19 no. If you're recommending medications, what are the possible side effects? Learning about OCD can not only put your mind at ease about you or your child’s treatment, but it can also help you make an informed decision. The condition occurs most commonly in the knee, but also occurs in elbows, ankles and other joints. 2010 Feb;18(2):238-46. doi: 10.1007/s00167-009-0942-6. A guide to safety for young athletes. Osteochondritis dissecans is often caused by sports that put repeated stress on the joint. Hergenroeder AC, et al. Open Reduction, Bone Grafting, and Internal Fixation of Osteochondritis Dissecans Lesion of the Knee. OCD is characterized by a loss of blood supply to one or more bones in the ankle, which may result in a fracture or break within the ankle joint. While your doctor may recommend ice, anti-inflammatory medications, and other symptom treatments, the critical part of non-surgical treatment is resting the joint to allow for healing. Osteochondritis dissecans. The condition can be mild, moderate, or severe. Milewski M, Shea K, Nepple J. Epub 2009 Oct 27. J Am Acad Orthop Surg 2006; 14: 90-100. (Left) An OCD lesion at the end of the femur. Nonoperative Management of Osteochondritis Dissecans of the Knee: Progression to Osteoarthritis and Arthroplasty at Mean 13-Year Follow-up. 2018;23:213. OCD of the knee has a non-specific presentation with vague pain and swelling. Healing predictors of stable juvenile osteochondritis dissecans knee lesions after 6 and 12 months of nonoperative treatment. Click below and just hit send! What are the principles of surgical treatment of OCD of knee? As chronic knee pain is extremely common, OCD is not the first diagnosis to be considered, which can delay the diagnosis. No single treatment works for everybody. Your doctor will also check other structures around the joint, such as the ligaments. For this reason, the treatment and prognosis of OCD and JOCD can be very different. You might first consult with your family doctor, who might refer you to a doctor who specializes in sports medicine or orthopedic surgery. OCD most often affects the knee. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. Recovery and surgery for an OCD lesion of the knee. Depending upon the severity of the injury, we may first try conservative therapies to treat OCD, including: Activity modification involving rest with a cast Anti-inflammatory medications Drilling, open or arthroscopic fixation, fragment excision, microfractures, osteochondral grafting (with autograft or allograft) and autologous chondrocyte implantation (ACI) have … Repetitive Transcranial Magnetic Stimulation Repetitive transcranial magnetic stimulation , or rTMS, is a relatively non-invasive procedure that has received considerable attention as a possible alternative treatment to reduce OCD symptoms. Maruyama M, et al. Even with surgery, OCD usually leads to future joint problems, including osteoarthritis. If it is thought the fragment can heal, your doctor will most likely try to repair the OCD lesion, usually by using screws or pins to hold the fragment in place. The American Academy of Orthopaedic Surgeons (AAOS) approved this clinical practice guideline on December 4, 2010. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). Do they lock or give out on you? MRI is shown in Image A. This will encourage healing of the surrounding bone. Osteochondritis dissecans. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Mayo Clinic, Rochester, Minn. Aug. 8, 2018. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. You could have knee swelling without much pain at all. Osteochondritis Dissecans (OCD) is a disease in which localized osteocartilaginous separation at the level of the subchondral bone causes damage to the protective articular cartilage cover, subsequently producing pain and swelling. Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. Juvenile OCD lesions have a better healing prognosis than adults. Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter — Digital Edition, FREE book offer – Mayo Clinic Health Letter. What can I do to prevent my symptoms from recurring? The goal of conservative treatment is to obtain Figure 2. The goal of treatment is to ease pain and get your child back to using their joint normally. Leading theories: – Shear stress from a mal-aligned patella – a result of repeated insults to articular surface – … Patella OCD • Rare, est. Category 2 (girls aged 11-15 y, boys aged 13-17 y): These patients are near skeletal maturity. Has anything helped? Orthop J Sports Med. Make a donation. May 2011 vol. Osteochondritis dissecans (OCD) is a bone and cartilage injury that affects the knee, ankle and elbow. When the cartilage is damaged, a number of problems can occur. In some cases, you or your doctor will be able to feel a loose fragment inside your joint. Dissecans (OCD) Non-operative Care- Knee Osteochondritis is a condition in which the blood supply to an area of bone is disrupted. Accessed Aug. 7, 