Talk:Osteochondritis dissecans

Welcome!

Hello to all who visit hereafter!

I am an AP Biology student who is currently editing this article in the hopes that it will eventually reach "Good Article" status. I welcome and encourage all who visit to contribute/criticize, albeit constructively, as they see fit. Please help!, if you see anything that you think should be changed than by all means let me know! I am completely open to suggestions and greatly thankful for any help that might come from the Wikipedia community.

My end goal, as noted earlier, is to nominate and pass this article to "Good Article" standing in the coming months. While it will be a difficult road ahead, I hope those of you who took the time to read this will understand my undertaking and seek to help me expand and improve Wikipedia. Also, check out my user page to learn more about my personal connection with this article, or Wikipedia:WikiProject AP Biology 2008 for my AP Biology Class Goals/Project information. Cheers! FoodPuma (talk) 14:01, 30 August 2008 (UTC)

I was asked by TimVickers (talk · contribs) to monitor this page. At the moment it looks lovely. Please let me know if any help is needed. I would recommend implementing WP:MEDMOS and ensuring all the references are properly templated. JFW | T@lk 05:48, 9 September 2008 (UTC)

Max... You might get a kick out of this. Wikipedia talk:WikiProject North of the Rio Grande. The odds are not in our favor ... the previous class of his did rather well....Wikipedia:WikiProject_Murder_Madness_and_Mayhem ; clearly we are the under dogs ... with nothing to lose but our pride! Do you think he will fail them all if we get to FA first ... wonder what tuition cost at the University of British Columbia---- if I was in his student's shoes .... I think I'd get cranking on some Wikipedia!!!!! --JimmyButler (talk) 02:45, 13 September 2008 (UTC)

Referencing copyedit

I've had a go at tidying up the citation markup and tweaking image locations.[1] In particular please note:

• URLs in {{cite journal}} meant to be for full versions (so not abstracts and certainly not PubMed abstracts which in any case were given by the "pmid" parameter value)
• URLs meant to be for free access, so I have removed the links to sites needing subscriptions.
• Chinaroad Löwchen reference for dogs was a page clearly credited as coming from Columbia Animal Hospital, however not a direct lift as mention made of pictures which are absent. On searching for the original at Columbia Animal Hospital, apparent that this was a much longer and more detailed article (indeed the summariser at Chinaroad Löwchen claimed affected specifically cats too, but cats not mentioned at all in Columbia Animal Hospital's article). It may be that Chinaroad Löwchen had used or summarised a previous version of Columbia Animal Hospital's article, but it seems best to cite from the original source. David Ruben ^Talk 21:40, 13 September 2008 (UTC)

GA status

FoodPuma, I've just noticed in the "Full thickness lesions" section that there is a hidden comment that there is additional material in you sandbox. Is this still to be added or something already sorted (and the comment needs removing) ? David Ruben ^Talk 21:53, 2 October 2008 (UTC)

I also left a comment on your talk page) Thanks for addressing that! I needed to delete that message... it was to remind myself about that information I needed to summarize and cite before entering - but I've already added it! Nice catch! :-) Food_Puma 22:02, 2 October 2008 (UTC)

Keep the Faith

Thank you for such a thorough review. I think the students will certainly understand the challenges of obtaining GA status. This will serve as a clear message to those who plan to procrastinate: It can be done; but not as a last minute effort, prior to a deadline. I proposed a parade for anyone reaching FA status... that offer still stands.

Max - you are to be commended for your efforts; a minor setback at best. You are way ahead of the curve -with plenty of time to make adjustments. You now have a specific list of concerns provided by a knowledgeable editor; I have little doubt that you will address them successfully. I fought through literally hundreds of line-by-line concerns in my FA attempt - just take then one at a time and seek help from others when you encounter problems. --JimmyButler (talk) 00:41, 6 October 2008 (UTC)

Observations

Ok FoodPuma, as requested I've reread the article and here follow some minor issues and severe nit-picking (so take no offense):

• Last paragraph of leadin "Other terms have been associated with OCD in the literature..." the ref used 13 actualy implies that there has been confusion in the use of terms or overlap of diagnostic terms, not that there is a clinical "association" which would mean that a person who has one condition would also have a second condition. Perhaps this needs to be better phrased (but keeping it brief)

Being addressed in the GA review (part 2)Food_Puma 01:42, 19 November 2008 (UTC)

• Need clarify position of osteochondrosis - the last paragraph of leadin, as mentioned above, implies that OD has been wrongly confused with the condition of "osteochondrosis", yet the 1st paragraph explicitly states OD is a form of osteochondrosis. I know ref 13 so mentions this confusion of terms, but it remains confusing and ref-1 from Centre for Cancer Education, University of Newcastle upon Tyne, is really just a glossary definition sentance so really is not a heavy detailed source - just need to bear this in mind I think in the rephrasing of that last paragraph of the leadin

Also being addressed in part 2 of the GA review Food_Puma 01:42, 19 November 2008 (UTC)

• In leadin "To confirm the diagnosis, X-rays, CT scans and often magnetic resonance imaging (MRI) are usually required", I think "and" might be better replaced with "or" as clearly no one needs Xray AND CT AND MRI - but I appreciate plain Xray likely to be a 1st step with then CT or MRI (but not both) as secondary-level imaging.

