With this machine, we are able to create pictures that look like slices of the knee and see the anatomy, and any injuries, very clearly. Osteochondritis dissecans (OCD) most commonly affects the knee. However, even though it was first described in 1888 by German surgeon Franz König, osteochondritis dissecans (OCD) of the knee remains an enigma. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. The goal of nonsurgical rehabilitation is to help you learn ways to protect the injured area of cartilage while improving knee motion and strength. Share on Pinterest OCD can cause pain and discomfort in the knee and other joints. Nonsurgical treatments help in about half the cases of JOCD. What is osteochondritis dissecans (OCD)? 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. There are a number of treatment options. 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. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). 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). Like a machine that is out of balance, over time this imbalance can lead to abnormal wear and tear on the joint. OCD of the knee is thought to be bilateral, or in both knees, about 1 out of 4 times. Dr. Kiritsis will order an X-ray of your knee. Osteochondritis Dissecans (OCD) of the Knee Dr. David Geier is an orthopedic surgeon and sports medicine specialist in Charleston, South Carolina. Even in JOCD, surgery may eventually be required. The cartilage over this dead section of bone (the lesion) may become damaged. If there is no improvement in the X-rays or the symptoms, then surgery may be beneficial. It is a process that evolves over a few years. If a lesion is seen the contralateral knee should also be xrayed. 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. Dr. Kiritsis will need to gather lots of information about your knee and your problem before surgery. See osteochondritis dissecans article for a general discussion. The exercises should be done carefully and should not cause any pain. Surgery is usually the only effective treatment for OCD. This may require additional X-rays, or MRIs. You may be asked to walk, move, or stretch your knee. AP films alone may miss a lesion on the posterior aspect of the medial femoral condyle. Treatments & Surgery. During that time, it is crucial to stop doing everything that causes pain to the knee. The symptoms start out mild and grow worse with time. Patient Question: My 13 year old son has been diagnosed with OCD of the patella, although I am very confused as to what this means. Learn more about different pediatric orthopaedic treatments, procedures and surgery. An arthroscopic surgery may be done to make small drill holes in the healthier bone around the OCD to improve the blood supply The younger the patient and the smaller more stable appearing the OCD, the better the outcome and prognosis to heal. Although many surgeons feel that surgery is the more conservative treatment with less risk and improved outcomes, it is not universally accepted as the initial treatment. An allograft is an actual transplant of bone and cartilage from a donor into your knee. Osteochondritis dissecans (OCD) is an abnormality in the development of bone from cartilage. If the arthroscope can be used, the procedure requires smaller incisions than for an open surgery. Many cases of JOCD can be completely healed with careful treatment. In this case, Dr. Kiritsis grafts a small amount of bone (osteo) and cartilage (chondral) from the donor site to put into the lesion. The damaged fragment often doesn’t fit perfectly into the bone anymore. Related Document: A Patient’s Guide to Osteoarthritis of the Knee. 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. Osteochondritis Dissecans Knee | Knee Specialist | Minnesota If I have an OCD of my knee, what is the chance that I will have an OCD of another joint? There is less of a link between strenuous, repetitive use and OCD. 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. My doctor preformed the OATS (osteoarticular transfer system) procedure on July 1st. Click here for a PDF of the PT Protocol Protocol: NOTE: Time frames below are provided for reference, but should not be used as criteria to progress each patient to the subsequent phase of rehabilitation. When these problems develop, your Dr. Kiritsis may suggest surgery. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. For unstabl … The leading thought as to why knee OCD happens relates to the thin layer of growth cartilage that caps the end of long bones, such as the femur or thigh bone. OCD is a radiologic diagnosis. In the world of childhood knee injuries and complaints, there are few mysteries that still persist. OCD Lesion – Knee Arthroscopy with Cartilage Repair and Regeneration. When this happens, JOCD develops into OCD. Surgery may include removing or fixing loose pieces, or stimulating the OCD to heal by drilling it with a small wire. You will be asked about your current symptoms and about other knee or joint problems you have had in the past. The OCD lesion can remain in contact with the adjacent bone, maybe partially separated or completely separated. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur).A joint surface damaged by OCD doesn't heal naturally. The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. To know more please visit http://www.hanyelrashidymd.com/ Ideally, patients will be able to resume their previous lifestyle activities. Moving the knee becomes painful, and it may be swollen and sore to the touch. The MRI will tell us the true size of the lesion, location of the lesion, and demonstrate evidence of potential looseness. A decision to progress each patient to the next phase should be … Posted December 15, 2008. 