, Frankel VH. The focus on joint protection education, therefore, was made to provide for present symptom management and preventive measures against further articular cartilage degeneration. OCD is defined as “a fragment of articular cartilage together with subchondral bone that has become separated partly or completely from a joint surface”. Wright The active electrode was then resecured with tape and the patient was instructed to leave it in place for 8 to 12 hours as tolerated. , Lysholm J. , Hamel L, Behnke P. Hasson The literature does not yield conclusive evidence regarding the contribution of specific gene products to the development of a lesion. Later, a lack of evidence for the presence of an inflammatory process in the region of the articular lesion led Pappas3 to name the condition “osteochondrosis dissecans.” Although some authors4 support this nomenclature, the term “osteochon… We discussed a plan to progress her exercise program next visit and began discharge planning. Some authors have argued that several factors are responsible for the increased potential of DEX-P diffusion into the underlying tissues with iontophoresis: polarity of the active electrode,42–45 localized cutaneous blood flow,43,46 pH level in the skin,47 and current intensity.43 Although use of the anode as the active electrode was originally posited by Glass et al,48 many authors42–45 have recently provided persuasive arguments for the use of the cathode. Management Strategies for Osteochondritis Dissecans of the Knee in the Skeletally Immature Athlete, Surgical management of osteochondritis dissecans of the knee in the paediatric population: a systematic review addressing surgical techniques, Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle, Osteochondritis dissecans of the knee. Serial radiographs can also increase radiation exposure; however, the effective dose of radiation for a knee radiograph in children ranges from 0.077 to 0.19 mrem,50 which is minimal considering that the average exposure from natural sources (eg, radon) per year in the United States is 300 mrem.120 An MRI scan or needle biopsy may give the most definitive evidence of healing. Osteochondritis dissecans (OCD) of the elbow doesn't occur in immature throwing athletes very often so there isn't a lot of information about it to help guide treatment. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. She reported only mild tenderness along the anteromedial femoral condyle on the right knee (pain rating 4/10) with direct palpation to the area. , Ilahi OA, Graf BK. Radin Therefore, it appears that careful and controlled loading of the articular lesion must be considered given its potential to contribute to healing during conservative management.32,54. RK The decision to return to sports is a collective one, involving the patient, health care team, and patient's family. osteochondritis dissecans can lead to the development of osteoarthritis at an early age, resulting in progressive pain and disability. . It is also possible that the early decrease in symptoms may have been the result of factors other than, or in addition to, the application of electrical stimulation (eg, a change in footwear, addition of the customized home exercise program, the patient's new knowledge of joint protection principles). Her home exercise program was modified to include strengthening exercises for the muscles about the hip, knee, and ankle that required movement of the tibiofemoral joint. J DJ 3.4. Increasing strength with a focus on the lower extremity and core musculature serves as a stabilizing force to protect the joint and dampen forces around the joint.104 Balance activities are critical to restore normal proprioceptive feedback from the knee joint.126 Once full active range of motion and weight bearing are achieved, the patient is progressed to the advanced phase and should begin running and gradually proceed to impact and sport-specific activities, as tolerated.110, A recent systematic review identified a lack of consistency on the indications for operative treatment of JOCD lesions, with 40% of studies not providing clear indications and 60% recommending surgery after failure of nonoperative treatment.108 Proposed treatment algorithms, however, offer many recommendations.33,95 For stable JOCD lesions without loose bodies, 3 to 12 months of nonoperative treatment is recommended, followed by drilling if the lesion remains unhealed.33,124 Approximately 50% to 67% of JOCD lesions heal in 6 to 18 months with nonoperative treatment, and thus do not require surgery.17,18,100,124 For unstable or displaced lesions with salvageable fragments, fixation with or without drilling or microfracture is recommended. Pellecchia I am back with another exercise and injury interview for you and today it focuses on a knee injury. In the long term OCD can lead to subsequent dege… , Morris RL, Sembrowich WL. Walker It usually takes 3 months or longer to heal completely. After the 6 months his pain was gone, which was a blessing, however, he still has issues with function. , Zoppi M, Vecchiet F, et al. Iontophoresis was discontinued given her 0/10 pain rating maintained over a 10-day period. It is different from various other types of joint pain that commonly have an effect on older people, like arthritis. Osteochondritis dissecans takes place when some of the cartilage material in a joint, along with a slim layer of bone under it, separates from completion of a bone. Ischemia, the loss of blood flow, was proposed as an etiological factor by Paget93 in 1870, who described JOCD as a “quiet necrosis.” It was speculated that a loss of blood supply to the affected area may inhibit the tissue's ability to effectively re-form bone, resulting in cell death and separation of the bone from the cartilage.36,51 It has also been proposed that OCD lesions may be filled with fibro-cartilage resulting from deficient vascularization.72 The many authors who have investigated the possibility of lesion development due to ischemia have found little supporting evidence.3,4,23,107 However, some supporting evidence exists, including the ability to revascularize a partially attached lesion81 and the presence of osteonecrosis in most histology studies (7/10).111 Conversely, other studies have found a rich blood supply and no cell death in lesions of the medial femoral condyle.3,4,23,107 Authors of a recent study on the viability of detached