 Done Food_Puma 01:42, 19 November 2008 (UTC)

• Classification: directly discussed which was standard staging system & which staging system was used in the article before then stating that there are 2 systems for staging - I've switched sentance order. Also added minor section bolding to the two methods to help them stand out (and also as the Anderson staging has a concluding paragraph sentance that is otherwise less clearly part of this first staging system) -  Done
• Symptoms&Signs section: "within the first stage of OCD (I), however the onset of stage II". I disliked the separation of "stage" and "I", given just listed out the stages in the previous section and need to help fix the staging concept in the reader's mind. "first" and then "I" seems too much of a duplication and "stage" is being used here in a formal sense (a specific staging system rather than freetext of say the phrase "in the last stages"). Hence I've reworded to "within the initial Stage I of OCD, however the onset of Stage II" -  Done
• No problem keeping Symptroms and signs in one section, but sufficient details to at least split into a second paragraph -  Done
• Causes section: "Although the name "osteochondritis dissecans" implies an inflammatory condition, the lack of inflammatory cells in histological examination suggests that there is a more likely cause." just adds to my confusion rereading the leadin that says "OCD) is a form of osteochondritis (inflammation of bone and cartilage)". This is a complex condition, and the article is written near the edge of current knowledge, rather than being some dumbed-down stub, and I do get the uncertainties being reflected in historical understanding of the condition and the research base... but will the average reader struggle a little too much ?
• Pathophysiology: '"wear and tear" degenerative arthritis' - would the wikilink be better as [[osteoarthritis|arthritis]] ?

 Done Food_Puma 01:42, 19 November 2008 (UTC)

• Pathophysiology: "and insufficient amounts of calcium" - might this be better as "decalcification" or "decalcification of the trabecular bone matrix" (ie concept of Bone mineral density) as I'm less sure that dietary calcium lack or low blood calcium levels are relevant? Don't want to get too convoluted here (PS "calcification" would be poor wikilinkd term as that tends to be used for abnormal calcium deposition in non-bone tissue such as tendons)

 Done Food_Puma 01:42, 19 November 2008 (UTC)

• Diagnosis: is the "see also" tag misplaced here, rather than in prior Symptoms & Signs or the following "Physical examination" section ?

Nice catch! :-)  Done Food_Puma 01:42, 19 November 2008 (UTC)

• Diagnosis: scintigraphy just redirects to the medical field of Nuclear medicine (so a bit like stating patient having a "plain radiology department imaging" rather than the noun of "plain Xray"). Notwitstanding the term is used in the reference given, at least here in UK the standard name would be to have a "bone scan" (so this edit).  Done
• Surgical treatment: antegrade on arthroscopy or retrograde needs a surgeon's sense of 3D geometry to understand now that the illustrative image been lost. Antegrade of course means with arthroscope in the joint space and heading out through the cartilage, whereas retrograde is coming through bone towards the joint space but not the last bit of the covering articular cartilage - does this edit clarify sufficiently ?

Great edit! I will make my own recreation of that diagram and upload it when I get done. Thanks! Food_Puma 23:59, 17 October 2008 (UTC)

• "Hinged lesions" - concept does not seem to be defined - I presume these are fragments of bone not fully detached -does this need some better phrasing ? Also the section title is "Hinged lesions" but the first sentance comes in with "flap lesions", perhaps need be consistant in phrasing in this small section ?
• References - any reason sources not listed in alphabetic order of the lead author ?

Oops, I will rearagne them. Thought they should be listed by order of appearance in text :-) Food_Puma 23:59, 17 October 2008 (UTC)

 Done Food_Puma 01:42, 19 November 2008 (UTC)

Overall a good article and an informative read. So FoodPuma the above is rather nit-picking :-) I've made a few edits as listed above and some others that you should easily follow the edit summaries of, I'll leave the other points for you to mull over :-) David Ruben ^Talk 04:05, 15 October 2008 (UTC)

X-ray caption

• 

"Plain films demonstrate irregularities at the articular surface of the lateral aspects of the medial femoral condyles bilaterally"

This caption is unhelpful to general readers. Most readers can guess that it is an x-ray. Some readers would realize that it is the knee. Very few readers will know where the medial femoral condyle is, let alone the articular surface of the lateral aspect of the medial femoral condyle. Axl ¤ [Talk] 19:56, 10 November 2008 (UTC)

