Osteochondritis dissecans is a loss of blood supply to part of a bone under the surface of joint. It usually affects the knee. It can, however, affect the elbow and ankle.
Osteochondritis is caused by repeated injuries or stresses to a joint. This may be tiny fractures to the surface of the cartilage. Motions that are repeated often tend to increase the risk of developing the condition. It can also be caused by a problem in the blood supply to the bone. This might be due to a blockage in a blood vessel. There is some tendency for osteochondritis dissecans to run in families.
Sometimes the affected area and its coating of cartilage stay in play and cause no symptoms. In other cases, the bone segment may loosen and cause pain. The condition causes pain that is usually triggered by physical activity. The joint may click or lock, making it impossible to go through a full range of motion. The joint may feel weak. Sometimes osteochondritis dissecans makes it impossible to straighten a leg or arm. There may be swelling over the joint and stiffness after resting.
Osteochondritis is more likely to affect teenagers and young adults. It affects males more than females. However, as more girls and young women become active in sports, it is becoming more common in females.
It is important that osteochondritis dissecans be diagnosed and treated early. This reduces the chance of long-term disability or of developing osteoarthritis. Timely treatment also increases the chance of a full recovering and return to sports activities.
Diagnosing Osteochondritis Dissecans
After taking a medical history and doing a physical exam, a doctor may order certain tests or scans. These may include:
- X-rays. These can show certain types of problems in a joint, but not damage to the cartilage or looseness in the joint.
- Computerized tomography, which can show bone and cartilage fragments in the joint space
- Magnetic resonance imaging (MRI), which can show the structure of the joint, fluid and loose fragments of bones. An MRI can help a doctor decide whether healing is likely to occur on its own or whether surgery will be needed.
- Bone scans, which can show whether areas of the joint are not receiving blood.
Treating Osteochondritis Dissecans
Without treatment, a person with osteochondritis dissecans can develop osteoarthritis. There is no one treatment that is suitable everyone. Treatment usually starts with the least invasive measures first. If these fail, then surgery may be necessary.
Conservative Treatment for Osteochondritis Dissecans
Since this condition is caused by repetitive movements, the first approach to healing is resting the joint. It is important to avoid impact activities such as jumping and cut-pivot movements that can rotate and strain the knee joint. Competitive sports and intense physical activities should be avoided for six to eight weeks. In some cases, the joint may need to be immobilized with a hinged brace. It may be necessary to use crutches if the knee or ankle is affected.
Nonsteroidal anti-inflammatory drugs may be used to relieve pain and swelling.
Finally, physical therapy can be helpful. Low intensity stretching and range of motion exercises are usually recommended. Sometimes exercises to strengthen the muscles that support the affect joint may also be recommended.
If pain and stiffness continue after three to six months of conservative treatment, surgery may be needed.
Minimally Invasive Surgery for Osteochondritis Dissecans
Whenever possible arthroscopic surgery is used to treat osteochondritis dissecans. This minimally invasive approach to surgery usually means less pain, a faster recovery and fewer complications. The goal of surgery is to restore normal blood flow and improve the joint's ability to work normally.
When arthroscopic surgery is done, the surgeon inserts a thin scope into the joint space. The image seen by the scope is transmitted to a television monitor. This allows the surgeon to see inside the body, pinpointing the damaged area and identifying the best type of procedure to use.
Tiny instruments are then inserted into small incisions. Using these instruments, the surgeon can either reattach or remove the loose fragments of bone. If the cartilage is still attached to the bone, it can be secured with pins or screws.
Another approach to repairing the damage caused by osteochondritis dissecans is Osteochondral autograft transfer (OATS). OATS is like a a cartilage transplant where healthy cartilage is used to replace damaged cartilage on the weight-bearing surface of a joint.
After surgery, physical therapy can be helpful in increasing the strength and stability of the joint and improving its function.
In some cases, doctors may recommend certain restrictions to daily activities. It may be necessary to return to sports activities gradually, allowing the body to build up its strength before returning to competition or intense workouts. Making sure to do stretching and strengthening exercises can help prevent a return of osteochonritis dissecans.