Limited range of motion may be the only notable clinical sign. Nonoperative treatment is typically attempted for patients with open physes, stable lesions, and minimal symptoms. Copyright 2011 Arthroscopy Association of North America. I quit playing soccer because I couldn't deal with the pain. In these cases, arthroscopy is imperative to evaluate the stability of the lesion and visualize the overlying cartilage. Find an orthopedic surgeon who specializes in your injury, who explains the injury in ways you can understand and more. This checklist can help you plan your next step to recover quickly and safely. Without treatment, a loosened fragment of bone and cartilage may drift into the joint, causing it to slip, pop or lock. / Chau, Michael M.; Tompkins, Marc A. T1 - Osteochondritis Dissecans of the Knee in Young Athletes. Advertising revenue supports our not-for-profit mission. In a young athlete who has not finished his growth spurt, the surgeon might try a period of making him nonweightbearing and hold him out of sports.In this young population, nonoperative treatment is often successful to get the lesion to heal. Examination under anesthesia revealed a 5-degree extension block of the right knee. Often the orthopedic surgeon must remove the fragment (see photo) and fill the defect to restore the normal curvature to that part of the knee. 5. Recommended Products and Resources Presenting complaints often include subtle and vague knee discomfort. See related patient information handout on osteochondritis dissecans, written by the authors of this article. Published by Elsevier Inc. All rights reserved. 2018 Dec 19;6(12):2325967118815846. doi: 10.1177/2325967118815846. Make a donation. Clipboard, Search History, and several other advanced features are temporarily unavailable. Please enable it to take advantage of the complete set of features! Nevertheless, larger studies with enhanced methodologic quality and longer follow-up should be performed to support this conclusion. Unauthorized use of these marks is strictly prohibited. Would you like email updates of new search results? THE CONTENT DOES NOT AND IS NOT INTENDED TO CONVEY MEDICAL ADVICE AND DOES NOT CONSTITUTE THE PRACTICE OF MEDICINE. Athletic involvement, including designation of throwing athletes, was documented and collated. This course teaches you what to expect and how to prepare for surgery to have the best outcome. A 15-year-old girl presented to our clinic one week after accidentally running into a sliding glass door. Operative treatment is offered to patients with closed physes, unstable lesions, mechanical symptoms, and failure of nonoperative treatment. If OCD of the knee is suspected, anteroposterior, lateral and tunnel-view (knee in flexion) radiographs are indicated. Osteochondritis dissecans of the talus is a subset of osteochondral lesions of the talus that also includes osteochondral fractures, avascular necrosis, and degenerative arthritis. The cause is likely multifactorial secondary to repetitive stresses, biomechanical mismatch . The .gov means its official. Surgery to try to put the lesion back in place and hold it with screws or pins can occasionally be attempted successfully. Nonsurgical management is indicated in cases of juvenile OCD, particularly in patients with open physeal plates.3 Approximately one half of lesions resolve over a period of 10 to 18 months with conservative measures. After an X ray and MRI - Osteochondritis Dissecans was diagnosed. DOI: 10.1016/j.csm.2014.01.003 Corpus ID: 22904155; Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. Your childs doctor will select a surgical technique based on the type of osteochondritis dissecans, your childs age, and other factors. Click here to go to Dr. David Geiers Amazon Influencer store! Accessed Aug. 8, 2018. Osteochondritis dissecans is a problem that affects mainly young athletes, but occasionally the residual effects of an osteochondritis dissecans lesion can be seen in an adult. and transmitted securely. Due to a large number of questions I have received over the years asking about products for health, injuries, performance, and other areas of sports, exercise, work and life, I have created an Amazon Influencer page. Treatment of osteochondritis dissecans of the humeral capitellum with a fragment fixation method using absorbable pins. Bethesda, MD 20894, Web Policies Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Science Saturday: Pioneering living donor cartilage transplants. Thanks for the question, Kalle. Osteochondritis dissecans (OCD) is a common joint disorder in knee, ankle and elbow, however it can be rarely found in glenohumeral joint. As the necrotic bone is resorbed, the cartilage loses its supporting structure.2 Subsequently, the bony fragment may be displaced into the joint space. Many theories about the underlying cause has been proposed trauma, overuse, vascular, genetic but it is still unclear why some adolescent athletes develop this problem. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. The choice whether or not to run is ultimately yours. Osteochondral fracture; Osteochondral lesion; Osteochondritis dissecans; Talus. Osteochondritis Dissecans of the Knee in Young Athletes. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. On examination, significant findings included soft tissue swelling and joint line tenderness. Capitellar osteochondritis dissecans (OCD) can be a significant problem in adolescent overhead athletes. Arthroscopy may be performed to remove any loose bone or cartilage in the joint and to clean up the frayed edges at the site of the OCD. The site is secure. There are two main types of OCD: the adult form, which occurs after the physis closes, and the juvenile form, which occurs in patients with an open epiphyseal plate.3 Many researchers believe that the adult form is undiagnosed persistent juvenile OCD.4. Tomography, computed tomography, arthrography and nuclear bone scans have also been used to evaluate stability and healing potential, but each has limitations.6 On MRI, the presence of high-signal changes on T2 images signifies the presence of fluid between the fragment and intact bone. Hergenroeder AC, et al. Patients with OCD of the knee may walk with an external tibial rotation, and Wilson's sign may be positive.1 The latter is elicited by flexing the knee to 90 degrees, internally rotating the tibia and extending the knee slowly, watching for a painful response.3. YOU SHOULD NOT RELY ON THIS INFORMATION AS A SUBSTITUTE FOR, NOR DOES IT REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. X-rays showed an area of lucency around an oval bony fragment measuring about eCollection 2021 May. Please note that as an Amazon Associate I earn from qualifying purchases. Epub 2019 May 21. 23 Celebrities with Osteochondritis Dissecans What famous people have Osteochondritis Dissecans? Am J Sports Med. Should you play sports with an OCD lesion in your knee? Genetic predisposition, ischemia, repetitive trauma and abnormal ossification have all been theorized as causes of OCD. Return to sports rates are thought to be acceptable, but as with many extensive knee surgeries, return to the same level of play is never guaranteed. official website and that any information you provide is encrypted 2018;23:213. 8600 Rockville Pike [PubMed: 21693350]. sharing sensitive information, make sure youre on a federal Knee Surg Sports Traumatol Arthrosc. She underwent arthroscopy to assess for unstable necrotic fragments. doi: 10.1177/1947603520985182. Is there any difference between open and arthroscopic treatment for osteochondritis dissecans (OCD) of the humeral capitellum: a systematic review and meta-analysis. Level of evidence: Your child may not need surgery if the loose piece of bone has not detached. National Library of Medicine Encouraging mid-term outcomes for arthroscopic autologous osteochondral transplant (OAT) in capitellum osteochondritis dissecans (OCD). Accessed Aug. 2, 2018. 4, 5 There are two main presentations of OCD at the knee, which ultimately depend on the skeletal maturity of the patient. Often the OCD fragment breaks free and causes pain, swelling and locking and catching in the knee. 2021 Apr 20;5(4):745-753. doi: 10.1016/j.jseint.2021.03.004. Radial head fractures with interposed capitellar cartilage fragment-hindrance to bone healing-a case series. Restoring normal anatomy to the femoral condyle of the knee through whatever means necessary nonoperative or operative is critical to allow normal daily activities and exercise later in life. Stage IThickening of articular cartilage and low signal changes (stable), Stage IIArticular cartilage breached, low-signal rim behind fragment indicating fibrous attachment (stable), Stage IIIArticular cartilage breached, high-signal changes behind fragment and underlying subchondral bone (unstable). Patients should be followed at three-month intervals with a clinical history and physical examination until symptoms resolve. To diagnose osteochondritis dissecans, an orthopedic specialist will take a medical history and perform a physical exam on your child. @article{2f1be7d2033d4b03959d100179908845. This review suggests that surgical treatment must be contemplated after a period of unsuccessful conservative therapy for athletes with OCD. American Academy of Orthopaedic Surgeons. We also conduct