0 . Jeong JH, Mascarenhas R, Yoon HS. Osteochondritis Dissecans of the Knee – Physiopedia Definition. Level of evidence: 5, Van Nugteren, K. (2008). [10], Computerised Tomography (CT) can detect any bony fragments, pinpoint their location and determine whether they have settled in the joint space. In the end, in case the knee is not fully recovered, surgery should be necessary. There are two cartilage covered parts of the end on the humerus. 2013 Jun 1;25(2):88-92. [18][19], Immobilization is not necessary before surgery. 3. Radiographs and MRI can also confirm diagnosis, monitor progress and assess for potential surgical intervention. Examination and Treatment of the Knee. When refering to evidence in academic writing, you should always try to reference the primary (original) source. This can occur during tackling in contact sports or if hit in the chest in ball sports. Surgery is also required when the conservative treatment in stages one and two was inadequate. Epidemiology. That is usually the journal article where the information was first stated. Clinical orthopaedics and related research. https://www.physio-pedia.com/index.php?title=Osteochondritis_Dissecans_of_the_Elbow&oldid=198273, Panner's Disease in younger Shildren (9-10 years), Insertional Apophysitis in pre-pubescent patients, Epicondylar avulsion fractures in older patients, Complaints of aching post exercise or activity, Crepitus or popping (indicating osteochondral defects), Positive radio-capitellar compression test: full extension with active pronation and supination. Erickson BJ, Chalmers PN, Yanke AB, Cole BJ. Patellar chondral fracture (C2023) Knee & Sports - Osteochondritis Dissecans E 9/10/2014 266 . Which form loose bodies within the joint. Sport activities should be stopped temporally [13][17]. Next criteria should be managed: the patient is pain free, has a full joint mobility, no swelling, no pressure sensitivity and there’s radiological prove of recovery. [3]When pain has settled, management would be to gradually introduce full ROM and strengthening exercises out of a painful range. There are two main places in the knee joint where osteochondritis dissecans can appear. [21], Return to play will depend on sport and pain. To adress any gait deviations that developed during the immobilization and decreased weight-bearing phases of rehabilitation gait training techniques may be used, such as manual facilitation and visual feedback tot the patient via a full length mirror. Osteochondritis Dissecans presentation. Original Editors - Tania Appelmans as part of the Vrije Universiteit Brussel Evidence-based Practice Project, Top Contributors - Tania Appelmans, Tarina van der Stockt, Mats Vandervelde, Charlotte Bellen and Michelle Lee, Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. The femoral condyles (lateral and medial) which are the distal rounded ends of the femur, articulate with the proximal side of the tibia (tibia plateau). Following immobilization, range of motion exercises, as well as progressive quadriceps and hamstring strengthening should be performed. [19], The initial stage should be focused on advice, education and pain management. To localise the lesion, determine the size, and to assess the distal femoral physis, OCD may or may not be evident on plain radiographs (depending on the size), Views: weight bearing anteroposterior, posterioranterior tunnel (at 45. [5], Magnetic Resonance Imaging (MRI) will show any accumulation of fluid in the area and can detect any loose fragments. Some other mechanisms that can contribute to the development of OCD are: trauma, ischaemia, disordered ossification and genetic abnormalities. [3] Physiotherapy post-operative management is fairly standard and will vary depending on consultant preference, however, conservative management mainly reports to avoid symptoms and aggravating activities until the bony fragments have healed. This fragment falls between the moving parts of the knee joint and blocks it. The second joint is the one between the femur and the patella. 1) damage at the articular cartilage2) piece of the articular cartilage is separated from the condyle3) piece of the articular cartilage completely separate from the condyle(Level of evidence: E). Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and relieve pain, as well as reduce the risk of osteoarthritis. Osteochondritis dissecans of the capitellum: minimum 1-year follow-up after arthroscopic debridement. 2010: p434-444. The American journal of sports medicine. Sports Health: A Multidisciplinary Approach. The passive and active extension of the knee is limited . Bohndorf K. Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification. Osteochondritis Dissecans can be seen at any age but it is common in kids and teenagers between 10-15 years of age. Ostechondritis of the humeral capitellum is secondary to repetitive compression forces between radial head and capitellum. OCD can mean one or more flakes of articular cartilage have become separated. Repeated micro-trauma could lead to a production of a relatively avascular state in the vulnerable immature capitellar chondroepiphysis.[2]. Level of evidence: A1. The arthroscopic management of osteochondritis dissecans of the adolescent elbow. The entire knee is irritated because of the loose pieces, and it responds by producing extra synovial fluid in the knee joint, Giving away (having the feeling of knee bends), OCD can exist for years without symptoms, but suddenly cause discomfort due heavy straining of the joint. Folio LR, Craig SH, Wright GA, Battaglia MJ. Septic arthritis: purulent invasion of the knee which produces arthritis, In stages one and two the articular cartilage is still intact, through retrograde operation trying to tap into to the affected bone ‘from behind’ and clear it. p.478. Pain is usually related to activity and is typically over the inferior pole of the patella. In the talus, 96% of lateral lesions and 62% of … [1] It can arise as a result of a direct trauma; when the articular cartilage is damaged (for instance a fall, twist, sprain, tackle, etc.)[9]. Bone Joint Journal. The second joint is the one between the femur and the patella. It occurs when small pieces of cartilage and bone become dislodged in the joint due to a lack of blood flow. Surgical treatment options for osteochondritis dissecans of the knee. Using neuromuscular electrical stimulation to the quadriceps and hamstrings for coactivation contractions can further augment the strength maintenance program. Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K. Jones KJ, Wiesel BB, Sankar WN, Ganley TJ. Inflammatory arthritites: a group of conditions which affect your own immune system. 2009 Jul 1;1(4):326-34. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. Available from: Brunton LM, Anderson MW, Pannunzio ME, Khanna AJ, Chhabra AB. Additional exercises to restore ankle joint and normal knee proprioception, such as biomechanical ankle platform systems (BAPS board) exercises or unilateral stance, are also beneficial to the athlete planning to return to competition. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. The smooth articular surface of th… Usually, only a small portion of the affected cartilage is involved. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). European radiology. In most cases Physiopedia articles are a secondary source and so should not be used as references. In case immobilization is insufficient, as would normally be the case for adults, a mobilization procedure must be started up. Osteochondritis dissecans can be split into a juvenile form (JOCD) and an adult form (OCD)[1] [6]. Physical therapist management of an adult with osteochondritis dissecans of the knee. Which form loose bodies within the joint. Impaired function, limited range of motion, stiffness, catching, locking an… 1977;59:769-776. The tibial plateau could damage one of the condyles of the femur [10][1]. [7] More frequently seen in males (ages 10-14) than females and often affecting the dominant arm. [2] For medical management, the use of arthroscopic surgery is the main route of management to remove the bony fragments. In 10% of the cases it is located on the patella. Costochondritis is often confused with Tietze syndrome. Note the large bone spurs that have formed around the joint. Pappas AM. If there is no certain radiological determination of osteochondritis dissecans, there can also be alternative causes of the same symptoms that should be sought for e.g.:[16]. In these two stages conservative therapy can be applied[13]. Causes of this pathology normally include injury or repetitive stress on the joint, lack of blood supply, and/or genetic makeup[5]. This can be through use of NSAIDs, activity modification, cessation of sports and/or bracing for 6-12 weeks.[3]. Maniwa S, Tadenuma T, Sakai Y, Aoki A, Yamagami N, Yamamoto S, Uchio Y. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. The surgery goals would be to remove loose fragments or to reattach fragments. In the elbow, the most common area affected is the capitellum, although it has been reported to affect the olecranon and the trochlea. - Bend the patient’s knee so that it is flexed at a 90° angle. See osteochondritis dissecans article for a general discussion. Arthroscopy and microfracture technique in the treatment of osteochondritis dissecans of the humeral capitellum: report of three adolescent gymnasts. [3] In severe cases osteochondral grafting may be required. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. Osteochondrosis is a family of orthopedic diseases of the joint that occur in children, adolescents and other rapidly growing animals, particularly pigs, horses, dogs, and broiler chickens. Positive test will reproduce lateral pain, Bracing to offload the joint. Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults … Palpation of the affected chondrosternal joints of the chest wall elicits tenderness and pain is reproduced by palpation of the affe… In minor cases rest can be prescribed. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. B. Linden et al,. Repetitive high stress forces on the joint can result in a series of minor injuries on the elbow that can eventually lead to bony fragmentation and ultimately detachment of the bony fragment from the bone. - Osteochondritis Dissecans E 10/1/2014 226 . (accessed 18 Oct 2016). Level of evidence: 2 B, Johnson MP. As you age, the ligaments of your spine may thicken and calcify, and start to compromise the adjacent tunnels. Radiographs at the time were negative and his pain improved over the next two months. OCD occurs when one or more flakes of articular cartilage separates and forms loose bodies within the joint. [10] (Level of evidence: C5, F5) Stages three and four are always treated surgically. Radiographs and MRI image are provided in figures A,B, and C. Repetitive microtrauma due to high levels of participation in sports can also be a factor. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Spinal stenosis most often results from a gradual, degenerative ageing process of your spine. That is usually the journal article where the information was first stated. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 1996 Mar 1;78(3):439-56. [3][21] Athletes have the potential to return to their pre-injury level if motivation and compliance with rehabilitation allows. Elbow involvement in osteochondritis dissecans is rare.It is defined as a localized fragmentation of bone overlying the capitellum cartilage. The separated flakes can then ossify due to nourishment by the synovial fluid. Weight-bearing progression throughout rehabilitation should be to patient tolerance. Although some clinicians include osteochondritis dissecans among the osteochondroses, this inclusion is controversial. However, for the last six months, he has developed persistent ankle pain with intermittent swelling. 1173185. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Curry H. Essentials of Rheumatology. 2 weeks of immobilization and partial support is recommended when having an acute injury. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. - Osteochondritis Dissecans of Elbow B 6/7/2020 262 . The patient can start return to play exercises as long as symptoms are not an issue. See More See Less. Surgical management may be necessary if conservative care fails, if the lesion is Grade III or higher, or if disruption of the cartilage cap continues. 2011 May 1;19(5):297-306. [3], Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. A hinged brace can be used to help offload the joint and any valgus pressure. It mostly affects the femoral condyles, especially the medial condyle on the lateral joint surface (±80%). p.82-87. [4]  In patients with osteochondritis dissecans, the subchondral bone with his articular cartilage doesn’t get any blood supply anymore and degenerates.[5]. There are four distinct stages of OCD [13][14][12][7]: Stage one: ischemic osteonecrose begin to arise in a part of the subchondral bone, because the tissue is not well vascularized. Sometimes, swelling accompanies the pain (Tietze syndrome).Costochondritis usually has no apparent cause. The cause of OCD is likely multi-factorial. The separated flakes can then ossify due to nourishment by the synovial fluid.The cartilage is damaged and can form a loose body. There is an intermittent swelling palpable. O’Connor MA, Palaniappan M, Khan N, Bruce CE. Da Knorpel keine eigenen Blutgefäße besitzt, sondern durch Diffusion ernährt wird, werden die tiefer gelegenen Knorpelschichten immer schlechter ernährt und degenerieren. It is possible that both capsular and non-capsular movement restrictions can be found during functional assessment, the severity is dependent on a possible herniation of the knee joint and the degree of joint irritation . It can be a cause of anterior knee pain. Costochondritis is a self-limiting condition defined as painful chronic inflammation of the costochondral junctions of ribsor chondrosternal joints of the anterior chest wall. She has full ROM and no instability of the knee. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its … Osteochondritis Dissecans is, in adolescent athletes, an increasingly common cause of elbow dysfunction and elbow pain. Arthroscopic images of patient with capitellar osteochondritis dissecans lesion with multiple loose bodies. Gentle circulation and residual joint ROM exercises can be started (fingers, wrist and shoulder). Osteochondritis dissecans of the femoral condyles: a long-term follow-up study. [3], At three weeks post operatively ROM and gradual strengthening may be commenced however; this may vary depending on consultant preference. The knee feels warmer than the non-injured knee. [3], Main characteristics of the disease that are commonly mentioned are locking, giving away, stiffness and recurrent effusions. [9], X-ray can show if the cartilage flake includes a piece of underlying bone. With MRI the status of the subcondral bone, the articular cartilage, and the stability of the OCD lesion can be assessed. femorotibialis). Osteochondritis dissecans is another form of osteochondrosis. Elbows and knees are most commonly affected. Osteochondritis dissecans can involve the bone and cartilage of virtually any joint. 0 . Stabilization of the fragment through pinning or through screw fixation . J Bone Joint Surg Am. [2] That process can lead to pain, loose body formation and joint effusion. "Famous" Physical Therapists Bob Schrupp and Brad Heineck present 5 proven exercises for reducing or eliminating the pain of arthritis in your knees. Loose body in elbow of a baseball player: arthroscopic/radiologic correlation. J Bone Joint Surg Am. [17]A variety of surgical methods exist for the management of articular cartilage lesions at the knee, such as OCD. 4 . [2] It can eventually lead to osteoarthritis and other elbow pathologies if not treated. 0 . The test has to be performed as followed: - Ask the patient to sit on a table with his legs dangling over the edge. The first is located between the femur and tibia (art. No single treatment works for everybody. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. [1], The knee (art.genus) is a synovial joint where 3 bones articulate with each other: femur, tibia and patella. It consists of 2 articulations. [1] This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space. Coactivation or setting of the quadriceps and hamstring can be performed while in an immobilizer or cast. 2013 Jun 1;6(2):102-14. Involved anatomy of this disorder includes the radial head or the central and/or lateral aspect of the capitellum. Houten: Bohn Stafleu Van Loghum. Diagnosis and treatment of osteochondritis dissecans. These disorders result from abnormal growth, injury, or overuse of the developing growth plate and surrounding ossification centers. [3] The articular bones are covered by white, shiny and elastic cartilage. The stages (typically 3 or 4 levels) represent a continuum of tissue degeneration leading to complete disruption and instability of the lesion (loose body). [6] The cartilage is damaged and can form a loose body. If there is no radiological confirmation of Osteochondritis Dissecans, other diagnoses may include: Radiographs can detect any abnormalities on the surface of the joint. Curr Rev Musculoskelet Med. Sportinjuries,Brussels, Elsevier. On MRI typically the entire capitellum is affected and demonstrates low T1 signal and high T2 signal. Greene W., Netter's Orthopaedics: The knee and leg. In severe cases of osteochondritis dissecans, it may be necessary to resort to a procedure known as bulk allograft transplantation, which involves taking bone and cartilage from a cadaver and grafting it into the damaged talus of the injured person. Moktassi A, Popkin CA, White LM, Murnaghan ML. The smooth articular surface of the femur roll and slide on the tibia plateau. Late OCD findings might include quadriceps muscle atrophy and gait deviations. The patient has to stop activities for three to six months and the lesion will heal spontaneously, especially with young adolescents. [17], In some cases a large fragment may need to be re-attached to the capitellum which will be done via K wire or