-019-09875-6

  Many microRNAs have been identified in recent years as playing a crucial role in the regulation of various processes during osteochondral ossification. […] The oxidative phorphorylation provided by the mitochondria is seen to be significantly reduced during ischemia, this leads to a decrease in the level of produced cellular ATP. […] The Wnt signalling pathway, which comprises numerous proteins, receptors and inhibitors, takes part in various physiological processes and in particular, in the regulation of proliferation, maturation, differentiation and endochondral ossification of chondrocytes. […] It has been postulated that disturbance of the Wnt signalling pathway, a key regulator of mitochondrial function, typically characteristic of OC equine cartilage may be partly responsible for mitochondrial dysfunction. […] The ultimate consequence of this damage lies in the development of an abnormally structured cartilaginous ECM.

• #31 Osteochondroses: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1254668-overview

  The initial events in the pathogenesis of osteochondrosis remain elusive, but clinical and radiologic evidence points to ischemic necrosis of the ossification center. This process could be due to a primary vascular event, a definite traumatic event, or multiple additive traumas. […] The osteochondrotic process is essentially degeneration of the epiphyseal osseous nucleus. This process is almost certainly due to either (1) interference with the blood supply, which leads to necrosis of the cartilage-canal vessels in the subchondral bone and adjacent epiphysis, or (2) failure of the bony centrum to enlarge and disordered proliferation of the cartilaginous cells in the epiphysis. Secondary changes (eg, fragmentation, collapse, and sequestrum formation) develop in accordance with the characteristics of the affected region.

• #32 Osteochondroses: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1254668-overview

  The initial events in the pathogenesis of osteochondrosis remain elusive, but clinical and radiologic evidence points to ischemic necrosis of the ossification center. This process could be due to a primary vascular event, a definite traumatic event, or multiple additive traumas. […] The osteochondrotic process is essentially degeneration of the epiphyseal osseous nucleus. This process is almost certainly due to either (1) interference with the blood supply, which leads to necrosis of the cartilage-canal vessels in the subchondral bone and adjacent epiphysis, or (2) failure of the bony centrum to enlarge and disordered proliferation of the cartilaginous cells in the epiphysis. Secondary changes (eg, fragmentation, collapse, and sequestrum formation) develop in accordance with the characteristics of the affected region.

• #33 Osteochondritis dissecans (OCD) – Manchester Veterinary Specialists

  https://www.mvsvets.co.uk/pet-owners/osteochondritis-dissecans-ocd/

  In a young growing animal, the skeleton starts off as almost all cartilage. As the animal grows, the cartilage will eventually turn into bone, with cartilage only present on the bone ends to form the joints. If there is a failure of the bone to form normally, a process called osteochondrosis or OC, a thicker than normal layer of cartilage develops. The joint cartilage receives nutrients from joint fluid but when the layer is thicker than normal, the nutrients cannot reach the deepest cartilage cells, which causes them to die. The adhesion of the cartilage to the bone is lost and a flap of cartilage, an OCD flap, elevates. […] The exact cause of this condition is not fully understood but could relate to genetics, nutritional imbalance, trauma etc. […] When the cartilage flap elevates and the underlying bony tissue is exposed, an inflammatory process will start to develop (osteoarthritis). This will progress with time but the rate can depend on the individual and also on the joint affected. Some joints tolerate the changes better than others and the location of the cartilage defect may also limit the progression.

• #34 Osteochondritis dissecans (OCD) – Manchester Veterinary Specialists

  https://www.mvsvets.co.uk/pet-owners/osteochondritis-dissecans-ocd/

  In a young growing animal, the skeleton starts off as almost all cartilage. As the animal grows, the cartilage will eventually turn into bone, with cartilage only present on the bone ends to form the joints. If there is a failure of the bone to form normally, a process called osteochondrosis or OC, a thicker than normal layer of cartilage develops. The joint cartilage receives nutrients from joint fluid but when the layer is thicker than normal, the nutrients cannot reach the deepest cartilage cells, which causes them to die. The adhesion of the cartilage to the bone is lost and a flap of cartilage, an OCD flap, elevates. […] The exact cause of this condition is not fully understood but could relate to genetics, nutritional imbalance, trauma etc. […] When the cartilage flap elevates and the underlying bony tissue is exposed, an inflammatory process will start to develop (osteoarthritis). This will progress with time but the rate can depend on the individual and also on the joint affected. Some joints tolerate the changes better than others and the location of the cartilage defect may also limit the progression.

