Maruyama M, et al. 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. Among different non-surgical treatment options, strenuous activity restriction seems a favorable approach, whereas there is no evidence that physical instrumental therapy, immobilization, or weightbearing limitation could be beneficia … Sign up and learn how to better take care of your body. Osteochondritis dissecans of the knee is often the result of sports that involve high-impact landings, such as football, soccer, and gymnastics. As the blood flow to the bone is diminished, the attached cartilage can separate away from the bone. Patella OCD • Rare, est. We retrospectively reviewed 11 children with OCD of the knee treated with a fresh stored osteochondral allograft between 2004 and 2009 (six males and five females). The first line of treatment, particularly for children, is to manage OCD without surgical operations. 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Osteochronditis dissecans (aka “OCD”) is a condition in which the bone that supports the cartilage inside a joint undergoes softening. https://www.uptodate.com/contents/search. treatment.5 AOCD lesions have a greater propensity for instabil-ity, and they typically follow a clinical course that is progressive and unremitting.30 The highest rates of OCD appear among patients between 10 and 15 years old, ranking among the most common causes of knee pain and dysfunction in teenagers.5,30,35 The prevalence of Even with surgery, OCD usually leads to future joint problems, … 5 297-306. 2010 Feb;18(2):238-46. doi: 10.1007/s00167-009-0942-6. Nonoperative Management of Osteochondritis Dissecans of the Knee: Progression to Osteoarthritis and Arthroplasty at Mean 13-Year Follow-up. 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. OCD most often occurs in the knee joint, although it can also occur in other joints including the ankle and the elbow.. In the adult, the bones are not growing. Indications for surgical treatment are based on … Surgery is usually the only effective treatment for OCD. https://orthoinfo.aaos.org/en/diseases--conditions/osteochondritis-dissecans. Radiographs of the right knee demonstrate open growth plates and a well circumscribed 1x1cm area of sclerotic subchondral bone with a radiolucent halo separating this area from his femoral epiphysis. No single treatment works for everybody. 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. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. Due to a lack of evidence on its early diagnosis, optimal treatment, and long-term course of healing, JOCD presents a unique challenge for the health care team. Laskowski ER (expert opinion). We also have provided a list of resources to find more information. Drilling, open or arthroscopic fixation, fragment excision, microfractures, osteochondral grafting (with autograft or allograft) and autologous chondrocyte implantation (ACI) have … This content does not have an English version. Treatment of OCD lesions is dictated by the extent of the lesion and the age of the patient at the time of diagnosis. Signs and symptoms. Methods of Stimulating New Cartilage Growth. However, as females and younger children participate in sports there has been an increased prevalence among girls and a younger mean age of OCD onset. If the articular surface is intact, protected activities and possible crutch use for 2-3 months may produce healing. The cause of OCD is not well understood. What's the most likely cause of my joint pain? The condition occurs most commonly in the knee, but also occurs in elbows, ankles and other joints. p.82-87. Osteochondritis dissecans is often caused by sports that put repeated stress on the joint. J Am Acad Orthop Surg. (Right) The lesion has detached from the femur and is floating within the knee joint. 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. Management of osteochondritis dissecans (OCD). Treatment of OCD lesions is dictated by the extent of the lesion and the age of the patient at the time of diagnosis. Chambers HG, et al. If so, when? All rights reserved. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. In summary, OCD is an abnormality of subchondral bone that most commonly affect the medial femoral condyle of the knee. Hergenroeder AC, et al. The authors’ preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. Advertising revenue supports our not-for-profit mission. Are your joints swollen? OCD of the knee has a non-specific presentation with vague pain and swelling. A joint surface damaged by OCD doesn’t heal naturally. Leading theories: – Shear stress from a mal-aligned patella – a result of repeated insults to articular surface – … Patella OCD • Rare, est. 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. JBJS Essent Surg Tech. The goal is to help the lesions heal before growth stops in the thighbone. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. Category 2 (girls aged 11-15 y, boys aged 13-17 y): These patients are near skeletal maturity. American Academy of Orthopaedic Surgeons. This will encourage healing of the surrounding bone. The lack of normal blood flow damages the bone that supports the layer of cartilage. Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. Theodore Ganley MD, Kevin Shea MDWhen OCD affects the knee, the most common location is within the lateral aspect of the medial femoral condyle. In children with open growth plates, there is a higher chance for spontaneous healing with activity modification or immobilization than in adults. Milewski M, Shea K, Nepple J. For this reason, the treatment and prognosis of OCD and JOCD can be very different. If you're recommending medications, what are the possible side effects? We have many case loads that reflect common scenarios patients face. The OCD lesion ('lesion' is the cartilage and any bone attached to the cartilage fragment) can loosen and break off from the joint surface. Nonsurgical treatments help in about half the cases of JOCD. OCD is a type of osteochondrosis in which a lesion has formed within the cartilage layer itself, giving rise to secondary inflammation. MRI is shown in Image A. Orthop J Sports Med. Guidelines for treatment are outlined by the following categories: 1. Your doctor might order one or more of these tests: Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and relieve pain, as well as reduce the risk of osteoarthritis. Modern screws and pins are made of bioabsorbable material (rather than metal) so that they will not cause future problems to the joint cartilage.. 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. 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. It is treated by orthopaedic physicians at CHOP. Diagnosis can be made with plain radiography, and the lesion can be further characterized by MRI. Genetic and Rare Diseases Information Center. or MRI will be used follow the OCD and see if your OCD is healing. 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. 2018;23:213. The American Academy of Orthopaedic Surgeons (AAOS) approved this clinical practice guideline on December 4, 2010. The goal of treatment is to ease pain and get your child back to using their joint normally. Have you injured that joint? Does Joint Cracking and Snapping Cause Arthritis? The normal cartilage is smooth and slippery and firmly attached to the underlying bone.. The condition can be mild, moderate, or severe. 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. Osteochondritis dissecans. This piece of bone and cartilage can become loose and even break off into the joint. Anatomic locations of juvenile osteochondritis dissecans and osteochondritis dissecans in the knee. You could have knee swelling without much pain at all. This site complies with the HONcode standard for trustworthy health information: verify here. Houten: Bohn Stafleu Van Loghum. His exam is completely normal and symmetric to his left knee. Do they lock or give out on you? We continue to monitor COVID-19 in our area. Generally, OCD seems to affect males more commonly than females (between 2:1 and 3:1). Category 1 (ie, girls younger than 11 y, boys younger than 13 y): These patients usually do well with nonoperative treatment. 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. It is based on a systematic review of published studies on the diagnosis and treatment of osteochondritis dissecans (OCD) of the knee. Leading theories: – Shear stress from a mal-aligned patella – a result of repeated insults to articular surface – … Click below and just hit send! Treatment depends on th… Theodore Ganley MD, Kevin Shea MD. Abbreviation: OCD, osteochondritis dissecans. Your doctor will also check other structures around the joint, such as the ligaments. What treatments or self-care measures have you tried? The type of surgery will depend on the size and stage of the injury and how mature your bones are. Osteochondritis dissecans (OCD): Clinical manifestations and diagnosis. Osteochondritis Dissecans (OCD) is a disease in which localized osteocartilaginous separation at the level of the subchondral bone causes damage to the protective articular cartilage cover, subsequently producing pain and swelling. (OBQ07.91) An 11-year-old boy complains of 4 weeks of medial knee pain that began while playing tennis. This guide will help you understand 1. where in the knee the condition develops 2. how doctors diagnose the problem 3. what treatment options are available Epub 2009 Oct 27. Accessed Aug. 7, 2018. The goal of surgical treatment is to end up with a stable cartilage surface of the joint. If left untreated, OCD can cause severe arthritis as well as a host of other physical problems. It is an important diagnosis to consider in an active pediatric/adolescent patient presenting with knee pain with or without mechanical symptoms. What are the principles of surgical treatment of OCD of knee? 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. Thank you, {{form.email}}, for signing up. 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. By Dr. Eric W. Edmonds . Skip Navigation. Research in Osteochondritis Dissecans of the Knee: 2016 Update. More severe symptoms can occur when there is a fragment of cartilage floating around the joint. What happens in patients with OCD is the blood flow to the bone around a joint surface becomes abnormal. In the world of childhood knee injuries and complaints, there are few mysteries that still persist. Osteochondritis dissecans (OCD) is a bone and cartilage injury that affects the knee, ankle and elbow. OCD typically occurs in patients between the ages of 10 and 20 years although adults can also be affected . One randomized clinical trial was identified. A radiograph and MRI is shown in Figures A and B. 