What is Osteochondritis Dissecans?
Osteochondritis dissecans is caused at the end of the big bone of the thigh (femur), when a fragment of bone detaches from the rest of the bone due to poor blood supply. The bone required sufficient amount of blood supply to be alive and if the blood flow is decreased or reduced, then the bone will dried up and falls. If the detached bone falls in the joint, then massive pain will be experienced because the knee joint will not work as usual and it will become swollen .
Children involving in only one type of sports are often diagnosed with the case of OCD. It generally affects articular cartilage and subchondral bone, wherein the former is soft covering at the end of the bones while the latter is located under the cartilage. There are three OCD conditions;
Mild OCD: If the fragments are safely sitting in their normal position because of safe cartilage, then this condition is called stable lesion or mild OCD.
Moderate OCD: When the bone separate and cartilage gets torn, then this condition is called as moderate OCD.
Severe OCD: The fragments of bone and cartilage becomes loose or detached from the base and float in the knee joint, then this condition is called unstable lesion or severe OCD.
Osteochondritis dissecans is split into two types:
- Juvenile Osteochondritis Dissecans – JOCD
- Osteochondritis Dissecans – OCD
Knee is a synovial joint, where femur, tibia & patella articulate with each other. There are two articulation i.e. femur – tibia and femur – patella. The bones are covered with smooth and slippery cartilage, which helps the joint to move freely and even protects ends of the bones in the knee joint. Synovial fluid lubricates the cartilage and helps in smooth movement of joint. However, when there is no blood supply, subchondral bone and its overlying articular cartilage dries up and detaches from the bone.
OCD generally occurs in knee joint i.e. 75% of cases when compared to elbow, ankle, shoulder, hand, wrist and hip. Kids who specializes in one type of sports are often diagnosed with OCD. It can affect both girls and boys.
What are the Symptoms of Osteochondritis Dissecans?
One of the most common symptoms of osteochondritis dissecans is general achy pain, when moving the leg of putting weight on the knee. It will become acute when climbing stairs or playing any sports. When bending the knee, clunking sound can be experienced. The sensation of knee catching, knee locking and knee giving away is also felt.
The knee joint will become weak, inflamed and tender resulting in inability to extend or straighten the knee i.e. decrease in range of motion. The knee will become stiff due to prolonged period of inactivity. Due to the pain and uneasiness, you will end up limping.
What are the Causes of Osteochondritis Dissecans?
The exact cause of Osteochondritis Dissecans is still unknown but there e several possibilities, which will result in this rare condition.
- Ischemia – Restriction of blood supply to end of the bone
- Repetitive trauma – leads to interruption of blood
- Genetics – Hereditary also leads to OCD
- Joint overuse – repetitive injury
- Endocrine factors -Avascular necrosis
- Rapid growth in adolescence and malnourishment
- Deficiencies & disparity in the ratio of calcium to phosphorus
- Abnormal ossification – Irregularities in the formation of bones during adolescence
- Ligamentous laxity or loose ligaments
- Biomechanical factors
Diagnosis of Osteochondritis Dissecans:
Doctors will conduct detailed physical examinations after analyzing the symptoms and discussing the medical history of the patient. X-ray and MRI are also conducted for acquiring the detailed images of bone and cartilage for proper diagnosing. CT scan is useful in monitoring the progress of OCD’s treatment.
Treatment of Osteochondritis Dissecans :
OCD can be completely healed with careful and effective treatments. However, surgery is the best possible option for successfully healing the case of OCD. If OCD is not treated on time it will potentially leads to the condition of osteoarthritis. However, some of the possible effective treatment for reducing the pain, swelling and minimizing the possibilities of future complications are:
- Immobilization or Rest: Resting will allow the pain to settle down and avoiding the aggravating activities will provide much needed comfort in the knee joint. Doctors usually advice to rest the joint for 2-3 months. Completely avoid running, jumping, hopping, climbing stairs, etc.
- Ice: Applying ice to the affected part will provide relief to the patient. Apply icepack or ice covered with towel on the affected area for no more than 15 minutes. It can be applied several times a day but ensure you do not apply the ice directly because it will trigger the issue furthermore.
- Activity Modification: Modifying your activities will help the bone to heal and prevent future fracture. Avoid high intensity sports to provide maximum rest to the joint.
- Knee brace: Knee braces are extremely effective in the case of OCD because it will protect the knee for any sudden injury or harm and keeps the joint in still motion that helps in quick healing. They also provide proper support to the knee joint and reduce the pressure on the knee joint.
- Clutches: Use crutches upon the advice of the doctor. Usually crutches decrease the stress on the knee joint and helps you in movement.
- Physical Therapy: The knee exercises will strengthen the muscles around the knee joint and helps in treating the OCD. Some of the effective exercises are straight leg raises and ankle band exercises. Cycling and swimming are also effective and beneficial activities.
- Surgery: If the nonsurgical or conservative treatments fails to provide the relief, then doctors may suggest surgery to separate or detach the lesion from the joint. Some of the possible surgeries for Osteochondritis Dissecans are:
- Arthroscopic Surgery: Small incisions are made to fill the defected part with fibrocartilage. Fiber-optic camera and thin surgical tools for optimum accuracy.
- Osteochondral Autograft Transfer: Healthy cartilage from the same person is transferred to the defected part.
Recovery Period for Osteochondritis Dissecans :
Crutches and knee brace are required for the initial two months. Then, physical therapy and low impact activities can be followed for regaining the strength in the joint. You can return gradually to sports after a period of 5-6 months. However, consult your doctor and physical therapist for best possible results.
Conclusion – Osteochondritis Dissecans:
The outlook is good. Children should learn the proper techniques under the guidance of expert sportsmen’s to reduce the chances of any further injury. Your physical therapist is useful resource in the case of Osteochondritis Dissecans. Whatever your problem is, always consult him or her for best guidance and advice.