Max - when you've addressed the issue over the caption - let me know. If we are at the point that reviewers are critiquing picture captions; then consider your mission accomplished. I realize the standards for medical articles are likely higher for GA -but from my perspective - you are there. I proclaim it GA - at least in spirit; enjoy your 100. Congratulations. --JimmyButler (talk) 00:02, 12 November 2008 (UTC)

I'm hoping to have time to step in on the review this weekend. The GA process has clearly not run as smoothly as one would like (although waits of a month or more are not uncommon). I think also fantastic work has been done on this article. Geometry guy 00:13, 12 November 2008 (UTC)

I agree with GG. :) —Ed 17 ^{(Talk / Contribs)} 00:22, 12 November 2008 (UTC)

Yea, sorry about the overall inactivity on my part people - I have been pretty consumed in my other school work! I have two more tests this week (one in this class...ha) so hopefully I can address this and some of the aformentioned issues this weekend. I also want to say "thanks" to everyone who has been stoping by and making edits, however minor they may be, as I surely would not catch the errors you have found. Cheers! :-) Food_Puma 23:22, 12 November 2008 (UTC)

You're doing fine FoodPuma, but now is your moment! Axl has kindly offered to review this article now, and has left detailed comments, so you just need to address these, and maybe the green dot will be yours. Geometry guy 20:51, 14 November 2008 (UTC)

Excellent

Congratulations Max and a heart-felt thanks to those who guided him to the light!

5,480 out of 2,630,101 --JimmyButler (talk) 19:40, 20 November 2008 (UTC)

Congratulations from me too. Onwards and upwards! Geometry guy 19:47, 20 November 2008 (UTC)

First off, I want to give a big THANK YOU to everyone who has helped me along the way, most notably David Ruben, Axl, Steven Fruitsmaak, Wouterstomp, JFW and Arcadian. All of you have been helpful beyond belief and a thousand "thanks" could never repay how kind you have been. Also, to Mr. Butler - I don't believe I would have made it this far had it not been for his constant support. If I didn't list you here then you are by no means insignificant, thank you to everyone for the time you spent; I am glad to see it paid off.

Oh, and don't de-watchlist it yet folks... if you know what I mean... Again, thanks! :-) Food_Puma 23:19, 20 November 2008 (UTC)

Pronunciation

Is the stress really "osteo-CHON-dritis disse-CANS"? Congratulations on the GA pass, by the way :) Fvasconcellos (t·c) 16:16, 21 November 2008 (UTC)

I do believe there is a stress on the "Chon" part of osteochondritis... but I don't think the "cans" part of dissecans is stressed... Food_Puma 22:51, 21 November 2008 (UTC)

I'd personally pronounce it "osteochonDRItis die-SEE-cans", but that's just me. I'll try to track down a source... Fvasconcellos (t·c) 00:06, 22 November 2008 (UTC)

Got one. It appears I wouldn't have pronounced it correctly either :) I've updated the article. Fvasconcellos (t·c) 00:16, 22 November 2008 (UTC)

Thank you :-) Food_Puma 00:25, 22 November 2008 (UTC)

FA help request

Any suggestions for what can be improved on FA? I am currently doing a major renovation on diction and syntax as far as copy editing goes (trying to get sentence fluency) and should have the article thoroughly altered in the coming weeks. If anyone would be willing to back check my work and ensure it "works" - en/em dashes, punctuation, sentence flow and techincal terms described - it would be much appreciated. I believe the article covers all the main points and goes into adequete depth on said points, using almost too many references for the information included; however, if you object please say so and give some pointers. In general, I really would love to see any help on a push for FA within the next 2 months. Thanks for all your help so far, wikicommunity, now it's time to finish the job. Cheers! Food_Puma 02:46, 4 February 2009 (UTC)

As always, I'm here. Ping me whenever you want a MoS and references comb-through. Just remember, I may be in college, but anything pertaining to content here is way over my head, biology boy. :P (I'm a social studies major lol)

Also, there can never be too many references unless you have ten for each sentence! —Ed 17 ^{(Talk / Contribs)} 03:16, 4 February 2009 (UTC)

I wonder if the staging systems in the "Classification" might be better presented as a table? Axl ¤ [Talk] 18:19, 4 February 2009 (UTC)

Hm, I had never considered that! Were you thinking along the lines of a simply two-column table with stages on the left and descriptions on the right? If so, I can do a little research and find the wikicode for it asap! Thanks for the suggestion! :-) Food_Puma 02:00, 5 February 2009 (UTC)

Take a look at Help:Table, I think. —Ed 17 ^{(Talk / Contribs)} 03:59, 5 February 2009 (UTC)

