Osteochondritis Dissecans of the Knee: Etiology and Pathogenetic Mechanisms. A Systematic Review

Cartilage - Tập 11 Số 3 - Trang 273-290 - 2020
Luca Andriolo1, Dennis C. Crawford2, Davide Reale1, Stefano Zaffagnini1, Christian Candrian3, Alessia Cavicchioli1, Giuseppe Filardo1
1II Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
2Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
3Ospedale Regionale di Lugano, EOC, Lugano, Switzerland

Tóm tắt

ObjectiveThe purpose of this manuscript is to analyze the evidence regarding etiopathogenesis of knee osteochondritis dissecans (OCD) lesions through a systematic review, so to summate the current understanding of the origin and progression of this pathologic articular processes.DesignA systematic review of the literature was performed on the PubMed and Cochrane databases on October 2017 by 2 independent authors and included all levels of evidence. This included all English language literature, pertaining specifically to etiopathology of knee OCD with exclusions for review articles and expert opinion. Of 965 identified records, 154 full-text articles were assessed for eligibility and 86 studies met the inclusion criteria.ResultsAccording to these studies, the etiology of OCD can be of a biological or mechanical origin: 40 articles proposed a biological hypothesis, including genetic causes (27), ossification center deficit (12), and endocrine disorders (9); conversely, 52 articles supported a mechanical hypothesis, including injury/overuse (18), tibial spine impingement (5), discoid meniscus (16), and biomechanical alterations (20) as the cause of the onset of OCD. The pathogenic processes were investigated by 36 of these articles, with a focus on subchondral bone fracture and ischemia as the ultimate events leading to OCD.ConclusionsBiological and mechanical factors are found to result in subchondral bone remodeling alterations, acting independently or more likely synergically in the progression of knee OCD. The former includes genetic causes, deficit of ossification centers and endocrine disorders; the latter, tibial spine impingement, discoid meniscus, and biomechanical alterations, together with injuries and overuse. The resultant subchondral bone ischemia and/or fracturing appears to determine the onset and progression of OCD.Level of EvidenceSystematic review of level II-IV studies, level IV.

Từ khóa


Tài liệu tham khảo

10.11138/jts/2016.4.3.165

10.1007/s11999-013-2824-y

10.1177/0363546506290127

10.1016/j.joca.2017.07.005

10.5435/00124635-200602000-00004

10.1177/1947603518758435

10.1177/036354658301100509

10.1136/bmj.b2535

10.1016/j.knee.2015.05.004

10.1007/s00167-014-3413-7

10.3928/01477447-20130821-27

10.5792/ksrr.2013.25.4.225

10.3928/01477447-20131120-23

10.1186/1546-0096-11-18

10.5792/ksrr.2013.25.2.88

10.1177/230949901202000123

10.2214/AJR.11.8085

10.1007/s00167-010-1370-3

10.1111/j.1600-0838.2010.01128.x

10.1016/j.ajhg.2009.12.018

10.1002/ajmg.a.33240

10.1007/s11999-009-1017-1

10.1016/j.joca.2007.11.009

10.1302/0301-620X.90B2.19705

10.1007/s00167-004-0543-3

10.1007/s00247-005-1507-6

Kilic SS, 2002, Turk J Pediatr, 44

Fonseca AS, 1990, Orthopedics, 13, 10.3928/0147-7447-19901101-13

Barrie HJ., 1984, J Rheumatol, 11

10.1097/00003086-198106000-00033

10.1097/00005373-196603000-00007

10.2106/00004623-195739050-00010

10.1302/0301-620X.37B1.142

Ribbing S., 1955, Acta Orthop Scand, 24

10.2106/00004623-195335010-00004

10.1302/0301-620X.39B2.261

Stougaard J., 1964, J Bone Joint Surg Br, 46

10.2106/00004623-196749050-00009

10.1097/00003086-197905000-00025

10.3109/17453678108992141

10.2106/00004623-198567010-00020

10.1007/s10140-004-0387-7

10.1177/0363546515572579

10.1097/BPO.0000000000000660

10.1148/radiol.2016160071

10.1007/s11999-016-5059-x

10.1007/BF00180201

10.2106/00004623-197759060-00010

10.1097/BPO.0000000000000511

10.3928/01477447-20140124-30

10.1016/j.eats.2013.09.003

10.1007/s00167-014-3289-6

10.1016/j.arthro.2014.05.010

10.1007/s12570-013-0227-x

10.1007/s00167-012-1983-9

10.1007/s00776-011-0190-8

10.1007/s11999-012-2324-5

10.1016/j.ejrad.2012.01.009

10.1177/0363546509359070

10.1007/s00167-009-0898-6

10.1177/0363546509346542

10.1016/j.knee.2009.07.016

10.3928/01477447-20080501-02

10.1007/s00402-007-0499-0

10.1097/01.bpo.0000191554.34197.fd

10.1177/0363546503261728

Bramer JA, Clin Orthop Relat Res, 2004

10.1007/s00247-003-0876-y

10.1053/jars.2001.19979

10.1007/s00167-002-0292-0

10.1007/s001670050180

10.1053/ar.1999.v15.015002

10.1016/S0749-8063(98)70063-5

10.2106/00004623-199811000-00003

10.1007/s001670050023

10.1302/0301-620X.73B6.1955439

10.1302/0301-620X.69B2.3818768

10.1097/01241398-198405000-00014

10.1148/126.2.305

10.1302/0301-620X.59B1.845229

10.1097/00005373-197508000-00011

10.1055/s-0031-1299657

10.1097/BPB.0000000000000094

10.1007/s00167-015-3907-y

10.1177/0363546515596410

10.1097/BPB.0000000000000180

10.1097/BPO.0000000000000839

10.1177/2325967116648138

10.1097/BPB.0000000000000316

10.1007/s00167-017-4451-8

10.1302/1863-2548-11-160173

10.1097/BPB.0000000000000398

10.1007/BF00350575

10.1302/0301-620X.59B3.893517

10.1016/0021-9290(91)90030-Q

10.1302/0301-620X.39B2.248

Thông tin
Thông tin xuất bản

Cartilage

Tập 11 Số 3

273-290

Thông tin tác giả