Osteochondritis Dissecans of the Knee | Treatment for Osteochondritis Dissecans
Home/Osteochondritis Dissecans of the Knee | Treatment for Osteochondritis Dissecans
Description of Osteochondritis Dissecans Knee
Osteochondritis dissecans can affect any joint in the body but the knee is the most commonly affected joint.
Osteochondritis dissecans of the knee, or OCD knee, is a condition that is caused by a reduction of blood flow to the end of a bone within the knee joint. This condition occurs most often in adolescent males under the age of 25. OCD of the knee is a painful joint condition in which a piece of cartilage, along with a portion of the bone under it, may come loose from the end of a bone.
Some individuals who have this condition may or may not experience symptoms. One of the most important prognostic factors for OCD is whether the patient's growth plates are still open. If the loosened cartilage and bone does not completely detach, with rest and limited activity, the fragment has the ability to naturally repair itself if their growth plates are still open. In patients whose growth plates are closed or where the bone has completely detached, symptoms will often be present and could continue to get worse.
Symptoms associated with osteochondritis dissecans knee include:
Swelling: The area around the knee joint will become swollen and tender
Pain: Pain is the most evident symptom of this condition; it will continue to worsen with activity.
Limited Range of Motion: As the condition worsens, it will become more difficult to straighten your leg
Joint Locking: When the bone and cartilage detach from the end of a bone in the knee joint, loose fragments are at risk for getting caught between the bones. This may result in the joint locking up, popping or getting stuck (locked) in one position. Sometimes patients can feel fragments floating in their joints, usually up and around the kneecap.
Young athletes appear to be at risk for developing OCD of the knee. Sports that involve quick moves and fast changes in direction may increase the chances. Ongoing over-use, knee trauma, repetitive, unrecognized injuries and other episodes or hard falls could also damage the end of an affected bone.
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How to Read a MRI of an Osteochondritis Dissecans Lesion
Treatment of Osteochondritis Dissecans Knee
Dr. LaPrade offers specialized treatment for osteochondritis dissecans of the knee. In order to properly diagnose this condition and plan the most affective course of treatment, he will order specific x-rays and usually an MRI. X-rays will be needed so that Dr. LaPrade can determine if the patient is bow-legged or knock-kneed and to determine the location of the defect. X-rays also help to visually the opposite knee, which is important because 30% of patients will have OCD in both knees. The MRI will offer him the ability to examine the extent of the injury through detailed imaging of the joint to determine the defect size, whether it is one piece or fragmented, and to evaluate for the presence of cysts in the surrounding bone. Treatment for osteochondritis dissecans of the knee will vary depending on the patient. If the MRI shows that the cartilage and bone have not completely detached in a patient with open growth plates, Dr. LaPrade will first establish a protocol involving rest, the use of crutches, range of motion exercises, strengthening moves, and possibly anti-inflammatory medication. These are conservative measures for the treatment of OCD knee that are taken for the affected joint to restore normal function.
In patients where Dr. LaPrade recommends surgery, an arthroscopic surgical approach may be performed to drill into the dead bone or to remove the loose fragments and debris deep in the lesion in the knee joint and reattach the bone with bioabsorbable screws and bone graft. Dr. LaPrade may use a fresh donor cartilage allograft in patients with a large and/or deep lesion, in which case the patient will need a second surgery and be put on a cartilage donor list. In these circumstances, a cartilage allograft is used to replace the bone and cartilage that has fallen off.
A very specific, detailed post-op protocol will be given to patients who undergo arthroscopic surgery for the treatment of osteochondritis dissecans. It is crucial that the patient work directly with rehab specialists and Dr. LaPrade in following this precise treatment plan. Patients who have a drilling procedure or a reattachment of their defect with bone grafting will be advised to avoid putting weight on their foot for a minimum of 6 weeks and may need to use an unloader brace for a few months after surgery. For those who undergo a fresh osteoarticular allograft procedure, they will be non-weight bearing for 8 weeks and will need to use a CPM for 6-8 hours a day while they are non-weight bearing. Depending on the severity of the injury and surgical repair site and size, some patients will be told to modify their current activities (partaking in competitive or recreational sports). This is often the case when a cartilage transplant takes place.
Refrigerated Osteoarticular Allografts
Articular Cartilage Injuries of the Knee
Osteochondritis Dissecans FAQ
1. What is osteochondritis dissecans?
Osteochondritis dissecans is primarily a bony problem of the joint. It is a failure of the normal bony healing center to heal, most commonly involving the lateral aspect of the medial femoral condyle in the knee. The ability of a patient to heal an osteochondritis dissecans lesion in the knee is mainly due to whether their overall growth plates are still open. Of those patients who have open growth plates and the osteochondritis dissecans lesion has not partially or completely detached, there is still a chance that it could heal with activity modification and use of an unloader brace. For those patients who have a symptomatic osteochondritis dissecans lesion and the growth plates are closed, the outcomes are not as good and a surgical treatment may be indicated.