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. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. Dr. Kiritsis may want to reevaluate the knee and may suggest additional tests if your symptoms change. 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. This requires a period of activity modification and even bracing or casting during this rest period. came across ur ocd knee post and am kinda looking for some questions if u don't mind. OCD lesions may occur in any joint, but are most common in the knee. The risk with an OCD is that the compromised segment of bone and cartilage may come loose, break away from the femur and float around inside the joint. Dr. Kiritsis may try to fill in the hole using an allograft. 1. Patients often work with physical therapists to develop an exercise program. OCD most often occurs in the knee joint, although it can also occur in other joints including the ankle and the elbow. Osteochondritis dissecans (OCD) is a disease that originates in the subchondral bone that affects the articular cartilage. 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. This gives the area time to heal. The leading thought as to why knee OCD happens relates to the thin layer of growth cartilage that caps the end of long bones, such as the femur or thigh bone. In this case, bone material is transplanted into the hole left in the bone. The condition can be mild, moderate, or severe. In the elbow, it affects the capitellum of the humerus and, in the ankle, it affects the talar dome. This sometimes proves difficult. The next test is a magnetic resonance imaging (MRI). Eric W. Edmonds, M.D., is a pediatric and adolescent orthopedic sports medicine specialist at Rady Children’s Hospital-San Diego and an assistant professor at UC San Diego. These symptoms are fairly common in athletes. This can cause a snapping or catching feeling as the knee joint moves across the notched area. The place where the graft is taken is called the donor site. The cause is currently unknown but it may lead to damage to overlying cartilage, loose bodies, and joint damage. How does Dr. Kiritsis treat the condition? In some cases, Dr. Kiritsis will be able to use the arthroscope to do the surgery. The goal is to help the lesions heal before growth stops in the thighbone. Even if imaging tests show that growth has already stopped, it is usually worth trying nonsurgical treatments. Most areas of scientific inquiry concerning the knee revolve around the major ligaments and our knowledge of these injuries is so far advanced that often the remaining questions are minor fine-tuning. Doctors aren’t sure what causes OCD. When these treatments work, the knee seems as good as new, and the JOCD doesn’t seem to lead to arthritis. Some patients may be encouraged to modify their activity choices, especially if an allograft was used. A joint surface damaged by OCD doesn’t heal naturally. A heavy schedule of training and competing can stress the femur in a way that leads to JOCD. I plan to go out of town to see a specialist and so I can get surgery on it. Introduction. Once the piece has broken off, surgery is almost always necessary. A lesion of the cartilage and bone due to necrosis and loss of continuity of the underlying bone. knee (most common) ... World Series of Surgery OCD Lesion: Diagnosis, Evaluation and Management - Geoffrey Van Thiel, MD (CSMS #45, 2018) Knee & Sports - Osteochondritis Dissecans A … 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). Your therapist may issue shock-absorbing shoe insoles to reduce impact and protect your knee joint. 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. Even with surgery, OCD usually leads to future joint problems, including degenerative arthritis and osteoarthritis. A new technology called autologous chondrocyte implantation is currently being developed. The shoulder and elbow are more commonly affected. In the child who is still growing, the problem is much more likely to heal itself. Dr. Kiritsis has seen excellent results with this surgery and has seen many athletes return to their pre-injury level of activity. In order to do that, the bone must be healthy and have enough blood supply. Usually, the donor site for this procedure is on the joint surface of the injured knee. This means that the problem area is under constant stress and doesn’t get time to heal. OCD and JOCD cause the same kind of damage to the knee, but they are separate diseases. Sometimes JOCD is not treated or does not heal completely. It is more common for the lesions to occur on the medial femoral condyle, because the inside of the knee bears more weight. This loose body may float around inside of the knee joint. In the adult, the bones are not growing. Osteochondritis dissecans, often called OCD for short, is a condition that causes loosening of cartilage and its supporting bone. 1 Although not necessarily an inflammatory process, the name has remained throughout the literature. Many doctors think that JOCD is caused by repeated stress to the bone. Exercises are chosen to help improve knee motion and to get the muscles toned and active again. This technology looks promising for treating JOCD and OCD but is still very much experimental. AthletiCo Bulls' Injury Report. Related Document: A Patient’s Guide to Knee Anatomy. The