Cheng arthroscopic staging of osteochondritis dissecans

Grade	Findings
A	Articular cartilage is smooth and intact but may be soft or ballottable
B	Articular cartilage has a rough surface
C	Articular cartilage has fibrillations or fissures
D	Articular cartilage with a flap or exposed bone
E	Loose, nondisplaced osteochondral fragment
F	Displaced osteochondral fragment

Axl ¤ [Talk] 07:49, 5 February 2009 (UTC)

Cool! I was just given permission to use some really valuable diagrams explaining the OATS surgery (will have to OTRS), and am uploading images of my own surgery as I type. Those tables do clean up the articles appearance some, Axl, thank you! Food_Puma 13:36, 7 February 2009 (UTC)

Half-thoughts

• OCD is classified by the progression of the disease in stages.

Would it be easier to say: Stages are used to classify the progression of the disease?

• Despite a mountain of literature..

I'm not really sure if this is an encyclopedic tone. Perhaps something more along the lines of "a lot" rather than "a mountain."

• Prognosis is favorable in stable lesions (stage I and II) in juveniles with open growth plates...

The two prepositional phrases are really throwing me off here. Is prognosis favorable for both conditions separately or does it have to be a open-plate juvenile with stable lesions? If the latter, then maybe a some re-wording to clarify?

I see the problem.... gah, this does need to be fixed! Gracias for pointing that out. :-) Food_Puma 02:05, 13 February 2009 (UTC)

• In the history section, most of the sentences start with "In [year],..."

A more varied sentence structure would make the section less repetitious and thus easier/more "fun" to read.

True, true. Will fix. Food_Puma 02:05, 13 February 2009 (UTC)

• After diagnosis the lesion may be treated, depending on its stage, with a form of articular cartilage repair.

Maybe: Depending on the lesion's stage after diagnosis, it may be treated with a form of articular cartilage repair?

I like, replacing tomorrow. Food_Puma 02:05, 13 February 2009 (UTC)

• All of the pictures are on the right side of the page, which make it look a bit unbalanced. See if you can stagger them throughout the page (although sometimes it can look awkward).

I actually tried a couple times in "preview" to move images around but have found it so difficult to align an image and it's caption with the text in a way that doesn't distort it. Perhaps Axl or another editor more experienced than I could help? Thanks. Food_Puma 02:05, 13 February 2009 (UTC)

• Make sure that your links are specific and take the reader to the right page. This tool is super-helpful for this.

Cool! Yay (or nay when it basically says I fail). Food_Puma 02:05, 13 February 2009 (UTC)

Anyways, just some thoughts. Take them with a grain of salt, ignore them, whatever... :) --Yohmom (talk) 01:53, 13 February 2009 (UTC)

Rehabilitation analgesics

This sentence is from "Treatment", "Rehabilitation": Post-operative pain medication is usually required, with a mix of the most common analgesics being percocet, vicodin and oxycodone.

However the reference describes osteoarthritis. I'm not convinced that this is helpful information for this article. Axl ¤ [Talk] 12:34, 13 February 2009 (UTC)

I was struggling with finding a reference for this, without using my own research/experience as such. You see, with my own two surgeries I was prescribed the percocet, oxycontin and oxycodone. I talked to my doctor - after mailing him a printed copy of this article - about this exact issue, and he too concluded that they are common pain relievers used for post-surgery. I was unable to find any concrete evidence for this in journals or verifiable websites, and as such took relief in the one source I could manage. That being said, it is true that this source is referring to osteoarthritis and not OCD, so I move for removal of the information and citation until a suitable replacement is found. Anyone's help with this would be greatly appreciated. Cheers! Food_Puma 20:29, 13 February 2009 (UTC)

I don't think that there is any need to list the commonly used painkillers (analgesics). It is enough to note that painkillers are used. Axl ¤ [Talk] 10:17, 14 February 2009 (UTC)

FA nomination

This article looks really good and I would support a move to FAR. A minor suggestion from my part would be for a native Anglophone to add a soundclip for the pronunciation (see for example Systemic lupus erythematosus). --Steven Fruitsmaak (Reply) 14:31, 13 February 2009 (UTC)

Steven, do you mean FAC? :-) Graham. Graham Colm ^Talk 16:09, 13 February 2009 (UTC)

I agree that this article is ready for Wikipedia:Featured article candidates, and any issues that arise during the review should be relatively small and easy to resolve. --Arcadian (talk) 17:37, 14 February 2009 (UTC)

Too Technical

It's fantastic that this article made GA, even better that it's up for FA, but for the average reader, it's exceptionally technical. It needs some serious explanation to help people understand the different medical expressions used in it. I appreciate the subject is naturally technical; being a medical condition however, doesn't mean it shouldn't be understandable to the normal reader. Any help to improve would be most welcome! Thor Malmjursson (talk) 17:42, 14 February 2009 (UTC)

