Talk:Osteochondritis dissecans/GA1

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GA Review[edit]

  • I'm not sure about the organisation of headers: a very scholarly and logical organisation is used, but per WP:MEDMOS, sections which are important for readers (especially symptoms and signs, diagnosis, prognosis and treatment) have priority and should be moved higher up. "Presentation" is also medical jargon and should be changed to something like "symptoms and signs". --Steven Fruitsmaak (Reply) 17:46, 5 October 2008 (UTC)

As requested by FoodPuma, a review of the current article:

  • Many old references are used. These can be useful in some cases, but in most places a more recent reference would be appropriate.
 Done For the most part, old references have been removed. Several references from the 1960's remain, yet they have been cited as credible evidence in many other medical journals that I have found and thus I have reason to believe their word is true.
  • For the references linked to the books in the references section, the link doesn't work for me.
 Done I fixed the issue - seems someone changed it from {{citation}} to {{cite book}} (or maybe I just screwed up... either way it works now)
  • The books all seem to be referenced only once, so they could just be in the notes section, no need for a separate section.
YesY Is this truly necessary? My train of thought was that separating the few books I am using (and trying to expand on) from the multitude of medical journals and web sites would help any potential readers in verifying and obtaining resources on the topic... Your thoughts?
Probably just a matter of personal preference, but adding an section when you can do without it seems not so logical to me. More useful would be a further reading section with one or two good books mentioned. --WS (talk) 17:32, 9 October 2008 (UTC)
  • References are sometimes in the middle of a sentence where they should be at the end.
Not done Is it always true that they should be placed at the end? If so, then I can move them; however, I believed they were supposed to be located directly after the information or fact they validate (if a sentence is a conglomerate of different facts or statements from different sources). Your thoughts?
 Done I've fixed those lines using in-line citations improperly.
That is indeed how they are meant to be used, and they should not always be at the end, but take e.g. this sentence: In 1870, Paget[66] described the disease process for the first time. For readability I think it would be better to put the reference at the end of the sentence and I think it supports the whole sentence.
Thanks for clarifying, I will get to fixing that tomorrow if not tonight. FoodPuma 19:55, 9 October 2008 (UTC)
  • Many literal citations throughout the article. Not incorrect, but I prefer if it is reworded.
 Done Removed and reworded many (if not all) literal citations.
  • Lead: That OD may be treated with articular cartilage repair doesn't need 3 references, one reference to a good recent review article would suffice.
 Done Noted, references that were used elsewhere in article have been removed
Why specifically removing the references that were used elsewhere? --WS (talk) 17:32, 9 October 2008 (UTC)
See below, but I understand. I will go over the history and change make sure I am citing the most reliabel (recent) references tomorrow or saturday. FoodPuma 19:55, 9 October 2008 (UTC)
  • Causes section: nine references for listing possible causes is overkill when one or two can tell the same.
 Done Again, references that appeared elswhere in the article were removed. (The reason for this "overkill" was that the information presented had been condensed from a paragraph to a sentence. Would it be more appropriate to re expand it to a full paragraph? I could go into more detail about the possible causes and the consensus on such causes (some are more supported than others). Please share your thoughts!)
There are still 6 references while one or two would be enough. Just find one good recent review article, if not all these causes are mentioned in it they are probably not worth including here either. When causes are discussed separately and in more detail, more references can be useful. And again, why removing the references listed elsewhere? More different references in an article does not make it better, in fact it would be better to use fewer but higher quality articles. --WS (talk) 17:32, 9 October 2008 (UTC)
True, however if it is overkill to list multiple references for a certain line, and the references for just that line (not used elsewhere) are recent and reliable, then shouldn't I remove the references that are already used elsewhere? (There was no major difference in publish date or other info to suggest reliabilty differences). Also, the different causative factors described in the article are not agreed upon by all. No studies have concluded the true cause(s) of OCD, yet several published journals and websites overlap in their beliefs of the true etiology: I included the most common causative factors I found. FoodPuma 19:55, 9 October 2008 (UTC)
 Done Sorry, I was unfamiliar with the copyright request and didn't get an ORTS ticket! Subseqent e-mails have proven that this does indeed require deletion)
Also, found some quality images and will upload when time allows. They seem to be covered as property of the US Federal Government (see [[User_talk:Stevenfruitsmaak#Thanks!).
  • In fact, unless special permission was obtained, all current images seem to be copyright violations.
 Done See above

That's it for now, I will see if I can add some more later. --WS (talk) 19:04, 5 October 2008 (UTC)