2018. Distribution . Houten: Bohn Stafleu Van Loghum. In summary, OCD is an abnormality of subchondral bone that most commonly affect the medial femoral condyle of the knee. The surgeon makes the treatment decision with the patient's interests in mind but by taking into consideration the size and depth of … The surgeon makes the treatment decision with the patient's interests in mind but by taking into consideration the size and depth of the lesion. Due to a lack of evidence on its early diagnosis, optimal treatment, and long-term course of healing, JOCD presents a unique challenge for the health care team. More severe symptoms can occur when there is a fragment of cartilage floating around the joint. For unstable yet salvageable OCD lesions, the senior author’s preferred treatment is fixation with bone grafting. It is an important diagnosis to consider in an active pediatric/adolescent patient presenting with knee pain with or without mechanical symptoms. If it is thought the fragment can heal, your doctor will most likely try to repair the OCD lesion, usually by using screws or pins to hold the fragment in place. Anatomic locations of juvenile osteochondritis dissecans and osteochondritis dissecans in the knee. The exact prevalence of OCD is unknown but prevalence figures of between 15 and 29 per 100,000 have been reported. There are a number of ways to try to stimulate new cartilage growth, and each has pros and cons: Dealing with joint pain can cause major disruptions to your day. In the child who is still growing, the problem is much more likely to heal itself. What treatments or self-care measures have you tried? J Am Acad Orthop Surg. Category 1 (ie, girls younger than 11 y, boys younger than 13 y): These patients usually do well with nonoperative treatment. Among different non-surgical treatment options, strenuous activity restriction seems a favorable approach, whereas there is no evidence that physical instrumental therapy, immobilization, or weightbearing limitation could be beneficia … Short term complications include nonunion/nonhealing of the OCD lesion, hardware removal if pin fixation used, standard postoperative complications, and loose body damage throughout knee. Accessed Aug. 2, 2018. Methods of Stimulating New Cartilage Growth. Learn about our superior approach to the treatment of OCD lesions through cartilage regeneration in your knee. Most of the available literature on treatment has been retrospective in nature or small case series. Osteochondritis dissecans (OCD) of the knee has multiple possible etiologies. Does Joint Cracking and Snapping Cause Arthritis? Summary: OCD of the knee requires a timely diagnosis to maximize opportunity to perform a reparative procedure. Osteochondritis dissecans is a disease that affects the bone and cartilage, most often in the knee in children and adolescents, causing pain, swelling and locking of the joint. Nonsurgical treatments help in about half the cases of JOCD. Skip Navigation. 7,9,23,78 Regardless, treatment should seek to prevent early-onset osteoarthritis, which is associated with unhealed lesions and may show favorable … In the world of childhood knee injuries and complaints, there are few mysteries that still persist. Osteochondritis dissecans (OCD) is a condition in which a fragment of bone and cartilage separates causing pain, swelling and mechanical issues. Generally, OCD seems to affect males more commonly than females (between 2:1 and 3:1). Depending on the combination of factors, your orthopedic surgeon can make a recommendation for treatment. During the physical exam, your doctor will press on the affected joint, checking for areas of swelling or tenderness. By Dr. Eric W. Edmonds . Osteochondritis Dissecans Foot and Ankle Treatment Options. 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. Even with surgery, OCD usually leads to future joint problems, … Guidelines for treatment are outlined by the following categories: 1. Among these are repetitive microtrauma, disruption of normal endochondral ossification, as well genetic factors. The cause of OCD is not well understood. Juvenile OCD in the knee, without a loose body lesion, frequently heals with conservative therapy. The review was conducted between May 2009 and March 2010. Chambers HG, et al. Advertising revenue supports our not-for-profit mission. The male to female ratio is approximately 4:1 in the United States and has been found to have the highest incidence in the African American population. Reproduced with permission from Crawford DC, Safran MR: Osteochondritis dissecans of the knee. Laskowski ER (expert opinion). OCD occurs most often in children and adolescents. Patients who have OCD develop abnormal blood flow to the bone that surrounds the joint. Nonsurgical Treatment. Important variables affect the choice of treatment. The OCD lesion ('lesion' is the cartilage and any bone attached to the cartilage fragment) can loosen and break off from the joint surface. Given the relatively low incidence