• #35 Osteochondritis dissecans – Wikipedia

  https://en.wikipedia.org/wiki/Osteochondritis_dissecans

  Four minor stages of OCD have been identified after trauma. These include revascularization and formation of granulation (scar) tissue, absorption of necrotic fragments, intertrabecular osteoid deposition, and remodeling of new bone. […] OCD occurs when a loose piece of bone or cartilage partially (or fully) separates from the end of the bone, often because of a loss of blood supply (osteonecrosis) and decalcification of the trabecular bone matrix.

• #36 Osteochondritis dissecans – Wikipedia

  https://en.wikipedia.org/wiki/Osteochondritis_dissecans

  Four minor stages of OCD have been identified after trauma. These include revascularization and formation of granulation (scar) tissue, absorption of necrotic fragments, intertrabecular osteoid deposition, and remodeling of new bone. […] OCD occurs when a loose piece of bone or cartilage partially (or fully) separates from the end of the bone, often because of a loss of blood supply (osteonecrosis) and decalcification of the trabecular bone matrix.

• #37 Osteochondritis dissecans – Wikipedia

  https://en.wikipedia.org/wiki/Osteochondritis_dissecans

  Four minor stages of OCD have been identified after trauma. These include revascularization and formation of granulation (scar) tissue, absorption of necrotic fragments, intertrabecular osteoid deposition, and remodeling of new bone. […] OCD occurs when a loose piece of bone or cartilage partially (or fully) separates from the end of the bone, often because of a loss of blood supply (osteonecrosis) and decalcification of the trabecular bone matrix.

• #38 Osteochondritis dissecans – Wikipedia

  https://en.wikipedia.org/wiki/Osteochondritis_dissecans

  Four minor stages of OCD have been identified after trauma. These include revascularization and formation of granulation (scar) tissue, absorption of necrotic fragments, intertrabecular osteoid deposition, and remodeling of new bone. […] OCD occurs when a loose piece of bone or cartilage partially (or fully) separates from the end of the bone, often because of a loss of blood supply (osteonecrosis) and decalcification of the trabecular bone matrix.

• #39 Osteochondritis Dissecans and Avascular Necrosis | Musculoskeletal Key

  https://musculoskeletalkey.com/osteochondritis-dissecans-and-avascular-necrosis/

  The definitive cause of OCD lesions remains elusive. Several theories exist, including trauma, ischemia, abnormal ossification involving the physes, genetic predisposition, and combinations of these. Prominent theories are further discussed in the following paragraphs, with most authors suspecting that repetitive stress plays a central role. […] Repetitive microtrauma may create a stress fracture within subchondral bone. If the microtrauma continues and overwhelms the ability of the subchondral bone to heal, necrosis may occur, leading to separation and nonunion of the segment. […] The alteration of subchondral vascularity is precipitated by insult at a vulnerable point. […] In most situations, however, healing is inadequate, and persistent avascularity of the fragment, along with mechanical forces at the subchondral region, leads to articular surface fracture. […] Synovial fluid pumped into the bone around the fragment via knee motion limits healing by preventing fibrin clot formation. The pressurized fluid can even erode bone and create a cystic defect. Loss of fragment stability results in loose body formation.

