Osteochondritis dissecans

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For other uses of "OCD", see OCD (disambiguation). Osteochondritis dissecans_sentence_0

Osteochondritis dissecans_table_infobox_0

Osteochondritis dissecansOsteochondritis dissecans_header_cell_0_0_0
PronunciationOsteochondritis dissecans_header_cell_0_1_0 Osteochondritis dissecans_cell_0_1_1
SpecialtyOsteochondritis dissecans_header_cell_0_2_0 Orthopedic surgery Q127556?uselang=en#P1995Osteochondritis dissecans_cell_0_2_1

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. Osteochondritis dissecans_sentence_1

OCD usually causes pain during and after sports. Osteochondritis dissecans_sentence_2

In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Osteochondritis dissecans_sentence_3

Physical examination in the early stages does only show pain as symptom, in later stages there could be an effusion, tenderness, and a crackling sound with joint movement. Osteochondritis dissecans_sentence_4

OCD is caused by blood deprivation of the secondary physes around the bone core of the femoral condyle. Osteochondritis dissecans_sentence_5

This happens to the epiphyseal vessels under the influence of repetitive overloading of the joint during running and jumping sports. Osteochondritis dissecans_sentence_6

During growth such chondronecrotic areas grow into the subchondral bone. Osteochondritis dissecans_sentence_7

There it will show as bone defect area under articular cartilage. Osteochondritis dissecans_sentence_8

The bone will then possibly heal to the surrounding condylar bone in 50% of the cases. Osteochondritis dissecans_sentence_9

Or it will develop into a pseudarthrosis between condylar bone core and osteochondritis flake leaving the articular cartilage it supports prone to damage. Osteochondritis dissecans_sentence_10

The damage is executed by ongoing sport overload. Osteochondritis dissecans_sentence_11

The result is fragmentation (dissection) of both cartilage and bone, and the free movement of these bone and cartilage fragments within the joint space, causing pain, blockage and further damage. Osteochondritis dissecans_sentence_12

OCD has a typical anamnesis with pain during and after sports without any history of trauma. Osteochondritis dissecans_sentence_13

Some symptoms of late stages of osteochondritis dissecans are found with other diseases like rheumatoid disease of children and meniscal ruptures. Osteochondritis dissecans_sentence_14

However, the disease can be confirmed by X-rays, computed tomography (CT) or magnetic resonance imaging (MRI) scans. Osteochondritis dissecans_sentence_15

Non-surgical treatment is successful in 50% of the cases. Osteochondritis dissecans_sentence_16

If in late stages the lesion is unstable and the cartilage is damaged, surgical intervention is an option as the ability for articular cartilage to heal is limited. Osteochondritis dissecans_sentence_17

When possible, non-operative forms of management such as protected reduced or non-weight bearing and immobilization are used. Osteochondritis dissecans_sentence_18

Surgical treatment includes arthroscopic drilling of intact lesions, securing of cartilage flap lesions with pins or screws, drilling and replacement of cartilage plugs, stem cell transplantation, and in very difficult situation in adults joint replacement. Osteochondritis dissecans_sentence_19

After surgery rehabilitation is usually a two-stage process of unloading and physical therapy. Osteochondritis dissecans_sentence_20

Most rehabilitation programs combine efforts to protect the joint with muscle strengthening and range of motion. Osteochondritis dissecans_sentence_21

During an immobilization period, isometric exercises, such as straight leg raises, are commonly used to restore muscle loss without disturbing the cartilage of the affected joint. Osteochondritis dissecans_sentence_22

Once the immobilization period has ended, physical therapy involves continuous passive motion (CPM) and/or low impact activities, such as walking or swimming. Osteochondritis dissecans_sentence_23

OCD occurs in 15 to 30 people per 100,000 in the general population each year. Osteochondritis dissecans_sentence_24

Although rare, it is an important cause of joint pain in physically active children and adolescents. Osteochondritis dissecans_sentence_25

Because their bones are still growing, adolescents are more likely than adults to recover from OCD; recovery in adolescents can be attributed to the bone's ability to repair damaged or dead bone tissue and cartilage in a process called bone remodeling. Osteochondritis dissecans_sentence_26

While OCD may affect any joint, the knee tends to be the most commonly affected, and constitutes 75% of all cases. Osteochondritis dissecans_sentence_27

