Osteochondritis Dissecans Still a MysteryIt's been over 100 years since doctors first named osteochondritis dissecans (OCD). Despite the lapse of this much time, scientists still don't know what causes this problem. In this article OCD of the knee is reviewed. The authors discuss the clinical presentation and diagnosis. They also look at patterns of OCD and its prognosis. Current management of the problem is presented.
With OCD a loose piece of bone and cartilage separates from the end of the bone. This is called a loose osteocartilaginous fragment. It looks OCD could be caused by a decreased blood supply to the area. In some, but not all cases, there's been a traumatic injury to the knee.
X-rays are used to stage the disease from one to four. The more severe stages affect the joint cartilage and first layer of bone in both the tibia (lower leg bone) and the femur (thigh bone). A free or loose fragment is present in stages three and four.
The symptoms of OCD vary but usually there's pain along the front of the knee. Swelling comes and goes. The more active the person is, the more likely swelling will occur. The loose fragment may stay in place (stage three) or fall into the joint space (stage four). The patient tells the doctor it feels like the joint is catching, locking, or giving way.
Small lesions can be treated successfully without surgery. Reduced activity over a long period of time is usually necessary. Casting and crutches may be needed to limit weight-bearing. Pain medications and an exercise program for strengthening are also used.
Surgery may be needed to remove the loose fragment and repair the joint. The surgeon may drill holes into the bone to increase blood supply and bone healing. Bone grafting may be needed when a crater or hole is left from the missing piece of osteocartilage.
The authors conclude by saying that OCD is not a benign condition. It can cause many problems with joint degeneration. More studies are needed to help define the best treatment for each stage of OCD.
Dennis C. Crawford, MD, PhD, and Marc R. Safran, MD. Osteochondritis Dissecans of the Knee. In Journal of the American Academy of Orthopaedic Surgeons. February 2006. Vol. 14. No. 2. Pp. 90-100.
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