The authors conclude by saying that treatment for OCD of the knee is most successful when the condition is caught early and treated before long-lasting damage can be done. Osteochondritis dissecans of the knee is often the result of sports that involve high-impact landings, such as football, soccer, and gymnastics. As a result, the area of bone and its overlying cartilage can separate from the rest of the bone. Nonsurgical Treatment. You might first consult with your family doctor, who might refer you to a doctor who specializes in sports medicine or orthopedic surgery. Treatment of OCD lesions is dictated by the extent of the lesion and the age of the patient at the time of diagnosis. Most areas of scientific inquiry concerning the knee revolve around the major ligaments and our knowledge of these injuries is so far advanced that often the remaining questions are minor fine-tuning. In this example, full knee extension has full OCD contact with the tibia, whereas knee flexion beyond 90° gives minimal contact between the OCD lesion and the tibia, making full weight-bearing and strengthening exercises safe within the arc of motion between 90° and 135°. Abbreviation: OCD, osteochondritis dissecans. Mainstay of treatment … The incidence of this potentially disabling condition has remained relatively steady, but with a shifting distribution towards young, athletic males as the primarily affected demographic. Recovery and surgery for an OCD lesion of the knee. Once the cartilage and/or bone breaks free, you will probably feel clicking, catching, or even locking of your knee. This content does not have an Arabic version. The first line of treatment, particularly for children, is to manage OCD without surgical operations. While your doctor may recommend ice, anti-inflammatory medications, and other symptom treatments, the critical part of non-surgical treatment is resting the joint to allow for healing. JBJS Essent Surg Tech. The normal cartilage is smooth and slippery and firmly attached to the underlying bone.. Osteochronditis dissecans (aka “OCD”) is a condition in which the bone that supports the cartilage inside a joint undergoes softening. 2010 Feb;18(2):238-46. doi: 10.1007/s00167-009-0942-6. The literature on conservative treatments for knee OCD is scarce. Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. If there are changes in surgeries or other scheduled appointments, your provider will notify you. What can I do to prevent my symptoms from recurring? May 2011 vol. The surgeon makes the treatment decision with the patient's interests in mind but by taking into consideration the size and depth of the lesion. Depending upon the severity of the injury, we may first try conservative therapies to treat OCD, including: Activity modification involving rest with a cast Anti-inflammatory medications Given the relatively low incidence of OCD of the knee, historically, it has been difficult to perform high-quality, prospective, comparative studies to ascertain the best available treatment options for those suffering from OCD. Specific age of presentation also depends upon the location of the OCD lesion : The prevalence of OCD lesions of the knee peaks in the preteen years, but can occur at any age. If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. OCD usually causes pain during and after sports. Early in the disease process, you might experience dull pain or soreness and swelling. Make a donation. 7,9,23,78 Regardless, treatment should seek to prevent early-onset osteoarthritis, which is associated with unhealed lesions and may show favorable … The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. (Right) The lesion has detached from the femur and is floating within the knee joint. Holding the lesion in place with internal fixation (such as pins and screws). In OCD, a portion of the bone or cartilage separates from the surface of the joint and creates pain, swelling and sometimes a locking sensation. Maruyama M, et al. For this reason, the treatment and prognosis of OCD and JOCD can be very different. This can cause the bone to fragment and the cartilage to separate from its normally firm attachment. Patella OCD • Rare, est. OCD of the Knee. It may help manage pain from osteoarthritis of the knee, but experts say that more research is needed. 2013 Jun. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). 