Franz König coined the term osteochondritis dissecans in 1887, describing it as an inflammation of the bone–cartilage interface. Osteochondritis dissecans_sentence_28

Many other conditions were once confused with OCD when attempting to describe how the disease affected the joint, including osteochondral fracture, osteonecrosis, accessory ossification center, osteochondrosis, and hereditary epiphyseal dysplasia. Osteochondritis dissecans_sentence_29

Some authors have used the terms osteochondrosis dissecans and osteochondral fragments as synonyms for OCD. Osteochondritis dissecans_sentence_30

Signs and symptoms Osteochondritis dissecans_section_0

In osteochondritis dissecans, fragments of cartilage or bone become loose within a joint, leading to pain and inflammation. Osteochondritis dissecans_sentence_31

These fragments are sometimes referred to as joint mice. Osteochondritis dissecans_sentence_32

OCD is a type of osteochondrosis in which a lesion has formed within the cartilage layer itself, giving rise to secondary inflammation. Osteochondritis dissecans_sentence_33

OCD most commonly affects the knee, although it can affect other joints such as the ankle or the elbow. Osteochondritis dissecans_sentence_34

People with OCD report activity-related pain that develops gradually. Osteochondritis dissecans_sentence_35

Individual complaints usually consist of mechanical symptoms including pain, swelling, catching, locking, popping noises, and buckling / giving way; the primary presenting symptom may be a restriction in the range of movement. Osteochondritis dissecans_sentence_36

Symptoms typically present within the initial weeks of stage I; however, the onset of stage II occurs within months and offers little time for diagnosis. Osteochondritis dissecans_sentence_37

The disease progresses rapidly beyond stage II, as OCD lesions quickly move from stable cysts or fissures to unstable fragments. Osteochondritis dissecans_sentence_38

Non-specific symptoms, caused by similar injuries such as sprains and strains, can delay a definitive diagnosis. Osteochondritis dissecans_sentence_39

Physical examination typically reveals fluid in the joint, tenderness, and crepitus. Osteochondritis dissecans_sentence_40

The tenderness may initially spread, but often reverts to a well-defined focal point as the lesion progresses. Osteochondritis dissecans_sentence_41

Just as OCD shares symptoms with common maladies, acute osteochondral fracture has a similar presentation with tenderness in the affected joint, but is usually associated with a fatty hemarthrosis. Osteochondritis dissecans_sentence_42

Although there is no significant pathologic gait or characteristic alignment abnormality associated with OCD, the patient may walk with the involved leg externally rotated in an attempt to avoid tibial spine impingement on the lateral aspect of the medial condyle of the femur. Osteochondritis dissecans_sentence_43

Causes Osteochondritis dissecans_section_1

See also: Osteochondrosis Osteochondritis dissecans_sentence_44

Despite much research, the causes remain unclear but include repetitive physical trauma, ischemia (restriction of blood flow), hereditary and endocrine factors, avascular necrosis (loss of blood flow), rapid growth, deficiencies and imbalances in the ratio of calcium to phosphorus, and problems of bone formation. Osteochondritis dissecans_sentence_45

Although the name "osteochondritis" implies inflammation, the lack of inflammatory cells in histological examination suggests a non-inflammatory cause. Osteochondritis dissecans_sentence_46

It is thought that repetitive microtrauma, which leads to microfractures and sometimes an interruption of blood supply to the subchondral bone, may cause subsequent localized loss of blood supply or alteration of growth. Osteochondritis dissecans_sentence_47

Trauma, rather than avascular necrosis, is thought to cause osteochondritis dissecans in juveniles. Osteochondritis dissecans_sentence_48

In adults, trauma is thought to be the main or perhaps the sole cause, and may be endogenous, exogenous or both. Osteochondritis dissecans_sentence_49

The incidence of repetitive strain injury in young athletes is on the rise and accounts for a significant number of visits to primary care; this reinforces the theory that OCD may be associated with increased participation in sports and subsequent trauma. Osteochondritis dissecans_sentence_50

High-impact sports such as gymnastics, soccer, basketball, lacrosse, football, tennis, squash, baseball and weight lifting may put participants at a higher risk of OCD in stressed joints (knees, ankles and elbows). Osteochondritis dissecans_sentence_51

Recent case reports suggest that some people may be genetically predisposed to OCD. Osteochondritis dissecans_sentence_52

