The problem occurs where the cartilage of the knee attaches to the bone underneath. 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. An autograft is a procedure for grafting tissue from the patient’s own body. A lesion of the cartilage and bone due to necrosis and loss of continuity of the underlying bone. Eventually, there is too much pain to put full weight on that knee. These tests are important because Dr. Kiritsis needs to know the exact location and the size of the lesion to determine what kind of surgery will work best. If there is no improvement in the X-rays or the symptoms, then surgery may be beneficial. Even in JOCD, surgery may eventually be required. You may be asked to walk, move, or stretch your knee. When, for example, repetitive trauma results in a blood supply injury or blunt injury to this growth cartilage, then the bone can either fail to develop from the original cartilage, or the maturing bone dies, softens and collapses. At first, emphasis is placed on exercising the knee in positions and movements that don’t strain the healing part of the cartilage. Dr. Kiritsis has seen excellent results with this surgery and has seen many athletes return to their pre-injury level of activity. OCD is most common in people between the ages of 10 ... was trained at Harvard University in internal medicine and orthopaedic surgery and at Stanford University in general surgery. Without blood flow, the area of damaged bone actually dies. Range-of-motion and stretching exercises are used to improve knee motion. Osteochondritis dissecans, often called OCD for short, is a condition that causes loosening of cartilage and its supporting bone. OCD most often occurs in the knee joint, although it can also occur in other joints including the ankle and the elbow. Medical Website Design by PBHS © 2020 • Non-Discrimination Notice, Orthopedic Surgeon Paul Kiritsis Treats Injuries and Disorders of the Shoulder and Knee in Midlothian VA, ACL Reconstruction with Hamstring Autograft, ACL Reconstruction with Patellar Tendon Autograft, Glucosamine and Chondroitin Sulfate for Osteoarthritis of the Knee, Viscosupplementation for Osteoarthritis of the Knee, Post-Operative Instructions: Shoulder Surgery, Post-Operative Instructions: Knee Surgery, A Patient’s Guide to Osteoarthritis of the Knee, A Patient’s Guide to Articular Cartilage Problems of the Knee. The cases of OCD that are first diagnosed in early adulthood probably began as JOCD. In this case, bone material is transplanted into the hole left in the bone. The highest rates of OCD appear among patients between 10 and 15 years old, ranking among the most common causes of knee pain and dysfunction in teenagers.5,30,35 The prevalence of OCD is estimated at 15 to 21 per 100 000.27 Lesions most fre-quently occur … When the lesion has become so bad that it detaches totally or partially from the bone, nonsurgical treatment will not work. It most commonly affects the knee joint (75% of cases). I am a 23 year old male, about to be 24 on july 9th, and this had been a problem I have been dealing with since Jan 22nd of this year. The area of bone just under the cartilage surface is injured, leading to damage to the blood vessels of the bone. But they can be very successful in returning function to the knee. The MRI will tell us the true size of the lesion, location of the lesion, and demonstrate evidence of potential looseness. The goals of treatment for Osteochondritis Dissecans are to reduce pain, restore the continuity of the articular surface, and decrease the likelihood of future degenerative joint disease (osteoarthritis). OCD Lesion – Knee Arthroscopy with Cartilage Repair and Regeneration. Even with the treatment, some patients continue to have symptoms or their bone scans show signs that the damage is getting worse. The purpose of this clinical practice guideline is to help improve … The goal is to help the lesions heal before growth stops in the thighbone. The OCD lesion can remain in contact with the adjacent bone, maybe partially separated or completely separated. When this happens, JOCD develops into OCD. This may reduce the time needed for your recovery. When these problems develop, your Dr. Kiritsis may suggest surgery. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. Most OCD lesions will show up on an X-ray of the knee. Even with surgery, OCD usually leads to future joint problems, including osteoarthritis. This requires a period of activity modification and even bracing or casting during this rest period. Usually, the donor site for this procedure is on the joint surface of the injured knee. In order to do that, the bone must be healthy and have enough blood supply. It involves using cartilage cells (chondrocytes) to help regenerate articular cartilage. The summation of these MRI findings may be predictive of OCD progression or ability to heal without surgery. Stable lesions will be left alone to heal, although unstable lesions may be surgically fixed back in place. AthletiCo Bulls' Injury Report. Exercises are chosen to help improve knee motion and to get the muscles toned and active again. This can cause a snapping or catching feeling as the knee joint moves across the notched area. An arthroscopic surgery may be done to make small drill holes in the healthier bone around the OCD to improve the blood supply However, even though it was first described in 1888 by German surgeon Franz König, osteochondritis dissecans (OCD) of the knee remains an enigma. As the program evolves, more challenging exercises are chosen to safely advance the knee’s strength and function. In the world of childhood knee injuries and complaints, there are few mysteries that still persist. Osteochondritis dissecans ( OCD ) can occur in different joints, including the … Doing exercises in a pool can help you stay limber and fit while protecting the knee during this period. In this case, Dr. Kiritsis grafts a small amount of bone (osteo) and cartilage (chondral) from the donor site to put into the lesion. These symptoms are fairly common in athletes. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). Sometimes JOCD is not treated or does not heal completely. Osteochondritis Dissecans (OCD) of the knee is an acquired, reversible, idiopathic condition of the subchondral bone. This means stopping exercise and sports. If I have an OCD of my knee, what is the chance that I will have an OCD of another joint? Patients often work with physical therapists to develop an exercise program. The savviest of surgeons will take into consideration the age of the child, activity level and the radiographic findings. There is less of a link between strenuous, repetitive use and OCD. And the bone around the fragment has often changed in ways that mean Dr. Kiritsis will need to rebuild it. Weight bearing is usually restricted for up to four months after transplant procedures. The therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program. Related Document: A Patient’s Guide to Knee Anatomy. See osteochondritis dissecans article for a general discussion. The shoulder and elbow are more commonly affected. Share on Pinterest OCD can cause pain and discomfort in the knee and other joints. Any loose bodies and bo… The term OCD was first used by Koenig to explain the late formation of loose bodies in the knee joint. The authors' preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. OCD can occur any time from early adulthood on, but most patients are adults under age 50. A joint surface damaged by OCD doesn’t heal naturally. This means that the problem area is under constant stress and doesn’t get time to heal. If OCD of the knee is suspected, AP, lateral, notch-view (knee in flexion) and skyline patella xrays should be ordered. The exercises should be done carefully and should not cause any pain. Many people who develop OCD don’t have any particular risk factors. When these treatments work, the knee seems as good as new, and the JOCD doesn’t seem to lead to arthritis. What is osteochondritis dissecans (OCD)? OCD and JOCD cause the same symptoms. Recovery and surgery for an OCD lesion of the knee. These tests may help determine the extent of damage from OCD and JOCD, and they also help rule out other problems. 2. Signs and symptoms. The therapist’s goal is to help you keep your pain under control, ensure safe weight bearing, and improve your strength and range of motion. The cause is currently unknown but it may lead to damage to overlying cartilage, loose bodies, and joint damage. Osteochondritis Dissecans of Knee (OCD) What is osteochondritis dissecans (OCD)? Even then, people sometimes end up with problems around the donor site. Your therapist may issue shock-absorbing shoe insoles to reduce impact and protect your knee joint. Posted December 15, 2008. How does Dr. Kiritsis treat the condition? Osteochondritis dissecans (OCD) most commonly affects the knee. The femoral condyle is the rounded end of the lower thighbone, or femur. He will then examine the painful knee by feeling it and moving it. 