• #40 Osteochondritis Dissecans and Avascular Necrosis | Musculoskeletal Key

  https://musculoskeletalkey.com/osteochondritis-dissecans-and-avascular-necrosis/

  The definitive cause of OCD lesions remains elusive. Several theories exist, including trauma, ischemia, abnormal ossification involving the physes, genetic predisposition, and combinations of these. Prominent theories are further discussed in the following paragraphs, with most authors suspecting that repetitive stress plays a central role. […] Repetitive microtrauma may create a stress fracture within subchondral bone. If the microtrauma continues and overwhelms the ability of the subchondral bone to heal, necrosis may occur, leading to separation and nonunion of the segment. […] The alteration of subchondral vascularity is precipitated by insult at a vulnerable point. […] In most situations, however, healing is inadequate, and persistent avascularity of the fragment, along with mechanical forces at the subchondral region, leads to articular surface fracture. […] Synovial fluid pumped into the bone around the fragment via knee motion limits healing by preventing fibrin clot formation. The pressurized fluid can even erode bone and create a cystic defect. Loss of fragment stability results in loose body formation.

• #41 Osteochondritis Dissecans | Concise Medical Knowledge

  https://www.lecturio.com/concepts/osteochondritis-dissecans/

  Osteochondritis dissecans (OCD) is an orthopedic disorder characterized by the detachment of a focal segment of subchondral bone and cartilage as a result of focal aseptic necrosis. […] The exact etiology is unknown. Many theories have been proposed, and OCD is likely multifactorial. […] Pathogenesis of osteochondritis dissecans: Repetitive microtrauma injury to the subchondral bone fragmentation. […] A defect develops between the osteochondral lesion and the underlying bone. […] Results in hypovascularity osteonecrosis of the lesion. […] Involvement of the overlying cartilage instability of the fragment. […] Subchondral bone and cartilage may become partially or totally separated. […] Osteochondritis dissecans progresses through 4 stages. With continued injury, the lesion fragments and becomes separated from the underlying bone, eventually becoming displaced in the joint space (loose body).

• #42 Osteochondritis Dissecans (OCD) | Boston Children’s Hspital

  https://www.childrenshospital.org/conditions/osteochondritis-dissecans

  Osteochondritis dissecans (OCD) is a joint disorder in which a segment of bone and cartilage starts to separate from the rest of the bone after repeated stress or trauma. The fragment may stay in place or fall into the joint space. This causes pain and a sense that the joint is “catching” or “giving way.” These loose pieces are sometimes called “joint mice” or “loose bodies.” […] 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. […] Young athletes involved in high-impact sports can sustain an osteochondritis dissecans injury from motions that put repetitive stress on the joint.

• #43 Osteochondritis Dissecans (OCD) | Boston Children’s Hspital

  https://www.childrenshospital.org/conditions/osteochondritis-dissecans

  Osteochondritis dissecans (OCD) is a joint disorder in which a segment of bone and cartilage starts to separate from the rest of the bone after repeated stress or trauma. The fragment may stay in place or fall into the joint space. This causes pain and a sense that the joint is “catching” or “giving way.” These loose pieces are sometimes called “joint mice” or “loose bodies.” […] 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. […] Young athletes involved in high-impact sports can sustain an osteochondritis dissecans injury from motions that put repetitive stress on the joint.

• #44 (Fig 5-B.20) Pathogenesis of Osteochondritis Dissecans

  https://mskmri.tistory.com/1078

  Osteochondritis Dissecans […] The disturbed segment, known as „a progeny,” may develop laminar calcifications or ossify partially/completely. […] Detachment starts at the deep, basal portion of the lesion, creating a cleft and causing fragment instability. […] This instability disrupts the bone plate and overlying articular cartilage, leading to fragment separation. […] Disturbance of Epiphyseal Growth Plate […] An unknown insult disturbs a small area of the epiphyseal growth plate. […] This leads to localized delay or cessation of normal ossification. […] The affected segment remains cartilaginous while the rest of the epiphysis continues to ossify. […] A radiolucent crater forms in the area of hindered cartilage ossification. […] Chronic Osteochondral Lesion […] Osteochondritis dissecans is a chronic lesion occurring in young adults and children. […] It involves progressive separation of articular cartilage and underlying subchondral bone. […] The cleavage plane is situated in the subchondral bone, eventually affecting the full thickness of the overlying articular cartilage.

