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J Knee Surg 2018; 31(05): 382-391
DOI: 10.1055/s-0038-1625956
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Osteochondral Injuries of the Knee in Pediatric Patients

Kathryn L. Bauer
1   Pediatric Orthopaedics and Sports Medicine, Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas
› Author Affiliations
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Publication History

09 December 2017

19 December 2017

Publication Date:
30 January 2018 (online)

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Abstract

Osteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans (OCD) lesion. Lateral patella dislocation is a common traumatic cause of osteochondral injury that typically occurs at the medial facet of the patella or at the lateral aspect of the distal femur. Multiple theories have been proposed for the cause of an OCD lesion in the knee, including trauma or repetitive microtrauma, local vascular insufficiency, and family history. The most “classic” location for OCD lesions of the knee is the lateral aspect of the medial femoral condyle of the distal femur. Multiple treatment options are available for both traumatic osteochondral injuries and OCD lesions, with important determining factors of treatment being skeletal maturity of the patient, instability of the fragment, lesion location, and size of the lesion. Nonsurgical management is appropriate in some situations. Surgical options range from simple fragment excision to internal fixation of the fracture fragment to more complex cartilage restoration or replacement procedures. This special focus section will discuss the diagnosis and treatment options for traumatic osteochondral knee injuries, including the subset secondary to juvenile OCD lesions.

Keywords

osteochondral injury - articular cartilage - osteochondritis dissecans - osteochondral allograft - patellar dislocation
 