cases of OCD that are first diagnosed in early adulthood probably began as JOCD. Osteochondritis Dissecans (OCD) of the knee is an acquired, reversible, idiopathic condition of the subchondral bone. Nonsurgical treatment of JOCD can take from 10 to 18 months. The articular cartilage surface may be intact or may be breached allowing communication of the joint fluid with the bone. The American Academy of Orthopaedic Surgeons (AAOS) approved this clinical practice guideline on December 4, 2010. Even with surgery, OCD often requires a long period of rest from sports to allow for healing. The term OCD was first used by Koenig to explain the late formation of loose bodies in the knee joint. Once the cartilage and/or bone breaks free, you will probably feel clicking, catching, or even locking of your knee. This area of dead bone can be seen on an X-ray and is sometimes referred to as the osteochondritis lesion. An autograft is a procedure for grafting tissue from the patient’s own body. Osteochondritis Dissecans of Knee (OCD) What is osteochondritis dissecans (OCD)? 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. 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 … 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… You could have knee swelling without much pain at all. 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. 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. And the bone around the fragment has often changed in ways that mean Dr. Kiritsis will need to rebuild it. I was recently diagnosed with OCD of the left knee. There are two methods of treating JOCD: nonsurgical treatment to help the lesions heal, and surgery. The knee may catch or lock when it is moved if the loose body gets in the way. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. OCD is a type of osteochondrosis in which a lesion has formed within the cartilage layer itself, giving rise to secondary inflammation. OCD will probably never completely heal, but it can be treated. But they can be very successful in returning function to the knee. For unstable yet salvageable OCD lesions, the senior author's preferred treatment is fixation with bone grafting. It involves using cartilage cells (chondrocytes) to help regenerate articular cartilage. This may reduce the time needed for your recovery. He loves discussing and writing about sports & exercise injuries, and has been featured in major media publications over … If the loose bone fragment is in a weight-bearing area of your bone, Dr. Kiritsis may try to reattach it if  possible. Even with surgery, OCD usually leads to future joint problems, including osteoarthritis. The savviest of surgeons will take into consideration the age of the child, activity level and the radiographic findings. Download a Guide to our Knee-Saving Procedures. The review was conducted between May 2009 and March 2010. It may require using crutches or wearing a brace for a couple of months when symptoms are present. If OCD of the knee is suspected, AP, lateral, notch-view (knee in flexion) and skyline patella xrays should be ordered. Range-of-motion and stretching exercises are used to improve knee motion. Dr. Kiritsis will have his patients take part in formal physical therapy after knee surgery for osteochondritis lesions. Doing exercises in a pool can help you stay limber and fit while protecting the knee during this period. Both problems usually start with a mild aching pain. © 2020 Rady Children's Hospital–San Diego, OCD of the Knee May Require Rest or Surgery, COVID-19 Updates: Latest Information for Parents. 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 Hello, I am 14 years old, a freshman in high school, and am a Track and Cross Country runner. The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. The OCD lesion can remain in contact with the adjacent bone, maybe partially separated or completely separated. As knee symptoms ease, exercises can be started that don’t involve placing weight through your foot. As the condition becomes worse, the area of bone that is affected may collapse, causing a notch to form in the smooth joint surface. I am currently stuck at home with my leg elevated, with ice on the ace bandage. OCD and JOCD cause the same symptoms. Like most joint surfaces, the femoral condyles are covered in articular cartilage. 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. Allografts have risks, including graft rejection and infection. It also means that the lesions cause pain and problems when walking and putting weight on the knee. Moreover, if the OCD is large or unstable, then surgery is a good first choice of treatment. 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. Children as young as nine or ten can develop this condition. They are similar to the symptoms of sprains, strains, and other knee problems. If the lesion becomes totally or partially detached, surgery is needed to remove the loose body or to fix it in place. 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. The authors' preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. The goal of surgery is to get the piece of bone to heal. Midlothian Orthopedic Surgeon, Dr. Paul Kiritsis, is dedicated to providing you with a pleasant visit. At first, emphasis is placed on exercising the knee in positions and movements that don’t strain the healing part of the cartilage. The area of bone just under the cartilage surface is injured, leading to damage to the blood vessels of the bone.

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