What is Osteochondritis Dissecans?
A knee injury at any time is never a good thing. When it happens to adolescent athletes it can be even more devastating. Most knee injuries will require a certain period of recovery, rehabilitation and maybe surgery. Adolescent athletes, in most cases, return to the same level of play as prior to the injury and even achieve the elite level or professional status.
Osteochondritis dissecans, although an uncommon injury, is one injury that can have long term effects on the ability to participate in sports. Defined as a loss of adequate blood supply to the bone and supporting cartilage resulting in possible fracture or fissuring of the cartilage causing loose bodies and cartilage fragments causing pain, swelling and locking.
The knee is the most commonly affected joint, but osteochondritis dissecans (OD) can also occur in the elbow, hip and ankle. The majority of the people diagnosed with symptomatic OD are older children, teenagers and young adults and particularly those who participate in sports.
What are the causes, signs and symptoms?
OD is generally caused by the result of a direct trauma to the knee or a series of repetitive stresses over time. Typically the signs and symptoms include pain, joint locking, and decreased range of motion, swelling and tenderness, joint stiffness and giving way and loose bodies in the joint. Early diagnosis and treatment of osteochondritis are essential to minimizing the long-term effects. If caught early enough, especially in young growing children the condition will most likely heal itself. However, if improperly diagnosed or missed the condition can cause joint surface damage in older teenagers and young adults, even with surgery. OD can produce future disability including degenerative arthritis and osteoarthritis.
Evaluation and Treatment
Proper diagnosis will minimize the risk of long-term disability and provide the patient with more treatment options. Diagnosis begins with a proper physical examination followed by X-Rays. Your doctor may also request a bone scan or MRI to aid in the diagnosis and to pinpoint the extent of damage of the area affected.
If the patient is young and the bone is still growing a conservative treatment approach of complete rest will be suggested. All activities will have to be stopped and may require a period of non-weight bearing of several weeks. The treatment period could be as long as 12 – 18 months and will require follow-up X-Rays, bone scan or MRI to evaluate the progress and healing process.
If no progress is made or the healing is slow, surgery may eventually be required. In cases where fragments of cartilage are loose in the joint, surgery is necessary to either reattach the fragments or remove them to limit the irritation they can cause. The extent of the damage will decide the type of surgery, arthroscopic or open.
Rehabilitation and Recovery
Post-surgery rehabilitation will involve a period of non-weight bearing and require an extensive period of physical therapy to regain range of motion, strength, flexibility and coordination. The goal of rehabilitation will ensure proper and progressive weight-bearing and to control pain. Ideally, the goal is for patients to resume their previous lifestyle. Continued supervision and check-ups with your doctor and therapist will be required to evaluate the effectiveness of the treatment and the evolution of the cartilage for degenerative arthritis.
Osteochondritis dissecans is an uncommon but potentially a significant debilitating injury to young athletes caused by direct trauma or repetitive stress. Early diagnosis is imperative for proper healing and recovery. Surgery may be required with an extensive rehabilitation program to aid in the recovery and eventual return to physical activity.