• #45 Osteochondritis Dissecans and Avascular Necrosis | Musculoskeletal Key

  https://musculoskeletalkey.com/osteochondritis-dissecans-and-avascular-necrosis/

  The definitive cause of OCD lesions remains elusive. Several theories exist, including trauma, ischemia, abnormal ossification involving the physes, genetic predisposition, and combinations of these. Prominent theories are further discussed in the following paragraphs, with most authors suspecting that repetitive stress plays a central role. […] Repetitive microtrauma may create a stress fracture within subchondral bone. If the microtrauma continues and overwhelms the ability of the subchondral bone to heal, necrosis may occur, leading to separation and nonunion of the segment. […] The alteration of subchondral vascularity is precipitated by insult at a vulnerable point. […] In most situations, however, healing is inadequate, and persistent avascularity of the fragment, along with mechanical forces at the subchondral region, leads to articular surface fracture. […] Synovial fluid pumped into the bone around the fragment via knee motion limits healing by preventing fibrin clot formation. The pressurized fluid can even erode bone and create a cystic defect. Loss of fragment stability results in loose body formation.

• #46 Osteochondritis Dissecans (OCD): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21073-osteochondritis-dissecans

  Untreated osteochondritis dissecans can cause worsening symptoms over time. Eventually, you might develop chronic pain or arthritis. […] Your provider will suggest treatments that help your joint heal and restore blood flow to your affected bone. The most common OCD treatments include: Rest: Avoiding more stress on your joint is the best way to help it heal. […] Your provider might suggest surgery if you’ve tried other treatments and still have severe symptoms after a few months. […] Osteochondritis dissecans happens when a section of bone in one of your joints loses its blood supply and becomes soft and weak. Even though experts aren’t sure what causes it, your provider will suggest treatments to help your bones and joint heal.

• #47 Osteochondritis Dissecans (OCD): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21073-osteochondritis-dissecans

  Untreated osteochondritis dissecans can cause worsening symptoms over time. Eventually, you might develop chronic pain or arthritis. […] Your provider will suggest treatments that help your joint heal and restore blood flow to your affected bone. The most common OCD treatments include: Rest: Avoiding more stress on your joint is the best way to help it heal. […] Your provider might suggest surgery if you’ve tried other treatments and still have severe symptoms after a few months. […] Osteochondritis dissecans happens when a section of bone in one of your joints loses its blood supply and becomes soft and weak. Even though experts aren’t sure what causes it, your provider will suggest treatments to help your bones and joint heal.

• #48 Osteochondritis dissecans (OCD) – Manchester Veterinary Specialists

  https://www.mvsvets.co.uk/pet-owners/osteochondritis-dissecans-ocd/

  In a young growing animal, the skeleton starts off as almost all cartilage. As the animal grows, the cartilage will eventually turn into bone, with cartilage only present on the bone ends to form the joints. If there is a failure of the bone to form normally, a process called osteochondrosis or OC, a thicker than normal layer of cartilage develops. The joint cartilage receives nutrients from joint fluid but when the layer is thicker than normal, the nutrients cannot reach the deepest cartilage cells, which causes them to die. The adhesion of the cartilage to the bone is lost and a flap of cartilage, an OCD flap, elevates. […] The exact cause of this condition is not fully understood but could relate to genetics, nutritional imbalance, trauma etc. […] When the cartilage flap elevates and the underlying bony tissue is exposed, an inflammatory process will start to develop (osteoarthritis). This will progress with time but the rate can depend on the individual and also on the joint affected. Some joints tolerate the changes better than others and the location of the cartilage defect may also limit the progression.

• #49 Osteochondritis dissecans (OCD) – Manchester Veterinary Specialists

  https://www.mvsvets.co.uk/pet-owners/osteochondritis-dissecans-ocd/

  In a young growing animal, the skeleton starts off as almost all cartilage. As the animal grows, the cartilage will eventually turn into bone, with cartilage only present on the bone ends to form the joints. If there is a failure of the bone to form normally, a process called osteochondrosis or OC, a thicker than normal layer of cartilage develops. The joint cartilage receives nutrients from joint fluid but when the layer is thicker than normal, the nutrients cannot reach the deepest cartilage cells, which causes them to die. The adhesion of the cartilage to the bone is lost and a flap of cartilage, an OCD flap, elevates. […] The exact cause of this condition is not fully understood but could relate to genetics, nutritional imbalance, trauma etc. […] When the cartilage flap elevates and the underlying bony tissue is exposed, an inflammatory process will start to develop (osteoarthritis). This will progress with time but the rate can depend on the individual and also on the joint affected. Some joints tolerate the changes better than others and the location of the cartilage defect may also limit the progression.