Families with OCD may have mutations in the aggrecan gene. Osteochondritis dissecans_sentence_53

Studies in horses have implicated specific genetic defects. Osteochondritis dissecans_sentence_54

Pathophysiology Osteochondritis dissecans_section_2

Osteochondritis dissecans differs from "wear and tear" degenerative arthritis, which is primarily an articular surface problem. Osteochondritis dissecans_sentence_55

Instead, OCD is a problem of the bone underlying the cartilage, which may secondarily affect the articular cartilage. Osteochondritis dissecans_sentence_56

Left untreated, OCD can lead to the development of degenerative arthritis secondary to joint incongruity and abnormal wear patterns. Osteochondritis dissecans_sentence_57

OCD occurs when a loose piece of bone or cartilage partially (or fully) separates from the end of the bone, often because of a loss of blood supply (osteonecrosis) and decalcification of the trabecular bone matrix. Osteochondritis dissecans_sentence_58

The loose piece may stay in place or slide around, making the joint stiff and unstable. Osteochondritis dissecans_sentence_59

OCD in humans most commonly affects the knees, ankles, and elbow but can affect any joint. Osteochondritis dissecans_sentence_60

In skeletally immature individuals, the blood supply to the epiphyseal bone is good, supporting both osteogenesis and chondrogenesis. Osteochondritis dissecans_sentence_61

With disruption of the epiphyseal plate vessels, varying degrees and depth of necrosis occur, resulting in a cessation of growth to both osteocytes and chondrocytes. Osteochondritis dissecans_sentence_62

In turn, this pattern leads to disordered ossification of cartilage, resulting in subchondral avascular necrosis and consequently OCD. Osteochondritis dissecans_sentence_63

Four minor stages of OCD have been identified after trauma. Osteochondritis dissecans_sentence_64

These include revascularization and formation of granulation (scar) tissue, absorption of necrotic fragments, intertrabecular osteoid deposition, and remodeling of new bone. Osteochondritis dissecans_sentence_65

With delay in the revascularization stage, an OCD lesion develops. Osteochondritis dissecans_sentence_66

A lesion can lead to articular-surface irregularities, which in turn may cause progressive arthritic deterioration. Osteochondritis dissecans_sentence_67

Diagnosis Osteochondritis dissecans_section_3

To diagnose osteochondritis dissecans, an X-ray, CT scan or MRI scan can be performed to show necrosis of subchondral bone, formation of loose fragments, or both. Osteochondritis dissecans_sentence_68

Occasionally a nuclear medicine bone scan is used to assess the degree of loosening within the joint. Osteochondritis dissecans_sentence_69

Physical examination Osteochondritis dissecans_section_4

Physical examination often begins with examination of the patient's gait. Osteochondritis dissecans_sentence_70

In OCD of the knee, people may walk with the involved leg externally rotated in an attempt to avoid tibial spine impingement on the lateral aspect of the medial condyle of the femur. Osteochondritis dissecans_sentence_71

Next, the examining physician may check for weakness of the quadriceps. Osteochondritis dissecans_sentence_72

This examination may reveal fluid in the joint, tenderness, and crepitus. Osteochondritis dissecans_sentence_73

The Wilson test is also useful in locating OCD lesions of the femoral condyle. Osteochondritis dissecans_sentence_74

The test is performed by slowly extending the knee from 90 degrees, maintaining internal rotation. Osteochondritis dissecans_sentence_75

Pain at 30 degrees of flexion and relief with tibial external rotation is indicative of OCD. Osteochondritis dissecans_sentence_76

Physical examination of a patient with ankle OCD often returns symptoms of joint effusion, crepitus, and diffuse or localized tenderness. Osteochondritis dissecans_sentence_77

Examination often reveals symptoms of generalized joint pain, swelling, and times with limited range of motion. Osteochondritis dissecans_sentence_78

Some with loose body lesions may report catching, locking, or both. Osteochondritis dissecans_sentence_79

The possibility of microtrauma emphasizes a need for evaluation of biomechanical forces at the knee in a physical examination. Osteochondritis dissecans_sentence_80

As a result, the alignment and rotation of all major joints in the affected extremity is common, as are extrinsic and intrinsic abnormalities concerning the affected joint, including laxity. Osteochondritis dissecans_sentence_81