2. What causes osteochondritis dissecans?
The cause of osteochondritis dissecans is a failure of a normal bony growth center to heal. The rate of osteochondritis dissecans in the general population is felt to be about 3 per 1000 people. Many people have studied osteochondritis dissecans and it is felt that there are many issues that contribute towards the development of osteochondritis dissecans. Some of these may be genetic, but it is generally rare that isolated cases of osteochondritis dissecans occur in siblings or within families.
3. Where does osteochondritis dissecans of the knee occur?
The most common location for osteochondritis dissecans to occur in the knee is in the lateral aspect of the medial femoral condyle. Other common places include the lateral femoral condyle, where it can be quite large, the trochlea, and the kneecap. About 30% of the time it can occur in both knees (bilateral).
4. What is an OCD knee injury?
An osteochondritis dissecans, or OCD, knee injury usually occurs when there is an underlying OCD lesion which was asymptomatic and it becomes symptomatic due to an injury or just because the lesion did not heal and it eventually falls off the bone. Many patients who present with an OCD lesion have either a partial detachment of the OCD lesion from the bone, which causes symptoms, or they can have a complete detachment of the OCD lesion, which causes the piece to float inside the knee and the knee may become locked. In general, when these types of lesions occur, surgical treatment is almost always indicated.
5. How to prevent osteochondritis dissecans?
Because we don't really know how osteochondritis dissecans develops, there is no real prevention for it. In addition, because it is caused by multiple factors, there does not appear to be a specific genetic cause of it within families.
6. How does one diagnose an osteochondritis dissecans lesion of the knee?
The diagnosis of an osteochondritis dissecans lesion of the knee depends both on the physical exam and imaging studies. Patients with a symptomatic osteochondritis dissecans lesion of the knee will usually have pinpoint joint line or kneecap pain in the region of their OCD lesion. Plain x-rays will usually demonstrate an OCD lesion as a lucency below the piece of bone or even a complete cavity. It is usually recommended to obtain a notch view or Rosenberg view x-ray to best demonstrate OCD lesions of the femoral condyles. OCD lesions of the patella and trochlear groove are best seen on a patellar sunrise x-ray. An MRI scan is almost always indicated to determine the extent of the OCD lesion and to see if there are any cysts in the bone beneath the OCD lesion. It can also determine if the piece is loose, and if there is a loose body, the location of the loose body. The MRI can also be very useful in younger patients where it can show whether the OCD lesion may have a potential for healing in those with open growth plates.
7. How to treat osteochondritis dissecans of the knee?
The treatment of osteochondritis dissecans of the knee is very varied depending upon the age of the patient, if there are other problems present in the knee, and the patient's overall alignment.
In younger patients where the OCD lesion may be symptomatic, but is not detached, and there are open growth plates, a trial of physical therapy with activity modification, and the use of an unloader brace may be indicated. Following a program like this for several months with a follow-up set of x-rays and probably an MRI scan may indicate if the OCD lesion is healing. We have found this to be successful approximately 50-60% of the time, so it is a viable option in patients with open growth plates who do not have a detached lesion.
For those patients who have a detached lesion of the OCD, or it is completely displaced, surgery is indicated. In general, trying to preserve one's own cartilage is better than trying a cartilage resurfacing technique. However, it is entirely dependent upon whether the OCD lesion is very fragmented or if there is a solid piece of bone present. If one does have a solid piece of bone present, it may be indicated to try a surgery to reattach the OCD lesion. We feel that making a small incision to clean out the base of the lesion, drill through the sclerotic bone at the base, and then placing a bone graft and pinning the OCD lesion may be indicated in many of these cases. For those patients who have a very fragmented OCD lesion, which has a low chance of healing with a pinning, or where the piece is completely dislodged and is macerated and not able to be put back, then one may have to look at replacing the whole bone and cartilage unit. In our hands, the use of a fresh osteoarticular allograft is indicated in these circumstances. We have found them to be highly successful for the majority of patients. In these circumstances, a complete workup is necessary to look at a patient's alignment to determine if an osteotomy may be indicated and to verify that the meniscus cushion on the side of the proposed fresh allograft is adequate. In addition, one should ensure that all ligaments of the knee are stable to have the best outcomes with the use of a fresh allograft to treat an OCD lesion.