• #50 Osteochondritis Dissecans | PM&R KnowledgeNow

  https://now.aapmr.org/osteochondritis-dessicans/

  Those with stable lesions are predicted to heal more quickly and with less aggressive measures than those with unstable lesions. In addition, patients with open physis have better outcomes than patients with closed physis. Furthermore, patients with BMI greater than 25 have poorer outcomes. The presence of Vitamin D deficiency could impede the healing process of osteochondral lesions. […] Joints of patients having unstable OCD lesions, despite surgical treatment, have been observed over time, often to progress to early osteoarthritis. A number of recent interventions have shown promise in reducing risk of progressive joint degeneration for patients with unstable OCD lesions that have failed surgical fixation. Cartilage reconstruction or unstable fragment (OCD knee) removal have been helpful in these cases.

• #51 Physical therapy in Middleton for Knee – Osteochondritis Dissecans

  https://www.sportsrehabu.com/Injuries-Conditions/Knee/Knee-Issues/Osteochondritis-Dissecans-of-the-Knee/a~344/article.html

  Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). A joint surface damaged by OCD doesn’t heal naturally. Even with surgery, OCD usually leads to future joint problems, including degenerative arthritis and osteoarthritis. […] Doctors aren’t sure what causes OCD. There is less of a link between strenuous, repetitive use and OCD. Many people who develop OCD don’t have any particular risk factors. […] Because OCD leads to damage to the surface of the joint, the condition can lead to problems with bone degeneration and osteoarthritis. The damage to the joint surface affects the way that the joint works. Like a machine that is out of balance, over time this imbalance can lead to abnormal wear and tear on the joint. This is one cause of degenerative arthritis and osteoarthritis.

• #52 Physical therapy in Middleton for Knee – Osteochondritis Dissecans

  https://www.sportsrehabu.com/Injuries-Conditions/Knee/Knee-Issues/Osteochondritis-Dissecans-of-the-Knee/a~344/article.html

  Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). A joint surface damaged by OCD doesn’t heal naturally. Even with surgery, OCD usually leads to future joint problems, including degenerative arthritis and osteoarthritis. […] Doctors aren’t sure what causes OCD. There is less of a link between strenuous, repetitive use and OCD. Many people who develop OCD don’t have any particular risk factors. […] Because OCD leads to damage to the surface of the joint, the condition can lead to problems with bone degeneration and osteoarthritis. The damage to the joint surface affects the way that the joint works. Like a machine that is out of balance, over time this imbalance can lead to abnormal wear and tear on the joint. This is one cause of degenerative arthritis and osteoarthritis.

• #53 Osteochondritis Dissecans of the Knee: Pathophysiology and Treatment | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4939-7587-7_10

  Osteochondritis dissecans (OCD) involves injury to the subchondral bone, which can progress to involve the overlying articular cartilage. […] Despite being a known clinical entity for more than 120 years, there is no consensus as to the etiology. […] Furthermore, there is a paucity of high level literature on this topic and not one paper on the natural history of OCD. […] Treatment for OCD lesions is dictated by many factors; however physeal status, lesion stability, and lesion size are the most important to consider when contemplating surgery. […] While considerable progress has been made in the treatment of this condition, current treatment options lack uniform success, and future research is required. […] Andriolo L, Crawford DC, Reale D, Zaffagnini S, Candrian C, Cavicchioli A, Filardo G. Osteochondritis dissecans of the knee: etiology and pathogenetic mechanisms. A systematic review. Cartilage. 2018 July 1:1947603518786557. https://doi.org/10.1177/1947603518786557. (Epub ahead of print).

• #54 Osteochondritis Dissecans of the Knee | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23937

  The prognosis of osteochondritis dissecans of the knee is influenced by the patient’s age and the location and appearance of the lesion on imaging. Generally, the prognosis for juvenile patients is more favorable than for adults. In particular, pediatric patients with open distal femoral physes have the best prognosis for complete recovery with conservative measures.