osteochondral fragments from 5 patients reported that 88% of chondrocytes (the cells found in cartilage) were viable, compared to 92% of chondrocytes in the healthy native cartilage.96 This perhaps suggests that either OCD lesions are not a product of ischemia or the synovial fluid provides enough nutrition for the cells to remain viable.96 Despite this controversy, the ischemia hypothesis has generated many current treatments for OCD, including drilling to produce revascularization for improved blood flow into the lesion.9,95. Sellards JC He can walk okay but he has problems on steps, stairs, hills, and inclines. Repetitive stress, especially in young athletes, is one of the most accepted causes of JOCD.14,47,51,64,123 A majority of patients with OCD (55%–60%) are regularly involved in sports,3,47 and repetitive cyclical stress through an athlete's joint may lead to chondral injury and possible vascular damage, leading to ischemia.14 Laor et al68,69 hypothesized that JOCD lesions could result from repetitive stress to the growth plate of the secondary ossification center that resides just between the surface cartilage and its supporting bone in the epiphysis of a growing athlete (FIGURE 2). During the initial phase, striving for a normal range of motion, equal to the contralateral side, is beneficial for healing and is accomplished through passive range-of-motion exercises and stretching.104 Although controversial, basic science studies suggest that the use of controlled range-of-motion exercises, either through a continuous passive motion device or repetitive active assisted range of motion, may help to nourish the articular cartilage surface and promote a healthy knee joint.11,56,59,104 Once full passive range of motion and partial weight bearing are achieved, the patient can be progressed to the intermediate phase, with active range-of-motion exercises, muscle strengthening, and balance training.126 Neuromuscular electrical stimulation of the quadriceps muscles113 and weight-bearing and non-weight-bearing activities or progressive resistive exercises126 can facilitate muscle strengthening. FP Therapy, level 5. Some patients may be referred to a doctor for further diagnosis. Williams A prospective study, Osteochondritis of the femoral condyles in children and adolescents: our experience over the last 28 years, American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis and treatment of osteochondritis dissecans, AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans, MR grading system of osteochondritis dissecans lesions: comparison with arthroscopy, Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair, Osteochondritis dissecans: a histologic and microradiographic analysis of surgically excised lesions, Osteochondritis dissecans: Wilson's sign revisited, Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle, Untreated osteochondritis dissecans of the femoral condyles: prediction of patient outcome using radiographic and MR findings, Evaluation and treatment of osteochondritis dissecans lesions of the knee, Internal fixation of undisplaced lesions of osteochondritis dissecans in the knee, Characterizing osteochondral lesions by magnetic resonance imaging, Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee, Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee, Surgical management of osteochondritis dissecans of the knee, Load moments about the hip and knee joints during ergometer cycling, Arthroscopic surgical management of osteochondritis dissecans of the knee, Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes, A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children, Arthroscopic treatment of osteochondritis dissecans. First, the patient was encouraged to use cushioned footwear (ie, running shoes) to limit ground reaction forces at the knee. Osteochondritis dissecans is a localized injury or condition affecting a surface of the joint that involves a separation of a segment of cartilage and the underlying bone. Which form loose bodies within the joint. Please check for further notifications by email. On MRI, healing has been defined by an absence of a sclerotic rim at the interface between the osteochondral fragment and subchondral bone.29,78,102 Magnetic resonance imaging, however, is more expensive than radiographs, and a biopsy requires a second surgery. . Mueller The patient then was instructed in joint protection strategies to decrease loading across the right tibiofemoral joint. Hinshaw The healing process for JOCD can be frustratingly slow for all parties involved; however, premature return to activity can be devastating. SH Garrett CJ The femoral condyles of the knee are the most common locations for OCD, and the incidence of OCD appears to be increasing among active children. Common Osteochondritis Dissecans Lesion Classification Systems, Magnetic resonance imaging is much more accurate and useful than radiographs for classifying the stability of JOCD knee lesions. Due to slow healing and extended period of sports participation restriction, JOCD can be a frustrating condition for the young athlete.2 In cases with stable lesions, JOCD has been reported to heal most readily.17,36,51 However, it is difficult to accurately predict who will heal from nonoperative or operative treatment. A The previous injury to the medial ligament of the elbow may also result in this injury as it causes an increase angle and loading of the capitellum. , Stephen RL, Jacobson SC. Failure to establish a familial background, Familial multiple osteochondritis dissecans. She reported minor “fatigue” in the right lower extremity at the end of her 8-hour workday. Familial osteochondritis dissecans: a dysplasia of articular cartilage? Pappas Rauh et al103 reported that prior injury was a primary risk factor for future injury in young athletes. Magnetic resonance imaging also enhances the visibility of bone cysts, subarticular high-signal lines, and articular cartilage fissures that may affect prognosis and treatment.30 For identifying JOCD knee lesions, MRI has been found to have a sensitivity ranging from 78% to 100%, a specificity ranging from 95% to 100%, and an accuracy of 100%.61,73 These findings for MRI are similar to those for radiographs and physical examination combined.61 Typically, all 3 methods are used for diagnosis and to make treatment decisions. , Han S, Han JS. 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