Received: 20 March 2020 Revised: 15 September 2020 Accepted: 22 September 2020 DOI: 10.1002/oa.2926 RESEARCH ARTICLE Osteochondritis dissecans and physical activity in skeletal remains of ancient hunter-gatherers from Southern Patagonia Rodrigo Zúñiga Thayer1 1 Grupo de Investigación en Bioarqueología, IMHICIHU-CONICET, Buenos Aires, Argentina 2 Facultad de Ciencias Sociales, Grupo de Investigación en Bioarqueología, INCUAPACONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Quequén, Buenos Aires, Argentina 3 Facultad de Filosofía y Letras, Grupo de Investigación en Bioarqueología, IMHICIHUCONICET, Universidad de Buenos Aires, Buenos Aires, Argentina 4 Facultad de Ciencias Sociales, Grupo de Investigación en Bioarqueología, INCUAPACONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Olavarría, Buenos Aires, Argentina Correspondence Lic. Rodrigo Zúñiga Thayer, Grupo de Investigación en Bioarqueología, IMHICIHUCONICET, Saavedra Street No. 15, C1083ACA Buenos Aires, Argentina. Email: rzunigat89@gmail.com | Jorge Suby2 | Leandro Luna3 | Gustavo Flensborg4 Abstract Osteochondritis dissecans (OCD) is a joint disease characterized by the detachment or separation of an articular cartilage fragment and subchondral bone in joint epiphyses. It has been diagnosed in archaeological skeletons worldwide but scarcely studied in hunter-gatherer skeletal remains. The aim of this paper is to analyse the variation of OCD in skeletons of past populations that lived in Southern Patagonia during the Late Holocene, which can be useful to improve our understanding about the effects of the mechanical demands in hunter-gatherers. The overall prevalence observed in this sample (40.5%), higher than the data reported for current populations and mostly located in the shoulder of young and middle adult males of terrestrial and maritime hunter-gatherers, suggests that physical activity involved in both economic strategies would have played an important role in the development of OCD. The contact with European colonizers does not seem to have produced differences in the prevalence of OCD, although more dated skeletons are needed to test this hypothesis. KEYWORDS hunter-gatherers, OCD, paleopathology, Patagonia, physical activity Funding information National Agency for Science and Technology, Argentina, Grant/Award Number: PICT 0191-2016; National Council for Science and Technology (CONICET-Argentina) 1 | I N T RO DU CT I O N pathological joint diseases, also related to mechanical demands, have been less studied. Consequently, they are rarely included in discus- The understanding of physical activity in hunter-gatherers' health rep- sions about stress and disease among these populations. resents one of the major issues in bioarchaeological and paleopatho- One of these diseases is Osteochondritis dissecans (OCD), a joint logical research since at least the 1980s. The results mainly show defect characterized by the detachment or separation of an articular higher mechanical loadings, body size and sexual dimorphism in cartilage fragment and the subchondral bone in joint epiphyses hunter-gatherers than in agriculturalist and industrial societies, (Schenck & Goodnight, 1996). The aetiology of the OCD has not changes that are attributed to differences in social practices and been completely clarified. Genetic components (Padgett, Mostosky, mobility (e.g., Larsen & Ruff, 2011; Ruff, 2008). These investigations Probst, Thomas, & Krecke, 1995) and ischaemia of the articular car- also suggest that the high mobility of hunter-gatherers strongly tilage (Carlson, Meuten, & Richardson, 1991) have been stated as increased the development of joint diseases (Kennedy, 1989; Molnar, possible causes. However, most authors argued that OCD is mainly Ahlstrom, & Leden, 2011; Ponce, 2010; Weiss, Corona, & related to repetitive microtraumas associated with physical activity Schultz, 2012). Most of the studies to date have been carried out (Edmonds & Polousky, 2013). Therefore, the study of OCD offers using markers of occupational stress (MOS), like long-bone shape, valuable insights about the impact of mechanical demands in ancient osteoarthrosis past populations. (OA) and entheseal Int J Osteoarchaeol. 2021;31:77–87. changes, whereas other wileyonlinelibrary.com/journal/oa © 2020 John Wiley & Sons, Ltd. 77 78 TABLE 1 Human remains analysed and summary of joints presence Present joints References Chronology (years BP) Sex Age at death (years) Shoulder Elbow Wrist Hip Diet R L R L R L R Knee Ankle L R L R L Region Site Santa Cruz/ Magallanes N = 10 Rincón del Buque Suby et al. (2009) 830 ± 42 M MA T P P P P P P P P P P P P Cabo Vírgenes 17 L'Heureux, Guichón, Barberena, and Borrero (2003) 900 ± 40 M YA T P P P P P P P P P P P P Cerro Johnny Borrero and Barberena (2006) 390 ± 60 M YA T P P P P P P A P A A A A Juni Aike Borrero and Barberena (2006) Contact a M YA T P P P P P P P P P P P P Orejas de Burro 1 L'Heureux and Barberena (2008) 3,565 ± 45 M YA Mt P P P P P A A A A A A A Orejas de Burro 2 L'Heureux and Barberena (2008) 3,565 ± 45 M MA Mt P P P P P P P P P P P P Puerto Natales 3 Prieto (1993–1994) XIX Century F YA NA P P P P P P P P P P P P Northern Tierra del Fuego N = 11 Southern Tierra del Fuego N = 16 Punta Daniel Suby (2014b) 1,118 ± 43 M YA Mt P P P P P P P P P P A A Posesión Olimpia 2 Suby (2014b) XIX Century M YA T P A P P P P P P P P A A Cañadón Misionero Suby et al. (2009) 70 ± 30 M MA T P P P P P P P P P P P P Chorrillos 2 Santiago, Salemme, Suby, and Guichón (2011) 265 ± 44 M YA T P P P P A A P P P P P P Lengua de Vaca Suby (2014b) 251 ± 41 F YA Mt P P P P P P P P P P P P Las Mandíbulas Guichón, Muñoz, and Borrero (2000) Contact M YA T P P P P P P P P P P P P Bahía Gente Grande Suby (2014b) Contact M YA T P P P P P P P P P P P P Bahía Felipe 1 Suby (2014b) 1,608 ± 45 M MA Mt P P P P P P P P P P P P Bahía Felipe 2 Suby (2014b) 1,608 ± 45 F YA Mt A A P P A A A A P P A A La Arcillosa 2 Santiago et al. (2011) 5,208 ± 58 F YA T P P P P P P P P P P P P MFM-2667 This paper NA M MA NA P P P P P P P P P P P P Myren 1 Suby (2014b) 640 ± 20 M YA Mt A P A P A P P P P P P P Puesto Pescador Suby et al. (2009) 335 ± 35 M YA T P P P P P P P P P P P P Santiago et al. (2011) 269 ± 46 M MA T P