  • References

  • 1 Stanitski CL, Harvell JC, Fu F. Observations on acute knee hemarthrosis in children and adolescents. J Pediatr Orthop 1993; 13 (04) 506-510
    CrossrefPubMedGoogle Scholar
  • 2 Abbasi D, May MM, Wall EJ, Chan G, Parikh SN. MRI findings in adolescent patients with acute traumatic knee hemarthrosis. J Pediatr Orthop 2012; 32 (08) 760-764
    CrossrefPubMedGoogle Scholar
  • 3 Siparsky PN, Bailey JR, Dale KM, Klement MR, Taylor DC. Open reduction and internal fixation of isolated chondral fragments without osseous attachment in the knee: A case series. Orthop J Sports Med 2017; 5 (03) 2325967117696281
    PubMedGoogle Scholar
  • 4 Fithian DC, Paxton EW, Stone ML. , et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (05) 1114-1121
    CrossrefPubMedGoogle Scholar
  • 5 Seeley MA, Knesek M, Vanderhave KL. Osteochondral injury after acute patellar dislocation in children and adolescents. J Pediatr Orthop 2013; 33 (05) 511-518
    CrossrefPubMedGoogle Scholar
  • 6 Brophy RH, Zeltser D, Wright RW, Flanigan D. Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment. Arthroscopy 2010; 26 (01) 112-120
    CrossrefPubMedGoogle Scholar
  • 7 Edmonds EW, Shea KG. Osteochondritis dissecans: editorial comment. Clin Orthop Relat Res 2013; 471 (04) 1105-1106
    CrossrefPubMedGoogle Scholar
  • 8 Fairbanks H. Osteo-chondritis dissecans. Br J Surg 1933; 21: 67-82
    CrossrefPubMedGoogle Scholar
  • 9 Mubarak SJ, Carroll NC. Juvenile osteochondritis dissecans of the knee: etiology. Clin Orthop Relat Res 1981; (157) 200-211
    PubMedGoogle Scholar
  • 10 Cahill BR. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg 1995; 3 (04) 237-247
    CrossrefPubMedGoogle Scholar
  • 11 Phillips HO, Grubb SA. Familial multiple osteochondritis dissecans. Report of a kindred. J Bone Joint Surg Am 1985; 67 (01) 155-156
    CrossrefPubMedGoogle Scholar
  • 12 Green WT, Banks HH. Osteochondritis dissecans in children. J Bone Joint Surg Am 1953; 35-A (01) 26-47
    PubMedGoogle Scholar
  • 13 Aichroth P. Osteochondritis dissecans of the knee. A clinical survey. J Bone Joint Surg Br 1971; 53 (03) 440-447
    CrossrefPubMedGoogle Scholar
  • 14 Lindén B. The incidence of osteochondritis dissecans in the condyles of the femur. Acta Orthop Scand 1976; 47 (06) 664-667
    CrossrefPubMedGoogle Scholar
  • 15 Chambers HG, Shea KG, Carey JL. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg 2011; 19 (05) 307-309
    CrossrefPubMedGoogle Scholar
  • 16 Wessel LM, Scholz S, Rüsch M. Characteristic pattern and management of intra-articular knee lesions in different pediatric age groups. J Pediatr Orthop 2001; 21 (01) 14-19
    CrossrefPubMedGoogle Scholar
  • 17 Wessel LM, Scholz S, Rüsch M. , et al. Hemarthrosis after trauma to the pediatric knee joint: what is the value of magnetic resonance imaging in the diagnostic algorithm?. J Pediatr Orthop 2001; 21 (03) 338-342
    PubMedGoogle Scholar
  • 18 Chotel F, Knorr G, Simian E, Dubrana F, Versier G. ; French Arthroscopy Society. Knee osteochondral fractures in skeletally immature patients: French multicenter study. Orthop Traumatol Surg Res 2011; 97 (8, Suppl): S154-S159
    CrossrefPubMedGoogle Scholar
  • 19 Kocher MS, Micheli LJ, Yaniv M, Zurakowski D, Ames A, Adrignolo AA. Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med 2001; 29 (05) 562-566
    CrossrefPubMedGoogle Scholar
  • 20 Cahill BR, Ahten SM. The three critical components in the conservative treatment of juvenile osteochondritis dissecans (JOCD). Physician, parent, and child. Clin Sports Med 2001; 20 (02) 287-298
    CrossrefPubMedGoogle Scholar
  • 21 Hefti F, Beguiristain J, Krauspe R. , et al. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B 1999; 8 (04) 231-245
    PubMedGoogle Scholar
  • 22 Wilson JN. A diagnostic sign in osteochondritis dissecans of the knee. J Bone Joint Surg Am 1967; 49 (03) 477-480
    CrossrefPubMedGoogle Scholar
  • 23 Conrad JM, Stanitski CL. Osteochondritis dissecans: Wilson's sign revisited. Am J Sports Med 2003; 31 (05) 777-778
    CrossrefPubMedGoogle Scholar
  • 24 Crawford DC, Safran MR. Osteochondritis dissecans of the knee. J Am Acad Orthop Surg 2006; 14 (02) 90-100
