However, studies by Aichroth 1,2 have presented clinical and experimental evidence to suggest that . There was no evidence of exposed bone. Clinically, the patient remained unable to fully extend her right leg. Copyright 2011 Arthroscopy Association of North America. Accessed Aug. 8, 2018. X-rays almost always show this lesion. I am a soccer player that plays at a very high level. Clipboard, Search History, and several other advanced features are temporarily unavailable. Recover From Knee Surgery Like a Champion! 8600 Rockville Pike Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. J Am Acad Orthop Surg. Neurologic examination revealed symmetric reflexes with normal sensation and strength. Osteochondritis dissecans (OCD) in a young athlete Dr. David Geier is an orthopedic surgeon and sports medicine specialist in Charleston, South Carolina and Charlotte, North Carolina. Osteochondritis dissecans (OCD) is the end result of the aseptic separation of an osteochondral fragment with the gradual fragmentation of the articular surface and results in an osteochondral defect. Osteochondritis dissecans (OCD) of the humeral capitellum is an increasingly recognized condition diagnosed in young, active patients that involves disruption of the subchondral bone and articular cartilage, resulting in pain and dysfunction. X-rays showed an area of lucency around an oval bony fragment measuring about 1 cm on the superior aspect of the humeral head. Other than the "clean out" surgery, each of these procedures will require a prolonged period of recovery. A prospective clinical study used joint scintigraphy to investigate conservative treatment of juvenile osteo chondritis dissecans (JOCD) of the femoral condyle and found that based on specific indications for failure of conserva tive treatment, 50% of these patients failed and under went surgery. Through the stories of a dozen athletes whose injuries and recovery advanced the field (including Joan Benoit, Michael Jordan, Brandi Chastain, and Tommy John), Dr. Geier explains how sports medicine makes sports safer for the pros, amateurs, student-athletes, and weekend warriors alike. This content does not have an English version. 1987 Mar-Apr;125(2):194-200. doi: 10.1055/s-2008-1044914. Would you like email updates of new search results? Early in the disease process, the main complaints are dull pain or soreness and swelling. . Attempts may be made to "patch" the bald spot in the bone, though these procedures are usually performed on much younger people. Recommended Products and Resources In this Ask Dr. Geier column, I answer the question of a 17-year-old soccer player with a challenging knee problem osteochondritis dissecans. Learning the proper mechanics and techniques of their sport, using the proper protective gear, and participating in strength training and stability training exercises can help reduce the chance of injury. Encouraging mid-term outcomes for arthroscopic autologous osteochondral transplant (OAT) in capitellum osteochondritis dissecans (OCD). There might be a genetic component, making some people more inclined to develop the disorder. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 2019 Oct;27(10):3291-3296. doi: 10.1007/s00167-019-05568-2. Dr. David Geiers Amazon Influencer store, Tips For Choosing the Perfect Orthopedic Surgeon For You, Ask Dr. Geier: Overuse and Degenerative Knee Injuries. They will need to take a break from high-impact sports while they heal. Last day on crutches, surgery 1! This program offers a comprehensive Q&A collection on arthritis, cartilage injuries, plica syndrome, patellofemoral pain, prepatellar bursitis and more. Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. The cause of osteochondritis . Conclusions: Am J Sports Med. HHS Vulnerability Disclosure, Help Ask Dr. Geier Is surgery necessary for a meniscus tear? TLDR. author = "Chau, {Michael M.} and Tompkins, {Marc A.}". The medical team may not be aware of the multiple ways that a rare disease can change the quality of life of the patient and family. 2021 Dec;13(1_suppl):1380S-1401S. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. Mayo Clinic, Rochester, Minn. Aug. 8, 2018. Presenting complaints often include subtle and vague knee discomfort. THE SITE MAY OFFER HEALTH, FITNESS, NUTRITIONAL AND OTHER SUCH INFORMATION, BUT SUCH INFORMATION IS DESIGNED FOR EDUCATIONAL AND INFORMATIONAL PURPOSES ONLY. All OCD lesions evident on radiographs should be staged for stability with MRI. Your child may also have: The signs and symptoms of osteochondritis dissecans can resemble those of other overuse injuries. American Academy of Orthopaedic Surgeons. If a period of no weight-bearing does not cause the lesion to heal, the surgeon can occasionally drill small holes into the bone arthroscopically to stimulate blood flow into it. Copyright 2011 Arthroscopy Association of North America. Despite much speculation, the cause of both juvenile and adult osteochondritis dissecans