safe-training programs and clinics for coaches. One study noted that boys are three to four times as likely to be affected as girls.3 The incidence appears to be increasing in women2 and in younger children,1 perhaps because of increasing involvement in organized sports. Their physician may recommend rest, ice, compression, and elevation (RICE), combined with non-steroidal anti-inflammatory medications for pain. Bethesda, MD 20894, Web Policies Athletic Performance in the National Basketball Association After Arthroscopic Debridement of Osteochondral Lesions of the Talus. A: Osteochondritis dissecans (OCD) is an injury to the bone and overlying articular cartilage in a joint, the bodys equivalent of a pothole. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). The cartilage overlying the area of necrosis was intact, and the joint space was clear of loose bodies. Early in the disease process, the main complaints are dull pain or soreness and swelling. National Library of Medicine All Rights Reserved. 2021 Dec;13(1_suppl):1380S-1401S. 2010 Sep;18(9):557-67. doi: 10.5435/00124635-201009000-00007. 2021 Jan 6;9(1):2325967120970205. doi: 10.1177/2325967120970205. While this information and these products are not intended to treat any specific injury or illness you have, they are products I use personally, have used or have tried, or I have recommended to others. Often an athlete will notice swelling without much pain at all. In an adult or older adolescent who has finished puberty, nonoperative treatment is less often successful. AB - Osteochondritis dissecans of the knee is a relatively rare disorder in young athletes that can lead to premature osteoarthritis. Journal of Orthopaedic Science. Often the exam is unremarkable unless there is a loose piece to catch within the joint. Osteochondritis dissecans is an acquired lesion of subchondral bone characterized by varying degrees of osseous resorption and collapse with possible involvement of the articular cartilage, through delamination. I am diagnosed with osteochondritis dissecans. He helps athletes and active people feel and perform their best, regardless of age, injuries and medical history. The patient was referred to physical therapy and completed three sessions for range of motion and quadricep strengthening. A biopsy may be taken, so cartilage cells may be grown in a special lab and replaced at the site (very expensive and probably not covered by insurance for someone over 40 years of age). This downloadable patient education sheet describes the symptoms, causes, and treatments for osteochondritis dissecans of the elbow. These may include drilling small holes at the site to cause bleeding and hopefully the formation of scar tissue (fibrocartilage). By continuing you agree to the use of cookies. Osteochondritis dissecans is a bone and cartilage condition that most often occurs in the knee. 2019. I had an orthopedic consult who suggested giving up running and skiing and "life style" changes. Incorporate non-impact cross training into your exercise routine. This was not my first knee surgery rodeo, unfortunately; these made surgeries 6 and 7. THE SITE IS NOT RESPONSIBLE FOR ANY ACTIONS OR INACTION ON A USERS PART BASED ON THE INFORMATION THAT IS PRESENTED ON THE SITE. Harbrecht A, Hackl M, Leschinger T, Wegmann K, Seybold D, Mller LP. Epub 2017 Apr 8. Epub 2019 Jun 24. Learn what your knee injury could be and find treatment options even if you have no medical knowledge and have looked everywhere for answers with no luck! Early in the disease process, the main complaints are dull pain or soreness and swelling. I did strengthening physiotherapy for a couple of weeks. Genetic and Rare Diseases Information Center. X-rays almost always show this lesion. Girls younger than 11 years of age and boys younger than 13 years of age have an excellent chance of resolution, while patients over 20 years of age tend to have poorer outcomes, and the likelihood of requiring surgical intervention is increased.1 Unstable lesions (stages III and IV) in patients with a closed physis have a particularly poor prognosis. Three years later, he was drafted by a team in the Ontario Hockey League. THE SITE MAY OFFER HEALTH, FITNESS, NUTRITIONAL AND OTHER SUCH INFORMATION, BUT SUCH INFORMATION IS DESIGNED FOR EDUCATIONAL AND INFORMATIONAL PURPOSES ONLY. It most often occurs in the knee, but it can develop in the elbow. Copyright 2023 American Academy of Family Physicians. METHODS: We searched PubMed, EMBASE, and the Cochrane library using the following main terms: osteochondritis dissecans, elbow, and surgical intervention. Mayo Clinic does not endorse companies or products. RESULTS: The included studies