A P P A P P P P P P P Kochi (2017) Contact F YA Mar P P P P P P P P P P P P Harberton Cementerio Suby, Zangrando, and Piana (2011) Contact M YA Mar P P P P P P P P P P A A Paiashauaia Suby et al. (2011) 1,504 ± 46 F MA Mar P P P P P P P P P P P P Bahía Tethis Tessone, Guichón, Suby, and Kozameh (2011) NA M YA Mar P A P A P P P P P P P P Caleta Falsa 8–4 Guichón and Suby (2011) NA M MA NA A A A A A A P P P P P P Caleta Falsa 7–2 Guichón and Suby (2011) NA F YA NA P A A A A A P P P P P P ZÚÑIGA THAYER ET AL. Santana 1 Acatushún OCD was diagnosed in skeletal remains worldwide, but most of P A A P P P A P L P 79 P sites (e.g., McWhirr, Viner, & Wells, 1982; Vikatou, 2012; Vikatou, P Hoogland, & Waters-Rist, 2017; Wells, 1974). Only a few research P A A P P P P P P P P P P P A A P P A A R P P P A P P L R P the analyses are case studies of historical European archaeological P Knee Ankle ZÚÑIGA THAYER ET AL. described this defect on hunter-gatherer skeletons, most of them a small number of samples P in (e.g., Flensborg, Martínez, González, & Bayala, 2011; Scabuzzo, 2013; P descriptions Suby, Guichón, & Zangrando, 2009) or considering OCD as part of P P P P P P P P P P P P A A P A A A A P P A P P P L R P P L brief studies on osteoarthritis (e.g., Merbs, 1983). Thus, the prevalence and Abbreviations: A, absent; F, female; L, left; M, male; MA, middle adult; Mar, maritime; Mt, mixed; NA, not available; P, present; R, right; T, terrestrial; YA, young adult. Period that considers contact with European colonizers (after 400 years BP). P P P P NA YA M NA This paper MFM-2403(2) tion with physical demands, are poorly understood. a P P P A P P P P A NA NA YA MA F M NA NA This paper This paper MFM-796 MFM-2379 P P P P P P A P P P NA NA YA MA F F NA NA This paper This paper MFM-2670 MFM-852 P A P A P P P A P P Mar Mar MA MA M F NA 1,536 ± 46 Suby et al. (2011) Tessone et al. (2011) MFM-795 Shamakush Ent. 6 A P P A A A P P P P NA NA MA MA F M NA NA This paper This paper Harberton Caja 7 La Anónima P P A R P P L P P R Diet Mar YA M Sex References Site 820 ± 40 Age at death (years) Chronology (years BP) Region Guichón and Suby (2011) R L causes of OCD in hunter-gatherer societies, and its possible associa- Caleta Falsa 8–1 Hip Wrist Elbow Shoulder Present joints (Continued) TABLE 1 P including Southern Patagonia has been occupied since ca. 11,000 years BP by terrestrial hunter-gatherers in the southern continental area and Northern Tierra del Fuego and since ca. 8,000 years BP by maritime hunter-gatherers in the south and southwest littoral of Tierra del Fuego until recent times (Prates, Politis, & Steele, 2013). For that reason, these ancient populations offer the opportunity to study the evolution of human diseases in hunter-gatherer societies. Recent studies suggest a high prevalence of joint diseases in skeletons from this region, as well as possible differences in physical activity patterns between individuals with maritime and terrestrial economies (e.g., D'Angelo del Campo, Suby, García-Laborde, & Guichón, 2017; Suby, 2014a). However, the impact of different activity patterns and modes of subsistence on joint diseases, including OCD, is not fully clarified (Suby, 2020). Therefore, the present paper aims to analyse the variation of OCD in skeletons of hunter-gatherer populations that lived in Southern Patagonia during the Late Holocene, which can be useful to improve our understanding about the effects of the mechanical demands in this particular lifestyle. 2 2.1 | M A T E R I A L S A N D M ET H O D S | Sample Adult (older than 18 years of age) human skeletons recovered from Southern Patagonia (South American territory below 50 S latitude) were selected for this study. Skeletal remains from mission cemeteries were not included in the present research because important differences in ways of living were suggested compared with a strict huntergatherer lifestyle (D'Angelo del Campo et al., 2017). Only skeletons with at least 50% of well-preserved shoulder, elbow, wrist, hip, knee and ankle joints (Table 1) were included. These joints are the most common sites for OCD. Sex of the skeletons was estimated recording the dimorphic structures of the pelvis (Phenice, 1969) and the skull (Acsádi & Nemeskéri, 1970). Age at death was estimated by mor- phological changes of the auricular surface (Lovejoy, Meindl, Mensforth, & Barton, 1985) and the pubic symphysis (Brooks & Suchey, 1990; Todd, 1921); the individuals were grouped as young adults (18–34 years old), middle adults (35–49 years old) and old adults (50 years of age or over). The sample includes 37 individuals (Table 1; Figure 1), 25 males (67.6%) and 12 females (32.4%), ZÚÑIGA THAYER ET AL. 80 F I G U R E 1 Location of the archaeological sites where the skeletons included in this paper were recovered [Colour figure can be viewed at wileyonlinelibrary.com] 23 (62.2%) young adults and 14 (37.8%) middle adults. No old absence of the articular cartilage. Therefore, and because the adults were identified, almost absent in this region (Suby, Luna, pathological condition does not necessarily imply the development Aranda, & Flensborg, 2017). Ten of the skeletons are from Santa of an inflammatory process, the term OCD has recently been con- Cruz/Magallanes (27%), 11 from Northern Tierra del Fuego (29.7%) sidered as incorrect in paleopathological diagnosis, and it was and 16 from Southern Tierra del Fuego (43.3%). suggested that it must be replaced by osteochondrosis (Thomas & Human skeletal remains from Southern Patagonia are relatively Johannsen, 2011; Ytrehus, Carlson, & Ekman, 2007). However, scarce (Suby et al., 2017), so research commonly studied samples osteochondrosis is a term also used in other syndromes, such as assembled by isolated skeletons from different archaeological sites, Scheuermann's syndrome and Sever's disease (Hendrix, 2005; grouped under spatial, temporal and/or dietary patterns criteria. Most Lowe, 1990). Thus, as the term osteochondrosis could be confusing of the skeletons included in this study were found in simple primary at least, in this paper we continue using the term osteochondritis burials, except for Orejas de Burro archaeological site (L'Heureux & dissecans, but taking into account