Diagnostic imaging Osteochondritis dissecans_section_5

X-rays show lucency of the ossification front in juveniles. Osteochondritis dissecans_sentence_82

In older people, the lesion typically appears as an area of osteosclerotic bone with a radiolucent line between the osteochondral defect and the epiphysis. Osteochondritis dissecans_sentence_83

The visibility of the lesion depends on its location and on the amount of knee flexion used. Osteochondritis dissecans_sentence_84

Harding described the lateral X-ray as a method to identify the site of an OCD lesion. Osteochondritis dissecans_sentence_85

Magnetic resonance imaging (MRI) is useful for staging OCD lesions, evaluating the integrity of the joint surface, and distinguishing normal variants of bone formation from OCD by showing bone and cartilage edema in the area of the irregularity. Osteochondritis dissecans_sentence_86

MRI provides information regarding features of the articular cartilage and bone under the cartilage, including edema, fractures, fluid interfaces, articular surface integrity, and fragment displacement. Osteochondritis dissecans_sentence_87

A low T1 and high T2 signal at the fragment interface is seen in active lesions. Osteochondritis dissecans_sentence_88

This indicates an unstable lesion or recent microfractures. Osteochondritis dissecans_sentence_89

While MRI and arthroscopy have a close correlation, X-ray films tend to be less inductive of similar MRI results. Osteochondritis dissecans_sentence_90

Computed tomography (CT) scans and Technetium-99m bone scans are also sometimes used to monitor the progress of treatment. Osteochondritis dissecans_sentence_91

Unlike plain radiographs (X-rays), CT scans and MRI scans can show the exact location and extent of the lesion. Osteochondritis dissecans_sentence_92

Technetium bone scans can detect regional blood flow and the amount of osseous uptake. Osteochondritis dissecans_sentence_93

Both of these seem to be closely correlated to the potential for healing in the fragment. Osteochondritis dissecans_sentence_94

Osteochondritis dissecans_unordered_list_0

  • Osteochondritis dissecans_item_0_0
  • Osteochondritis dissecans_item_0_1
  • Osteochondritis dissecans_item_0_2

Classification Osteochondritis dissecans_section_6

OCD is classified by the progression of the disease in stages. Osteochondritis dissecans_sentence_95

There are two main staging classifications used; one is determined by MRI diagnostic imaging while the other is determined arthroscopically. Osteochondritis dissecans_sentence_96

However, both stagings represent the pathological conditions associated with OCD's natural progression. Osteochondritis dissecans_sentence_97

While the arthroscopic classification of bone and cartilage lesions is considered standard, the Anderson MRI staging is the main form of staging used in this article. Osteochondritis dissecans_sentence_98

Stages I and II are stable lesions. Osteochondritis dissecans_sentence_99

Stages III and IV describe unstable lesions in which a lesion of the cartilage has allowed synovial fluid between the fragment and bone. Osteochondritis dissecans_sentence_100

Osteochondritis dissecans_table_general_1

MRI staging of osteochondritis dissecansOsteochondritis dissecans_table_caption_1
StageOsteochondritis dissecans_header_cell_1_0_0 EvaluationOsteochondritis dissecans_header_cell_1_0_1 FindingsOsteochondritis dissecans_header_cell_1_0_2
IOsteochondritis dissecans_cell_1_1_0 StableOsteochondritis dissecans_cell_1_1_1 Articular cartilage thickeningOsteochondritis dissecans_cell_1_1_2
IIOsteochondritis dissecans_cell_1_2_0 StableOsteochondritis dissecans_cell_1_2_1 The articular cartilage is breached; low signal behind the fragment indicates fibrous attachmentOsteochondritis dissecans_cell_1_2_2
IIIOsteochondritis dissecans_cell_1_3_0 UnstableOsteochondritis dissecans_cell_1_3_1 The articular cartilage is breached; high signal behind the fragment indicates loss of attachmentOsteochondritis dissecans_cell_1_3_2
IVOsteochondritis dissecans_cell_1_4_0 UnstableOsteochondritis dissecans_cell_1_4_1 Formation of loose bodiesOsteochondritis dissecans_cell_1_4_2

