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Abstract(s)
A osteocondrite dissecante (OCD) é uma patologia rara que atinge inicialmente o osso subcondral, com consequente afecção da cartilagem articular adjacente, podendo resultar na separação parcial ou total de um fragmento da superfície articular. Afecta qualquer articulação, sendo mais comum o envolvimento da articulação do joelho. A sua prevalência exacta é desconhecida. Pode ocorrer em qualquer faixa etária, sendo mais comum nos jovens e praticantes de exercício físico regular, constituindo a principal causa de corpo livre intra-articular em adolescentes. Factores como inflamação, isquémia, trauma, genética e alterações da ossificação foram propostos para explicar a etiopatogénese da OCD, mas esta permanece por esclarecer. É frequente a confusão na prática clínica com outras patologias, como a osteonecrose, defeitos osteocondrais e distúrbios da ossificação. A OCD manifesta-se frequentemente através de sintomas inespecíficos de dor, edema e sintomas mecânicos. O diagnóstico baseia-se em exames de imagem, sendo actualmente a ressonância magnética nuclear o método de eleição. As características do paciente e da lesão influenciam o prognóstico, implicando abordagens terapêuticas distintas, desde tratamento conservador a técnicas cirúrgicas modernas utilizando engenharia de tecidos. O objectivo desta dissertação é reunir informação teórica actualizada sobre esta patologia ainda pouco entendida, recorrendo a uma pesquisa em bases de dados científicas, e apresentar dois casos clínicos ilustrativos, tanto na sua forma de apresentação clínica como nos resultados obtidos com os tratamentos efectuados, seleccionados a partir da casuística disponibilizada pelo Serviço de Ortopedia do CHLN.
Osteochondritis dissecans (OCD) is a rare disorder that initially involves the subchondral bone, with consequent damage to the overlying articular cartilage. It can result in partial or total separation of a fragment from the articular surface. Any joint can be affected, with the knee being most commonly involved. OCD can occur at any age and is more common in young people and practitioners of regular exercise though its exact prevalence is unknown. It is the leading cause of intra-articular loose body in adolescents. Factors such as inflammation, ischemia, trauma, genetics and ossification disturbances have been proposed to explain the etiopathogenesis of OCD, but it remains to be elucidated. It is commonly confused in clinical practice with other diseases such as osteonecrosis, osteochondral defects and ossification disorders. OCD often manifests through nonspecific symptoms of pain, swelling and mechanical symptoms. Diagnosis is based on imaging studies, with nuclear magnetic resonance being currently the gold standard. Patient and injury characteristics influence prognosis, implying different therapeutic approaches that range from conservative treatment to modern surgical techniques using tissue engineering. This work’s main goal is to gather updated theoretical information on this poorly understood disease through search in scientific databases, and present two illustrative clinical cases, both in its presentation and the outcomes with applied treatments, selected from the sample provided by CHLN’s Section of Orthopedics.
Osteochondritis dissecans (OCD) is a rare disorder that initially involves the subchondral bone, with consequent damage to the overlying articular cartilage. It can result in partial or total separation of a fragment from the articular surface. Any joint can be affected, with the knee being most commonly involved. OCD can occur at any age and is more common in young people and practitioners of regular exercise though its exact prevalence is unknown. It is the leading cause of intra-articular loose body in adolescents. Factors such as inflammation, ischemia, trauma, genetics and ossification disturbances have been proposed to explain the etiopathogenesis of OCD, but it remains to be elucidated. It is commonly confused in clinical practice with other diseases such as osteonecrosis, osteochondral defects and ossification disorders. OCD often manifests through nonspecific symptoms of pain, swelling and mechanical symptoms. Diagnosis is based on imaging studies, with nuclear magnetic resonance being currently the gold standard. Patient and injury characteristics influence prognosis, implying different therapeutic approaches that range from conservative treatment to modern surgical techniques using tissue engineering. This work’s main goal is to gather updated theoretical information on this poorly understood disease through search in scientific databases, and present two illustrative clinical cases, both in its presentation and the outcomes with applied treatments, selected from the sample provided by CHLN’s Section of Orthopedics.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Keywords
Osteocondrite dissecante Cartilagem articular Joelho Osso subcondral Ressonância magnética nuclear Tratamento cirúrgico