that it might also include the Barberena, 2008). The archaeological contextual analyses of each site phase described as osteochondritis manifesta. are described in the references cited in Table 1. When no reference is In this paper, OCD was studied in those elements that correspond included, no further archaeological data are available. Thus, although to the joints where it was more diagnosed in current populations small, the sample studied here includes most of the well-preserved (i.e., shoulder, elbow, wrist, hip, knee and ankle) (Table 1). However, skeletons known in the region. elements of other joints, as the vertebrae and bones of hands and feet were also studied when possible. OCD was diagnosed when a subchondral circular necrotic area or a crater depression, evidencing an 2.2 | Methods osteonecrotic focal area, was identified at any synovial joint (Ortner, 2003; Vikatou, 2012; Vikatou et al., 2017; Waldron, 2009; The development of OCD is part of a wider process named Wells, 1974). The anatomical distribution was recorded and also osteochondrosis, a deficiency of blood supply in the subchondral bone, whether the necrotic portion was found in situ or it had been followed by a necrotic process. Osteochondrosis includes three detached. The depressions were measured using a digital calliper. and The prevalence of OCD was calculated by joint, individual, sex osteochondritis dissecans. Only the last two phases are recordable in and age at death. The possible association between OCD and dietary skeletons, and the distinction between them is not possible due to the pattern information based on carbon (13C/12C) and nitrogen (15N/14N) phases: osteochondritis latens, osteochondritis manifesta ZÚÑIGA THAYER ET AL. 81 stable isotopes (see references in Table 1) was analysed. The skeletons soft and rounded edges, without any internal bone fragment were grouped following three dietary classes: terrestrial, maritime and (Figure 2). The only lesion that presents the necrotic portion in situ is mixed. The last one was interpreted as a dietary pattern in which located at the right scapula glenoid cavity of the skeleton from the there is no predominance of one kind of consumed resources over the Harberton Caja 7 site. The average size of the lesions was approxi- other (Barberena, 2002; Borrero & Barberena, 2006; Borrero, Barbe- mately 3 mm of diameter and between 2 and 3 mm of depth. None of rena, Franco, Charlin, & Tykot, 2009). As some of the skeletons lack the joints with OCD showed evidence of trauma or OA. paleodietary data, the sample for this particular analysis was reduced No sign of subchondral cyst or erosive lesions was identified in to 26 individuals. Moreover, the prevalence of OCD was also the recorded lesions, compatible with other diseases such as osteoar- evaluated according to the location of the burial by region, taking thritis, rheumatoid arthritis, psoriatic arthritis, gout, osteomyelitis and into account that both terrestrial and mixed economic strategies tuberculosis, all suggested by Vikatou et al. (2017) as part of the dif- were mostly identified in human groups that inhabited Santa ferential diagnosis. There was also no taphonomic evidence Cruz/Magallanes and Northern Tierra del Fuego, whereas maritime (i.e., ragged margin and colour contrast) observed in the identified hunter-gatherers mainly lived in Southern Tierra del Fuego (Santiago, foramen. Salemme, Suby, & Guichón, 2011). Thus, in order to evaluate Thirteen (68.4%) out of the 19 OCD were recorded in scapulae, differences in economic strategies, skeletons from Santa Cruz/Magallanes two of them bilateral; three lesions (15.8%) affected the first proximal and Northern Tierra del Fuego were assumed as a group belonging phalanx of the foot, two of them bilateral; one (5.3%) was observed in to terrestrial/mixed hunter-gatherers, while those from Southern Tierra the lateral condyle of the left femur, one (5.3%) in the proximal epiph- del Fuego were inferred as maritime hunter-gatherers. ysis of the right ulna and one (5.3%) in the right joint facet of an axis Finally, we studied the possible association between the fre- (Figures 2 and 3a). OCD was diagnosed in 24.2% (15/62) of the quency of OCD and the chronology of the human remains, classified studied joints. The shoulder was the most affected joint (Table 2), only as pre-contact (before 400 years BP) and during contact (after in the glenoid fossa of the scapula, nine right (69.2%) and four left 400 years BP). The differences of the frequencies related to age, sex, (30.8%). Moreover, one lesion was recorded in the right elbow (1.6%) economic strategies, regions and chronology were statistically tested and another in the left knee (1.5%; Figure 3b). No lesions were with the Fisher exact test (F; two tales, p = 0.05). Following the aim of observed in the wrist, hip or ankle (Table 2). this research, no other type of MOS was evaluated. Fifteen (40.5%) out of the 37 individuals analysed presented at least one lesion diagnosed as OCD, three of them bilateral (Table 2). The OCD affected 14 (56%) males and one (8.3%) female (p = 0.04). 3 | RESULTS Concerning the age at death, OCD was diagnosed in nine young adults (39.1%) and six middle adults (42.9%; p = 1). OCD was recorded in 19 elements (Table 2). Most of the lesions were Concerning the paleodietary patterns, OCD was recorded in identified in the interarticular subchondral surface as a foramen with seven individuals (58.3%) associated with terrestrial resources, four TABLE 2 Individuals affected with Osteochondritis dissecans and location of the lesions Region Site No. of lesions Affected areas Santa Cruz/Magallanes Rincón del Buque 1 Proximal epiphysis of the right ulna Cabo Vírgenes 17 1 Glenoid fossa of the right scapula Juni Aike 3 First proximal phalanx of the foot (bilateral) and right articular facet of the axis Orejas de Burro 1 1 Glenoid fossa of the left scapula Northern Tierra del Fuego Southern Tierra del Fuego Orejas de Burro 2 1 Glenoid fossa of the left scapula Posesión Olimpia 2 1 Glenoid fossa of the right scapula Chorrillos 2 1 Glenoid fossa of the right scapula Lengua de Vaca 1 First proximal phalanx of the right foot Las Mandíbulas 1 Glenoid fossa of the