remains unclear. The patient's menses were regular and had started when she was 12 years of age. and transmitted securely. While the majority of patients respond to conservative treatment, those with unstable lesions require arthroscopic management. Following surgery, range-of-motion exercises should be initiated early. Anteroposterior films alone may miss a lesion on the posterior aspect of the medial femoral condyle.1 If a lesion is noted, the contralateral knee should also be examined. Osteochondritis dissecans of the talus: diagnosis and treatment in athletes Clin Sports Med. MRI has a 97 percent sensitivity for detecting unstable lesions.12 Short of direct visualization, MRI is the most accurate method for staging lesions and is critical for clinical management.13 Stages I and II are stable lesions, while stages III and IV describe unstable lesions in which not only is the cartilage breached, but synovial fluid exists between the fragment and underlying bone (Table 1). Osteochondritis dissecans (OCD) of the elbow is an avascular necrosis of the articular cartilage and underlying subchondral bone that occurs in the capitellum. These loose pieces are sometimes called "joint mice" or "loose bodies.". Please note that as an Amazon Associate I earn from qualifying purchases. Three years later, he was drafted by a team in the Ontario Hockey League. Had a bone graft at the age of 11. ALLEN L. HIXON, M.D., AND LISA M. GIBBS, M.D. All rights reserved. Arthroscopy2011;27(7):986-993. Is there any difference between open and arthroscopic treatment for osteochondritis dissecans (OCD) of the humeral capitellum: a systematic review and meta-analysis. Laskowski ER (expert opinion). One study noted that boys are three to four times as likely to be affected as girls.3 The incidence appears to be increasing in women2 and in younger children,1 perhaps because of increasing involvement in organized sports. Copyright 2023 Dr. David Geier Enterprises, LLC. I was told it was everything from "growing pains" to "Osgood-Schlatters" to (my favorite) "it's all in your head." Osteochondritis Dissecans of the Knee in Young Athletes. DOI: 10.1016/j.csm.2014.01.003 Corpus ID: 22904155; Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. Treatment of osteochondritis dissecans of the humeral capitellum with a fragment fixation method using absorbable pins. The Sports Ultrasound Clinic uses innovative technology to diagnose injuries of the joints, ligaments, and muscles. Any suggestions? Research output: Contribution to journal Review article peer-review. Epub 2018 Jan 18. JSES Int. The included studies had low methodologic quality and showed satisfactory results regarding pain, return to sports, and elbow function. In the office, the sports medicine physician will perform a physical examination. In the circumstances where the lesion does not seem to be healing but is still in place with intact cartilage, the surgeon can drill holes into the lesion to try to stimulate healing. More aggressive intervention is indicated in older symptomatic patients.3, Nonsurgical management includes observation. Arthroscopic surgery in athletes with osteochondritis dissecans of the elbow. Learn what your knee injury could be and find treatment options even if you have no medical knowledge and have looked everywhere for answers with no luck! It may be caused by multiple factors, including repetitive stress, local ischemia, aberrant endochondral ossification of the subarticular physis, and hereditary disposition. 393. OCD has typically been known to affect males between 10 and 20 years of age. They will also test the range of motion of the joint. Arthritis makes it hard for many people to perform their jobs. The 9 selected articles were criticized by use of a quality assessment tool derived from the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. 393. Bookshelf Centre for Reviews and Dissemination (UK), York (UK). Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. The doctor will check for pain along the affected joint line and may order an x-ray or MRI to help them see the joint. Information on diseasemaps.org is reported by users and is not medical advice. Arthroscopic surgery in athletes with osteochondritis dissecans of the elbow, Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet], Centre for Reviews and Dissemination (UK). OCD is a relatively rare disorder,. If the OCD lesion starts to break free but it is still in place, the surgeon might try to fix the lesion in place with pins or screws. Often the exam is unremarkable unless there is a loose piece to catch within the joint. Osteochondritis dissecans can increase your risk of eventually developing osteoarthritis in that joint. Athletic Performance in the National Basketball Association After Arthroscopic Debridement of Osteochondral Lesions of the Talus. Acta Belg Med Phys. 2010 Sep;18(9):557-67. doi: 10.5435/00124635-201009000-00007. Disclaimer. The .gov means its official. Low-level