    CrossrefPubMedGoogle Scholar
  • 25 Weiss JM, Nikizad H, Shea KG. , et al. The incidence of surgery in osteochondritis dissecans in children and adolescents. Orthop J Sports Med 2016; 4 (03) 2325967116635515
    PubMedGoogle Scholar
  • 26 Pascual-Garrido C, Moran CJ, Green DW, Cole BJ. Osteochondritis dissecans of the knee in children and adolescents. Curr Opin Pediatr 2013; 25 (01) 46-51
    CrossrefPubMedGoogle Scholar
  • 27 Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop 1994; 14 (04) 513-515
    CrossrefPubMedGoogle Scholar
  • 28 Stanitski CL, Paletta Jr GA. Articular cartilage injury with acute patellar dislocation in adolescents. Arthroscopic and radiographic correlation. Am J Sports Med 1998; 26 (01) 52-55
    CrossrefPubMedGoogle Scholar
  • 29 Harilainen A, Sandelin J. Prospective long-term results of operative treatment in primary dislocation of the patella. Knee Surg Sports Traumatol Arthrosc 1993; 1 (02) 100-103
    CrossrefPubMedGoogle Scholar
  • 30 Olsson O, Isacsson A, Englund M, Frobell RB. Epidemiology of intra- and peri-articular structural injuries in traumatic knee joint hemarthrosis - data from 1145 consecutive knees with subacute MRI. Osteoarthritis Cartilage 2016; 24 (11) 1890-1897
    CrossrefPubMedGoogle Scholar
  • 31 Link TM, Sell CA, Masi JN. , et al. 3.0 vs 1.5 T MRI in the detection of focal cartilage pathology--ROC analysis in an experimental model. Osteoarthritis Cartilage 2006; 14 (01) 63-70
    CrossrefPubMedGoogle Scholar
  • 32 Campbell AB, Knopp MV, Kolovich GP. , et al. Preoperative MRI underestimates articular cartilage defect size compared with findings at arthroscopic knee surgery. Am J Sports Med 2013; 41 (03) 590-595
    CrossrefPubMedGoogle Scholar
  • 33 Edmonds EW, Polousky J. A review of knowledge in osteochondritis dissecans: 123 years of minimal evolution from König to the ROCK study group. Clin Orthop Relat Res 2013; 471 (04) 1118-1126
    CrossrefPubMedGoogle Scholar
  • 34 De Smet AA, Fisher DR, Graf BK, Lange RH. Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. Am J Roentgenol 1990; 155 (03) 549-553
    CrossrefPubMedGoogle Scholar
  • 35 De Smet AA, Ilahi OA, Graf BK. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol 1996; 25 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 36 Kijowski R, Blankenbaker DG, Shinki K, Fine JP, Graf BK, De Smet AA. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology 2008; 248 (02) 571-578
    CrossrefPubMedGoogle Scholar
  • 37 Heywood CS, Benke MT, Brindle K, Fine KM. Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans. Arthroscopy 2011; 27 (02) 194-199
    CrossrefPubMedGoogle Scholar
  • 38 Nomura E, Inoue M. Cartilage lesions of the patella in recurrent patellar dislocation. Am J Sports Med 2004; 32 (02) 498-502
    CrossrefPubMedGoogle Scholar
  • 39 Flachsmann R, Broom ND, Hardy AE, Moltschaniwskyj G. Why is the adolescent joint particularly susceptible to osteochondral shear fracture?. Clin Orthop Relat Res 2000; (381) 212-221
    PubMedGoogle Scholar
  • 40 Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 2008; 90 (03) 463-470
    CrossrefPubMedGoogle Scholar
  • 41 Wall EJ, Vourazeris J, Myer GD. , et al. The healing potential of stable juvenile osteochondritis dissecans knee lesions. J Bone Joint Surg Am 2008; 90 (12) 2655-2664
    CrossrefPubMedGoogle Scholar
  • 42 Jurgensen I, Bachmann G, Schleicher I, Haas H. Arthroscopic versus conservative treatment of osteochondritis dissecans of the knee: value of magnetic resonance imaging in therapy planning and follow-up. Arthroscopy 2002; 18 (04) 376-386
    PubMedGoogle Scholar
  • 43 Schenck Jr RC, Goodnight JM. Osteochondritis dissecans. J Bone Joint Surg Am 1996; 78 (03) 439-456
    CrossrefPubMedGoogle Scholar
  • 44 Prince MR, King AH, Stuart MJ, Dahm DL, Krych AJ. Treatment of patellofemoral cartilage lesions in the young, active patient. J Knee Surg 2015; 28 (04) 285-295
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Mashoof AA, Scholl MD, Lahav A, Greis PE, Burks RT. Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy 2005; 21 (02) 228-232
    CrossrefPubMedGoogle Scholar