right scapula Bahía Felipe 1 2 Glenoid fossa of both scapulae MFM-2667 1 Lateral condyle of the left femur Santana 1 1 Glenoid fossa of the right scapula Caleta Falsa 8-1 2 Glenoid fossa of both scapulae Harberton Caja 7 1 Glenoid fossa of the right scapula MFM-2403(2) 1 Glenoid fossa of the right scapula 82 ZÚÑIGA THAYER ET AL. F I G U R E 2 Osteochondritis dissecans in the skeletal remains analysed. (a) Lateral condyle of the left femur (MFM-2667); (b) glenoid fossa of the right scapula (MFM-2403-2); (c) proximal epiphysis of the right ulna (Rincón del Buque); (d) right articular facet of the axis (Juni Aike); (e) first proximal phalanx of the right foot (Lengua de Vaca) [Colour figure can be viewed at wileyonlinelibrary.com] F I G U R E 3 Prevalence of Osteochondritis dissecans in the sample studied by element (a) and joint (b) [Colour figure can be viewed at wileyonlinelibrary.com] (57.1%) linked to a mixed diet and only one (14.3%) with maritime diet differences. Among the 13 scapulae with OCD, four (30.8%) were (Table 3). However, no significant differences were found in the prev- diagnosed in skeletons from Santa Cruz/Magallanes, five (38.5%) from alence of OCD among individuals with terrestrial and maritime diet Northern Tierra del Fuego and four (30.8%) from Southern Tierra del (p = 0.2). When the results are analysed by region, six individuals Fuego (Table 2). If skeletons from Santa Cruz/Magallanes and Northern (60%) from Santa Cruz/Magallanes presented OCD, whereas six skel- Tierra del Fuego are assumed as terrestrial and mixed hunter-gatherers, etons (54.5%) from Northern Tierra del Fuego and three (18.8%) from 12 of the 21 (57.1%) individuals showed OCD. On the contrary, only Southern Patagonia were affected (Table 3), with no significant three out of the 16 (18.8%) skeletons from Southern Tierra del Fuego, ZÚÑIGA THAYER ET AL. 83 T A B L E 3 Number of individuals with lesions and prevalence of OCD in the sample of skeletons from Southern Patagonia Total elbow (1.6%) is similar to the one recorded in athletes (Aicale, Tarantino, & Maffulli, 2018; Patel, Yamasaki, & Brown, 2017). For N studied n with OCD % example, it affects between 2.1% (Matsuura, Suzue, Iwame, Nishio, & 37 15 40.5 Sairyo, 2014) and 3.4% (Kida et al., 2014) of elbows in baseball players. Sex 56 The most affected joints recorded in this paper (the shoulder, and Male 25 14 Female 12 1 8.3 23 9 39.1 14 6 42.9 Santa Cruz/Magallanes 10 6 60 Northern Tierra del Fuego 11 6 54.5 first proximal phalanx of the foot and the axis. Although only Southern Tierra del Fuego 16 3 18.8 described in a few clinical cases, lesions in the foot were recorded in Age at death Young adults (20–35) Middle adults (35–50) Subregion mainly the right scapula) are not coincident with those described for current populations. Nevertheless, this is one of the most common bone shoulder lesions in overhead throwing athletes, like tennis players and archers (Chu et al., 2009; Gogus & Ozturk, 2008; Hamada, Tamai, Koguchi, Ono, & Saotome, 2005; Ishikawa et al., 1988; Wilk et al., 2009). Another non-typical joint for OCD recorded in this paper is the several archaeological samples (McWhirr et al., 1982; Rodríguez- Paleodiet Terrestrial 12 7 58.3 Martín, 2000; Vikatou et al., 2017; Wells, 1974), with prevalence as Mixed 7 4 57.1 high as 17.9% (McWhirr et al., 1982). Wells (1974) stated that OCD in Maritime 7 1 14.3 this joint could be caused by both the use of shoes that reduce the flexion during walking and microtrauma related to physical activities. Chronology Pre-contact 12 5 41.7 During-contact 13 6 46.2 Abbreviation: OCD, Osteochondritis dissecans. In the same way, OCD in the axis was documented only in a few archaeological samples (McWhirr et al., 1982; Wells, 1974), related to repetitive microtrauma. As this lesion was scarcely described in current populations, the possible causes remain unknown. OCD was recorded more frequently in men than in women, in the same way that it occurs in current populations (Edmonds & assigned to maritime economy, showed this trait. However, no Polousky, 2013; Schenck & Goodnight, 1996). This pattern was statistical difference between these two groups was found (p = 0.2). suggested for all joints, as stated by many clinical studies in the knee Finally, from the chronological point of view, five (41.7%) individuals in (Uematsu et al., 2005), the elbow (Brownlow, O'Connor-Read, & the pre-contact period and six (46.2%) individuals in the during-contact Perko, 2006), the ankle (Ming, Jin, & Kanta, 2004) and the shoulder period had OCD in at least one joint (p = 1) (Table 3). (Debeer & Brys, 2005). However, as females are less represented, a possible bias in the structure of the sample could explain part of the observed differences in the present study. 4 | DISCUSSION Concerning age at death, middle adults showed a higher prevalence of OCD than young adults, although this trend is not statistically OCD is a relatively common finding in skeletal human remains. How- significant, in contrast with previous research in skeletal remains ever, data from ancient hunter-gatherers are particularly scarce. This (Ortner, 2003; Rogers & Waldron, 1995) and clinical samples paper offers an overview of the prevalence of OCD in past maritime (Takahara et al., 1999). This difference could be explained considering and terrestrial hunter-gatherers from Southern Patagonia, useful to that some of the diagnosed OCD in the middle adults are produced understand the impact of these economic strategies in physical during the adolescence and early adulthood, periods when the joints demands. may be more affected. The aspect of most of the lesions indicates that All the recorded lesions are of low extension and with smooth they could have been produced a short time before the death of the edges, which suggests that the necrotic area was reduced and was individuals. Most clinical studies associated OCD with epiphyseal not recently produced. Only one lesion includes the necrotic portion, bone growth and development, which can be persistent throughout whereas the other cases only display the remaining crater-like struc- adulthood (e.g., Edmonds & Polousky, 2013; Takahara et al., 1999). tures. In current