Osteochondritis dissecans_table_general_2

Cheng arthroscopic staging of osteochondritis dissecansOsteochondritis dissecans_table_caption_2
GradeOsteochondritis dissecans_header_cell_2_0_0 FindingsOsteochondritis dissecans_header_cell_2_0_1
AOsteochondritis dissecans_cell_2_1_0 Articular cartilage is smooth and intact but may be soft or ballottableOsteochondritis dissecans_cell_2_1_1
BOsteochondritis dissecans_cell_2_2_0 Articular cartilage has a rough surfaceOsteochondritis dissecans_cell_2_2_1
COsteochondritis dissecans_cell_2_3_0 Articular cartilage has fibrillations or fissuresOsteochondritis dissecans_cell_2_3_1
DOsteochondritis dissecans_cell_2_4_0 Articular cartilage with a flap or exposed boneOsteochondritis dissecans_cell_2_4_1
EOsteochondritis dissecans_cell_2_5_0 Loose, nondisplaced osteochondral fragmentOsteochondritis dissecans_cell_2_5_1
FOsteochondritis dissecans_cell_2_6_0 Displaced osteochondral fragmentOsteochondritis dissecans_cell_2_6_1

Treatment Osteochondritis dissecans_section_7

See also: Knee cartilage replacement therapy Osteochondritis dissecans_sentence_101

Treatment options include modified activity with or without weight bearing; immobilization; cryotherapy; anti-inflammatory medication; drilling of subchondral bone; microfracture; removal or reattachment of loose bodies; mosaicplasty and osteoarticular transfer system (OATS) procedures. Osteochondritis dissecans_sentence_102

The primary goals of treatment are: Osteochondritis dissecans_sentence_103

Osteochondritis dissecans_ordered_list_1

  1. Enhance the healing potential of subchondral bone;Osteochondritis dissecans_item_1_3
  2. Fix unstable fragments while maintaining joint congruity; andOsteochondritis dissecans_item_1_4
  3. Replace damaged bone and cartilage with implanted tissues or cells that can grow cartilage.Osteochondritis dissecans_item_1_5

The articular cartilage's capacity for repair is limited: partial-thickness defects in the articular cartilage do not heal spontaneously, and injuries of the articular cartilage which fail to penetrate subchondral bone tend to lead to deterioration of the articular surface. Osteochondritis dissecans_sentence_104

As a result, surgery is often required in even moderate cases where the osteochondral fragment has not detached from the bone (Anderson Stage II, III). Osteochondritis dissecans_sentence_105

Non-surgical Osteochondritis dissecans_section_8

Candidates for non-operative treatment are limited to skeletally immature teenagers with a relatively small, intact lesion and the absence of loose bodies. Osteochondritis dissecans_sentence_106

Non-operative management may include activity modification, protected weight bearing (partial or non-weight bearing), and immobilization. Osteochondritis dissecans_sentence_107

The goal of non-operative intervention is to promote healing in the subchondral bone and prevent potential chondral collapse, subsequent fracture, and crater formation. Osteochondritis dissecans_sentence_108

Once candidates for treatment have been screened, treatment proceeds according to the lesion's location. Osteochondritis dissecans_sentence_109

For example, those with OCD of the knee are immobilized for four to six weeks or even up to six months in extension to remove shear stress from the involved area; however, they are permitted to walk with weight bearing as tolerated. Osteochondritis dissecans_sentence_110

X-rays are usually taken three months after the start of non-operative therapy; if they reveal that the lesion has healed, a gradual return to activities is instituted. Osteochondritis dissecans_sentence_111

Those demonstrating healing by increased radiodensity in the subchondral region, or those whose lesions are unchanged, are candidates to repeat the above described three-month protocol until healing is noted. Osteochondritis dissecans_sentence_112

Surgery Osteochondritis dissecans_section_9

The choice of surgical versus non-surgical treatments for osteochondritis dissecans is controversial. Osteochondritis dissecans_sentence_113

Consequently, the type and extent of surgery necessary varies based on patient age, severity of the lesion, and personal bias of the treating surgeon—entailing an exhaustive list of suggested treatments. Osteochondritis dissecans_sentence_114

A variety of surgical options exist for the treatment of persistently symptomatic, intact, partially detached, and completely detached OCD lesions. Osteochondritis dissecans_sentence_115

Post-surgery reparative cartilage is inferior to healthy hyaline cartilage in glycosaminoglycan concentration, histological, and immunohistochemical appearance. Osteochondritis dissecans_sentence_116

As a result, surgery is often avoided if non-operative treatment is viable. Osteochondritis dissecans_sentence_117