• #55 Osteochondritis Dissecans of the Knee | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23937

  The prognosis of osteochondritis dissecans of the knee is influenced by the patient’s age and the location and appearance of the lesion on imaging. Generally, the prognosis for juvenile patients is more favorable than for adults. In particular, pediatric patients with open distal femoral physes have the best prognosis for complete recovery with conservative measures.

• #56 Osteochondritis Dissecans of the Knee | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23937

  The prognosis of osteochondritis dissecans of the knee is influenced by the patient’s age and the location and appearance of the lesion on imaging. Generally, the prognosis for juvenile patients is more favorable than for adults. In particular, pediatric patients with open distal femoral physes have the best prognosis for complete recovery with conservative measures.

• #57 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://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. […] The nature of OCD remains unclear, although several pathophysiology hypotheses have been proposed. […] 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 impingement). […] Ultimately, the microtraumatic theory plays a central role in the etiopathogenesis of the OCD, despite being a multifactorial pathology.

• #58 Osteochondritis dissecans – Wikipedia

  https://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. […] It is thought that repetitive microtrauma, which leads to microfractures and sometimes an interruption of blood supply to the subchondral bone, may cause subsequent localized loss of blood supply or alteration of growth. […] In skeletally immature individuals, the blood supply to the epiphyseal bone is good, supporting both osteogenesis and chondrogenesis. With disruption of the epiphyseal plate vessels, varying degrees and depth of necrosis occur, resulting in a cessation of growth to both osteocytes and chondrocytes.

• #59 Osteochondritis dissecans – Wikipedia

  https://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. […] It is thought that repetitive microtrauma, which leads to microfractures and sometimes an interruption of blood supply to the subchondral bone, may cause subsequent localized loss of blood supply or alteration of growth. […] In skeletally immature individuals, the blood supply to the epiphyseal bone is good, supporting both osteogenesis and chondrogenesis. With disruption of the epiphyseal plate vessels, varying degrees and depth of necrosis occur, resulting in a cessation of growth to both osteocytes and chondrocytes.

• #60 Osteochondritis dissecans – Wikipedia

  https://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. […] It is thought that repetitive microtrauma, which leads to microfractures and sometimes an interruption of blood supply to the subchondral bone, may cause subsequent localized loss of blood supply or alteration of growth. […] In skeletally immature individuals, the blood supply to the epiphyseal bone is good, supporting both osteogenesis and chondrogenesis. With disruption of the epiphyseal plate vessels, varying degrees and depth of necrosis occur, resulting in a cessation of growth to both osteocytes and chondrocytes.

• #61 Osteochondritis Dissecans – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526091/

  The theory of spontaneous osteonecrosis is thought to occur during the maturation of the overlying cartilage during adolescence. At this time, the vascular supply to the subchondral bone transitions from a juvenile perichondrial supply to the mature supply from the medullary cavity. It is thought that during this transition period, the epiphyseal bone is predisposed to avascular necrosis. […] The most commonly accepted etiology is that of repetitive microtrauma, with or without an inciting event, that results in the patients initial presentation.

• #62 Osteochondritis Dissecans – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526091/

  The theory of spontaneous osteonecrosis is thought to occur during the maturation of the overlying cartilage during adolescence. At this time, the vascular supply to the subchondral bone transitions from a juvenile perichondrial supply to the mature supply from the medullary cavity. It is thought that during this transition period, the epiphyseal bone is predisposed to avascular necrosis. […] The most commonly accepted etiology is that of repetitive microtrauma, with or without an inciting event, that results in the patients initial presentation.

• #63 Osteochondritis Dissecans – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526091/

  The theory of spontaneous osteonecrosis is thought to occur during the maturation of the overlying cartilage during adolescence. At this time, the vascular supply to the subchondral bone transitions from a juvenile perichondrial supply to the mature supply from the medullary cavity. It is thought that during this transition period, the epiphyseal bone is predisposed to avascular necrosis. […] The most commonly accepted etiology is that of repetitive microtrauma, with or without an inciting event, that results in the patients initial presentation.