populations, the knee, the ankle and the elbow are However, other authors reported that OCD can also begin during the most frequently affected joints by OCD, whereas it is less com- adulthood (Garrett, 1991). mon in the shoulder, the cervical vertebrae and the first proximal pha- The higher prevalence of OCD in many joints recorded in this lanx of the foot (Edmonds & Heyworth, 2014; Edmonds & paper compared with current data suggests that the proliferation of Polousky, 2013). In the present research, the prevalence of OCD in these lesions may be related to mechanical demands associated with the knee (1.5%) is higher than those reported in clinical research hunter-gatherer economic strategies, mainly the influence of physical ranged between 0.01% and 0.06% (Petersen, Steinhagen, Catala- activity involving the upper limbs (e.g., use of hunting tools). Similarly, Lehnen, & Bruns, 2006). In contrast, the frequency of OCD in the most of the previous studies in skeletal samples attributed OCD to ZÚÑIGA THAYER ET AL. 84 intense physical activity (e.g., McWhirr et al., 1982; Ponce, 2010; need to be the aim of research in large samples, as was recently Rodríguez-Martín, 2000; Vikatou, 2012; Vikatou et al., 2017; proposed by Suby (2020). Previous studies were carried out in this Wells, 1974). matter, although with small samples, showing some differences in Lesions diagnosed as OCD were more frequent in Santa Cruz/ skeletal morphology and diseases on samples from Northern and Magallanes and Northern Tierra del Fuego than in Southern Tierra del Southern Tierra del Fuego. Zúñiga Thayer (2016) observed high fre- Fuego. Moreover, OCD was more prevalent in individuals with a ter- quencies of entheseal changes in the upper limbs on females in a restrial and mixed diet than in skeletons with a maritime diet, although preliminary study of a sample of 26 skeletons from Southern Tierra no statistical differences between regions and among economic strat- del Fuego, interpreted as evidence of rowing. Moreover, Suby and egies were found. Anyway, it should be noted that the small size of Guichón (2009) and Suby and Novellino (2017) identified higher tib- the sample may have biased the statistical comparisons. On the con- ial and femoral diaphyseal robusticity in individuals with maritime trary, OCD similarly affected the shoulder in all regions and economic economic strategies from Tierra del Fuego than in those with a ter- strategies. Given that this lesion is commonly diagnosed in contempo- restrial and mixed diet. On the contrary, Suby (2014b) stated that rary athletes, it is possible to assume that the individuals analysed adult individuals from the Santa Cruz/Magallanes region presented a supported high mechanical loadings in this joint. The results reinforce higher prevalence of Schmorl's nodes (62.5%) than the skeletons the hypothesis about the possible influence of physical activities in from Northern (12.5%) and Southern (0%) Tierra del Fuego. the development of joint diseases among hunter-gatherers from D'Angelo del Campo et al. (2017) found high frequencies of Southern Patagonia proposed in previous research (e.g., D'Angelo del spondylolysis in skeletons from Southern Patagonia, mostly in terres- Campo et al., 2017; Suby, 2014a). Nevertheless, developmental trial hunter-gatherers from the Northern Tierra del Fuego and Santa defects related to genetic factors cannot be completely rejected as a Cruz/Magallanes rather than in Southern Tierra del Fuego. Thus, previ- cause of OCD, at least in some of the skeletons, because biological ous research suggests that maritime hunter-gatherers were exposed differences between human populations from Northern and Southern to high mechanical demands in the limbs, whereas terrestrial hunter- Tierra del Fuego were suggested based on cranial morphology gatherers suffered from higher defects of the spine, as Schmorl's (Cocilovo & Guichón, 1985-1986; González José, García-Moro, nodes and spondylolysis. Dahinten, & Hernández, 2002) and DNA analyses (De la Fuente Finally, the prevalence of OCD does not seem to have changed et al., 2015; Lalueza Fox, Pérez-Pérez, Prats, Cornudella, & during the contact period, but as several skeletons affected by OCD Turbón, 1997). are not dated, this trend is only preliminary. It will be important to Ethnographical surveys (e.g., Saletta, 2015) mentioned the fre- increase the number of dated skeletons in the future, in order to study quent use of bow and arrow by terrestrial hunter-gatherer men. the possible impact of the contact on aboriginal populations more According to the results obtained here, OCD on the shoulder of males accurately. During-contact sample from missions and farms could may have been produced by physical activities like archery. Most of offer different insights about the cultural and biological changes pro- the recorded OCD affected the right glenoid cavity, so higher loading duced in these populations in historical times. demands in the right shoulder could be suspected in the studied skeletons. The OCD in the shoulder of three skeletons from Southern Tierra del Fuego could also be related to physical activities like rowing 5 | CONC LU SIONS and hunting. As mentioned above, data on large samples of hunter-gatherers The prevalence of OCD and the affected joint pattern found in are very scarce, and for that reason, there are only few results to be this paper suggest that physical activity and mechanical demands compared with those found in the present research. Merbs (1983) would have played an important role in the development of this studied a sample of 91 Inuit skeletons and recorded OA in the glenoid joint disease, especially in the shoulder of males. Although no cavity of the shoulder of males (22%) and females (12%), in some statistical differences were found between economic strategies and cases associated with OCD in the shoulder. He attributed these high regions, most of the diagnosed lesions affected individuals with frequencies contrast, terrestrial and mixed hunter-gatherers strategies. However, these Ponce (2010) only found one skeleton with OCD (0.6% of crude prev- results need to be considered with caution due to the small sample alence) in coastal populations