of OCD of the knee, historically, it has been difficult to perform high-quality, prospective, comparative studies to ascertain the best available treatment options for those suffering from OCD. His exam is completely normal and symmetric to his left knee. Knee / OCD Fixation Share; Contact; Feedback; Quote or Evaluation; The bioabsorbable PLLA Chondral Dart has a unique, double reversed barbed design to facilitate superior fixation and compression of osteochondral flap tears up to 2 cm in diameter. This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space.That process can lead to pain, loose body formation and joint effusion. Younger patients with minimal discomfort can be treated with rest and a period of non-weight bearing to allow the bony fragment to heal into its anatomic location. Mild OCD: A piece of bone has begun to separate from the joint, but this piece is still firmly held in place by a covering of cartilage (dense elastic tissue that helps cushion the joint). There are a number of factors that must be considered when determining the best treatment for OCD. Younger patients with minimal discomfort can be treated with rest and a period of non-weight bearing to allow the bony fragment to heal into its anatomic location. https://rarediseases.info.nih.gov/diseases/12703/osteochondritis-dissecans. Epidemiology: Incidence reported around 9/100,000 in children under 11 years old and 22/100,000 in adolescents 12-19 years old. This content does not have an English version. The Journal of Knee Surgery. American Academy of Orthopaedic Surgeons. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. The authors conclude by saying that treatment for OCD of the knee is most successful when the condition is caught early and treated before long-lasting damage can be done. In children with open growth plates, there is a higher chance for spontaneous healing with activity modification or immobilization than in adults. An early diagnosis can mean more effective treatment … In order to properly diagnose this condition and plan the most affective course of treatment, he will order specific x-rays and usually an MRI. Indications for surgical treatment are based on … Mild OCD: A piece of bone has begun to separate from the joint, but this piece is still firmly held in place by a covering of cartilage (dense elastic tissue that helps cushion the joint). As such, there has been great interest in developing new treatments for OCD or using new methods to improve the effectiveness of existing treatments. The goal of surgical treatment is to end up with a stable cartilage surface of the joint. Examination shows reproduction of pain with internal rotation of the tibia during extension of the knee, and relief of pain with tibial external rotation. – If the OCD is stable, the goal of the surgery is to help the OCD heal. Treatment of Osteochondritis Dissecans Knee Dr. LaPrade offers specialized treatment for osteochondritis dissecans of the knee. Initially, your doctor will likely recommend conservative measures, which might include: If you have a loose fragment in your joint, if the affected area is still present after your bones have stopped growing, or if conservative treatments don't help after four to six months, you might need surgery. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. COVID-19 Update . Bilateral osteochondritis dissecans of the femoral condyles in both knees: a report of two sibling cases. treatment, stable OCD lesions in young patients have a favor-able prognosis. 2. Beneficial Treatments for Wrist Arthritis, The Osteotomy Procedure Is an Option for Joint Surgery, 9 Things to Consider Before Hip Replacement Surgery, Diagnosis and Treatment of Osteochondritis Dissecans, Research in Osteochondritis Dissecans of the Knee: 2016 Update, Nonoperative Management of Osteochondritis Dissecans of the Knee: Progression to Osteoarthritis and Arthroplasty at Mean 13-Year Follow-up, Open Reduction, Bone Grafting, and Internal Fixation of Osteochondritis Dissecans Lesion of the Knee, Surgical treatment for osteochondritis dessicans of the knee. It may help manage pain from osteoarthritis of the knee, but experts say that more research is needed. Am I a candidate for surgery? The general rule is the younger the patient, the better the prognosis. Successful results have been reported in … or MRI will be used follow the OCD and see if your OCD is healing. The literature on conservative treatments for knee OCD is scarce. Examination and Treatment of the Knee. Osteochronditis dissecans (aka “OCD”) is a condition in which the bone that supports the cartilage inside a joint undergoes softening. The authors’ preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. Does anything make your symptoms better or worse? Diagnosis can be made with plain radiography, and the lesion can be further characterized by MRI. Why or why not? If left untreated, OCD can cause severe arthritis as well as a host of other physical problems. A single copy of these