• #64 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0101/p151.html

  Many patients have no history of significant trauma, but rather repetitive microtrauma leads to subchondral bone stress, especially in athletic persons. For OCD of the knee, impaction or impingement of the tibial spine and patella on fragments of the femoral condyle has been implicated. Because of the high incidence of bilaterality and nonweight-bearing areas affected, nontraumatic etiologies may be more likely. Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role. […] Pediatric patients may have a greater likelihood of injuries with less severe trauma associated with growth plates, more porous bone and susceptibility to injury during adolescent growth spurts. 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. Genetic predisposition is a less likely factor, although inherited bone disorders may be mistaken for OCD.

• #65 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0101/p151.html

  Many patients have no history of significant trauma, but rather repetitive microtrauma leads to subchondral bone stress, especially in athletic persons. For OCD of the knee, impaction or impingement of the tibial spine and patella on fragments of the femoral condyle has been implicated. Because of the high incidence of bilaterality and nonweight-bearing areas affected, nontraumatic etiologies may be more likely. Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role. […] Pediatric patients may have a greater likelihood of injuries with less severe trauma associated with growth plates, more porous bone and susceptibility to injury during adolescent growth spurts. 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. Genetic predisposition is a less likely factor, although inherited bone disorders may be mistaken for OCD.

• #66 Osteochondroses: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1254668-overview

  Other proposed pathogenetic factors for which further study is warranted include an altered collagen-to-proteoglycan ratio, biochemical abnormalities (eg, altered expression of matrix metalloproteinases [MMPs] such as MMP-1, MMP-3, and MMP-13), and overexpression of glycosaminoglycans and aggrecan as a consequence of altered mechanics that exacerbate damage to the cartilage.

• #67 Osteochondroses: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1254668-overview

  Other proposed pathogenetic factors for which further study is warranted include an altered collagen-to-proteoglycan ratio, biochemical abnormalities (eg, altered expression of matrix metalloproteinases [MMPs] such as MMP-1, MMP-3, and MMP-13), and overexpression of glycosaminoglycans and aggrecan as a consequence of altered mechanics that exacerbate damage to the cartilage.

• #68 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0101/p151.html

  Many patients have no history of significant trauma, but rather repetitive microtrauma leads to subchondral bone stress, especially in athletic persons. For OCD of the knee, impaction or impingement of the tibial spine and patella on fragments of the femoral condyle has been implicated. Because of the high incidence of bilaterality and nonweight-bearing areas affected, nontraumatic etiologies may be more likely. Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role. […] Pediatric patients may have a greater likelihood of injuries with less severe trauma associated with growth plates, more porous bone and susceptibility to injury during adolescent growth spurts. 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. Genetic predisposition is a less likely factor, although inherited bone disorders may be mistaken for OCD.

• #69 Osteochondritis Dissecans: A Diagnosis Not to Miss | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0101/p151.html

  Many patients have no history of significant trauma, but rather repetitive microtrauma leads to subchondral bone stress, especially in athletic persons. For OCD of the knee, impaction or impingement of the tibial spine and patella on fragments of the femoral condyle has been implicated. Because of the high incidence of bilaterality and nonweight-bearing areas affected, nontraumatic etiologies may be more likely. Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role. […] Pediatric patients may have a greater likelihood of injuries with less severe trauma associated with growth plates, more porous bone and susceptibility to injury during adolescent growth spurts. 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. Genetic predisposition is a less likely factor, although inherited bone disorders may be mistaken for OCD.

• #70 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://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. […] The nature of OCD remains unclear, although several pathophysiology hypotheses have been proposed. […] 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 impingement). […] Ultimately, the microtraumatic theory plays a central role in the etiopathogenesis of the OCD, despite being a multifactorial pathology.

• #71 Osteochondritis Dissecans – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526091/

  Osteochondritis dissecans (OCD), also known as an osteochondral lesion, is not a fully understood process, though it is believed to be multi-factorial in etiology. […] Although the etiology of osteochondritis dissecans is not fully elucidated, it is believed to be multi-factorial in nature. Postulated etiologies include genetic predisposition, inflammation, spontaneous avascular necrosis, and repetitive microtrauma. […] Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. […] The higher prevalence of OCD in young athletes also suggests a repetitive microtrauma etiology.