from northern Chile, affecting only one studied. to throwing and rowing practices. In knee. Nonetheless, she suggested that coastal fishers were more The contact between local and foreigner populations since influenced by mechanical demands than inland agriculturalist, based ca. 400 years BP seems not to have influenced the prevalence of on OA and other musculoskeletal stress markers. OCD, although more dated skeletons are needed to test this hypothe- Previous research in Southern Patagonia (i.e., Suby, 2007; Suby sis. Studies of OCD have been widely fulfilled in clinical and veterinary et al., 2009) observed evidence of OA in two of the skeletons with disciplines. As a result, a wealth of knowledge has been generated OCD (i.e., Rincón del Buque site and Cabo Vírgenes site). However, that can be used in the study of bioarchaeological remains. This a more specific study of OA in these skeletons needs to be further research could help to understand the impact of OCD in ancient conducted, as well as studies of other MOS (e.g., entheseal changes, hunter-gatherers and to evaluate the possible causes that produce robusticity and bilateral asymmetry in long bones). These issues this osteochondral defect. ZÚÑIGA THAYER ET AL. 85 ACKNOWLEDGEMEN TS We would like to thank Drs Luis Borrero, Mónica Salemme, Fernando Santiago, Ernesto Piana, Francisco Zangrando, Martín Vazquez and Ricardo Guichón for allowing access to the human remains recovered in their archaeological research; to the authorities of Museo del Fin del Mundo (Ushuaia, Argentina) and Instituto de la Patagonia, Universidad de Magallanes (Punta Arenas, Chile); to three reviewers for their comments that improved the manuscript; and to Sandra Baliño for her assistance in language revision. This paper has been supported by the National Council for Science and Technology (CONICET-Argentina) and Grant PICT 0191-2016 (National Agency for Science and Technology, Argentina). ORCID Rodrigo Zúñiga Thayer Jorge Suby https://orcid.org/0000-0001-9351-2483 https://orcid.org/0000-0002-6066-4031 Leandro Luna https://orcid.org/0000-0002-5454-5570 Gustavo Flensborg https://orcid.org/0000-0002-7418-459X RE FE R ENC E S Acsádi, G., & Nemeskéri, J. (1970). History of human life span and mortality. Akadémiai Kiadó, Budapest. https://doi.org/10.1017/ S0770451800026762 Aicale, R., Tarantino, D., & Maffulli, N. (2018). Overuse injuries in sport: A comprehensive overview. Journal of Orthopaedic Surgery and Research, 13, 309. https://doi.org/10.1186/s13018-018-1017-5 Barberena, R. (2002). Los límites del mar. Buenos Aires: Sociedad Argentina de Antropología. Borrero, L., & Barberena, R. (2006). Hunter-gatherer home ranges and marine resources: An archaeological case from southern Patagonia. Current Anthropology, 47(5), 855–867. https://doi.org/10.1086/ 507186 Borrero, L. A., Barberena, R., Franco, N. V., Charlin, J., & Tykot, R. H. (2009). Isotopes and rocks: Geographic organization of Patagonian hunter-gatherers. International Journal of Osteoarchaeology, 19(2), 309–327. https://doi.org/10.1002/oa.1036 Brooks, S., & Suchey, J. (1990). Skeletal age determination based on the os pubis: A comparison of the Acsádi-Nemeskéri and Suchey-Brooks methods. Human Evolution, 5(3), 227–238. https://doi.org/10.1007/ bf02437238 Brownlow, H., O'Connor-Read, L., & Perko, M. (2006). Arthroscopic treatment of osteochondritis dissecans of the capitellum. Knee Surgery, Sports Traumatology, Arthroscopy, 14(2), 198–202. https://doi.org/10. 1007/s00167-005-0623-z Carlson, C., Meuten, D., & Richardson, D. (1991). Ischemic necrosis of cartilage in spontaneous and experimental lesions of osteochondrosis. Journal of Orthopaedic Research, 9(3), 317–329. https://doi.org/10. 1002/jor.1100090303 Chu, P., Shih, J., Hou, Y., Hung, S., Chen, J., & Lee, H. (2009). Osteochondritis dissecans of the glenoid: A rare injury secondary to repetitive microtrauma. Journal of Trauma and Acute Care Surgery, 67 (3), e62–e64. https://doi.org/10.1097/ta.0b013e318047c02a Cocilovo, J. A., & Guichón, R. A. (1985-1986). Propuesta para el estudio de las poblaciones aborígenes del extremo austral de Patagonia. Anales del Instituto de la Patagonia, Serie Ciencias Sociales, 16, 111–123. D'Angelo del Campo, M., Suby, J., García-Laborde, P., & Guichón, R. (2017). Spondylolysis in the past: A case study of hunter-gatherers from Southern Patagonia. International Journal of Paleopathology, 19, 1–17. https://doi.org/10.1016/j.ijpp.2017.07.001 De la Fuente, C., Galimany, J., Kemp, B. M., Judd, K., Reyes, O., & Moraga, M. (2015). Ancient marine hunter-gatherers from Patagonia and Tierra Del Fuego: Diversity and differentiation using uniparentally inherited genetic markers. American Journal of Physical Anthropology, 158(4), 719–729. https://doi.org/10.1002/ajpa.22815 Debeer, P., & Brys, P. (2005). Osteochondritis dissecans of the humeral head: Clinical and radiological findings. Acta Orthopaedica Belgica, 71 (4), 484–488. Edmonds, E., & Heyworth, B. (2014). Osteochondritis dissecans of the shoulder and hip. Clinics in Sports Medicine, 33(2), 285–294. https:// doi.org/10.1016/j.csm.2013.11.001 Edmonds, E., & Polousky, J. (2013). A review of knowledge in osteochondritis dissecans: 123 years of minimal evolution from König to the ROCK study group. Clinical Orthopaedics and Related Research Research, 471, 1118–1126. https://doi.org/10.1007/s11999-0122290-y Flensborg, G., Martínez, G., González, M., & Bayala, P. (2011). Revisión de los restos óseos humanos del sitio La Petrona (Transición PampeanoPatagónica oriental, Argentina). Magallania, 39(1), 179–191. https:// doi.org/10.4067/s0718-22442011000100011 Garrett, J. (1991). Osteochondritis dissecans. Clinics in Sports Medicine, 10 (3), 569–593. Gogus, A., & Ozturk, C. (2008). Osteochondritis dissecans of the glenoid cavity: A case report. Archives of Orthopaedic and Trauma Surgery, 128 (5), 457–460. https://doi.org/10.1007/s00402-007-0558-6 González José, R., García-Moro, C., Dahinten, S., & Hernández, M. (2002). Origin of Fueguian-Patagonians: An approach to population history and structure using R matrix and matrix permutation methods. American Journal of Human Biology, 14, 308–320. https://doi.org/10.1002/ ajhb.10033 Guichón, R., Muñoz, A., & Borrero, L. A. (2000). Datos para una tafonomía de restos óseos humanos en Bahía San Sebastián, Tierra del Fuego. Relaciones de la Sociedad Argentina de Antropología, 25, 297–311. Guichón, R., & Suby, J. (2011). Estudio bioarqueológico de los restos humanos recuperados por Anne Chapman en Caleta Falsa, Tierra del Fuego. Magallania, 39(1), 163–177. https://doi.org/10.4067/s071822442011000100010 Hamada, J., Tamai, K., Koguchi, Y., Ono, W., & Saotome, K. (2005). Case report: A rare condition of secondary synovial osteochondromatosis of the shoulder joint in a young female patient. Journal of Shoulder and Elbow Surgery, 14(6), 653–656. https://doi.org/10.1016/j.jse.2004. 