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Osteochondritis Dissecans Knee Histology Studies Have Variable Findings and Theories of Etiology

  • Symposium: Osteochondritis Dissecans
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Although many etiological theories have been proposed for osteochondritis dissecans (OCD), its etiology remains unclear. Histological analysis of the articular cartilage and subchondral bone tissues of OCD lesions can provide useful information about the cellular changes and progression of OCD. Previous research is predominantly comprised of retrospective clinical studies from which limited conclusions can be drawn.

Questions/purposes

The purposes of this study were threefold: (1) Is osteonecrosis a consistent finding in OCD biopsy specimens? (2) Is normal articular cartilage a consistent finding in OCD biopsy specimens? (3) Do histological studies propose an etiology for OCD based on the tissue findings?

Methods

We searched the PubMed, Embase, and CINAHL databases for studies that conducted histological analyses of OCD lesions of the knee and identified 1560 articles. Of these, 11 met our inclusion criteria: a study of OCD lesions about the knee, published in the English language, and performed a histological analysis of subchondral bone and articular cartilage. These 11 studies were assessed for an etiology proposed in the study based on the study findings.

Results

Seven of 11 studies reported subchondral bone necrosis. Four studies reported normal articular cartilage, two studies reported degenerated or irregular articular cartilage, and five studies found a combination of normal and degenerated or irregular articular cartilage. Five studies proposed trauma or repetitive stress and two studies proposed poor blood supply as possible etiologies.

Conclusions

We found limited research on histological analysis of OCD lesions of the knee. Future studies with consistent methodology are necessary to draw major conclusions about the histology and progression of OCD lesions. Inconsistent histologic findings have resulted in a lack of consensus regarding the presence of osteonecrosis, whether the necrosis is primary or secondary, the association of cartilage degeneration, and the etiology of OCD. Such studies could use a standardized grading system to allow better comparison of findings.

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Acknowledgments

We thank Dr Eric Wall, Cincinnati Children’s Hospital Medical Center, Division of Orthopaedic Surgery, for his substantial contributions to this review. We also thank Mary McFarland, Information & Technology Consultant, Eccles Health Sciences Library, University of Utah School of Medicine, for consultation in the search strategy.

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Authors and Affiliations

  1. St Luke’s Health System, 109 East Bannock Street, Boise, ID, 83712, USA

    John C. Jacobs Jr BS

  2. St Luke’s Sports Medicine, St Luke’s Children’s Hospital, 109 East Bannock Street, Boise, ID, 83712, USA

    Kevin G. Shea MD

  3. Department of Orthopedics, University of Utah, Salt Lake City, UT, USA

    Kevin G. Shea MD

  4. Department of Orthopaedics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    James L. Carey MD, MPH

  5. Tennessee Orthopaedic Alliance, Nashville, TN, USA

    Allen F. Anderson MD

  6. Department of Biological Sciences, Boise State University, Boise, ID, USA

    Julia T. Oxford PhD

  7. Biomolecular Research Center, Boise State University, Boise, ID, USA

    Julia T. Oxford PhD

Authors
  1. Kevin G. Shea MD
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  2. John C. Jacobs Jr BS
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  3. James L. Carey MD, MPH
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  4. Allen F. Anderson MD
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  5. Julia T. Oxford PhD
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Corresponding author

Correspondence to John C. Jacobs Jr BS.

Additional information

Funding provided by the INBRE Program (JTO), National Institutes of Health grants P20 RR016454 (National Center for Research Resources), and P20 GM103408 (National Institute of General Medical Sciences).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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Shea, K.G., Jacobs, J.C., Carey, J.L. et al. Osteochondritis Dissecans Knee Histology Studies Have Variable Findings and Theories of Etiology. Clin Orthop Relat Res 471, 1127–1136 (2013). https://doi.org/10.1007/s11999-012-2619-6

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  • DOI: https://doi.org/10.1007/s11999-012-2619-6

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