Literal citations should, imho, only be used when they are notable by themselves (as quotations). Otherwise, this is editorial laziness. --Steven Fruitsmaak (Reply) 19:11, 5 October 2008 (UTC)
 Done (see above)
No time to fix these issues today, but I will when time presents itself! :-) FoodPuma 19:37, 5 October 2008 (UTC)
As a note, I thought images obtained from medical journals could be distributed under the creative commons 2.0 license. Seems like every other medical image that was taken from a journal uses this without any special permissions. Not saying that it is right (or legal) - merely that I took these images in the faith that it was okay to do such. FoodPuma 20:46, 5 October 2008 (UTC)
Unfortunately most journals don't use such a permissive license. --WS (talk) 20:59, 5 October 2008 (UTC)
YesY Fixed several of the presented issues today. Also, please check - I would like some more thought to several of the proposed changes! Again, thank you for reviewing! FoodPuma 22:48, 8 October 2008 (UTC)
YesY Fixed those problems remaining, if you have time time please ensure I fixed them correctly! Thanks for the excellent reviews and criticism! FoodPuma 00:09, 11 October 2008 (UTC)

This review appears to have stalled. Is WS or Steven Fruitsmaak the (lead) GA reviewer? Geometry guy 18:11, 26 October 2008 (UTC)

I believe Steven Fruitsmaak would be the "lead" GA review as he commented before Wouterstomp did. FoodPuma 21:44, 26 October 2008 (UTC)

Part 2[edit]

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)

"Lateral X-ray of the knee depicts OCD lesions of the medial condyle of the femur." I am not comfortable describing the position of the lesions/irregularities without these medical terms - would wikilinking solve the problem? FoodPuma 23:44, 14 November 2008 (UTC)
This isn't a lateral x-ray. A small arrow showing the affected part would be helpful. Wikilinking helps too. Axl ¤ [Talk] 01:14, 15 November 2008 (UTC)
Sorry about that, my ignorance for assuming what lateral was referring to in the image without looking at it (clearly it does need to be reworded!). Any who, do you believe "X-ray of the knee depicts OCD lesions of the outer medial femoral condyle" suffice? My desktop that had photoshop on it is being worked on right now, so if you or someone else could spare a few minutes layering an arrow on to point out the defect (Its on the right side, of the right notch of the knee). FoodPuma 19:56, 16 November 2008 (UTC)
Thanks. The new caption has useful information for the general reader. An arrow is not essential for GA status. Axl ¤ [Talk] 22:24, 16 November 2008 (UTC)
 Done :-) FoodPuma 22:53, 16 November 2008 (UTC)

From the lead section: "Other terms have been associated with OCD in the literature, including osteochondral (pertaining to cartilage) fracture, osteonecrosis, accessory ossification center, osteochondrosis, and hereditary epiphyseal dysplasia." Are these terms historical names for osteochondritis dissecans (synonyms), or are they diseases that can lead to OCD? Axl ¤ [Talk] 10:55, 14 November 2008 (UTC)

While they are not necessarily synonyms, they are diseases that afflict the joints in similar patterns to OCD and/or may be classified as a part of OCD (the death of bone it'sself is a disease, yet it is also a part of osteochondritis dissecans). FoodPuma 19:56, 16 November 2008 (UTC)

"Osteochondritis dissecans has been confused with other abnormalities of the joint surface, and therefore the orthopaedic literature must be read with care. Other, severe conditions described in the literature have been grouped under the heading of osteochondritis dissecans; these have included osteochondral fractures, osteonecrosis, accessory centers of ossification, osteochondrosis, and hereditary epiphyseal dysplasia. In several clinical investigations, different terms, such as osteochondrosis dissecans and osteochondral fragments have been used to describe this entity."

— Schenck

I am changing the Wikipedia article to: "In the past, many other conditions have been mistakenly confused with OCD, including osteochondral fractures, osteonecrosis, accessory centers of ossification, osteochondrosis, and hereditary epiphyseal dysplasia. Some authors have used the terms osteochondrosis dissecans and osteochondral fragments as synonyms for OCD." Axl ¤ [Talk] 12:47, 17 November 2008 (UTC)

Unfortunately, the claim that osteonecrosis is confused with osteochondritis dissecans most nearly contradicts the following statement made in "Signs and symptoms":

"Specifically, OCD is a type of osteochondrosis in which a lesion has formed within the cartilage layer itself, giving rise to secondary inflammation."

