A Comparative Analysis of Osteochondritis Dissecans and Avascular Necrosis: A Comprehensive Review
Abstract
:1. Introduction
2. Etiology
3. Epidemiology
4. Clinical Presentation and Diagnosis
4.1. Clinical Picture
- Incidental finding in a symptom-free individual;
- Exercise-induced mechanical pain (most frequently observed);
- Persistent mechanical pain with joint swelling and/or locking.
4.2. Diagnosis
4.3. Differential Diagnosis
- Osteoarthritis;
- Osteoarthritis secondary to acetabular dysplasia;
- Ankylosing spondylitis of the hip joint;
- Transient osteoporosis or bone marrow edema;
- Chondroblastoma of the femoral head;
- Incomplete fracture in subchondral bone;
- Pigmented villonodular synovitis;
- Synovial herniation;
- Femoroacetabular impingement syndrome;
- Bone infarction of the metaphysis.
- Patellofemoral syndrome;
- Patellar tendonitis;
- Osgood-Schlatter disease;
- Sinding-Larsen-Johannson syndrome;
- Fat pad impingement;
- Symptomatic discoid meniscus;
- Symptomatic synovial plica;
- Patellofemoral pain;
- Knee osteoarthritis;
- Chondromalacia;
- Patellar tendonitis;
- Meniscal tear;
- Fat pad impingement;
- Symptomatic synovial plica.
4.4. Classifications
5. Management
5.1. Nonsurgical Treatment
5.2. Surgical Treatment
5.3. Biologic Treatment
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Stage/Type | Radiography [70] | [69] |
---|---|---|
I | Small lesion, compression of subchondral bone | Articular cartilage thickening and low signal alterations, but no fractures detected |
II | Partially detached OCD fragment | Articular cartilage breached, with a low-signal rim behind the fragment indicating fibrous attachment. |
III | Completely separated OCD fragment, still located in the underlying crater | Articular cartilage breached, with a high-signal rim behind the fragment indicating synovial fluid between the fragment and the underlying subchondral bone |
IV | Full detachment or loose body | Loose body |
AVN | OCD | |
---|---|---|
Pathophysiology | Blockage and reduction in subchondral microcirculation leading to necrosis of hematopoietic cells and adipocytes with subsequential interstitial marrow edema and osteocyte death. | Subchondral bone injury progresses from resorption to collapse, leading to sequestration. This sequence may result in the separation of articular cartilage and the detachment of a subchondral bone fragment, forming a loose body. |
Risk factors | Traumatic factors:
|
|
Incidence | 0.1–4.3 cases/100,000 person-years—depending on the site | 2.3–31.6 cases per 100,000 individuals–depending on the site |
Most common sites |
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Age | Typically, 30–65 years old | Typically, 11–20 years old |
Clinical manifestation | In the early stages of AVN, symptoms are often absent. Typical signs of AVN may manifest as growing pain, stiffness, and crepitus. | Stable lesions cause nonspecific symptoms such as pain, especially during activities or during palpation, vague, crepitus, limited range of motion, and joint effusion. Unstable lesions or loose bodies may manifest by clicking or locking. |
Imaging | Radiography followed by MRI. | Radiography followed by MRI. |
Radiographic features | Subchondral radiolucency, referred to as the “crescent sign” suggesting subchondral collapse. | Early lesions manifest as contour abnormalities. Advanced lesions show a circumscribed ossified fragment separated from the bone by a radiolucent line. |
MRI features | T1-weighted images display a single-density, low-signal intensity line. T2-weighted images display a high-intensity line with early necrotic-viable bone interface. | In T1-weighted images, the progeny is typically hypointense. In T2-weighted images, the progeny is mostly heterogeneous; this sequence can assess the integrity of articular cartilage, reactive marrow edema in the parent bone, and fluid or cystic changes at the parent-progeny interface. |
Rate of bilateral cases | Up to 70% | 14–30% |
Conservative treatment |
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Surgical treatment |
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Konarski, W.; Poboży, T.; Konarska, K.; Śliwczyński, A.; Kotela, I.; Krakowiak, J. A Comparative Analysis of Osteochondritis Dissecans and Avascular Necrosis: A Comprehensive Review. J. Clin. Med. 2024, 13, 287. https://doi.org/10.3390/jcm13010287
Konarski W, Poboży T, Konarska K, Śliwczyński A, Kotela I, Krakowiak J. A Comparative Analysis of Osteochondritis Dissecans and Avascular Necrosis: A Comprehensive Review. Journal of Clinical Medicine. 2024; 13(1):287. https://doi.org/10.3390/jcm13010287
Chicago/Turabian StyleKonarski, Wojciech, Tomasz Poboży, Klaudia Konarska, Andrzej Śliwczyński, Ireneusz Kotela, and Jan Krakowiak. 2024. "A Comparative Analysis of Osteochondritis Dissecans and Avascular Necrosis: A Comprehensive Review" Journal of Clinical Medicine 13, no. 1: 287. https://doi.org/10.3390/jcm13010287