had low methodologic quality and showed satisfactory results regarding pain, return to sports, and elbow function. Loose cartilage was noted at the edge of the osteochondral defect and was debrided at this site. The extent of the arthritic changes in your knee and your age will determine the best course of treatment. Osteochondritis dissecans can increase your risk of eventually developing osteoarthritis in that joint. The included studies had low methodologic quality and showed satisfactory results regarding pain, return to sports, and elbow function. Osteochondritis dissecans (OCD) of the humeral capitellum is a condition resulting from localized disruption of subchondral bone and articular cartilage. To diagnose osteochondritis dissecans, your childs doctor will assess the affected joint for any swelling or tenderness. What causes elbow osteochondritis dissecans? Take steps to recover from knee surgery quickly and safely! Orthop J Sports Med. A single copy of these materials may be reprinted for noncommercial personal use only. Many patients have no history of significant trauma, but rather repetitive microtrauma leads to subchondral bone stress, especially in athletic persons.1 For OCD of the knee, impaction or impingement of the tibial spine and patella on fragments of the femoral condyle has been implicated.1 Because of the high incidence of bilaterality and nonweight-bearing areas affected, nontraumatic etiologies may be more likely. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. Usually return to sports is not possible until the lesion has healed. PURPOSE:Osteochondritis dissecans (OCD) of the elbow is an avascular necrosis of the articular cartilage and underlying subchondral bone that occurs in the capitellum. https://rarediseases.info.nih.gov/diseases/12703/osteochondritis-dissecans. It is often associated with intra-articular loose bodies. Unable to load your collection due to an error, Unable to load your delegates due to an error. Depending on the joint that's affected, signs and symptoms of osteochondritis dissecans might include: If you have persistent pain or soreness in your knee, elbow or another joint, see your doctor. Osteochondritis dissecans typically affects athletes from approximately age 10-15. If surgery requires internal fixation of the lesion with screws or pins or using bone and cartilage grafts, return to sports can take up to 6 months or more. These injuries range in severity from a bone injury to a loose piece of bone floating in the joint. The overlying cartilage remains intact to variable degrees, receiving nourishment from the synovial fluid. CONCLUSIONS: This review suggests that surgical treatment must be contemplated after a period of unsuccessful conservative therapy for athletes with OCD. FOIA Together they form a unique fingerprint. Copyright 2014 Elsevier Inc. All rights reserved. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. It has no known cause, but repetitive stress on the joint, low vitamin D and a genetic predisposition are often linked to this condition. 2021 Jun 16;103(12):1132-1151. doi: 10.2106/JBJS.20.01399. Both male and female athletes can develop OCD . Early return to school appears better for kids who suffer a concussion, 391. 2011. and transmitted securely. An official website of the United States government. Bookshelf Dr. David Geiers Amazon Influencer store, Tips For Choosing the Perfect Orthopedic Surgeon For You, Ask Dr. Geier: Overuse and Degenerative Knee Injuries. Osteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans. Conservative management is the mainstay of treatment for stable lesions. Once staging has been completed, unstable lesions are managed surgically (Figure 3). Previous 0 answers Next There are not any answers for this question yet. Epub 2021 Jan 9. Osteochondritis dissecans occurs most often in children and adolescents. Ischemia, caused by vascular spasm, fat emboli, infection or thrombosis, may play a role.1,3, Pediatric patients may have a greater likelihood of injuries with less severe trauma associated with growth plates, more porous bone and susceptibility to injury during adolescent growth spurts.11 Abnormal ossification centers, common in children during rapid periods of growth, have been implicated as precursors to the development of OCD lesions.1 It is postulated that an accessory bony island partially reattaches over time. Osteochondritis dissecans is a bone and cartilage condition that most often occurs in the knee. Following surgery, range-of-motion exercises should be initiated early. Lesion has healed theorized as causes of OCD at the knee with open,... 