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. The following are a few examples of the many surgeries that are currently available to treat OCD. This means limiting activity and may mean using crutches to limit weight on the joint. Early in the disease process, you might experience dull pain or soreness and swelling. Osteochondritis dissecans. OCD usually causes pain during and after sports. Younger patients with minimal discomfort can be treated with rest and a period of non-weight bearing to allow the bony fragment to heal into its anatomic location. Successful results have been reported in … OCD of the knee. The review was conducted between May 2009 and March 2010. Curr Rev Musculoskelet Med. 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. Open Reduction, Bone Grafting, and Internal Fixation of Osteochondritis Dissecans Lesion of the Knee. As such, there has been great interest in developing new treatments for OCD or using new methods to improve the effectiveness of existing treatments. If the OCD does not heal, if you are finished growing or if the lesion is unstable, surgery will most likely be Figure 1 Radiographic (x-ray) view of an OCD lesion of the knee Figure 2 MRI view of an OCD lesion of the knee. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. OCD occurs most often in children and adolescents. The optimal treatment is controversial. Even if imaging tests show that growth has already stopped, it is usually worth trying nonsurgical treatments. A single copy of these materials may be reprinted for noncommercial personal use only. He denies fevers or mechanical knee symptoms. Long term complication includes osteoarthritis. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. 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 Dissecans (OCD) Non-operative Care- Knee Osteochondritis is a condition in which the blood supply to an area of bone is disrupted. Knee / OCD Fixation Share; Contact; Feedback; Quote or Evaluation; The bioabsorbable PLLA Chondral Dart has a unique, double reversed barbed design to facilitate superior fixation and compression of osteochondral flap tears up to 2 cm in diameter. Which of the following is the most appropriate initial treatment? The elbow and ankle are the next most common joints affected. OCD is more common in males. 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. Mayo Clinic is a not-for-profit organization. Both male and female athletes can develop OCD, most commonly between the … The general rule is the younger the patient, the better the prognosis. Accessed Aug. 2, 2018. If the likelihood of healing is low, the loose cartilage will be removed from the knee, and treatment will be focused on stimulating new cartilage growth in the void on the joint surface. Both male and female athletes can develop OCD, most commonly between the ages of 10 and 20 years old. American Academy of Orthopaedic Surgeons. of the knee are the most common locations for OCD, and the incidence of OCD appears to be increasing among active children. The condition can be mild, moderate, or severe. As chronic knee pain is extremely common, OCD is not the first diagnosis to be considered, which can delay the diagnosis. doi:10.2106/JBJS.ST.18.00035, Winthrop Z, Pinkowsky G, Hennrikus W. Surgical treatment for osteochondritis dessicans of the knee. https://orthoinfo.aaos.org/en/staying-healthy/a-guide-to-safety-for-young-athletes. If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. During the physical exam, your doctor will press on the affected joint, checking for areas of swelling or tenderness. May 2011 vol. 19 no. Share on Pinterest OCD can cause pain and discomfort in the knee and other joints. There are a number of factors that must be considered when determining the best treatment for OCD. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Treatment of Osteochondritis Dissecans Knee Dr. LaPrade offers specialized treatment for osteochondritis dissecans of the knee. Does anything make your symptoms better or worse? Distribution . If there are changes in surgeries or other scheduled appointments, your provider will notify you. The exact prevalence of OCD is unknown but prevalence figures of between 15 and 29 per 100,000 have been reported. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 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. Knee Surg Sports Traumatol Arthrosc. 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. The cause is currently unknown but it may lead to damage to overlying cartilage, loose bodies, and joint damage. Epidemiology: Incidence reported around 9/100,000 in children under 11 years old and 22/100,000 in adolescents 12-19 years old. This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space.That process can lead to pain, loose body formation and joint effusion. The average age of the children at the time of their allograft surgery was 15.2 years (range, 13–20 years). Many researchers have speculated as to the reason for this disruption of blood flow, and it is thought to be related to repetitive stress or even traumatic injury to the bone. (Left) An OCD lesion at the end of the femur. to be 2-5% of all knee OCD – < 100 reported in the literature – most articles small series with dated techniques and imaging • Etiology unknown. The literature on conservative treatments for knee OCD is scarce. 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