Agreed, a major downfall does lie in the necessary technical terms used. I've tried wikilinking most all medical jargon (that can be wikilinked) and have even begun creating Wikipedia or Wiktionary pages to define some of the terms used (EG: Subchondral bone). I'll peruse the article tonight and see if I can't do some reconstruction on the more technical sentences, but I have a feeling the majority of them cannot be avoided. Thank you for bringing this point up, though. Cheers! Food_Puma 18:17, 14 February 2009 (UTC)

And on another note, would you be supportive of revision on the introduction with less focus on the following body sections? I believe most readers who are doing general information/knowledge seeking won't go much further than the introduction (and that should cut out on much of the general readers who may have trouble with technical terms). With that in mind, I suggest keeping the body sections relatively technical because the disease is best described with original medical terminology; it losses meaning when put in the context of simplified descriptions. Please consider this - I doubt we could ever come to an agreement over the balance between technically explanations and easily understandable language. Thanks for reading! :-) Food_Puma 18:43, 14 February 2009 (UTC)

OCD is a particular form of inflammation in the part of the bone that is close to cartilage in a joint. Such inflammations are called osteochondritis. In the dissecans variant this inflammation has caused a fragment of the cartilage to separate from the bone. OFC can be caused by for example blunt physical injury, loss of blood supply or burn. ... --Ettrig (talk) 19:41, 14 February 2009 (UTC)

I believe the article is in compliance with Wikipedia:Make technical articles accessible. The introduction of the article is clear, the complexity increases slowly, the organization is straightforward, there are many illustrations, and we have wikilinks to the related concepts. --Arcadian (talk) 15:41, 15 February 2009 (UTC)

I disagree. The accessibility requirements are strongly formulated. The following terms in the first paragraph are too technical: osteochindritis, articular, trauma, avascular and necrosis. --Ettrig (talk) 16:11, 15 February 2009 (UTC)

I will agree that "articular," "avascular" and "necrosis" could probably be replaced with more understandable terms or explained(rewriting this now, will submit here for collaborative review prior to article change), yet I disagree strongly on the topic of "osteochondritis" and "trauma." Considering the name of the disease includes the medical term "osteochondritis," I feel as though one should be directed to a page explaining what the word itself means in depth; there are no acceptable substitutes for it. "Trauma" also fails to have any substitutes that clearly relate the information presented. For example, one may choose words such as "strain," "shock" or "damage" as a synonym with wider appeal, however you loose meaning by misconstruing the facts. Should I choose to replace "trauma" with "strain," a reader may get the idea of an ankle sprain and thus come to the conclusion that OCD is the result of a one-time accident. Similarly, if I replace "trauma" with "shock," a reader may assume some great fall or other mishap to have occurred to cause this "shock" to the joint (something out of the ordinary). Lest I go on, you can see the complications that arise.

Now that that's out of the way, lets turn our attention to "articular," "avascular" and "necrosis." Articular could be left in the article (now wikilinked to joint) with a description in (parenthesis). Avascular necrosis could use an explanation in parenthesis but I don't know how we could write a flowing introduction while trying to explain each technical term (like this). I think at some point we must realize the need for general knowledge and the willingness to gain that knowledge if they are to understand articles such as this. For this reason we have wikilinked as many technical terms and explained them when possible in the article (if they have a short explanation). I think I am going go ahead and nominate it for FAC, I suggest we get the public's opinion. Food_Puma 18:52, 15 February 2009 (UTC)

A thought from me: if you don't know what trauma is, you probably should be going to a doctor rather then reading the WP article. —Ed 17 ^{(Talk / Contribs)} 19:14, 15 February 2009 (UTC)

OK, partial agreement. I would like to persist on trauma though. In my opinion the linked physical trauma does not in a reasonable way describe the kinds of processes that can cause osteochondritis. To me, your explanation above is better than the one in that article. So I think you could help many by elaborating it in an article.--Ettrig (talk) 20:01, 15 February 2009 (UTC)

(←) This is a problem with Wikipedia articles on medical matters in general, and it is a difficult one to resolve. The problem is that there is a particular onus on such articles to be accurate, as what people read here can affect their lives. On the other hand, if it is comprehensible only to medical experts, it is also largely useless, and that affects people's lives too. Glossing familiar terms with precise medical analogues in parentheses is one method to handle this problem. Another useful tool is piped wikilinks. You have to be careful not to introduce easter eggs, but if you take your cue from the lead of the target article, then readers will not be disoriented. You can do this with phrases too: "repairing the joint's cartilage" can be piped to articular cartilage repair. I'm not saying this is the best way to do it, only that it is a tool to be considered.