screw fixation. It is often used synonymously with osteochondral injury/defect and in the pediatric population. This area carries the least weight. Level of evidence: A1. femorotibialis). Arthroscopic management of osteochondritis dissecans of the capitellum: mid-term results in adolescent athletes, Elbow Brace Promotes Postoperative Rehabilitation of Osteochondral Graft in Young Athletes with Osteochondritis Dissecans of the Humeral Capitellum. [3][20], Initially post operatively the patient would likely be on a continuous passive movement machine until put in a hinge brace. The cause of the disease remains unclear and many theories have been developed, none of which has received unequivocal agreement. The sensitive location of the abandoned section of the osteochondral fracture can be felt, when the knee is in 90° of flexion . [10], Normally, immobilization of the knee for a couple of weeks is sufficient in the treatment of growing children. After this therapy is recommend, including 8 weeks of rehabilitation exercises for limb function and recruitment. The exact etiology of these disorders is unknown, but genetic causes, repetitive trauma, vascular abnormalities, mechanical factors, and hormonal imbalances may all play a role. Many diagnostic imaging methods (eg, radiography, magnetic resonance imaging (MRI), technetium 99m pyrophosphate joint scintigraphy, bone scans), as well as arthroscopic examination, have been used in an attempt to stage or classify osteochondral lesions. Level of evidence: 1B, Chambers HG, Shea KG, Anderson AF, Brunelle TJ, Carey JL, Ganley TJ, Paterno MV, Weiss JM, Sanders JO, Watters WC, Goldberg MJ. In this procedure, stretching exercises are performed. - Grasp the patient’s foot and bring the tibia in internelly rotation. Osteochondrosis dissecans. 1 . Physical examination in the early stages does only show pain as symptom, in later stages there could be an effusion, tenderness, and a crackling sound with joint movement. [7] Other possible etiologies are: chemical changes at the surface located in the subchondral bone, genetic conditions, growth disorders, hereditary factors, ischemia, etc.[11][12]. The articular bones are covered by white, shiny and elastic cartilage. For a general discussion of osteochondritis dissecans refer to the parent article - osteochondritis dissecans. Cain Jr EL, Dugas JR, Wolf RS, Andrews JR. de Graaff F, Krijnen MR, Poolman RW, Willems WJ. Vrije Universiteit Brussel Evidence-based Practice Project, http://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/surgical-management-of-osteochondritis-dissecans-of-the-knee.pdf, https://www.researchgate.net/profile/Randy_Mascarenhas/publication/237061466_Bilateral_Osteochondritis_Dissecans_of_the_Femoral_Condyles_in_Both_Knees_A_Report_of_Two_Sibling_Cases/links/00b7d529818a509cbe000000.pdf, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317804/pdf/jathtrain00028-0016.pdf, http://www.acldoc.org/Files/Eval%20n%20Treat506.pdf, https://www.researchgate.net/profile/Cecilia_Pascual-Garrido/publication/231215571_Surgical_Treatment_Options_for_Osteochondritis_Dissecans_of_the_Knee/links/00b7d530a055e93be4000000.pdf, http://www.bjj.boneandjoint.org.uk/content/84-B/2/258.short, http://www.mayoclinic.com/health/osteochondritisdissecans/DS00741/DSECTION=treatments-and-drugsfckLRLevel, https://www.physio-pedia.com/index.php?title=Osteochondritis_Dissecans_of_the_Knee&oldid=221759, OCD of the knee has a non-specific presentation, The knee swells simultaneously with the onset of the pain. Additional measures may be required in terms of return to sport, especially in professional level sport. [3][7], Thickening of cartilage and a stable lesion, Articular cartilage interrupted and a stable lesion low signal rim behind fragment showing that there is fibrous attachment, Articular cartilage interrupted, Unstable high signal changes behind fragment and underlying subchondral bone. Bilateral osteochondritis dissecans of the femoral condyles in both knees: a report of two sibling cases. Current concept review-Osteochondritis dissecans. The defects cause deep ankle pain associated with weightbearing. 2008;21(02):106-15. 2013 Oct 1;41(10):2384-91. Examination and Treatment of the Knee. Krause M, Hapfelmeier A, Möller M, Amling M, Bohndorf K, Meenen NM. Level of evidence: 1A. p.82-87. Physical exam is noteable for tenderness isolated to the medial joint line. Preferred choice to detect the location of the lesion and the size, when not visible on plain radiographs. 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