Intact lesions Osteochondritis dissecans_section_10

If non-surgical measures are unsuccessful, drilling may be considered to stimulate healing of the subchondral bone. Osteochondritis dissecans_sentence_118

Arthroscopic drilling may be performed by using an antegrade (from the front) approach from the joint space through the articular cartilage, or by using a retrograde (from behind) approach through the bone outside of the joint to avoid penetration of the articular cartilage. Osteochondritis dissecans_sentence_119

This has proven successful with positive results at one-year follow-up with antegrade drilling in nine out of eleven teenagers with the juvenile form of OCD, and in 18 of 20 skeletally immature people (follow-up of five years) who had failed prior conservative programs. Osteochondritis dissecans_sentence_120

Hinged lesions Osteochondritis dissecans_section_11

Pins and screws can be used to secure flap (sometimes referred to as hinged) lesions. Osteochondritis dissecans_sentence_121

Bone pegs, metallic pins and screws, and other bioresorbable screws may be used to secure these types of lesions. Osteochondritis dissecans_sentence_122

Full thickness lesions Osteochondritis dissecans_section_12

The three methods most commonly used in treating full thickness lesions are arthroscopic drilling, abrasion, and microfracturing. Osteochondritis dissecans_sentence_123

In 1946, Magnusson established the use of stem cells from bone marrow with the first surgical debridement of an OCD lesion. Osteochondritis dissecans_sentence_124

These cells typically differentiate into fibrocartilage and rarely form hyaline cartilage. Osteochondritis dissecans_sentence_125

While small lesions can be resurfaced using this form of surgery, the repair tissue tends to have less strength than normal hyaline cartilage and must be protected for 6 to 12 months. Osteochondritis dissecans_sentence_126

Results for large lesions tend to diminish over time; this can be attributed to the decreased resilience and poor wear characteristics of the fibrocartilage. Osteochondritis dissecans_sentence_127

In attempts to address the weaker structure of the reparative fibrocartilage, new techniques have been designed to fill the defect with tissue that more closely simulates normal hyaline articular cartilage. Osteochondritis dissecans_sentence_128

One such technique is autologous chondrocyte implantation (ACI), which is useful for large, isolated femoral defects in younger people. Osteochondritis dissecans_sentence_129

In this surgery, chondrocytes are arthroscopically extracted from the intercondylar notch of the articular surface. Osteochondritis dissecans_sentence_130

The chondrocytes are grown and injected into the defect under a periosteal patch. Osteochondritis dissecans_sentence_131

ACI surgery has reported good to excellent results for reduced swelling, pain and locking in clinical follow-up examinations. Osteochondritis dissecans_sentence_132

However, some physicians have preferred to use undifferentiated pluripotential cells, such as periosteal cells and bone marrow stem cells, as opposed to chondrocytes. Osteochondritis dissecans_sentence_133

These too have demonstrated the ability to regenerate both the cartilage and the underlying subchondral bone. Osteochondritis dissecans_sentence_134

Similar to OATS, arthroscopic articular cartilage paste grafting is a surgical procedure offering cost-effective, long-lasting results for stage IV lesions. Osteochondritis dissecans_sentence_135

A bone and cartilage paste derived from crushed plugs of the non-weight-bearing intercondylar notch can achieve pain relief, repair damaged tissue, and restore function. Osteochondritis dissecans_sentence_136

Unstable lesions Osteochondritis dissecans_section_13

Some methods of fixation for unstable lesions include countersunk compression screws and Herbert screws or pins made of stainless steel or materials that can be absorbed by the body. Osteochondritis dissecans_sentence_137

If loose bodies are found, they are removed. Osteochondritis dissecans_sentence_138

Although each case is unique and treatment is chosen on an individual basis, ACI is generally performed on large defects in skeletally mature people. Osteochondritis dissecans_sentence_139

Rehabilitation Osteochondritis dissecans_section_14

Continuous passive motion (CPM) has been used to improve healing of the articular surface during the postoperative period for people with full-thickness lesions. Osteochondritis dissecans_sentence_140

It has been shown to promote articular cartilage healing for small (< 3 mm in diameter) lesions in rabbits. Osteochondritis dissecans_sentence_141

Similarly, Rodrigo and Steadman reported that CPM for six hours per day for eight weeks produced an improved clinical outcome in humans. Osteochondritis dissecans_sentence_142