12.004 Hendrix, C. (2005). Calcaneal apophysitis (Sever disease). Clinics in Pediatric Medicine and Surgery, 22(1), 55–62. https://doi.org/10.1016/j.cpm. 2004.08.011 Ishikawa, H., Ueba, Y., Yonezawa, T., Kurosaka, M., Ohno, O., & Hirohata, K. (1988). Osteochondritis dissecans of the shoulder in a tennis player. American Journal of Sports Medicine, 16(5), 547–550. https://doi.org/10.1177/036354658801600522 Kennedy, K. A. R. (1989). Skeletal markers of occupational stress. In M. Y. K. Iscan & A. R (Eds.), Reconstruction of life from the skeleton (pp. 129–160). New York: Wiley-Liss. Kida, Y., Morihara, T., Kotoura, Y., Hojo, T., Tachiiri, H., Sukenari, T., … Kubo, T. (2014). Prevalence and clinical characteristics of osteochondritis dissecans of the humeral capitellum among adolescent baseball players. The American Journal of Sports Medicine, 42(8), 1963–1971. https://doi.org/10.1177/0363546514536843 Kochi, S. (2017). Paleodietas en cazadores-recolectores del canal Beagle durante el Holoceno tardío. Intesecciones en Antropología, 18(3), 329–340. Lalueza Fox, C., Pérez-Pérez, A., Prats, E., Cornudella, L., & Turbón, D. (1997). Lack of founding Amerindian mitochondrial DNA lineages in extinct Aborigines from Tierra del Fuego-Patagonia. Human Molecular Genetics, 6(1), 41–46. https://doi.org/10.1093/hmg/6.1.41 86 Larsen, C. S., & Ruff, C. (2011). An external agency of considerable importance: The stresses of agriculture in the foraging-to-farming transition in eastern North America. In R. Pinhasi & J. T. Stock (Eds.), Human bioarchaeology of the transition to agriculture (pp. 293–315). Chichester: Wiley Online Library Ltd, The Atrium, Southern Gate. L'Heureux, L., & Barberena, R. (2008). Evidencias bioarqueológicas en Patagonia Meridional: el sitio Orejas de Burro 1 (Pali Aike, provincia de Santa Cruz). Intersecciones en Antropología, 9, 11–24. L'Heureux, L., Guichón, R., Barberena, R., & Borrero, L. (2003). Durmiendo bajo el faro: estudio de un entierro humano en Cabo Vírgenes (CV 17), provincia de Santa Cruz, República Argentina. Intersecciones en Antropología, 4, 87–97. Lovejoy, C., Meindl, R., Mensforth, R., & Barton, T. (1985). Multifactorial determination of skeletal age at death: A method and blind tests of its accuracy. American Journal of Physical Anthropology, 68, 1–14. https:// doi.org/10.1002/ajpa.1330680102 Lowe, T. (1990). Scheuermann disease. The Journal of Bone and Joint Surgery American, 72(6), 940–945. https://doi.org/10.2106/00004623199072060-00026 Matsuura, T., Suzue, N., Iwame, T., Nishio, S., & Sairyo, K. K. (2014). Prevalence of Osteochondritis dissecans of the capitellum in young baseball players: Results based on ultrasonographic findings. The Orthopaedic Journal of Sports Medicine, 2(8), 1–5. https://doi.org/10.1177/ 2325967114545298 McWhirr, A., Viner, L., & Wells, C. (1982). Romano-British cemeteries at Cirencester (Vol. 2). Greece: Cirencester Excavation Committee Corinium Museum. https://doi.org/10.2307/526428 Merbs, C. F. (1983). Patterns of activity-induced pathology in a Canadian Inuit population. University of Ottawa Press. https://doi.org/10.2307/ j.ctv173qw Ming, S., Jin, D., & Kanta, M. (2004). Arthroscopic treatment of osteochondritis dissecans of the talus. Foot and Ankle Surgery, 10(4), 181–186. https://doi.org/10.1016/j.fas.2004.07.009 Molnar, P., Ahlstrom, T. P., & Leden, I. (2011). Osteoarthritis and activity—An analysis of the relationship between eburnation, musculoskeletal stress markers (MSM) and age in two Neolithic hunter–gatherer populations from Gotland, Sweden. International Journal of Osteoarchaeology, 21(3), 283–291. https://doi.org/10.1002/oa. 1131 Ortner, D. (2003). Identification of pathological conditions in human skeletal remains (Second ed.). New York: Elsevier Science/Academic Press. Padgett, G., Mostosky, U., Probst, C., Thomas, M., & Krecke, C. (1995). The inheritance of osteochondritis dissecans and fragmented coronoid process of the elbow joint in labrador retrievers. Journal of the American Animal Hospital Association, 31(4), 327–330. https://doi.org/10. 5326/15473317-31-4-327 Patel, D. R., Yamasaki, A., & Brown, K. (2017). Epidemiology of sportsrelated musculoskeletal injuries in young athletes in United States. Translational Pediatrics, 6(3), 160–166. https://doi.org/10.21037/tp. 2017.04.08 Petersen, J., Steinhagen, J., Catala-Lehnen, P., & Bruns, J. (2006). Osteochondritis dissecans of the knee joint. Zeitschrift fur Orthopadie und ihre Grenzgebiete, 144(4), R63–R76. https://doi.org/10.1055/s2006-924323 Phenice, T. (1969). A newly developed visual method of sexing in the os pubis. American Journal of Physical Anthropology, 30, 297–301. https:// doi.org/10.1002/ajpa.1330300214 Ponce, P. (2010). A comparative study of activity-related skeletal changes in 3rd-2nd millennium BC coastal fishers and 1st millenium AD inland agriculturists in Chile, South America. PhD thesis. England: Durham University. Prates, L., Politis, G., & Steele, J. (2013). Radiocarbon chronology of the early human occupation of Argentina. Quaternary International, 301, 104–122. ZÚÑIGA THAYER ET AL. Prieto, A. (1993–1994). Algunos datos en torno a los enterratorios humanos de la región continental de Magallanes. Anales del Instituto de la Patagonia, 22, 91–100. Rodríguez-Martín, C. (2000). Osteocondritis disecante en poblaciones del pasado. Una revisión sobre su etiología, fisiopatología y epidemiología, con especial referencia a Canarias. Eres (Serie de Arqueología-Bioantropología), 9, 201–219. Rogers, J., & Waldron, T. (1995). A