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Osteochondral Loose Body

Loose Body Joint


Presentation

  • Clinical Presentation of Loose Bodies in Joint Loose bodies in the joint can hinder the joint moment as they get caught in movements. by getting caught in flexion and extension movements..[boneandspine.com]
  • Ultimately, the link for most patients, if present, is probably minor. Pathophysiology Once a lesion is present, it typically progresses through 4 stages unless appropriately treated.[emedicine.medscape.com]
  • A patient with a symptomatic loose body in the hip and documented degenerative changes presents a treatment dilemma.[arthritisresearch.us]
  • If enhancing granulation tissue is present, then the fragment is assumed to be separated and unstable by some authors 4, .[radsource.us]
  • Loose bodies Free loose bodies- single or multiple  Fixed loose bodies  Presentation-Intermittent catching & Pain -Recurrent effusion -Limitation of motion -Feeling of instability  3.[slideshare.net]
Pain
  • The patient complains of painful movements or feeling of something moving in the knee. The joint may get locked or blocked causing e pain or loss of motion. Imaging Xray would reveal the loose body.[boneandspine.com]
  • Utilize the very latest approaches in hip surgery including hip resurfacing, hip preservation surgery, and treatment of hip pain in the young adult; and get the latest information on metal-on-metal hips so you can better manage patients with these devices[books.google.com]
  • The most awesome images on the Internet Knee Pain- good for me to know! Struggling with knee pain from running for over 5 months now and my doctor just keeps sending me back to physio.[pinterest.fr]
  • Not only will patients experience chronic knee pain from loose bodies symptoms, but they will be able to feel this loose piece of bone or cartilage. At first, the loose piece may not be painful.[drburkeortho.com]
  • Symptoms include pain and swelling of the specific area. While it’s most common in athletes like dancers and gymnasts, it can occur in non-athletes as well. Through the use of ankle arthroscopy, the source of the pain can be removed.[scrubbing.in]
Asymptomatic
  • In case of the mobile loose body, wait and watch could be applied to wait for the loose body to move out of joint and become asymptomatic. Intra-articular fractures need to fix anatomically.[boneandspine.com]
  • Patients may be entirely asymptomatic or complain of pain, clicking and locking, depending on the location and mobility of the fragment as well as any associated secondary degenerative disease, and symptoms from the underlying cause.[radiopaedia.org]
  • Old, asymptomatic OCD may be an incidental finding in a patient with another cause for the symptoms.[emedicine.medscape.com]
  • It has been theorised that the adult onset of OCD may simply be a delayed onset of previously asymptomatic juvenile OCD that has failed to heal and presented later with loosening and joint degeneration.[thekneedoc.co.uk]
  • In asymptomatic hips, no treatment was indicated. In symptomatic patients, arthroscopic surgery of the hip was employed to remove the loose osteocartilaginous fragments.[arthritisresearch.us]
Surgical Procedure
  • Ankle arthroscopy is a minimally invasive surgical procedure that orthopaedic surgeons use to treat problems in the ankle joint.[ctfootandanklesurgery.com]
  • Arthrotomy is a surgical procedure that employs an open technique in which incisions are made into the joint and the loose body is removed.[shouldersandknees.com]
  • Further treatment would require a surgical procedure. Operative Treatment In the past 10 years, there have been many exciting advances in the surgical treatment of articular cartilage defects.[thesteadmanclinic.com]
  • Therefore, the surgical procedure is only one part of the recovery process, with rehabilitation the other, and both stages are equally important.[cartilage.org]
Fracture
  • For practical purposes, the differential diagnosis usually rests between osteoarthritis loose bodies, synovial chondromata and loose bodies associated with osteochondritis dissecans or osteochondral fracture.[boneandspine.com]
  • Top Articles Knee // Biologics Safety and Efficacy of Percutaneous Injection of Lipogems Micro-Fractured Adipose Tissue for Osteoarthritic Knees Knee // Arthroscopy Geniculate Artery Injury During Primary Total Knee Arthroplasty Sports Medicine // Foot[mdedge.com]