A rehabilitation program often involves protection of the compromised articular surface and underlying subchondral bone combined with maintenance of strength and range of motion. Osteochondritis dissecans_sentence_143

Post-operative analgesics, namely a mix of opioids and NSAIDs, are usually required to control pain, inflammation and swelling. Osteochondritis dissecans_sentence_144

Straight leg raising and other isometric exercises are encouraged during the post-operative or immobilization period. Osteochondritis dissecans_sentence_145

A six to eight-week home or formal physical therapy program is usually instituted once the immobilization period has ended, incorporating range of motion, stretching, progressive strengthening, and functional or sport-specific training. Osteochondritis dissecans_sentence_146

During this time, patients are advised to avoid running and jumping, but are permitted to perform low impact activities, such as walking or swimming. Osteochondritis dissecans_sentence_147

If patients return to activity before the cartilage has become firm, they will typically complain of pain during maneuvers such as squatting or jumping. Osteochondritis dissecans_sentence_148

Prognosis Osteochondritis dissecans_section_15

The prognosis after different treatments varies and is based on several factors which include the age of the patient, the affected joint, the stage of the lesion and, most importantly, the state of the growth plate. Osteochondritis dissecans_sentence_149

It follows that the two main forms of osteochondritis dissecans are defined by skeletal maturity. Osteochondritis dissecans_sentence_150

The juvenile form of the disease occurs in open growth plates, usually affecting children between the ages of 5 and 15 years. Osteochondritis dissecans_sentence_151

The adult form commonly occurs between ages 16 to 50, although it is unclear whether these adults developed the disease after skeletal maturity or were undiagnosed as children. Osteochondritis dissecans_sentence_152

The prognosis is good for stable lesions (stage I and II) in juveniles with open growth plates; treated conservatively—typically without surgery—50% of cases will heal. Osteochondritis dissecans_sentence_153

Recovery in juveniles can be attributed to the bone's ability to repair damaged or dead bone tissue and cartilage in a process called bone remodeling. Osteochondritis dissecans_sentence_154

Open growth plates are characterized by increased numbers of undifferentiated chondrocytes (stem cells) which are precursors to both bone and cartilaginous tissue. Osteochondritis dissecans_sentence_155

As a result, open growth plates allow for more of the stem cells necessary for repair in the affected joint. Osteochondritis dissecans_sentence_156

Unstable, large, full-thickness lesions (stage III and IV) or lesions of any stage found in the skeletally mature are more likely to fail non-operative treatment. Osteochondritis dissecans_sentence_157

These lesions offer a worse prognosis and surgery is required in most cases. Osteochondritis dissecans_sentence_158

Epidemiology Osteochondritis dissecans_section_16

OCD is a relatively rare disorder, with an estimated incidence of 15 to 30 cases per 100,000 persons per year. Osteochondritis dissecans_sentence_159

Widuchowski W et al. Osteochondritis dissecans_sentence_160

found OCD to be the cause of articular cartilage defects in 2% of cases in a study of 25,124 knee arthroscopies. Osteochondritis dissecans_sentence_161

Although rare, OCD is noted as an important cause of joint pain in active adolescents. Osteochondritis dissecans_sentence_162

The juvenile form of the disease occurs in children with open growth plates, usually between the ages 5 and 15 years and occurs more commonly in males than females, with a ratio between 2:1 and 3:1. Osteochondritis dissecans_sentence_163

However, OCD has become more common among adolescent females as they become more active in sports. Osteochondritis dissecans_sentence_164

The adult form, which occurs in those who have reached skeletal maturity, is most commonly found in people 16 to 50 years old. Osteochondritis dissecans_sentence_165

While OCD may affect any joint, the knee—specifically the medial femoral condyle in 75–85% of knee cases—tends to be the most commonly affected, and constitutes 75% of all cases. Osteochondritis dissecans_sentence_166

The elbow (specifically the capitulum of the humerus) is the second most affected joint with 6% of cases; the talar dome of the ankle represents 4% of cases. Osteochondritis dissecans_sentence_167

Less frequent locations include the patella, vertebrae, the femoral head, and the glenoid of the scapula. Osteochondritis dissecans_sentence_168

The oldest case of OCD was identified on the temporo-mandibular joint of the Qafzeh 9 fossil. Osteochondritis dissecans_sentence_169