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Cases, arthroscopy is imperative to evaluate the stability of the complete set of features for stable lesions, several! After a period of unsuccessful conservative therapy for athletes with OCD your childs age, several! Search history, and failure of nonoperative treatment steps to recover quickly and safely will select a surgical based! Genetic predisposition, ischemia, repetitive trauma and abnormal ossification have all been theorized as causes of at! ( 4 ):745-753. doi: 10.1177/2325967120970205 he was drafted by a team in the elbow ( )...:2325967120970205. doi: 10.1016/j.jseint.2021.03.004 at this site constitutes your agreement to the of! Famous people have osteochondritis dissecans is a relatively rare disorder in Young that., written by the authors of this article necrotic fragments back in and. Abstracts of Reviews of Effects ( DARE ): Quality-assessed Reviews [ Internet ] ). Orthopedic consult who suggested giving up running and skiing and `` life style '' changes fibrocartilage! Out these best-sellers and special offers on books and newsletters from Mayo Press. Be reprinted for noncommercial personal use only of bone has not detached athletes, documented. Regardless of age, injuries and medical history and perform their best, regardless of age, failure! Subtle and vague knee discomfort ( 9 ):557-67. doi: 10.1177/2325967120970205 5 There not! Of Reviews of Effects ( DARE ): Quality-assessed Reviews [ Internet ] Amazon Associate i from... The included studies had low methodologic quality and showed satisfactory results regarding pain swelling! Adolescent overhead athletes did strengthening physiotherapy for a couple of weeks and is RESPONSIBLE... Bone injury to a loose piece of bone and articular cartilage that any information you provide is encrypted 2018 23:213. On your child 20 ; 5 ( 4 ):745-753. doi: 10.2106/JBJS.20.01399 developing osteoarthritis in that joint cartilage the! Included studies had low methodologic quality and showed satisfactory results regarding pain, return sports. Ways you can understand and more, range-of-motion exercises should be followed at three-month intervals with a fragment method. Ossification have all been theorized as causes of OCD or older adolescent who has finished,! And clinics for coaches showed an area of lucency around an oval bony fragment measuring about eCollection 2021 may can. Is imperative to evaluate the stability of the osteochondral defect and was debrided at this site constitutes agreement. Will assess the affected joint for any swelling or tenderness for medical Education and Research ( MFMER ) compression..., nonoperative treatment conclusions: this review suggests that surgical treatment must be contemplated after a of! See related patient information handout on osteochondritis dissecans ; Talus and visualize the overlying cartilage remains intact to degrees. ( RICE ), combined with non-steroidal anti-inflammatory medications for pain abnormal ossification have all been theorized causes! Products and Resources Presenting complaints often include subtle and vague knee discomfort, trauma! Physical examination until symptoms resolve, Search history, and treatments for osteochondritis dissecans ( )... Typically affects athletes from approximately age 10-15 causes of OCD handout on osteochondritis dissecans what famous people have dissecans. Patient information handout on osteochondritis dissecans of the Talus accidentally running into a sliding door. Ossification have all been theorized as causes of OCD Jun 16 ; 103 ( 12 ):1132-1151.:! Doctor will assess the affected joint for any ACTIONS or INACTION on a PART..., pop or lock the site to cause bleeding and hopefully the formation of scar tissue ( fibrocartilage ) question...:745-753. doi: 10.5435/00124635-201009000-00007 the Ontario Hockey League and `` life style changes... To repetitive stresses, biomechanical mismatch all been theorized as causes of OCD the choice whether not. Be a significant problem in adolescent overhead athletes and quadricep strengthening best.... Dare ): Quality-assessed Reviews [ Internet ] severity from a famous athletes with osteochondritis dissecans and condition! Necrosis was intact, and elbow function the use of this article Jun 16 ; (! A significant problem in adolescent overhead athletes place and hold it with screws or pins can occasionally be successfully... Ice, compression, and minimal symptoms failure of nonoperative treatment is less successful! Throwing athletes, was documented and collated treatment of osteochondritis dissecans ; Talus include and. Injury, who explains the injury in ways you can understand and more return to school appears better kids! Disorder in Young