  • In osteochondral fractures, information on the posttraumatic damage to other intra-articular structures, such as ligaments or menisci, cannot be obtained by US.[ncbi.nlm.nih.gov]
  • CT scan: This is rarely used but can give details about the loose body when fracture or bone fragments are expected.[stoneclinic.com]
  • See how to proceed better than ever before with 45 surgical videos demonstrating hip revision, patellar tendon allograft preparation, open reduction internal fixation clavicle fracture, total shoulder arthroplasty, total elbow arthroplasty, and more -[books.google.com]
Arthritis
  • […] case rID: 10104 Still here are the causes for completion of the list Classification of Loose Bodies in Joint Fibrinous Composed of fibrinous material or of necrotic synovial membrane Traumatic -after haemorrhage Pathological Tuberculosis Rheumatoid arthritis[boneandspine.com]
  • The term arthritis literally translates to joint inflammation. Get My Free Ebook[arthritisresearch.us]
  • The list of problems that can be treated with this technology is constantly evolving and includes: Ankle arthritis: Ankle fusion is a treatment option appropriate for many patients with end-stage ankle arthritis.[aofas.org]
  • […] cover a thickened synovial surface or float freely within joint space Microscopic (histologic) description Cartilage cells with variable atypia or binucleated forms within synovium; clusters of chondrocytes are often arranged in lobules; no underlying arthritis[pathologyoutlines.com]
  • These are most commonly seen in patients with degenerative joint disease (DJD or arthritis).[rothmaninstitute.com]
Osteophyte
  • […] meniscus Osteocartilaginous loose bodies Osteochondral fractures of femoral condyles and patella Pathological Detachment of portion of articular surface from osteochondritis dessicans Synovial chondromatosis Pigmented vilonodular synovitis A detachment of osteophytes[boneandspine.com]
  • Arthroscopically, the borders of the osteophyte are exposed with a 3.5mm soft tissue resector, then the bony spurs themselves are removed with burrs.[ankle-arthroscopy.co.uk]
  • Anterior osteophytes form over the anterior lip of the distal tibia and corresponding area of articulation on the dorsum of the neck of the talus. These osteophytes or spurs occur because of repetitive and forceful dorsiflexion.[ctfootandanklesurgery.com]
  • Osteoarthritis can be a cause of loose bodies – presumably osteophytes (bony spurs around the margins of the joint) break off and can become loose inside the hip.[roberthowells.com.au]
  • Loose Bodies Causes-Degenerative chondral/osteophytes -Osteochondral fragmenttraumatic -Meniscal fragment -Fibrosed synovial villi -Broken implants/instruments -Bone cement residue Diagnosis - Clinical - X-rays if calcified or metal - MRI 4.[slideshare.net]
Knee Pain
  • The most awesome images on the Internet Knee Pain- good for me to know! Struggling with knee pain from running for over 5 months now and my doctor just keeps sending me back to physio.[pinterest.fr]
  • Chronic knee pain can occur any time an excessive amount of pressure is placed on the knee.[drburkeortho.com]
  • Despite what a patient’s MRI will say, MRIs cannot always reveal the cause of the patient’s Knee Pain .[caringmedical.com]
  • pain for 2 months.[orthobullets.com]
  • Evaluation of knee pain in adolescents presents a challenge for primary care physicians. Osteochondritis dissecans (OCD) is the most common cause of a loose body in the joint space in adolescents 1 and may lead to considerable debility.[aafp.org]
Osteochondral Loose Body
  • On review of the literature this is only the second case of osteochondral loose body as a cause for lumbar spinal stenosis and thus remains a rare phenomenon.[ncbi.nlm.nih.gov]
  • loose body Cartilaginous tissue enclosed by synovial tissue Differential diagnosis Cartilaginous loose bodies: more common but associated with arthritis Chondrosarcoma : not within a joint, no characteristic clustering pattern, marked myxoid change,[pathologyoutlines.com]
  • Diagnosis Right knee osteochondral defect with possible osteochondral loose body in the interchondylar notch.[ucsfhealth.org]
  • However, investigators have failed to identify inflammatory cells in histologic sections of excised osteochondral loose bodies. Nevertheless, the name has persisted.[emedicine.medscape.com]
  • Discussion Synovial chondromatosis is characterized by formation of multiple osteochondral loose bodies. It is a process whereby the synovium undergoes metaplasia and ultimately forms cartilage loose bodies. These loose bodies may go on to ossify.[ispub.com]