  • 46 Murray JR, Chitnavis J, Dixon P. , et al. Osteochondritis dissecans of the knee; long-term clinical outcome following arthroscopic debridement. Knee 2007; 14 (02) 94-98
    CrossrefPubMedGoogle Scholar
  • 47 Michael JW, Wurth A, Eysel P, König DP. Long-term results after operative treatment of osteochondritis dissecans of the knee joint-30 year results. Int Orthop 2008; 32 (02) 217-221
    CrossrefPubMedGoogle Scholar
  • 48 Donaldson LD, Wojtys EM. Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee. J Pediatr Orthop 2008; 28 (08) 831-835
    CrossrefPubMedGoogle Scholar
  • 49 Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M. Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. Arthroscopy 2009; 25 (02) 145-152
    CrossrefPubMedGoogle Scholar
  • 50 Edmonds EW, Albright J, Bastrom T, Chambers HG. Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee. J Pediatr Orthop 2010; 30 (08) 870-878
    CrossrefPubMedGoogle Scholar
  • 51 Gunton MJ, Carey JL, Shaw CR, Murnaghan ML. Drilling juvenile osteochondritis dissecans: retro- or transarticular?. Clin Orthop Relat Res 2013; 471 (04) 1144-1151
    CrossrefPubMedGoogle Scholar
  • 52 Callewier A, Monsaert A, Lamraski G. Lateral femoral condyle osteochondral fracture combined to patellar dislocation: a case report. Orthop Traumatol Surg Res 2009; 95 (01) 85-88
    PubMedGoogle Scholar
  • 53 Dines JS, Fealy S, Potter HG, Warren RF. Outcomes of osteochondral lesions of the knee repaired with a bioabsorbable device. Arthroscopy 2008; 24 (01) 62-68
    CrossrefPubMedGoogle Scholar
  • 54 Jehan S, Loeffler MD, Pervez H. Osteochondral fracture of the lateral femoral condyle involving the entire weight bearing articular surface fixed with biodegradable screws. J Pak Med Assoc 2010; 60 (05) 400-401
    PubMedGoogle Scholar
  • 55 Walsh SJ, Boyle MJ, Morganti V. Large osteochondral fractures of the lateral femoral condyle in the adolescent: outcome of bioabsorbable pin fixation. J Bone Joint Surg Am 2008; 90 (07) 1473-1478
    CrossrefPubMedGoogle Scholar
  • 56 Makino A, Muscolo DL, Puigdevall M, Costa-Paz M, Ayerza M. Arthroscopic fixation of osteochondritis dissecans of the knee: clinical, magnetic resonance imaging, and arthroscopic follow-up. Am J Sports Med 2005; 33 (10) 1499-1504
    CrossrefPubMedGoogle Scholar
  • 57 Kouzelis A, Plessas S, Papadopoulos AX, Gliatis I, Lambiris E. Herbert screw fixation and reverse guided drillings, for treatment of types III and IV osteochondritis dissecans. Knee Surg Sports Traumatol Arthrosc 2006; 14 (01) 70-75
    CrossrefPubMedGoogle Scholar
  • 58 Mackie IG, Pemberton DJ, Maheson M. Arthroscopic use of the Herbert screw in osteochondritis dissecans. J Bone Joint Surg Br 1990; 72 (06) 1076
    PubMedGoogle Scholar
  • 59 Thomson NL. Osteochondritis dissecans and osteochondral fragments managed by Herbert compression screw fixation. Clin Orthop Relat Res 1987; (224) 71-78
    PubMedGoogle Scholar
  • 60 Magnussen RA, Carey JL, Spindler KP. Does operative fixation of an osteochondritis dissecans loose body result in healing and long-term maintenance of knee function?. Am J Sports Med 2009; 37 (04) 754-759
    CrossrefPubMedGoogle Scholar
  • 61 Kocher MS, Czarnecki JJ, Andersen JS, Micheli LJ. Internal fixation of juvenile osteochondritis dissecans lesions of the knee. Am J Sports Med 2007; 35 (05) 712-718
    CrossrefPubMedGoogle Scholar
  • 62 Tabaddor RR, Banffy MB, Andersen JS. , et al. Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop 2010; 30 (01) 14-20
    Google Scholar
  • 63 Millington KL, Shah JP, Dahm DL, Levy BA, Stuart MJ. Bioabsorbable fixation of unstable osteochondritis dissecans lesions. Am J Sports Med 2010; 38 (10) 2065-2070
    CrossrefPubMedGoogle Scholar
  • 64 Friederichs MG, Greis PE, Burks RT. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. Arthroscopy 2001; 17 (05) 542-545
    CrossrefPubMedGoogle Scholar
  • 65 Fabricant PD, Yen YM, Kramer DE, Kocher MS, Micheli LJ, Heyworth BE. Fixation of chondral-only shear fractures of the knee in pediatric and adolescent athletes. J Pediatr Orthop 2017; 37 (02) 156
    PubMedGoogle Scholar
  • 66 Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 2001; ;(391, Suppl) S362-S369
    PubMedGoogle Scholar
