Osteochondritis dissent is a circumstance of focal, idiopathic, and subchondral bone lesions with possible participation of the overlying cartilage. Osteochondritis disseminates affects the joints of kids and Young adults and is a common reason for loose bodies in the synovial joints, most often the knees. Let’s read more deeply about it.
What is Osteochondritis Dissecans (OCD)?
Osteochondritis Dissecans or more commonly known as OCD is an acquired and idiopathic lesion. Disorder of subchondral bone leading to cartilage lesions of the body. Osteochondritis Dissecans of the knee is an obtained, reversible, idiopathic condition of the subchondral bone of our body and the leg.
The cause of Osteochondritis Dissecans is currently not known to the medical world but if not cured in time OCD can cause damage to the overlying cartilage of the knees. It can also damage the joints and loose bodies of the knees.
Epidemiology of Osteochondritis Dissecans
9 incidents are reported in every 1 lakh children that age under 11 years old and there are 22 patients in every 1 lakh people who age between 12- 19. Boys are much more common as patients compared to girls. Reported Incidences are always at a higher rate than before. 1/4th of the time lesions are bilateral. In the medical profession, Adult OCD lesions are thought to occur over a long period.
What are the symptoms of Osteochondritis Dissecans?
Symptoms can vary from person to person in some patients it can start from vague knee pain and in some patients it can start with mechanical symptoms due to the non-balanced fragment of the body. While doing movements and recovery exercise pain in the knee is very common and it happens to 9 patients out of every 10 patients.
Etiology of Osteochondritis Dissecans
In 1870, Paget speculated that it had been a decrease in bone blood supply leading to necrobiosis and separation of bone and cartilage that caused these lesions. In 1887, Konig coined the term osteochondritis dissecans. It is suspected that repetitive micro-trauma is involved within the development of OCD lesions, though it’s not a tested theory.
Other causes that were shown are including impingement of the medial tibial part of the spine or inferior pole of the patella and lower limb mal-alignment of the knee and the body as much as the spine. There are many genetic components as well.
Imaging Studies of Osteochondritis Dissecans
AP, Lateral, Tunnel, Sunrise knee radiographs. Patients under age 7 may have anatomic variants of normal ossification centers that ought to not be confused as OCD lesions. Determining skeletal systems maturity will assist in the prognosis and treatment of the patient no matter what the age is. MRI recommended staging and treatment guidance.
A high signal line just behind the fragments seems to be the most predictive of unstable lesions and potential failure of non-operative treatment of the body and the knee. Bone scans have also been wont to assess the healing potential of OCD lesions.
Lesions descriptions include age, location of the injury, radiographic findings like the X-ray and the MRI, and also surgical appearance. The lateral aspect of the medial femoral condyle is the commonest location (approximately 60%). Lateral femoral condyle OCD lesions (30% of lesions) related to the discoid meniscus. Trochlear OCD lesions are one of the rarest
Location and commonly missed on plain radiographs of the tests that are conducted by the professional for the good fare of the body
- The Hefti Classification is employed for describing MRI findings of OCD Lesions.
- Chickenfeed of signal without clear margins of a fragment of the knee while doing the tests.
- Osteochondral fragments with clear margins but without fluid between the fragment and underlying bone can be harmful to the body.
- Fluid is visible partially between the fragment and underlying bone of the knee.
- Fluid is surrounding the fragment, but the fragment remains in the place near the bone and inside the bone marrow.
- Fragment is detached and displaced if the patient has a loose body.
Treatment of Osteochondritis Dissecans
Lesion size, location, stability, and symptomatology should be taken into consideration when determining treatment algorithms. Skeletally amateur patients for example children respond well to non-operative management including activity and weight-bearing restrictions, casting, or bracing compared to teenagers and adults.
Excessive running and jumping in sports may have to be limited. Age-appropriate participation in sports could also be possible if no effusion or signs of instability of the lesion. The extra sessions of conditioning and training of the body should be stopped until the end of the treatment or until the knee becomes normal. Some high-level competitive sports (gymnastics, year-round basketball, soccer, etc.) might not allow participation with restrictions.