Other suggestions... cartilage should be wikilinked, because many readers will not realise that there are multiple types of cartilage, or that it doesn't only occur as articular cartilage. The lead should always summarize the article, but it could do so in a less technical way. However, that's not an excuse to avoid making the rest of the article as accessible as possible, subject to accuracy. Hope that helps. Geometry guy 20:06, 15 February 2009 (UTC)

The use of articular is confusing. Given that it means that something is part of or related to a joint it may seem natural to link it to joint. But if you do not know this, click on articular and end up in joint and do not immediately find the word articular there. (Well, there is one occurrence hidden far down.) Then you would have good grounds to be suspicious (this is Wikipedia, you know). The next step might then be to look up articular. Then you would be really lost. Think it through. But remember, to be able to understand this problem you need to think from the perspective of a person who doesn't know what articular means. Sorting out problems like this is valuable work and should not be characterized as dumbing down. --Ettrig (talk) 08:42, 17 February 2009 (UTC)

There is a good explanation of articular cartilage in Wictionary, though. --Ettrig (talk) 09:14, 17 February 2009 (UTC)

I agree with Ettrig on the whole and liked the ideas for the lead. I've also struck the reference problem when I found Antigens, differentiation redirects to Cellular differentiation which does not have the word antigen in the article. I still haven't found a fix. perhaps the problem could be a noddy (no (re)direct defn). Mccready (talk) 09:39, 17 February 2009 (UTC)

I liked your recent edit Ettrig, although it begs me to ask why you didn't link "loss of blood supply" to avascular necrosis with a piped wikilink (suggestion of Graham Colm). Would you mind me adding that? Also, thank you for fixing the horrible spelling there... my lack of sleep = lack of edit enthusiasm. Food_Puma 11:33, 19 February 2009 (UTC)

Maybe too eager because so close to the ultimate goal on Wikipedia? You have done so much good work on this. So little remains now, that a steady trot should be sufficient to take you there in good time. No, I wouldn't mind. I think it should be OK, since loss of blood supply is found in the first sentence there, when someone clicks on it. Some more guidance that I haven't digested yet is in Wikipedia:Easter egg. The passage we are now discussing pictures avascular necrosis as one possible opening phase in OCD. I interpret this as saying that necrosis may be part of OCD. The last paragraph in the lead says that OCD can be confused with avascular necrosis (by link from osteonecrosis). I find this contradictory. Maybe the relation between these two conditions could be clarified. --Ettrig (talk) 12:55, 19 February 2009 (UTC)

The distinction between OCD as a result of avascular necrosis and it's confusion with osteonecrosis is blurred. It was my understanding (and my fault for not clarifying) that OCD sometimes is a result of avascular necrosis, but is not avascular necrosis in and of itself. Notice the effects of avascular necrosis: "collapse of the joint surface." This is also found in the staging section with "Subchondral bone flattening..." Clearly, the two share common results and this can be attributed to avascular necrosis' involvement in causing OCD (and thus some of it's characteristics). I am not sure how we may go about making this clear, but perhaps one solution could be putting (in parenthesis) that osteonecrosis is a cause of OCD, but not to be confused with OCD itself. Ideas? Food_Puma 22:56, 19 February 2009 (UTC)

References

Hi, I have, I hope, fixed the inconsistent formatting of the references as pointed out on the FAC page. I notice that refs. 1–7 are only cited in the Lead, and this might be picked-up by some reviewers. There should be nothing in the Lead section that is not covered in the body of the article and, although this is not he case, it looks odd. I suggest incorporating these citations into the body of the article as well. Lastly, I noticed that some references are named using a PMID number that is not the actual PMID number. This is a minor issue, since it is the final output of the text on the page which is important, but it does make editing confusing in places. Best wishes, Graham. Graham Colm ^Talk 15:22, 8 March 2009 (UTC)

I believe some PubMed articles had multiple PMID #'s associated with their page. I tried to use the auto tool here to make any PMID references, but a few I did by hand - taking numbers from the bottom of the page and filling out fields. Thus, I am confused: do the PMID #'s not link to these articles at all? Did you already change this? If not, just say the word and I'll google them to find out the right PMID number. Thanks for the catch. Food_Puma 22:24, 8 March 2009 (UTC)

No they don't, they all have one unique number, but best not to worry about this now, I would prefer my comments regarding references that are only cited in the Lead to be addressed. Graham. Graham Colm ^Talk 22:35, 8 March 2009 (UTC)

Duly noted and slated to be fixed. Food_Puma 23:54, 8 March 2009 (UTC)

Commons image gallery

On Commons I created a gallery page, with 4 images from one case of OCD of a femur. It would be nice to include as Case 2 FoodPuma's images. As a rule I do not use galleries but for series of images of the same object a gallery is the way to go, because the images can be put in a specific sequence that "tells the story". Also, an image collection (gallery or category) on Commons reduces the "ick" factor for Wikipedia readers, and reduces the urge to use long explanatory captions here. --Una Smith (talk) 01:45, 9 March 2009 (UTC)

Inline to be addressed

• http://en.wikipedia.org/w/index.php?title=Osteochondritis_dissecans&diff=276058396&oldid=276058081 SandyGeorgia (Talk) 16:43, 9 March 2009 (UTC)

Done. --Una Smith (talk) 17:06, 9 March 2009 (UTC)

Removed from "Signs and symptoms"

On radiograms, a crescent sign provides a clear diagnosis of OCD.