— Clanton

It seems that we must make the distinction that osteonecrosis is a part of OCD, so far that osteonecrosis describes the death of the subchondral bone - an early stage required for OCD to occure, but that OCD is not just osteonecrosis. In other words, OCD implies osteonecrosis is present, yet osteonecrosis does not imply with certainty that OCD is present. Ideas? FoodPuma 01:28, 19 November 2008 (UTC)

So OCD is a subgroup of osteonecrosis. How about we remove the word "mistakenly"? "In the past, many other conditions have been mistakenly confused with OCD, including osteochondral fractures, osteonecrosis, accessory centers of ossification, osteochondrosis, and hereditary epiphyseal dysplasia." Axl ¤ [Talk] 10:12, 20 November 2008 (UTC)
That appears to make the distinction without implying it is something entirely seperate. I'll edit it in when I get home (if you don't do it before me) FoodPuma 15:20, 20 November 2008 (UTC)

Is there a reference for the Anderson MRI classification? Axl ¤ [Talk] 11:01, 14 November 2008 (UTC)

 Done Added! FoodPuma 23:44, 14 November 2008 (UTC)
Thanks. Axl ¤ [Talk] 01:14, 15 November 2008 (UTC)

OCD most commonly affects the knee, right? However this isn't mentioned in the "Signs & symptoms" section. Axl ¤ [Talk] 11:05, 14 November 2008 (UTC)

I thought it more appropriate to be kept in etiology, as I tried to address only the general symptoms of OCD (those found in all joints). If I could have some more direction as to how this could be fixed/changed... FoodPuma 23:44, 14 November 2008 (UTC)
I have added a couple of sentences to the "Signs & symptoms" section. Axl ¤ [Talk] 01:17, 15 November 2008 (UTC)

From "Signs and symptoms": "Symptoms typically present themselves within the initial Stage I of OCD; however, the onset of Stage II is usually within months and the disease progresses rapidly. This quick progression of OCD ... leads to a late diagnosis and subsequently further damage." I can see that symptoms are similar to sprains, thus the diagnosis may be delayed. However stage I progresses to stage II within months? This doesn't strike me as "rapid progression". Axl ¤ [Talk] 11:12, 14 November 2008 (UTC)

Sorry, I was referring to the quick progression after diagnosis - that OCD tends to move from minor lesions to full thickness lesions and/or the creation of loose bodies.(diagnosis, according to what I've read, may not occur until late Stage I or Stage II... in my own case it was not until Stage III and almost Stage IV) FoodPuma 19:56, 16 November 2008 (UTC)
I have changed the wording to: "Symptoms typically present themselves within the initial Stage I of OCD. The onset of Stage II is usually within months. Beyond stage II, the disease progresses rapidly. The non-specific symptoms (similar to other causes such as sprains and strains) lead to late diagnosis and disease progression." Axl ¤ [Talk] 15:46, 18 November 2008 (UTC)
Thanks! FoodPuma 22:40, 18 November 2008 (UTC)

From "Causes": "The incidence of overuse injuries in young athletes is on the rise and accounts for a significant number of visits to primary care;[26] this reinforces the theory that OCD may be associated with increased participation in sports and subsequent trauma." This is weak circumstantial evidence. I see that from Williamson & Albright, the incidence of OCD might be rising among young athletes? Axl ¤ [Talk] 11:42, 14 November 2008 (UTC)

From "Diagnosis": "In specific cases, if caught early enough, a harmless dye will be injected into the blood stream to show where calcium will accumulate." Is this a bone scan? Axl ¤ [Talk] 11:54, 14 November 2008 (UTC)

Yes, I will try to reword that and indicate that it is the same as the bone scan described in "Diagnostic Imaging."
 Done FoodPuma 19:56, 16 November 2008 (UTC)
I have re-written that sentence and added a reference. Axl ¤ [Talk] 16:13, 18 November 2008 (UTC)

"Diagnosis", "Physical examination", paragraph two would benefit from a reference. Axl ¤ [Talk] 19:03, 14 November 2008 (UTC)

I added some new material with a reference. Wasn't sure if I had to place the reference two times, as the material used is split into two paragraphs. Your thoughts? FoodPuma 23:55, 18 November 2008 (UTC)

In "Treatment", why is "autologous osteochondral plugs" abbreviated as "OATS"? Axl ¤ [Talk] 19:17, 14 November 2008 (UTC)

Sorry for the confusion, I meant that oseochondral plugs are used in the OATS procedure; where OATS stands for "Osteoarticular Transfer System." I am working on a way to rewrite it, soon to be fixed. FoodPuma 23:44, 14 November 2008 (UTC)
 Done Rewritten, tell me what you think of it! FoodPuma 19:56, 16 November 2008 (UTC)
Thanks. Axl ¤ [Talk] 16:21, 18 November 2008 (UTC)

