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Osteochondritis Dissecans Of The Glenoid : An Analysis Of Grades, Treatment And Outcomes.

Osteochondritis Dissecans Of The Glenoid : An Analysis Of Grades, Treatment And Outcomes.

Dinshaw Pardiwala, MS(Orth), DNB(Orth), FCPS, INDIA Kushalappa Subbiah, MS(Orth), INDIA Nandan N Rao, M.B.B.S, M.S Orthopaedics, INDIA

Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, INDIA


2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Treatment / Technique

Anatomic Structure

Diagnosis Method

MRI

Sports Medicine

Cartilage

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Summary: Despite the glenoid being a concave non-weight bearing articular surface, OCD at this site has pathological grades similar to other convex weight-bearing articular surfaces, and it would appear that ICRS OCD I can be successfully treated with non-operative treatment, whereas ICRS OCD II, III, IV, warrant operative treatment.


Background

Osteochondritis dissecans (OCD) is an idiopathic disorder of subchondral bone that causes focal articular cartilage disruption with the potential long-term consequence of premature osteoarthritis. Glenoid OCD is exceedingly rare. This case series aims to identify the grades of glenoid OCD, and report its grade-specific treatment with clinical, radiological, and functional outcomes.

Methods

Prospectively collected data of consecutive patients diagnosed with a symptomatic glenoid OCD, who had a minimum two-year follow-up, following non-operative or surgical treatment, was retrospectively analyzed. Osteochondral defects secondary to acute trauma, instability, and primary osteoarthritis were excluded. Pre-treatment and post-treatment clinical, radiological, and sports participation data was collected. This included pre-treatment MRI for grading of glenoid OCD according to the International Cartilage Research Society (ICRS) OCD staging system, and postoperative MRI for grading of articular cartilage repair using the MOCART (MRI observation of cartilage repair tissue) scoring system.

Results

The study identified 7 competitive overhead athletes with symptomatic unilateral glenoid OCD, with a post-treatment minimum two-year follow-up. 3 patients with ICRS OCD I underwent non-operative treatment, whereas 4 patients with unstable glenoid OCD underwent arthroscopic OCD excision with bone marrow stimulation (BMS) cartilage repair. All patients improved following treatment and had full passive and active range of shoulder movements, with normal strength and stability at the 2- year follow-up. The mean MOCART score on MRI at 2 years for the 4 patients who underwent surgery was 82.5 (range, 75-90). MRI documented healing in 3 patients with ICRS OCD I who underwent non-operative treatment. All patients returned to the same or higher level of sport following treatment, with mean time to return to sports being 8.0 months (range, 6-11 months) for non-operative treatment, and 6.8 months (range, 5-10 months) for operative treatment. This difference was not statistically significant (p value 0.55). No patient had recurrence of symptoms till latest follow-up, and no patient required revision surgery for any reason within this period.

Conclusion

Despite the glenoid being a concave non-weight bearing articular surface, OCD at this site has pathological grades similar to other convex weight-bearing articular surfaces. Despite the limited number of cases, it would appear that ICRS OCD I can often be successfully treated with non-operative treatment, whereas ICRS OCD II, III, IV, warrant operative treatment. BMS is a safe and predictable option for glenoid OCD cartilage repair and allows athletes a quick and successful return to sports.


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