History Osteochondritis dissecans_section_17

The condition was initially described by Alexander Monro (primus) in 1738. Osteochondritis dissecans_sentence_170

In 1870, James Paget described the disease process for the first time, but it was not until 1887 that Franz König published a paper on the cause of loose bodies in the joint. Osteochondritis dissecans_sentence_171

In his paper, König concluded that: Osteochondritis dissecans_sentence_172

Osteochondritis dissecans_ordered_list_2

  1. Trauma had to be very severe to break off parts of the joint surface.Osteochondritis dissecans_item_2_6
  2. Less severe trauma might contuse the bone to cause an area of necrosis which might then separate.Osteochondritis dissecans_item_2_7
  3. In some cases, the absence of notable trauma made it likely that there existed some spontaneous cause of separation.Osteochondritis dissecans_item_2_8

König named the disease "osteochondritis dissecans", describing it as a subchondral inflammatory process of the knee, resulting in a loose fragment of cartilage from the femoral condyle. Osteochondritis dissecans_sentence_173

In 1922, Kappis described this process in the ankle joint. Osteochondritis dissecans_sentence_174

On review of all literature describing transchondral fractures of the talus, Berndt and Harty developed a classification system for staging of osteochondral lesions of the talus (OLTs). Osteochondritis dissecans_sentence_175

The term osteochondritis dissecans has persisted, and has since been broadened to describe a similar process occurring in many other joints, including the knee, hip, elbow, and metatarsophalangeal joints. Osteochondritis dissecans_sentence_176

Notable cases Osteochondritis dissecans_section_18

Osteochondritis dissecans_unordered_list_3

  • Michael Russell, American tennis playerOsteochondritis dissecans_item_3_9
  • Kristina Vaculik, Canadian artistic gymnastOsteochondritis dissecans_item_3_10
  • Jonathan Vilma, American football linebackerOsteochondritis dissecans_item_3_11
  • Seo In-guk, Korean actorOsteochondritis dissecans_item_3_12

Veterinary aspects Osteochondritis dissecans_section_19

Main article: Elbow dysplasia Osteochondritis dissecans_sentence_177

OCD also is found in animals, and is of particular concern in horses, as there may be a hereditary component in some horse breeds. Osteochondritis dissecans_sentence_178

Feeding for forced growth and selective breeding for increased size are also factors. Osteochondritis dissecans_sentence_179

OCD has also been studied in other animals—mainly dogs, especially the German Shepherd—where it is a common primary cause of elbow dysplasia in medium-large breeds. Osteochondritis dissecans_sentence_180

In animals, OCD is considered a developmental and metabolic disorder related to cartilage growth and endochondral ossification. Osteochondritis dissecans_sentence_181

Osteochondritis itself signifies the disturbance of the usual growth process of cartilage, and OCD is the term used when this affects joint cartilage causing a fragment to become loose. Osteochondritis dissecans_sentence_182

According to the Columbia Animal Hospital the frequency of affected animals is dogs, humans, pigs, horses, cattle, chickens, and turkeys, and in dogs the most commonly affected breeds include the German Shepherd, Golden and Labrador Retriever, Rottweiler, Great Dane, Bernese Mountain Dog, and Saint Bernard. Osteochondritis dissecans_sentence_183

Although any joint may be affected, those commonly affected by OCD in the dog are: shoulder (often bilaterally), elbow, knee and tarsus. Osteochondritis dissecans_sentence_184

The problem develops in puppyhood although often subclinically, and there may be pain or stiffness, discomfort on extension, or other compensating characteristics. Osteochondritis dissecans_sentence_185

Diagnosis generally depends on X-rays, arthroscopy, or MRI scans. Osteochondritis dissecans_sentence_186

While cases of OCD of the stifle go undetected and heal spontaneously, others are exhibited in acute lameness. Osteochondritis dissecans_sentence_187

Surgery is recommended once the animal has been deemed lame. Osteochondritis dissecans_sentence_188

Osteochondritis dissecans is difficult to diagnose clinically as the animal may only exhibit an unusual gait. Osteochondritis dissecans_sentence_189

Consequently, OCD may be masked by, or misdiagnosed as, other skeletal and joint conditions such as hip dysplasia. Osteochondritis dissecans_sentence_190

Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Osteochondritis dissecans.