For "Treatment", "Surgical treatment", "Unstable lesions", can we have a reference, please? Axl ¤ [Talk] 19:35, 14 November 2008 (UTC)

I am a bit perplexed at your question: what exactly are you referring to when you say "Treatment" or "Surgical Treatment?" Are you referring to that terminology used within the description of the treatment of OCD? FoodPuma 23:44, 14 November 2008 (UTC)
I'm referring to the subheadings within "Treatment". The subsection "Unstable lesions" could do with a reference. Axl ¤ [Talk] 01:17, 15 November 2008 (UTC)
 Done Thanks for clarifying! I found a suitable reference for my claims about serbert screws, and am currently searching for another on the topic of ACI surgery. FoodPuma 19:56, 16 November 2008 (UTC)
Thanks. Axl ¤ [Talk] 16:24, 18 November 2008 (UTC)

From "Epidemiology": "OCD is a relatively rare disorder with an estimated occurrence of 15 to 30 cases per 100,000 persons", referenced to Hughston "Osteochondritis dissecans of the femoral condyles". However Hughston quotes "estimated incidence, fifteen to twenty-one cases per 100,000 knees". Axl ¤ [Talk] 19:47, 14 November 2008 (UTC)

 Done Sorry, I do believe I had two references for that statement (the other of which stated 30 as the upper limit). I might have deleted that other ref when cleaning up unnecessary references a couple weeks ago. Regardless, it's fixed. FoodPuma 23:46, 14 November 2008 (UTC)
"Per 100,000 persons" is not the same as "per 100,000 knees". Also, is this a prevalence or an incidence? Axl ¤ [Talk] 03:22, 15 November 2008 (UTC)
 Done Sorry, that reference is much more appropriate when referring to the prevalence of OCD in the knee per cases (75%); the other reference claims 15 to 30 cases of OCD per 100,000 persons. Nice catch! FoodPuma 19:56, 16 November 2008 (UTC)
I have clarified this as incidence per year. Axl ¤ [Talk] 16:33, 18 November 2008 (UTC)

In "Epidemiology" is obesity a risk factor? What about high impact sports such as squash? Axl ¤ [Talk] 19:42, 14 November 2008 (UTC)

 Done I haven't found any evidence to support obesity as a risk factor, although it seems logical with increased stress on joints like knees/ankles. I did, however, add supporting material for the theory that high impact sports attribute additional risk for OCD. FoodPuma 19:56, 16 November 2008 (UTC)
Okay, thanks. Axl ¤ [Talk] 16:35, 18 November 2008 (UTC)

From "Epidemiology", paragraph 2: "The knee is the most commonly involved joint with 75% of cases when compared to the talus, capitellum, and wrist." The second half of the sentence doesn't make sense. What is the comparison here? Axl ¤ [Talk] 03:19, 15 November 2008 (UTC)

 Done Reworded. FoodPuma 19:56, 16 November 2008 (UTC)
Thanks. Axl ¤ [Talk] 16:35, 18 November 2008 (UTC)

From "Epidemiology":-

The most commonly affected areas of the knee are:

However the talar dome and capitellum of the humerus are not areas of the knee. Axl ¤ [Talk] 03:24, 15 November 2008 (UTC)

 Done Reworded. FoodPuma 19:56, 16 November 2008 (UTC)
Shouldn't this be "Weight-bearing", not "Non-weight-bearing"? Axl ¤ [Talk] 16:39, 18 November 2008 (UTC)
You would think, right? I did a search and found that the American Academy of Family Physicians claims a similar occurrence (they state 85%) of OCD lesions affecting the non-weight-bearing medial femoral condyle... it also appears that they site the same journal. It's listed under "Epidemiology" if you are interested: Osteochondritis Dissecans: A Diagnosis Not to Miss. FoodPuma 22:40, 18 November 2008 (UTC)
Looking through a few more references, I see what you mean. However the medial femoral condyle does weight-bear, which caused my confusion. I am changing the text to "Non­-weight-bearing part of the medial femoral condyle". Axl ¤ [Talk] 07:51, 20 November 2008 (UTC)

GA pass[edit]

Thanks to FoodPuma for excellent work on this article. It is well-written, accurate, comprehensive, well-referenced, and nicely illustrated. I am awarding it "Good article" status.

For future improvement:-

  • A small arrow on the x-ray at the top right would be helpful
  • General copyedit and review of prose (peer review might assist with this)
  • Consistency of reference format. Some references use full stops (periods) as part of their title abbreviations while others do not. (Actually it would be ideal to have journal names spelt out in full)

Axl ¤ [Talk] 16:46, 20 November 2008 (UTC)