  • 67 Kreuz PC, Erggelet C, Steinwachs MR. , et al. Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger?. Arthroscopy 2006; 22 (11) 1180-1186
    CrossrefPubMedGoogle Scholar
  • 68 Kreuz PC, Steinwachs MR, Erggelet C. , et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage 2006; 14 (11) 1119-1125
    CrossrefPubMedGoogle Scholar
  • 69 Blevins FT, Steadman JR, Rodrigo JJ, Silliman J. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics 1998; 21 (07) 761-767 , discussion 767–768
    PubMedGoogle Scholar
  • 70 Krych AJ, Harnly HW, Rodeo SA, Williams III RJ. Activity levels are higher after osteochondral autograft transfer mosaicplasty than after microfracture for articular cartilage defects of the knee: a retrospective comparative study. J Bone Joint Surg Am 2012; 94 (11) 971-978
    Google Scholar
  • 71 Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 2009; 37 (10) 2053-2063
    Google Scholar
  • 72 Gudas R, Simonaityte R, Cekanauskas E, Tamosiūnas R. A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop 2009; 29 (07) 741-748
    CrossrefPubMedGoogle Scholar
  • 73 Gomoll AH, Gillogly SD, Cole BJ. , et al. Autologous chondrocyte implantation in the patella: a multicenter experience. Am J Sports Med 2014; 42 (05) 1074-1081
    CrossrefPubMedGoogle Scholar
  • 74 Mandelbaum B, Browne JE, Fu F. , et al. Treatment outcomes of autologous chondrocyte implantation for full-thickness articular cartilage defects of the trochlea. Am J Sports Med 2007; 35 (06) 915-921
    CrossrefPubMedGoogle Scholar
  • 75 Siebold R, Karidakis G, Fernandez F. Clinical outcome after medial patellofemoral ligament reconstruction and autologous chondrocyte implantation following recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2477-2483
    CrossrefPubMedGoogle Scholar
  • 76 Nawaz SZ, Bentley G, Briggs TW. , et al. Autologous chondrocyte implantation in the knee: mid-term to long-term results. J Bone Joint Surg Am 2014; 96 (10) 824-830
    CrossrefPubMedGoogle Scholar
  • 77 Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 1994; 331 (14) 889-895
    CrossrefPubMedGoogle Scholar
  • 78 Knutsen G, Engebretsen L, Ludvigsen TC. , et al. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 2004; 86-A (03) 455-464
    PubMedGoogle Scholar
  • 79 Knutsen G, Drogset JO, Engebretsen L. , et al. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 2007; 89 (10) 2105-2112
    CrossrefPubMedGoogle Scholar
  • 80 Van Assche D, Staes F, Van Caspel D. , et al. Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 2010; 18 (04) 486-495
    CrossrefPubMedGoogle Scholar
  • 81 Peterson L, Minas T, Brittberg M. , et al. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 17-24
    PubMedGoogle Scholar
  • 82 Krishnan SP, Skinner JA, Bartlett W. , et al. Who is the ideal candidate for autologous chondrocyte implantation?. J Bone Joint Surg Br 2006; 88 (01) 61-64
    PubMedGoogle Scholar
  • 83 Micheli LJ, Moseley JB, Anderson AF. , et al. Articular cartilage defects of the distal femur in children and adolescents: treatment with autologous chondrocyte implantation. J Pediatr Orthop 2006; 26 (04) 455-460
    CrossrefPubMedGoogle Scholar
  • 84 Negrin LL, Vécsei V. Do meta-analyses reveal time-dependent differences between the clinical outcomes achieved by microfracture and autologous chondrocyte implantation in the treatment of cartilage defects of the knee?. J Orthop Sci 2013; 18 (06) 940-948
    Google Scholar
  • 85 Bugbee WD, Convery FR. Osteochondral allograft transplantation. Clin Sports Med 1999; 18 (01) 67-75
    CrossrefPubMedGoogle Scholar
  • 86 Yamashita F, Sakakida K, Suzu F, Takai S. The transplantation of an autogeneic osteochondral fragment for osteochondritis dissecans of the knee. Clin Orthop Relat Res 1985; (201) 43-50
    PubMedGoogle Scholar
  • 87 Lyon R, Nissen C, Liu XC, Curtin B. Can fresh osteochondral allografts restore function in juveniles with osteochondritis dissecans of the knee?. Clin Orthop Relat Res 2013; 471 (04) 1166-1173
    CrossrefPubMedGoogle Scholar
  • 88 Emmerson BC, Görtz S, Jamali AA, Chung C, Amiel D, Bugbee WD. Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med 2007; 35 (06) 907-914
    CrossrefPubMedGoogle Scholar