Name
OSTEOCHONDRITIS DISSECANS
DESCRIPTION
DETAIL
CAUSES . Etiology unclear however it is most often associated with trauma or repetitive micro-trauma . Most commonly effected joints are the knee, ankle, and elbow . Knee - overuse and with patellar dislocation, and with injury to the ACL . Elbow - overuse injury in overhead throwers and in female gymnasts . Ankle - frequently associated with history of previous ankle sprain . Possible theories include vulnerability secondary to fragile blood supply of the physeal line -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ In the knee: meniscal tear, patella-femoral pain syndrome β’ Stress fracture β’ TendinopathyNO LABORATORY TEST DIAGNOSTIC IMAGING . Plain radiographs are frequently normal . Knee - AP, lateral and tunnel view (most likely location for abnormality is in the lateral portion of the medial condyle) . Elbow - routine elbow series (common involvement of the humeral capitellum) . Ankle - AP, lateral, oblique and mortise view (lesions most commonly involve the posteromedial or anterolateral talus) . MRI. Can delineate the bony lesion as well as involvement of cartilage and any fluid behind the fragment. . CT scan - provides architectural description of bone lesion, providing less information than MRI . Technetium 99 bone scan - may be useful in evaluation of healing potential, but this is controversial
TYPENOTES
RISK FACTORS: No clear genetic predisposition however up to 30% of lesions are bilateral, Seen in active children and adults, Multi-sport athletics, especially gymnastics and overhead sport participationGENERAL MEASURES β’ Goals of treatment - maintain smooth congruous joint surface. Alleviate pain. Prevent degenerative joint disease. Promote revascularization of necrotic fragment and regeneration of effected cartilage. β’ There are no randomized controlled trials, however, in JOCD, non-surgical treatment initially is the norm β’ Treatment options include a spectrum of alternatives from relative rest (removal from sport) to crutches (partial or non-weight bearing) to cylindrical casting and splinting SURGICAL MEASURES Surgical treatment is utilized when conservative measures have failed or when physeal closure is approaching which carries a worse prognosis for healing (adult form). Surgical treatment includes drilling to increase blood supply and/or allograft insertion and requires an orthopedic consultation. ACTIVITY β’ Non-weight bearing, immobilization with intermittent maintenance of range of motion β’ Follow closely for 12 weeks for healing β’ Casting is utilized for 6 week intervals especially with JOCD due to issues of compliance DIET No specific diet recommended PATIENT EDUCATION β’ Compliance with immobilization and possibility of further trauma should be emphasized especially with the younger athlete β’ Many lesions heal without surgical intervention DRUG(S) OF CHOICE NSAIDs or acetaminophen PATIENT MONITORING Initially should be followed every 6 weeks with serial radiographs to check for healing and possible displacement. Expect healing in 4 to 6 months. In JOCD at one year radiographs may show no residual abnormality. PREVENTION/AVOIDANCE No clear way to avoid its development. POSSIBLE COMPLICATIONS β’ Failure to revascularize and heal β’ Displacement of fragment becoming loose body within a joint EXPECTED COURSE/PROGNOSIS β’ Patient age and degree of physeal closure has a significant effect on healing potential β’ An incongruous joint surface may lead to degenerative changes in the future β’ Clinical improvement may precede radiologic healing β’ Fragment displacement may occur, in which case arthroscopy is indicated
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
BONE SCAN, MRI, CT SCAN, X-RAY