persistent or intermittent pain is usually poorly localized and worsens with weight bearing.4 On examination, effusions, crepitus2 and joint line tenderness may be present. If OCD of the knee is suspected, anteroposterior, lateral and tunnel-view (knee in flexion) radiographs are indicated. Also read: Epub 2015 Jul 31. Patients with OCD of the knee may walk with an external tibial rotation, and Wilson's sign may be positive.1 The latter is elicited by flexing the knee to 90 degrees, internally rotating the tibia and extending the knee slowly, watching for a painful response.3. Views of the other knee were obtained to rule out contralateral involvement and were normal. Nonoperative treatment is typically attempted for patients with open physes, stable lesions, and minimal symptoms. Before The goal of activity modification is to allow symptom-free activities of daily living.1 Physical therapy may be initiated, including stretching and range-of-motion exercises. In the adult form, therapy is aimed at preserving function and preventing the development of early degenerative osteoarthritis.3, Factors such as location of the lesion, relationship to weight-bearing surface, stability, physis closure and clinical presentation should be considered. UR - http://www.scopus.com/inward/record.url?scp=85139284706&partnerID=8YFLogxK, UR - http://www.scopus.com/inward/citedby.url?scp=85139284706&partnerID=8YFLogxK, Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V, We use cookies to help provide and enhance our service and tailor content. He said arthroscopic surgery might help, but had no guarantee. When symptoms of inflammation set in, the affected joint feels painful and tight. 2018 Dec 19;6(12):2325967118815846. doi: 10.1177/2325967118815846. It may be caused by multiple factors, including repetitive stress, local ischemia, aberrant endochondral ossification of the subarticular physis, and hereditary disposition. journal = "Clinics in Sports Medicine", Osteochondritis Dissecans of the Knee in Young Athletes, https://doi.org/10.1016/j.csm.2022.06.001. Various tests may be used to confirm the osteochondritis dissecans diagnosis. As an active adolescent, she enjoyed basketball and soccer, although on further questioning she admitted having vague knee pain for several months that had prevented her from playing as vigorously as she wished. Early return to school appears better for kids who suffer a concussion, 391. https://orthoinfo.aaos.org/en/diseases--conditions/osteochondritis-dissecans. If the lesion is particularly large, he might take a cylinder of bone and cartilage from a donor (osteochondral allograft) and place it into the defect. Children with osteochondritis dissecans should receive medical treatment right away. A magnetic resonance imaging (MRI) scan of the right knee was obtained to evaluate for chondral disruption. This checklist can help you plan your next step to recover quickly and safely. Historically, immobilization has been encouraged; however, prolonged splinting leads to quadriceps atrophy and stiffness, which may complicate the condition.5 Persistent symptoms in a compliant, conservatively treated patient or the onset of joint catching or grinding suggest detachment, with the development of a loose body, and are an indication for arthroscopic evaluation.1. He has been featured in major media publications and shows over 2,500 times throughout his career. THE SITE IS NOT RESPONSIBLE FOR ANY ACTIONS OR INACTION ON A USERS PART BASED ON THE INFORMATION THAT IS PRESENTED ON THE SITE. Osteochondritis dissecans of the knee is a relatively rare disorder in young athletes that can lead to premature osteoarthritis. 1985 Jan-Feb;5(4):165-85. doi: 10.1177/107110078500500403. Learn what your knee injury could be and find treatment options even if you have no medical knowledge and have looked everywhere for answers with no luck! It may be caused by multiple factors, including repetitive stress, local ischemia, aberrant endochondral ossification of the subarticular physis, and hereditary disposition. Imaging studies are indicated for evaluation of clinical deterioration. eCollection 2018 Dec. Arthroscopic fragment fixation using hydroxyapatite/poly-L-lactate Acid thread pins for treating elbow osteochondritis dissecans. Federal government websites often end in .gov or .mil. Toy and Eric J. 2019. Girls younger than 11 years of age and boys younger than 13 years of age have an excellent chance of resolution, while patients over 20 years of age tend to have poorer outcomes, and the likelihood of requiring surgical intervention is increased.1 Unstable lesions (stages III and IV) in patients with a closed physis have a particularly poor prognosis. Recommended Products and Resources The cause of osteochondritis dissecans is unknown. Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. Osteochondral lesions of the talus can be associated with injury to the ankle.
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