c he r p protocol outline- osteochondritis dissecans（c他r p协议大纲分离性骨软骨炎）.docVIP

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c he r p protocol outline- osteochondritis dissecans（c他r p协议大纲分离性骨软骨炎）.doc

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c he r p protocol outline- osteochondritis dissecans（c他r p协议大纲分离性骨软骨炎）

CHeRP Protocol Outline: Version 2: 09/18/12 Version 1: 5/21/12 All protocols must include the following sections. If a section is not applicable for the current protocol please indicate why this is the case. TITLE: Clinical, functional, and radiographic outcomes of trans-articular drilling versus retro-articular drilling of stable juvenile osteochondritis dissecans (JOCD) lesions: A multicenter prospective study. A. Specific Aims/Objectives The purpose of this study is to compare the clinical, functional, and radiographic outcomes associated with trans-articular drilling versus retro-articular drilling, two commonly employed techniques of operative treatment for stable forms of juvenile osteochondritis dissecans (JOCD) lesions. This study also aims to better define the natural history of this condition in its most commonly identified pathological state (as a stable lesion) following surgical intervention by determining the rate of radiographic healing and any need for secondary surgery. B. Background and Significance Osteochondritis Dissecans (OCD) of the knee is a localized pathologic process in which an area of subchondral bone undergoes metabolic changes or diminished blood supply and may progress to separate, along with its overlying cartilage, from the surrounding bony tissues. Paget first described it as a “quiet necrosis” in 1870 (Paget 1870) and Konig later coined the term ‘OCD’ in 1888 (Konig 1887-1888). Despite the historical recognition of the entity, its precise etiology and natural history remain largely speculative. While ischemia, genetics, acute trauma, and inflammation have all been postulated in the past, increased youth participation in sports and the rising incidence rate of OCD in skeletally immature athletes support a theory of overuse and repetitive microtrauma (Cahill, Phillips et al. 1989; Flynn, Kocher et al. 2004; Donaldson and Wojtys 2008). OCD lesions may be identified at various points along a pathologic spectrum, ranging