• #72 Osteochondritis Dissecans – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526091/

  Osteochondritis dissecans (OCD), also known as an osteochondral lesion, is not a fully understood process, though it is believed to be multi-factorial in etiology. […] Although the etiology of osteochondritis dissecans is not fully elucidated, it is believed to be multi-factorial in nature. Postulated etiologies include genetic predisposition, inflammation, spontaneous avascular necrosis, and repetitive microtrauma. […] Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. […] The higher prevalence of OCD in young athletes also suggests a repetitive microtrauma etiology.

• #73 Osteochondritis Dissecans – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526091/

  Osteochondritis dissecans (OCD), also known as an osteochondral lesion, is not a fully understood process, though it is believed to be multi-factorial in etiology. […] Although the etiology of osteochondritis dissecans is not fully elucidated, it is believed to be multi-factorial in nature. Postulated etiologies include genetic predisposition, inflammation, spontaneous avascular necrosis, and repetitive microtrauma. […] Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. […] The higher prevalence of OCD in young athletes also suggests a repetitive microtrauma etiology.

• #74 Osteochondritis dissecans – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/symptoms-causes/syc-20375887

  Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion. […] 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.

• #75 Osteochondritis Dissecans – OrthoInfo – AAOS

  https://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. […] There are different surgical techniques for treating OCD, depending on the individual case: Drilling into the lesion to create pathways for new blood vessels to nourish the affected area. This will encourage healing of the surrounding bone.

• #76 Osteochondritis Dissecans (OCD) | Boston Children’s Hspital

  https://www.childrenshospital.org/conditions/osteochondritis-dissecans

  Osteochondritis dissecans (OCD) is a joint disorder in which a segment of bone and cartilage starts to separate from the rest of the bone after repeated stress or trauma. The fragment may stay in place or fall into the joint space. This causes pain and a sense that the joint is “catching” or “giving way.” These loose pieces are sometimes called “joint mice” or “loose bodies.” […] 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. […] Young athletes involved in high-impact sports can sustain an osteochondritis dissecans injury from motions that put repetitive stress on the joint.

• #77 Osteochondritis dissecans (OCD) in Horses – Molecular Background of its Pathogenesis and Perspectives for Progenitor Stem Cell Therapy. | Research Bank

  https://madbarn.com/research/osteochondritis-dissecans-ocd-in-horses-molecular-background-of-its-pathogenesis-and-perspectives-for-progenitor-stem-cell-therapy/?srsltid=AfmBOoq8z283tJx0jSJc9Dyv8KfFRgNPkBidr0f7UtPKLn6sTgMW5eF-

  It would therefore be important to provide more information on the exact pathophysiological mechanism(s) underlying early OC(D) lesions, in order to implement innovative strategies involving the use of progenitor stem cells, which are considered nowadays as a promising approach to regenerative medicine, with the potential to treat numerous orthopaedic disorders, including osteo-degenerative diseases, for prevention and reduction of incidence of the disease, not only in horses, but also in human medicine, as the equine model is already widely accepted by the scientific community and approved by the FDA, for the research and application of cellular therapies in the treatment of human conditions. […] The authors highlight that this disease is multifactorial, meaning it is initiated by multiple elements like ischemia in cartilage canals, impairment of chondrocyte biogenesis, and biochemical and genetic disturbances.

• #78 Multiple Osteochondritis Dissecans as Main Manifestation of Multiple Epiphyseal Dysplasia Caused by a Novel Cartilage Oligomeric Matrix Protein Pathogenic Variant: A Clinical Report

  https://www.mdpi.com/2073-4425/15/11/1490

  Further studies (i.e., mouse models with specific COMP or ACAN mutation, expression studies, and biochemical investigation in cartilage or muscle samples) are needed to clarify the mechanisms leading to the clinical variability of MED and the association of very particular clinical characteristics such as OCD or myopathic signs.

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