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). Very rarely it affects articula… Both problems usually start with a mild aching pain. Midlothian Orthopedic Surgeon, Dr. Paul Kiritsis, is dedicated to providing you with a pleasant visit. As the condition becomes worse, the area of bone that is affected may collapse, causing a notch to form in the smooth joint surface. He loves discussing and writing about sports & exercise injuries, and has been featured in major media publications over … OCD is a type of osteochondrosis in which a lesion has formed within the cartilage layer itself, giving rise to secondary inflammation. With the exception of arthroscopic removal of a loose body, patients are instructed to avoid putting too much weight on their foot when standing or walking for up to six weeks. This gives the area time to heal. The aforementioned 2012 study in The Journal of Bone and Joint Surgery assessed the clinical outcomes of these five different surgical techniques in patients affected by OCD of the knee… When you are well under way, regular visits to your therapist’s office will end. The OCD lesion can remain in contact with the adjacent bone, maybe partially separated or completely separated. Treatment options are largely dependent upon the age of the patient and the position and stability of the lesion: During surgery the knee specialist will examine the knee joint surface. In rare cases, the lesion must be removed from a weight-bearing area. Dr. Kiritsis is careful to take the graft from a spot that won’t cause a lot of problems, usually on the top and outside border of the knee cartilage. The review was conducted between May 2009 and March 2010. Even with surgery, OCD often requires a long period of rest from sports to allow for healing. Once your treating physician confirms that an OCD is present on X-ray, and that there is no evidence to suggest a second diagnosis as the source of pain, treatment should begin with further diagnostic evaluation and rest. The place where the graft is taken is called the donor site. Moving the knee becomes painful, and it may be swollen and sore to the touch. The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. In the elbow, it affects the capitellum of the humerus and, in the ankle, it affects the talar dome. Many cases of JOCD can be completely healed with careful treatment. When, for example, repetitive trauma results in a blood supply injury or blunt injury to this growth cartilage, then the bone can either fail to develop from the original cartilage, or the maturing bone dies, softens and collapses. The doctor says I have a 19mm indentation on the weight bearing portion of my knee. Introduction. Osteochondritis Dissecans (OCD) of the Knee Dr. David Geier is an orthopedic surgeon and sports medicine specialist in Charleston, South Carolina. OCD is a radiologic diagnosis. Call Paul Kiritsis, MD Phone Number 804-379-2414 with any questions or to make an appointment. In the child who is still growing, the problem is much more likely to heal itself. They may require a walker or pair of crutches for up to six weeks to avoid putting too much pressure on the joint when they are up and about. The goal of nonsurgical rehabilitation is to help you learn ways to protect the injured area of cartilage while improving knee motion and strength. For this reason, the treatment and prognosis of OCD and JOCD can be very different. Nonsurgical treatment of JOCD can take from 10 to 18 months. How does Dr. Kiritsis identify this problem? This may hurt, but it is important that Dr. Kiritsis knows exactly where and when your knee hurts. Some patients who are too near the end of bone growth may not benefit with nonsurgical treatment. came across ur ocd knee post and am kinda looking for some questions if u don't mind. You will also be shown strengthening exercises for the hip and knee to help steady the knee and give it additional protection from shock and stress. If the OCD does not heal or if it is unstable, surgery will be recommended. The next test is a magnetic resonance imaging (MRI). The condition can be mild, moderate, or severe. Children as young as nine or ten can develop this condition. If the lesion becomes totally or partially detached, surgery is needed to remove the loose body or to fix it in place. In the adult, the bones are not growing. 1. The American Academy of Orthopaedic Surgeons (AAOS) approved this clinical practice guideline on December 4, 2010. It is based on a systematic review of published studies on the diagnosis and treatment of osteochondritis dissecans (OCD) of the knee. OCD mostly affects the femoral condyles of the knee. This technology looks promising for treating JOCD and OCD but is still very much experimental. i just had surgery on my knee for ocd mine is 2.9cm by 1.8cm the doctor made the same cuts to my knee 2 small ones and one big one half way down my knee its like 2inches long. Download a Guide to our Knee-Saving Procedures. This is one cause of degenerative arthritis and osteoarthritis. Dr. Kiritsis will need to gather lots of information about your knee and your problem before surgery. Like most joint surfaces, the femoral condyles are covered in articular cartilage. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). This may include new X-rays, MRI scan or a bone scan if your symptoms warrant additional testing. In some cases, other muscle or bone problems can cause extra stress and contribute to JOCD. Dr. Kiritsis will have you work with a physical therapist for four to six to twelve weeks. If a lesion is seen the contralateral knee should also be xrayed. My doctor preformed the OATS (osteoarticular transfer system) procedure on July 1st. Nonsurgical treatments help in about half the cases of JOCD. Articular cartilage is a smooth, rubbery covering that allows the bones of a joint to slide smoothly against one another. The knee may catch or lock when it is moved if the loose body gets in the way. But the disease behaves much differently in children and for this reason is given a separate name, juvenile osteochondritis dissecans (JOCD), meaning osteochondritis dissecans of children. Each knee has two femoral condyles, referred to as the medial femoral condyle (on the inside of the knee) and the lateral femoral condyle (on the outside). This loose body may float around inside of the knee joint. This may require additional X-rays, or MRIs. Dr. Kiritsis may also use an arthroscope, a tiny camera inserted into the knee to look at your knee before doing surgery to fix the problem. If you have surgery, Dr. Kiritsis may have you use a continuous passive motion (CPM) machine after surgery to help the knee begin to move and to alleviate joint stiffness. The lesions usually occur in the part of the joint that holds most of the body’s weight. During that time, it is crucial to stop doing everything that causes pain to the knee. Dr. Kiritsis will order an X-ray of your knee. You may be advised to avoid heavy sport or work activities for up to eight weeks. For unstabl … This guide will help you understand 1. where in the knee the condition develops 2. how doctors diagnose the problem 3. what treatment options are available As a result, within joints such as the shoulder, elbow, knee, and hock (ankle), a flap of cartilage can develop causing lameness. Dr. Kiritsis may use tiny metal pins or screws to hold the fragment in place. OCD of the knee is thought to be bilateral, or in both knees, about 1 out of 4 times. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. Could you please tell me how long the recovery time would be for the surgery because … As knee symptoms ease, exercises can be started that don’t involve placing weight through your foot. © 2020 Rady Children's Hospital–San Diego, OCD of the Knee May Require Rest or Surgery, COVID-19 Updates: Latest Information for Parents. Patients are strongly advised to follow the recommendations about how much weight is safe. The damage to the joint surface affects the way that the joint works. This video demonstrates the treatment of an unstable osteochondritis dissecans (OCD) lesion of the knee. OCD and JOCD cause the same kind of damage to the knee, but they are separate diseases. Dr. Kiritsis may try to fill in the hole using an allograft. This sometimes proves difficult. The cartilage over this dead section of bone (the lesion) may become damaged. It may require using crutches or wearing a brace for a couple of months when symptoms are present. Osteochondritis dissecans (OCD) is a disease that originates in the subchondral bone that affects the articular cartilage. If the arthroscope can be used, the procedure requires smaller incisions than for an open surgery. Dr. Kiritsis may want to reevaluate the knee and may suggest additional tests if your symptoms change. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. The elbow and ankle are the next most common joints affected. A lesion of the cartilage and bone due to necrosis and loss of continuity of the underlying bone. Hello, I am 14 years old, a freshman in high school, and am a Track and Cross Country runner. Dr. Kiritsis will ask many questions about your medical history. Because OCD leads to damage to the surface of the joint, the condition can lead to problems with bone degeneration and osteoarthritis. Surgery may include removing or fixing loose pieces, or stimulating the OCD to heal by drilling it with a small wire. The younger the patient and the smaller more stable appearing the OCD, the better the outcome and prognosis to heal. Even if imaging tests show that growth has already stopped, it is usually worth trying nonsurgical treatments. Related Document: A Patient’s Guide to Articular Cartilage Problems of the Knee. 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