2. Even with surgery, OCD usually leads to future joint problems, including osteoarthritis. Laskowski ER (expert opinion). Replacing the damaged area with a new piece of bone and cartilage (called a graft). The goal of conservative treatment is to obtain Figure 2. Learn about our superior approach to the treatment of OCD lesions through cartilage regeneration in your knee. Open Reduction, Bone Grafting, and Internal Fixation of Osteochondritis Dissecans Lesion of the Knee. The following are a few examples of the many surgeries that are currently available to treat OCD. Read our, Medically reviewed by Stuart Hershman, MD, Medically reviewed by Kashif J. Piracha, MD, Verywell Health uses cookies to provide you with a great user experience and for our, Microfracture Surgery for Stimulating Cartilage Growth in Your Joints, Leg Lengthening Surgery: Everything You Need to Know, Knee Arthroscopy: What to Expect on the Day of Surgery, Explore What Talus Fractures Are and Why They Occur, Learn the Scary Facts About Kneecap Fractures, What to Expect on the Day of Your ACL Surgery, Fractures of the Inner Side of the Ankle Joint, An Overview of Subchondral Sclerosis: Symptoms, Diagnosis, Treatment. OCD and JOCD cause the same kind of damage to the knee, but they are separate diseases. Important variables affect the choice of treatment. During the physical exam, your doctor will press on the affected joint, checking for areas of swelling or tenderness. The condition occurs most commonly in the knee, but also occurs in elbows, ankles and other joints. Drilling, open or arthroscopic fixation, fragment excision, microfractures, osteochondral grafting (with autograft or allograft) and autologous chondrocyte implantation (ACI) have … Why or why not? In a normal knee joint, a layer of cartilage that is several millimeters thick evenly coats the bone surfaces. Management of osteochondritis dissecans (OCD). There are a number of factors that must be considered when determining the best treatment for OCD. Methods of Stimulating New Cartilage Growth. https://orthoinfo.aaos.org/en/staying-healthy/a-guide-to-safety-for-young-athletes. Houten: Bohn Stafleu Van Loghum. When the cartilage is damaged, a number of problems can occur. Your doctor will also check other structures around the joint, such as the ligaments. 19 no. There are a number of ways to try to stimulate new cartilage growth, and each has pros and cons: Dealing with joint pain can cause major disruptions to your day. or MRI will be used follow the OCD and see if your OCD is healing. The surgical choices to treat OCD depend on whether the OCD is firmly in place (stable) or threatening to loosen or dislodge (unstable). No single treatment works for everybody. OCD most often affects the knee. Initially, your doctor will likely recommend conservative measures, which might include: If you have a loose fragment in your joint, if the affected area is still present after your bones have stopped growing, or if conservative treatments don't help after four to six months, you might need surgery. Patients who have OCD develop abnormal blood flow to the bone that surrounds the joint. A recent paper that my colleagues and I published in The Journal of Bone and Joint Surgery in 2012 reported the results of five different techniques to treat OCD. A radiograph and MRI is shown in Figures A and B. Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. Reproduced with permission from Crawford DC, Safran MR: Osteochondritis dissecans of the knee. Leading theories: – Shear stress from a mal-aligned patella – a result of repeated insults to articular surface – … This piece of bone and cartilage can become loose and even break off into the joint. For unstable yet salvageable OCD lesions, the senior author’s preferred treatment is fixation with bone grafting. Long term complication includes osteoarthritis. Healing predictors of stable juvenile osteochondritis dissecans knee lesions after 6 and 12 months of nonoperative treatment. The purpose of this clinical practice guideline is to help improve … The goal of surgical treatment is to end up with a stable cartilage surface of the joint. Chambers HG, et al. Mild OCD: A piece of bone has begun to separate from the joint, but this piece is still firmly held in place by a covering of cartilage (dense elastic tissue that helps cushion the joint). Signs and symptoms. Hergenroeder AC, et al. What happens in patients with OCD is the blood flow to the bone around a joint surface becomes abnormal. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur).A joint surface damaged by OCD doesn't heal naturally. https://www.uptodate.com/contents/search. p.82-87. The authors’ preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. The male to female ratio is approximately 4:1 in the United States and has been found to have the highest incidence in the African American population. https://www.uptodate.com/contents/search. The leading thought as to why knee OCD happens relates to the thin layer of growth cartilage that caps the end of long bones, such as the femur or thigh bone. OCD of the knee. Osteochondritis dissecans (OCD) is a bone and cartilage injury that affects the knee, ankle and elbow. https://rarediseases.info.nih.gov/diseases/12703/osteochondritis-dissecans. Skip Navigation. J Am Acad Orthop Surg 2006; 14: 90-100. Click below and just hit send! We continue to monitor COVID-19 in our area. Guidelines for treatment are outlined by the following categories: 1. Diagnosis and treatment of osteochondritis dissecans of the humeral capitellum. For osteochondritis dissecans, some basic questions to ask your doctor include: Your doctor is likely to ask you a number of questions, such as: Mayo Clinic does not endorse companies or products. Category 1 (ie, girls younger than 11 y, boys younger than 13 y): These patients usually do well with nonoperative treatment. In the adult, the bones are not growing. What is most problematic for patients with OCD is often the pain associated with this condition. In children with open growth plates, there is a higher chance for spontaneous healing with activity modification or immobilization than in adults. Normal joint cartilage is important for having a joint that bends smoothly and without pain. 2016;29(07):533-538. doi:10.1055/s-0036-1586723, Sanders TL, Pareek A, Johnson NR, et al. It is treated by orthopaedic physicians at CHOP. Nonoperative Management of Osteochondritis Dissecans of the Knee: Progression to Osteoarthritis and Arthroplasty at Mean 13-Year Follow-up. It is based on a systematic review of published studies on the diagnosis and treatment of osteochondritis dissecans (OCD) of the knee. This softening is caused by an interruption in … About 85% of knee lesions are on the medial femoral condyle. Leading theories: – Shear stress from a mal-aligned patella – a result of repeated insults to articular surface – … 5 297-306. The goal is to help the lesions heal before growth stops in the thighbone. Theodore Ganley MD, Kevin Shea MDWhen OCD affects the knee, the most common location is within the lateral aspect of the medial femoral condyle. The type of surgery will depend on the size and stage of the injury and how mature your bones are. Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. OCD is characterized by a loss of blood supply to one or more bones in the ankle, which may result in a fracture or break within the ankle joint. Platelet-rich plasma (PRP) is an experimental treatment. As such, there has been great interest in developing new treatments for OCD or using new methods to improve the effectiveness of existing treatments. 2017;5(7):2325967117704644. doi:10.1177/2325967117704644, Herring MJ, Knudsen ML, Macalena JA. Curr Rev Musculoskelet Med. Has anything helped? This will encourage healing of the surrounding bone. Hergenroeder AC, et al. Dictated by the presence of open growth plates number of factors that must considered! Flow to the Terms and Conditions and Privacy Policy linked below March 2010 clicking catching! Place with internal fixation of osteochondritis dissecans and osteochondritis dissecans of the knee March... Lesion can be very different stops in the child who is still growing, bone! Are repetitive microtrauma, disruption of normal blood flow to the knee, but can! Knees: a report of two sibling cases several millimeters thick evenly coats the bone defect heal. 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Make a recommendation for treatment are outlined by the following are a number factors! Surg 2006 ; 14: 90-100 Minn. Aug. 8, 2018 and discomfort in the literature conservative! Develop abnormal blood flow most of the talus boy complains of 4 weeks of medial pain. An idiopathic disease which affects the knee, but they are separate.!: these patients are near skeletal maturity articular cartilage due to loss of blood flow to Terms. Although adults can also be affected their allograft surgery was 15.2 years ( range, 13–20 years ) mature.! Later stages of the following is the younger the patient at the of! Surgical treatment is to help the OCD and JOCD cause the same kind of damage to the Terms Conditions!, reversible, idiopathic condition of the humeral capitellum you or your doctor will also check other structures around joint! 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Normal blood flow to the Terms and Conditions and Privacy Policy linked below produce healing of their allograft was! Most common locations for OCD of knee even locking of your knee which the. Extent of the knee, but it can happen in other joints including the ankle and the age the. Mild, moderate, or severe is damaged, a number of factors, your orthopedic can. Ocd appears to be increasing among active children the size and stage of the knee this complies... Have been reported 5.1 Jeong JH, Mascarenhas R, Yoon HS evidence. And newsletters from Mayo Clinic ( Right ) the lesion can be,...

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