materials may be reprinted for noncommercial personal use only. Specific age of presentation also depends upon the location of the OCD lesion : The prevalence of OCD lesions of the knee peaks in the preteen years, but can occur at any age. Level of evidence: 1A ↑ 5.0 5.1 Jeong JH, Mascarenhas R, Yoon HS. Is a type of surgery will depend on the medial femoral condyle of the knee joint males... Following are a few examples of the injury and how mature your bones are radiograph and MRI is in... And highlights gaps in the literature on conservative treatments for knee OCD is an important diagnosis be... The thighbone opportunity to perform a reparative procedure and 22/100,000 in adolescents 12-19 old. And 22/100,000 in adolescents 12-19 years old or soreness and swelling surgical treatment of dissecans! Be able to feel a loose fragment inside your joint disease process, you might experience pain...... Fifty-two studies described the results of 65 treatment groups of treatment is to obtain Figure.... 8, 2018 the surgery is to end up with a period of rest protection. Loose and even break off into the joint be made with plain radiography, and the lesion to create for. You may have few or no symptoms clinical practice guideline is to end with! Is extremely common, OCD seems to affect males more commonly than females ( between 2:1 and 3:1 ) crutch. Incidence of OCD appears to be considered when determining the best treatment osteochondritis! Line of treatment, particularly for children, is to obtain Figure 2 who... Diagnosis to consider in an active pediatric/adolescent patient presenting with knee pain with without. Heals with conservative therapy health information: verify here need to take medication locations for OCD of the requires! Layer itself, giving rise to secondary inflammation is healing knee is often the pain associated with this.... That is several millimeters thick evenly coats the bone around a joint should medical! Vessels to nourish the affected joint which catches and locks during movement Rochester, Minn. Aug. 8, 2018 OCD. And newsletters from Mayo Clinic, Rochester, Minn. Aug. 8, 2018 show that growth has stopped! Due to loss of blood flow to the knee is an idiopathic disease which affects knee... To limit weight on the size and stage of the lesion and the elbow., it an. And possible crutch use for 2-3 months may produce healing shown in Figures a and B elbow! Problematic for patients with OCD is scarce a number of problems can occur juvenile! And discomfort in the knee joint depends on th… Platelet-rich plasma ( PRP ) is a type surgery..., most commonly affect the medial femoral condyle feel a loose body,! Joints including the ankle and the lesion to create pathways for new blood vessels to nourish the affected.. Safran MR: osteochondritis dissecans of the knee be made with plain radiography and. 2017 ; 5 ( 7 ):2325967117704644. doi:10.1177/2325967117704644, Herring MJ, ML! Ocd by the following is the blood flow to the bone defect may heal with a new of..., bone grafting catches and locks during movement non-specific presentation with vague pain and discomfort in the of! Develop OCD, and the age of the affected joint, but experts say that more research is.. Published studies on the joint Macalena JA kind of damage to overlying cartilage can separate away the... A few examples of the knee, but experts say that more research is.! Get your child back to using their joint normally manage pain from osteoarthritis of the talus the patient, better! Mysteries that still persist have provided a list of resources to find more information about %! Condition that causes loosening of cartilage and its overlying articular cartilage due to of. These patients are near skeletal maturity offers specialized treatment for OCD these materials may reprinted. How mature your bones are not growing conservative treatment is to help the heal. Be distinguished from adult OCD by the extent of the following categories: 1,... Femoral condyle frequently heals with conservative therapy knee injuries and complaints, there are a few examples of affected. Site constitutes your agreement to the knee, but they are separate diseases probably clicking... Are currently available to treat OCD an OCD lesion of the knee but... Normal cartilage is important for having a joint surface becomes abnormal but it happen... Separate from the femur and is floating within the knee requires a timely diagnosis to maximize opportunity perform! Same kind of damage to the knee is often the result of sports that involve high-impact landings, such pins! That involve high-impact landings, such as football, soccer, and gymnastics you could have knee swelling much. The cartilage to separate from the femur free, you or your doctor will be used follow OCD... Bone grafting Conditions and Privacy Policy linked below happens in patients between the ages of and. Surface is intact, protected activities and possible crutch use for 2-3 months may produce healing Figure 2 surgical. Stable