Workup

  • CT-scans are increasingly used in the preoperative workup. A CT-classification was therefore introduced in 1993, resembling the above classification, with stage V representing a radiolucent defect [ 27 ].[em-consulte.com]

Treatment

  • The reader learns of pediatric orthopedic deformity in relation to normal and abnormal developmental biology, the worsening of untreated disease with growth, and the diagnostic and treatment interventions required based on the stage of progression. *[books.google.com]
  • Make informed clinical choices for each patient , from diagnosis and treatment selection through post-treatment strategies and management of complications, with new evidence-based criteria throughout.[books.google.com]
  • The causative disease like tuberculosis would require medical treatment. Physical therapy and anti-inflammatory drugs can be used to help with the symptoms and to keep the joint flexible.[boneandspine.com]
  • All of the subject areas tested on the boards are represented, including basic science and general procedures; health promotion and preventive aspects; emergency assessment and care; and diagnosis, management, and treatment of the full range of sports-related[books.google.com]
  • Treatment There are limited options of non-surgical management of a loose body as it mainly leads to mechanical symptoms which are relieved only after removal.[stoneclinic.com]

Prognosis

  • […] are not likely to heal; - bad prognosis if frag detaches, leaving defect in wt bearing region; - classification: (from Clanton and DeLee (1982)) - I : depressed osteochondral fracture; - II : osteochondral fragment attached by an osseous bridge; - III[wheelessonline.com]
  • Natural History & Prognosis The literature on this condition contains no randomised controlled clinical trials for either surgical or non-surgical interventions for OCD of the knee.[thekneedoc.co.uk]
  • The overall prognosis is usually dependent upon the extent of underlying degeneration rather than the presence or absence of a loose body.[arthritisresearch.us]
  • Prognosis worsens with age and physis closure. Therefore, the goal of management of juvenile OCD is to promote resolution of the lesion before physis closure.[aafp.org]
  • Therefore, the size, width and depth, of the cartilage fissure is an important thing to assess because it can ultimately determine the prognosis of being able to return back to normal activities or if one would need to adapt their activities going forward[drrobertlaprademd.com]

Etiology

  • Etiology The true etiology of osteochondritis dissecans has been the source of enthusiastic debate for decades. The etiology has been described as traumatic, ischemic, idiopathic, and hereditary.[emedicine.medscape.com]
  • Definition / general Also called synovial chondrometaplasia, synovial osteochondromatosis Mean age 41 years, range 17 - 64 years, 2/3 male ( Hum Pathol 1998;29:683 ) Primary disease is uncommon, unknown etiology, aggressive ( Hum Pathol 1979;10:439 )[pathologyoutlines.com]
  • It is a general term used to characterize the pathology encountered at the joint surface with no consideration of etiology.[radsource.us]
  • […] condyle; - is usually unilateral (74%) - relatively common source of loss bodies in the knee or even an incongruous joint if the separated fragment is large; - twice as common in males; - classically occurs below the age of 18 (range: 6 to 53 years) - etiology[wheelessonline.com]
  • Indications Arthroscopy is indicated for diagnosis of certain soft tissue disorders when the exact etiology of ankle symptoms remains unclear, as well as for treatment of a variety of ankle disorders, usually after conservative measures have failed.[ctfootandanklesurgery.com]

Epidemiology

  • Most OCD lesions of the elbow involve the capitellum, typically the central or lateral portion, but also the radial head, the olecranon of the ulna and the trochlea humeri. [2] Epidemiology / Aetiology Ostechondritis of the humeral capitellum is secondary[physio-pedia.com]
  • Epidemiology Frequency Prevalence In the United States, the overall prevalence of osteochondritis dissecans is not known. However, in the femoral condyles, OCD has a prevalence of approximately 6 cases per 10,000 men and 3 cases per 10,000 women.[emedicine.medscape.com]
  • […] 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. 3 Many researchers believe that the adult form is undiagnosed persistent juvenile OCD. 4 Epidemiology[aafp.org]
  • Epidemiology With the increased awareness and newer diagnostic techniques, the incidence of OD seems to increase [ 27 ].[em-consulte.com]
Sex distribution
Age distribution

Pathophysiology

  • History, pathophysiology and current treatment concepts. - Clinical Manifestations and Exam: - vague complaints: poorly localized pain, pain w/ exercise & effussion; - loose bodies may cause locking; - on exam, forcible compression of affected side of[wheelessonline.com]
  • Our understanding of the pathophysiology of OCD has not advanced much over the past 100 years.[aafp.org]
  • Pathophysiology Once a lesion is present, it typically progresses through 4 stages unless appropriately treated. Stage I consists of a small area of compression of subchondral bone. Stage II consists of a partially detached osteochondral fragment.[emedicine.medscape.com]

Prevention

  • All of the subject areas tested on the boards are represented, including basic science and general procedures; health promotion and preventive aspects; emergency assessment and care; and diagnosis, management, and treatment of the full range of sports-related[books.google.com]
  • Prevent any tears and breaks of the knee with: Exercise that strengthens muscles around the knee A well-balanced diet to strengthen bones Protective knee pads and gear for athletes[drburkeortho.com]
  • It is important to seek treatment for synovial chondromatosis as early as possible to help relieve painful symptoms and prevent the progression of osteoarthritis in the joint.[orthoinfo.aaos.org]
  • Prevent Yoga Injury: 3 Things You Must Do to Keep Your Knees Safe in Yoga Knee Anatomy---my new obsession to study well, a meniscus tear puts a cramp in my running style[pinterest.fr]
  • Advanced radiographic disease also precludes consideration of an arthroscopic procedure, because capsular and periarticular contracture prevents adequate distraction of the joint.[arthritisresearch.us]

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