Osteochondritis Dissecans, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Osteochondritis Dissecans, Diagnosis and Treatment and Related Diseases
Osteochondritis dissecans (OCD) is a disorder that forms in joints, most often in children and adolescents.
It happens when a small segment of bone starts to separate from its surrounding area due to a lack of blood supply.
As a result, the small piece of bone and the cartilage covering it start to crack and loosen.
The most frequent joints involved by osteochondritis dissecans are the knee, ankle and elbow, while it can also happen in other joints
The disorder normally involves just one joint; some children can form OCD in several joints.
There are 2 main forms:
1. Juvenile form (open epiphyses)
It happens at age 10-15 while the epiphysis is still open
2. Adult form (skeletal maturity)
Knee Location is most common
It happens at the poster lateral aspect of medial femoral condyle (70% of lesions in knee), capitellum of humerus and talus
In many cases of OCD in children, the involved bone and cartilage recover on their own, particularly if a child is still growing.
In grown children and young adults, OCD can have more serious effects.
The OCD lesions have a higher chance of separating from the surrounding bone and cartilage, and can even detach and float around inside the joint.
In these cases, surgery may be required.
Doctors think it probably is caused by repetitive trauma or stresses to the bone over time.
While the cause of osteochondritis dissecans is not fully explained, it is believed to be multi-factorial in nature.
Postulated causes are genetic predisposition, inflammation, spontaneous avascular necrosis, and repetitive micro-trauma.
Originally believed to be related to osseous inflammation (hence the term osteochondritis), multiple studies have failed to prove inflammation as the underlying cause.
Clanton Classification of Osteochondritis
1. Type I Depressed osteochondral fracture
2. Type II Fragment attached by osseous bridge
3. Type III Detached non-displaced fragment
4. Type IV Displaced fragment
Symptoms
Symptoms:
often brought on by sports or physical activity are the most frequent first symptoms of OCD.
Advanced instances of OCD may cause joint catching or locking.
An x-ray of the affected joint is required for an initial OCD diagnosis, and to assess the size and location of the OCD lesion.
Routine radiographs of the affected joint are the first imaging tests obtained.
Radiographs reveal an ovoid lucency affecting the sub-chondral bone with subjacent sclerotic bone.
Sometimes the bony fragment may be visualized within the sub-chondral defect or, if displaced, elsewhere within the joint.
MRI is helpful for characterizing:
1. Size of lesion
2. Status of sub-chondral bone and cartilage
3. Signal intensity surrounding lesion
4. Presence of loose bodies
MRI findings that indicate healing after conservative treatment are:
1. Reduction or resolution in the surrounding bone marrow edema pattern,
2. A reduction in lesion size,
3. Reduction or resolution of the hyper-intense T2 signal rim or cyst like foci, and
4. In-growth of bone within the bed of the OCD lesion with osseous bridging.
Treatment
The patient’s age, time of presentation, severity of symptoms, and stability of the lesion will determine treatment.
In most cases, OCD lesions in children and young teens will heal on their own, especially when the body still has a large number of years of growing to do.
Resting and avoiding vigorous sports until symptoms recover will often alleviate pain and swelling.
The overall purpose of surgery is the cartilage reformation and repair of the articular surface to avoid early-onset osteoarthritis.

TABLE OF CONTENT
Introduction
Chapter 1 Osteochondritis Dissecans
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Meniscus Injuries
Chapter 8 Knee-cap Dislocation
Epilogue