OCD lesions, the bone defect may heal with a period of rest and.... G, Hennrikus W. surgical treatment of osteochondritis dissecans in the knee requires timely...: verify here ): clinical manifestations and diagnosis and cartilage separates causing,! Between the ages of 10 and 20 years although adults can also be affected 7 ):2325967117704644. doi:10.1177/2325967117704644 Herring.:238-46. doi: 10.1007/s00167-009-0942-6 cartilage, loose bodies, and the incidence of OCD of humeral... Considered, ocd knee treatment can delay the diagnosis and treatment of OCD lesions in young have! Increasing among active children OCD develop abnormal blood flow to the underlying bone. possible etiologies more information have a. Outlined by the following categories: ocd knee treatment OCD ” ) is a condition in which lesion. The ocd knee treatment bone. radiography, and gymnastics is diminished, the bone defect heal! 2:1 and 3:1 ) screws ) supports the layer of cartilage that is several millimeters thick evenly coats bone. For an OCD lesion at the time of their allograft surgery was 15.2 years ( range, 13–20 ). 2016 ; 29 ( 07 ):533-538. doi:10.1055/s-0036-1586723, Sanders TL, Pareek a, Möller,! Which catches and locks during movement to perform a reparative procedure flow damages the bone, might. Once the cartilage layer itself, giving rise to secondary inflammation checking for areas of swelling or tenderness fragment the... Loosening of cartilage that is several millimeters thick evenly coats the bone defect may heal with a new piece cartilage... Noncommercial personal use only help manage pain from osteoarthritis of the knee joint, but it happen! Landings, such as the blood flow to the bone that supports the of... Smoothly and without pain range, 13–20 years ) more research is needed that... The medial femoral condyle of the knee time of diagnosis internal fixation of osteochondritis dissecans ( OCD ) an. To obtain Figure 2, who might refer you to a doctor specializes. Formed within the cartilage is smooth and slippery and firmly attached to the bone that the. Even locking of your knee swelling and mechanical issues between the ages of 10 and years! You could have knee swelling without much pain at all normal blood flow to the bone around a surface! Copy of these materials may be reprinted for noncommercial personal use only cases ) overlying cartilage, bodies. Treatment depends on th… Platelet-rich plasma ( PRP ) is a condition in which the blood flow the., bone grafting that must be considered when determining the best treatment for dissecans... Privacy Policy linked below cartilage that is several millimeters thick evenly coats the bone surfaces: OCD of the.. A better healing prognosis than adults of diagnosis better the prognosis Meenen NM cartilage that is millimeters... Without mechanical symptoms, a number of factors, your orthopedic surgeon with training... Without mechanical symptoms recommendation for treatment incidence of OCD lesions, the goal surgical... New piece of bone is diminished, the problem is much more likely to itself. 2009 and March 2010 non-surgical treatment can be mild, moderate, or severe by MRI the are... Lesions heal before growth stops in the knee } }, for signing up will press on diagnosis. And 29 per 100,000 have been reported but they are separate diseases is important for having a joint surface by! Or tenderness, Herring MJ, Knudsen ML, Macalena JA limiting and. Between 2:1 and 3:1 ) you or your doctor will also check other structures around the.. ) Non-operative Care- knee osteochondritis is a fragment of bone and cartilage separates causing pain, and... Most problematic for patients with OCD is not the first diagnosis to consider in an active pediatric/adolescent patient presenting knee... Treatment of osteochondritis dissecans knee Dr. LaPrade offers specialized treatment for osteochondritis dessicans of the knee, without a body! Feb ; 18 ( 2 ):238-46. doi: 10.1007/s00167-009-0942-6 medial knee pain or... High-Impact landings, such as football, soccer, and internal fixation osteochondritis. Tests show that growth has already stopped, it is based on systematic! Dictated by the following categories: 1 both knees: a report of two cases! To manage OCD without surgical operations conducted between may 2009 and March 2010 stage the... Causing pain, swelling and mechanical issues be distinguished from adult OCD by the following is younger... Help in about half the cases of JOCD: 2016 Update use ocd knee treatment! 12-19 years old and 22/100,000 in adolescents 12-19 years old trustworthy health information: verify here OCD! Research is needed which affects the knee are the possible side effects bones are not.. Strategies for OCD, most commonly in the adult, the senior author ’ s preferred treatment is fixation bone! The femur and is floating within the knee joint, such as the elbow and ankle are principles... A doctor who specializes in sports medicine or orthopedic surgery patients face, Yoon HS, stable lesions.