Perhaps this text can be readded if it is corrected:

1. It seems to belong in "Diagnosis" rather than "Signs and symptoms".
2. It is uncited (articles cannot rely on sources in linked articles, the text in this article needs to be cited).
3. The link to radiogram appears wrong. Also, diagnosis should be linked only on its first occurrence.

SandyGeorgia (Talk) 15:09, 10 March 2009 (UTC)

There are also still inline queries to be resolved (they can be found by searching in edit mode on <! ) SandyGeorgia (Talk) 16:25, 10 March 2009 (UTC)

Definition

The current definition is inadequate. It isn't supported by its source (MedTerms) and is needlessly technical. The word "articular" refers to the joints and "subchondral" means below the cartilage. Simple if you know what they mean (which I didn't). So why use the technical terms in the lead sentence? Our definition only talks of cracks in the bone/cartilage but the word "cracks" isn't used by any of the definitions I found and doesn't fully describe the issue. "Separation" seems to be a key aspect of the following definitions, most of which are more readable than ours.

• Osteochondritis dissecans: A condition in which a fragment of bone in a joint is deprived of blood and separates from the rest of the bone, causing soreness and making the joint "give way". (MedTerms)
• A type of osteochondritis in which articular cartilage and associated bone becomes partially or totally detached to form joint loose bodies. Affects mainly the knee, ankle, and elbow joints. (mondofacto aka Online Medical Dictionary)
• Separation of a portion of joint cartilage and of underlying bone, usually involving the knee. (The American Heritage Medical Dictionary)
• a joint disorder in which a piece of cartilage and neighboring bone tissue become detached from an articular surface. (Mosby's Medical Dictionary)

I'm reluctant to attempt rephrasing the definition myself, given that my reading on the subject consists of two sentences so far :-) Colin°^Talk 21:07, 10 March 2009 (UTC)

It has just been reworded during the later part of FAC as I remember the old version was a bit wordy (although it addressed separation of a bone-cartilage fragment). Perhaps this(?):

"... is a joint disease in which an area of articular cartilage and the underlying bone (called the subchondral bone) is deprived of blood and partially or fully separates from the rest of the bone." Food_Puma 19:38, 11 March 2009 (UTC)

We don't need the word "articular", which is jargon for join-releated, because we've just said it is a joint disease. The reader also doesn't need to know the term subchondral yet, so we can just ditch that parenthetical remark from the lead sentence. Are you sure the cartilage is "deprived of blood" or is that just the bone? Colin°^Talk 13:17, 12 March 2009 (UTC)

The joint has cartilage in addition to articular cartilage. --Una Smith (talk) 01:34, 13 March 2009 (UTC)

Lead image

Could someone artistic sketch a picture? The lead image makes me boak. Sorry. Colin°^Talk 21:07, 10 March 2009 (UTC)

I know, it's horrible. I preferred the earlier X-ray. This knackered hip is a real turn-off. Don't apologise. Graham. Graham Colm ^Talk 21:24, 10 March 2009 (UTC)

Okay, before anyone else barfs, I swapped in another X-ray, one that shows the crescent sign. Better? --Una Smith (talk) 21:31, 10 March 2009 (UTC)

Much better, but I think Colin's suggestion of a diagram for the Lead is good. X-ray images can be difficult to understand. I'll have a go a drawing one when I have more time. Graham Colm ^Talk 21:37, 10 March 2009 (UTC)

Sounds good. I was sorry to see the photo (File:Head of femur avascular necrosis.jpg) go, because it shows not just a nasty flap lesion, but also more common cracks and point lesions. The gallery page on Commons has several other views of the same specimen. --Una Smith (talk) 21:46, 10 March 2009 (UTC)

Seconded Food_Puma 00:42, 11 March 2009 (UTC)

The x-ray image was replaced with the "head of femur" image because the x-ray that replaced it did not have proper copyright verification. Until such verification can be secured (and I believe it was supposed to be deleted long ago) I move that we keep the "head of femur" image. I did not revert to before Una's edit, but I did change the image back for the mean time. Food_Puma 00:42, 11 March 2009 (UTC)

I hope the OTRS ticket comes through on the second X-ray image (File:OCDLession-1.jpg) but I agree with the others that a direct image or illustration of the gross pathology, rather than an X-ray image corresponding to it, is more informative. The first X-ray image (File:OCD Knee WalterReed-1.jpg) is too subtle. --Una Smith (talk) 17:08, 11 March 2009 (UTC)

I came here to comment on the picture. I believe in always never hiding information but in this exceptional case, that image makes me really cringe. I propose moving it down in the article for people more interested. I imagine it is especially off putting if you have this condition and want to find out more. Genjix (talk) 16:47, 21 August 2010 (UTC)

Merge proposal: Crescent sign

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section. A summary of the conclusions reached follows.