Operative management is usually offered for skeletally mature patients such as the adults with unbalanced lesions, and balanced lesions not responding to non-operative management of the body. Operative interventions include trans-articular or retro-articular or notch drilling, internal fixation of the body and the bones bone grafting and fixation, osteochondral autograft, and osteochondral allograft techniques.
Postoperative healing time is approximately 3-6 months counting on the dimensions of the lesion. Radiograph and MRI follow-ups are generally recommended before returning to the sport that the patient used to play example cricket football or hockey.
Physical Therapy of Osteochondritis Dissecans:-
- Stretching to improve range of motion
- Strengthening exercises for the muscles
- First exercises: ring exercises, low impact activities like a cycle, and swim. Using exercises as straight leg raises and ankle band exercises, strength is often maintained.
- Coactivation or setting of the quadriceps and hamstring are often performed while in an immobilizer or cast.
- Using neuromuscular electrical stimulation to the quadriceps and hamstrings for the activation of the contractions can further augment the strength maintenance program of the body and the knee.
- Following immobilization, range of motion exercises, also as progressive quadriceps and hamstring strengthening should be performed.
- Weight-bearing progresses throughout rehabilitation should be tolerated since it is a long term policy and will help the patient in the future
- If the patient wants the full weight bearing to return aquatic therapy is one of the best options available.
- To address any gait deviations that developed during the immobilization and decreased weight-bearing phases of rehabilitation gait training techniques could also be used, like manual facilitation and visual feedback to the patient via a full-length mirror.
- The patient needs to do Additional exercises to revive ankle and normal knee movements the exercises can be -biomechanical ankle platform systems (BAPS board) exercises or unilateral stances are better for an athlete who is planning to make a return in the sports field
- After this era, the game activities are often partly restarted
- Next criteria could be managed if the patient is pain-free, features full joint mobility with no difficulties there should be no swelling, no pressure sensitivity and there’s radiological prove of recovery of the knee
Physical Therapy Management
In stages one and two the condition is localized within the subchondral bone, the cartilage remains intact and gets its nourishment from synovia. In these two stages, conservative therapy is often applied.
The goals of conservative therapy are to reduce the pain of the patient’s body and knee Increase the speed of the repair of the cartilage and stop degeneration on the surface of the knee. There is no standard treatment for OCD.
Adaption of the strain is required so that the bone can heal. 2 weeks of immobilization and partial support is suggested when having an acute injury. With children whose bones will still grow, the bone defect may heal by resting the joint since the children are cured much faster than grown adults.
Long-term immobilization has got to be prevented because joint motion is important for the nutrition and strengthening of the cartilage. Sports activities should be stopped temporally
The Short term difficulties include nonunited and nonhealing of the OCD lesion, hardware removal if the pin fixation is used, standard postoperative difficulties, and loose body damage throughout the knee. Future complication includes osteoarthritis which is common among the elderly
Frequently Asked Question
Can osteochondritis dissecans be cured?
There is no cure, yet the condition can be treated by the patient’s age and the area of the injury.
What are the Physical Therapy of osteochondritis dissecans?
Stretching to improve range of motion
Strengthening exercises for the muscles
First exercises: ring exercises, low impact activities like a cycle, and swim. Using exercises as straight leg raises and ankle band exercises, strength is often maintained.
Coactivation or setting of the quadriceps and hamstring are often performed while in an immobilizer or cast.
Using neuromuscular electrical stimulation to the quadriceps and hamstrings for the activation of the contractions can further augment the strength maintenance program of the body and the knee.
Can osteochondritis dissecans be cured permanently?
Similarly, as with all types of mental illness, there is no cure for OCD permanently. While medicine can eliminate the symptoms of Osteochondritis dissecans.
B. Linden et al,. Osteochondritis dissecans of the femoral condyles: a long-term follow-up study. J Bone Joint Surg Am. 1977;59:769-776.