Mosaicplasty
Harvest site
Option 1
- lateral and medial aspect femoral trochlea
Option 2
- intercondylar notch
Option 3
- allograft
- can take larger grafts without donor site risk
Size
Option 1
- lateral and medial aspect femoral trochlea
Option 2
- intercondylar notch
Option 3
- allograft
- can take larger grafts without donor site risk
European Orthopaedic Paediatric Study JPO 1999
- 452 patients
- juvenile and adult
Findings
- stable lesion with cartilage intact and no dissection had good prognosis
- if signs dissection, surgical management better than non surgical
- sclerosis on x-ray poor prognostic sign
- lesions > 2cm poor prognosis
- 20% OCD in juveniles abnormal x-ray findings at 3 years (not benign process)
Adolescents & young adults
Usually between 12 - 21 years
Throwing athletes / gymnasts
Little Leaguer's Elbow
- combination of capitellar OCD and MCL injury
- a repetitive throwing injury / seen in pitchers
1. Trauma & Overuse
Common throwing sports / gymnastics
Osteochondritis Dissecans
- separation of avascular fragment of bone & cartilage
M : F = 2:1
Mean age 18 years
- can present as young as 9
4:1000
Fracture talus through articular cartilage into subchondral bone
- 2° force transmitted from distal tibia
Osteochondritis dissecans v osteochondral fracture
6% ankle sprains
Average age = 25
M > F