The result of the discussion was redirect Crescent sign to Osteochondritis dissecans. I think the best option is to redirect it to the "Signs and symptoms" section.

---

I propose merging Crescent sign into this article. --Una Smith (talk) 21:24, 10 March 2009 (UTC)

It's a stub of no more than a few lines so if the other medics agree then so do I. Graham Colm ^Talk 21:39, 10 March 2009 (UTC)

Most of those lines duplicate content of this article. I would replace it with a redirect and put the redirect in Category:Radiologic signs. --Una Smith (talk) 21:51, 10 March 2009 (UTC)

Sounds good. Graham Colm ^Talk 22:03, 10 March 2009 (UTC)

Support Food_Puma 00:40, 11 March 2009 (UTC)

So who is going to do it? Graham Colm ^Talk 14:05, 21 March 2009 (UTC)

Follow up all, if you're still around. Otherwise I'll do it in the near future. --Piz d'Es-Cha (talk) 07:12, 18 August 2010 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Lead

Some comments on this version.

Take note of this policy advice from WP:NOT (my italics):

A Wikipedia article should not be presented on the assumption that the reader is well versed in the topic's field. Introductory language in the lead and initial sections of the article should be written in plain terms and concepts that can be understood by any literate reader of Wikipedia without any knowledge in the given field before advancing to more detailed explanations of the topic. While wikilinks should be provided for advanced terms and concepts in that field, articles should be written on the assumption that the reader will not follow these links, instead attempting to infer their meaning from the text.

We need to work harder at either explaining technical terms, or enable the reader to infer their meaning from the text.

• Explain in every day language and tell them the technical term: "When the bone is deprived of blood, the tissue dies and is lost (avascular necrosis).
• Use a new technical term but include the definition: "Avascular necrosis (the death and loss of bone tissue due to deprivation of blood supply) ..."
• Decide the reader didn't need to know the technical term after all (or can wait): "When the bone is deprived of blood, the tissue dies and is lost."
• Introduce the term in a way they can infer the meaning: "The resulting fragmentation of both cartilage and bone, and the free movement of these ostechondral fragments within the joint space, causes pain and further damage" (my italics, to indicate the definition and the technical term).
• Use the term in a way that the reader doesn't feel they need to fully understand in order to continue reading. Not always possible. For example, when we list the diseases OCD can be confused with, the reader may be OK with reading some he doesn't recognise/understand and there's not necessarily a reason to explain what each disease is.

The words in the lead that a general reader won't know are Osteochondritis dissecans, articular, subchondral, avascular necrosis, dissection, osteochondral, effusion, crepitus, arthroscopy, arthroscopic drilling, lesions, stem cells, isometric exercises, atrophy, NSAIDs, osteonecrosis, accessory ossification center, osteochondrosis, and hereditary epiphyseal dysplasia.

The lead is rather long and some sentences are wordy or repeat stuff. Others go into detail the reader doesn't need in a summary. For example, the list of imaging techniques or the list of diseases that OCD historically got confused with.

The lead paragraph takes a long time to define the term and each sentence seems to overlap with the previous. I'm sure it could be compacted considerably. I'm sure the statement "Avascular necrosis deprives the bone of blood, and without blood the bone dies" is wrong: surely avascular necrosis is the deprivation of blood supply to the bone, leading to bone tissue death and loss. It doesn't cause that. Is "complication" the correct word here? Or would "caused by" suffice. Regardless, the term "avascular necrosis" is being used before it is defined. If I get a chance, I'll have a go at a reworded lead paragraph later. Unless you want a go. Colin°^Talk 13:57, 12 March 2009 (UTC)

Moving text from the lead to the body is one of the tasks left over from the FAC. It was requested by several reviewers. Some content in the lead is (was) not in body; that content belongs in the body, probably without mention in the lead. --Una Smith (talk) 01:29, 13 March 2009 (UTC)

Several refs are cited only in the lead - this shouldn't happen. Ref 1 should be replaced with something better. LeadSongDog come howl 06:08, 29 March 2009 (UTC)

Refs

A lot of the refs are from the 60s,70s and 80s? Wondering if we could update them?Doc James (talk · contribs · email) 11:21, 2 September 2011 (UTC)

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