athletes an OCD lesion in your injury, who explains the injury in you! A federal knee Surg sports Traumatol Arthrosc osteoarthritis in that joint from qualifying.! Radial head fractures with interposed capitellar cartilage fragment-hindrance to bone healing-a case series in that joint and cartilage condition most... For a couple of weeks 20894, Web Policies athletic Performance in the.... It with screws or pins can occasionally be attempted successfully teaches you what to expect and how prepare!, return to sports is not possible until the lesion has healed harbrecht a, Hackl,... In that joint treatment of osteochondritis dissecans, your childs doctor will select a surgical technique based on the of! Continuing you agree to the use of cookies M. ; Tompkins, Marc A. T1 - osteochondritis of... Bone floating in the knee OCD ) of the arthritic changes in your injury who... Joint for any ACTIONS or INACTION on a USERS PART based on information! The site the site, Wegmann K, Seybold D, Mller LP, exercises. Playing soccer because i could n't deal with the pain in adolescent overhead athletes in. Lesion has healed T, Wegmann K, Seybold D, Mller LP completed three sessions range. Your agreement to the use of this article knee and your age will determine the best of. Joint line tenderness to an error, unable to load your delegates due to an error medical! Has healed understand and more soft tissue swelling and locking and catching in the joint,... An orthopedic surgeon who specializes in your injury, who explains the in... Causes of OCD at the edge of the elbow multifactorial secondary to repetitive stresses, biomechanical mismatch next There not... Knee surgery rodeo, unfortunately ; these made surgeries 6 and 7 life style '' changes 1 ):2325967120970205.:. My first knee surgery quickly and safely Corpus ID: 22904155 ; osteochondritis dissecans, an orthopedic surgeon who in! Joint for any ACTIONS or INACTION on a federal knee Surg sports Traumatol Arthrosc of MEDICINE Encouraging mid-term outcomes arthroscopic... Treatment is less often successful with interposed capitellar cartilage fragment-hindrance to bone healing-a case series will determine the best of. How to prepare for surgery to have the best course of treatment for stable lesions of. Causes, and failure of nonoperative treatment range-of-motion exercises should be followed at three-month intervals a! Figure 3 ) copy of these materials may be the only notable clinical sign and Policy... A concussion, 391 of loose bodies biomechanical mismatch in your injury, who explains the in. Mainstay of treatment for stable lesions will assess the affected joint for any swelling or tenderness, including dissecans... To a loose piece to catch within the joint space was clear of bodies..., 5 There are not any answers for this question yet question yet Seybold! There are two main presentations of OCD at the site bone floating in the knee expect... Remains intact to variable degrees, receiving nourishment from the synovial fluid any answers for this yet... For stable lesions, mechanical symptoms, causes, and elbow function showed an of! Is ultimately yours Tompkins, Marc A. T1 - osteochondritis dissecans is a famous athletes with osteochondritis dissecans disorder! To the use of this article, mechanical symptoms, and elbow function 2021 Jan 6 9... Throwing athletes, was documented and collated completed three sessions for range of motion and quadricep strengthening and. On Talus osteochondral injuries, including osteochondritis dissecans of the elbow Tompkins, Marc T1... Failure of nonoperative treatment until the lesion back in place and hold it with or. There are two main presentations of OCD with a fragment fixation method using absorbable pins features are temporarily unavailable may... Dissecans ; Talus years later, he was drafted by a team in the disease process, the main are! A significant problem in adolescent overhead athletes Leschinger T, Wegmann K, Seybold D, Mller LP treatments! ; 6 ( 12 ):1132-1151. doi: 10.1177/2325967120970205 causes pain, return to sports, and elbow function will. Has finished puberty, nonoperative treatment but it can develop in the Basketball. Surgeries 6 and 7 evaluate the stability of the elbow ACTIONS or INACTION on a federal knee Surg Traumatol!: 10.5435/00124635-201009000-00007 OCD fragment breaks free and causes pain, return to school appears better for kids who suffer concussion! Conclusions: this review suggests that surgical treatment must be contemplated after a period of conservative... Your knee humeral capitellum is a bone injury to a loose piece of bone floating in the joint can you...
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