field guide to joint disease in archaeology. New York: John Wiley & Sons. Ruff, C. B. (2008). Biomechanical analyses of archaeological human skeletons. In M. S. Katzenberg (Ed.), Biological anthropology of the human skeleton (pp. 183–206). New York: Wiley Online Library. Saletta, M. J. (2015). Excavando fuentes. La tecnología, subsistencia, movilidad y los sistemas simbólicos de Shelk'nam. Yámana/Yaghan y Aonikenk entre los siglos XVI y XX analizadas a partir de los registros escritos y arqueológicos. PhD thesis. Buenos Aires, Argentina: Facultad de Filosofía y Letras, Universidad de Buenos Aires. Santiago, F., Salemme, M., Suby, J., & Guichón, R. (2011). Restos humanos en el Norte de Tierra del Fuego: aspectos contextuales, dietarios y paleopatológicos. Intersecciones en Antropología, 12(1), 147–162. Scabuzzo, C. (2013). Estudios bioarqueológicos del sitio Paso Mayor, sudoeste de la Provincia de Buenos Aires. Revista del Museo de Antropología, 6(1), 49–62. Schenck, R., & Goodnight, J. (1996). Osteochondritis dissecans. Journal of Bone and Joint Surgery, 78, 439–456. https://doi.org/10.2106/ 00004623-199603000-00018 Suby, J. (2007). Propiedades Estructurales de Restos Óseos Humanos y Paleopatología en Patagonia Austral. PhD dissertation, Facultad de Ciencias Exactas y Naturales, Universidad de Mar del Plata, Buenos Aires. Suby, J. (2014a). Nódulos de Schmorl en restos humanos arqueológicos de Patagonia Austral. Magallania, 42(1), 135–147. https://doi.org/10. 4067/s0718-22442014000100008 Suby, J. (2014b). Porotic hyperostosis and cribra orbitalia in human remains from Southern Patagonia. Journal of Anthropological Sciences, 122(2), 69–79. https://doi.org/10.1537/ase.140430 Suby, J. (2020). Paleopathological research in Southern Patagonia: An approach to understanding stress and disease in hunter-gatherer populations. Latin American Antiquity, in press. https://doi.org/10. 1017/laq.2020.5 Suby, J., Guichón, R., & Zangrando, A. (2009). El registro biológico humano de la costa meridional de Santa Cruz. Revista Argentina de Antropología Biológica, 11(1), 109–124. Suby, J., Luna, L., Aranda, C., & Flensborg, G. (2017). First approximation to paleodemography through age-at-death profiles in hunter-gatherers from Southern Patagonia during middle-late Holocene. Quaternary International, 438, 174–188. https://doi.org/10.1016/j.quaint.2017. 04.035 Suby, J., Zangrando, A., & Piana, E. (2011). Exploraciones osteológicas de la salud de las poblaciones humanas del Canal Beagle. Relaciones de la Sociedad Argentina de Antropología, 36, 249–270. Suby, J. A., & Guichón, R. A. (2009). Diet, nutrition and femoral robusticity of hunter-gatherers in southern Patagonia: Experiences and perspectives. International Journal of Osteoarchaeology, 19(2), 328–336. https://doi.org/10.1002/oa.1040 Suby, J. A., & Novellino, P. (2017). Análisis comparativo de la geometría de la sección transversal de tibias de restos humanos de Patagonia Austral y centro-norte de Mendoza. Revista Argentina de Antropología Biológica, 19(2), 1–14. https://doi.org/10.17139/raab.2017.0019. 02.01 Takahara, M., Ogino, T., Sasaki, I., Kato, H., Minami, A., & Kaneda, K. (1999). Long term outcome of osteochondritis dissecans of the humeral capitellum. Clinical Orthopaedics and Related Research, 363, 108–115. https://doi.org/10.1097/00003086-199906000-00014 ZÚÑIGA THAYER ET AL. Tessone, A., Guichón, R., Suby, J., & Kozameh, L. (2011). Bioarqueología de Península Mitre. In A. Zangrando, M. Vázquez, & A. Tessone (Eds.), Los cazadores-recolectores del extremo oriental fueguino. Arqueología de Península Mitre e Isla de los Estados (pp. 231–270). Buenos Aires.: Sociedad Argentina de Antropología. Thomas, R., & Johannsen, N. (2011). Articular depressions in domestic cattle phalanges and their archaeological relevance. International Journal of Paleopathology, 1(1), 43–54. https://doi.org/10.1016/j.ijpp.2011. 02.007 Todd, T. (1921). Age changes in the pubic bone. American Journal of Physical Anthropology, 4(1), 1–70. https://doi.org/10.1002/ajpa. 1330040102 Uematsu, K., Habata, T., Hasegawa, Y., Hattori, K., Kasanami, R., Takakura, Y., & Fujisawa, Y. (2005). Osteochondritis dissecans of the knee: Long-term results of excision of the osteochondral fragment. The Knee, 12(3), 205–208. https://doi.org/10.1016/j.knee.2004.08.005 Vikatou, I. (2012). Are these ‘clogs’ made for walking? Osteochondritis dissecans: Evidence of strenuous activity and trauma on skeletal elements of the foot from a post-medieval rural society in the Netherlands. MA thesis. Holand: University of Leiden. Vikatou, I., Hoogland, M., & Waters-Rist, A. (2017). Osteochondritis Dissecans of skeletal elements of the foot in a 19th century rural farming community from The Netherlands. International Journal of Paleopathology, 19, 53–63. https://doi.org/10.1016/j.ijpp.2017.09.005 Waldron, T. (2009). Paleopathology. Cambridge: Cambridge University Press. Weiss, E., Corona, L., & Schultz, B. (2012). Sex differences in musculoskeletal stress markers: Problems with activity pattern reconstructions. 87 International Journal of Osteoarchaeology, 22(1), 70–80. https://doi. org/10.1002/oa.1183 Wells, C. (1974). Osteochondritis dissecans in ancient British skeletal material. Medical History, 18, 365–369. https://doi.org/10.1017/ s0025727300019815 Wilk, K. E., Obma, P., Simpson, C. D., Cain, E. L., Duglas, J., & Andrews, J. R. (2009). Shoulder injuries in the overhead athlete. Journal of Orthopaedic and Sport Physical Therapy, 39(2), 38–34. https:// doi.org/10.2519/jospt.2009.2929 Ytrehus, B., Carlson, C., & Ekman, S. (2007). Etiology and pathogenesis of osteochondrosis. Veterinary Pathology, 44(4), 429–448. https://doi. org/10.1354/vp.44-4-429 Zúñiga Thayer, R. (2016). Aproximación a la actividad de remo en canoa: Un estudio de cambios entésicos en miembro superior de individuos del antiguo territorio yagan. Degree dissertation. Concepción, Chile: Facultad de Ciencias Sociales, Universidad de Concepción. How to cite this article: Zúñiga Thayer R, Suby J, Luna L, Flensborg G. Osteochondritis dissecans and physical activity in skeletal remains of ancient hunter-gatherers from Southern Patagonia. Int J Osteoarchaeol. 2021;31:77–87. https://doi. org/10.1002/oa.2926