Once a patient reaches maturity, these lesions rarely heal on their own. When OCD affects the knee, the most common location is within the lateral aspect of the medial femoral condyle. Osteochondritis Dissecans (OCD) of the knee is an acquired, reversible, idiopathic condition of the subchondral bone. 2 UWSPORTSMEDICINE.ORG 621 SCIENCE DRIVE • MADISON, WI 53711 4602 EASTPARK BLVD. The lesion usually occurs in the knee on the lateral and posterior aspect of the medial femoral condyle (70% of lesions are in the posterolateral aspect of the knee). Figure 2 MRI view of an OCD lesion of the knee. Osteochondritis Dissecans (OCD) is a condition that affects the articular cartilage and the subchondral bone of the knee. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. Knee Osteochondritis Dissecans (OCD) An unusual cause of knee pain is that of osteochondritis dissecans (OCD). Theories range from abnormal vascular anatomy (leading to ischemic injury of the bone), abnormal ossification of the epiphysis, trauma, endocrine imbalances or some combination of the above. Study Design: Cross-sectional study; Level of evidence, 3. OCD lesions may occur in any joint, but are most common in the knee. Adults are less … In situ fixation of lesions can be performed using various types of metallic screws, bioabsorbable implants, or osteochondral plugs. * This results in a spectrum of pathology beginning with a lesion to the bone only,… It was once believed that all OLTs progress and worsen with time. Juvenile OCD lesions have a better healing prognosis than adults. Cartilage can also come loose due to damage in the underlying bone, OCD, or osteonecrosis. Sometimes cartilage damage occurs as part of degeneration, called osteoarthritis, which is the overall loss of tissue quality that occurs with aging. Osgood-Schlatter disease This ‘traction apophysitis’ is a very common cause of knee pain in adolescent athletes. OCD Lesion: Diagnosis, Evaluation and Management - Geoffrey Van Thiel, MD (CSMS #45, 2018) Knee & Sports - Osteochondritis Dissecans The affected area of subchondral bone and its attached articular cartilage can become loose and separate into the joint. OCD starts when a small area of bone just under the knee’s smooth cartilage loses some of its blood supply. The most "classic" location for OCD lesions of the knee is the lateral aspect of the medial femoral condyle of the distal femur. Unless the lesion repairs spontaneously or it is treated, the disease process progresses. The lesion is then hinged open. By Dr. Eric W. Edmonds . In the world of childhood knee injuries and complaints, there are few mysteries that still persist. Generally, OCD seems to affect males more commonly than females (between 2:1 and 3:1). Osteochondritis dissecans is an inflammatory condition that occurs when diseased cartilage separates from the underlying bone. We did drill several holes at the base of OCD lesion prior to re-fixation. For a knee OCD lesion, your child may be placed on crutches for up to 6 weeks. Osteochondritis dissecans (OCD) is a focal lesion of the subchondral bone that can result in fragmentation, instability, and if untreated, loose body formation with progression to early degenerative changes. This will need surgery to repair. When present, OCD lesions usually become symptomatic during a child’s development. Sometimes, high impact activities, like basketball, can be difficult to play after OCD. An OCD lesion is an area within the knee where the bone underneath a small area of cartilage starts to die. Particularly in adolescent male athletes, OCD of the knee is a common source of pain, effusion, and mechanical symptoms with sporting activities. It is more common in boys and is generally bilateral. The starved bone tissue starts to weaken and crumble, and, without this scaffold to support it, the cartilage can weaken as well. Then we were able to place 3 BioComposite headless screws in a triangular type fashion. Without early treatment, the lesion can become unstable or completely detached. The knee is the location most often requiring surgery, with 58% of procedures for OCD lesions being performed on the knee. Following this, I was able to range the knee. Chapter 29 Treatment of Juvenile Osteochondritis Dissecans of the Knee Matthew Leidl, Jon K. Sekiya Juvenile osteochondritis dissecans (JOCD) is a condition in which a portion of subchondral bone and its overlying cartilage become damaged; it usually affects the knee. It is an important diagnosis to consider in an active pediatric/adolescent patient presenting with knee pain with or without mechanical symptoms. • MADISON, WI 53718 The younger you are, the better chance you have of healing the OCD and getting back to the activities you enjoy. OCD is characterized by the separation of an osteochondral fragment from its surrounding bone and cartilage tissues. lesion of the knee. Once the OCD is hinged open, the bed of the lesion is prepared. Key Points: • High-intensity T2-signal behind the progeny fragment of the OCD lesion is suggestive of instability. There is a history of trauma to the knee in 40% of patients. To determine if mechanical axis deviation correlates with OCD lesion location in the knee, if degree of mechanical axis deviation correlates with size of OCD lesion, and if the deformity was primarily in the distal femur or proximal tibia. The surgeon treated the OCD lesion by implanting a biomimetic osteochondral scaffold onto the lesion site, which was properly prepared. Various modalities and techniques exist, such as fixation, debridement, microfracture, and cartilage grafting/transplantation. Epidemiology: Incidence reported around 9/100,000 in children under 11 years old and 22/100,000 in adolescents 12-19 years old. Over time, the cartilage can fragment as well, leaving a loose piece of bone and cartilage. There was no evidence of rocking of the lesion or of catching within the knee. Patients may have an OLT that is present and doesn't cause pain or limitations or a lesion that becomes painful but improves. OCD of the knee has a non-specific presentation with vague pain and swelling. Theodore Ganley MD, Kevin Shea MD. This has been shown to no longer be true. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. promote OCD lesion healing, fixation methods, and salvage techniques. Sometimes it is necessary to incise the overlying cartilage to liberate the lesion. The lesion, which has multiple causes, has a loss of blood supply to a small portion of the bone. 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. Cartilage damage is most frequently seen between the ages of 15 and 30 or above the age of 50. The ankle OCD lesion is rare in the pediatric population, mainly occurring in adults with the average age being 21 years of age. Diagnosis can be made with plain radiography, and the lesion can be further characterized by MRI. OCD of the Knee May Require Rest or Surgery. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. If OCD of the knee is suspected, AP, lateral, notch-view (knee in flexion) and skyline patella xrays should be ordered. For unstable yet salvageable OCD lesions, the senior author’s preferred treatment is fixation with bone grafting. The authors’ preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. In these cases, no additional treatment is necessary. After a clinical examination of the knee with the patient under anesthesia and a formal arthroscopic evaluation of the knee, the OCD lesion is identified. An osteochondritis dissecans, or OCD, knee injury usually occurs when there is an underlying OCD lesion which was asymptomatic and it becomes symptomatic due to an injury or just because the lesion did not heal and it eventually falls off the bone. 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