These symptoms are fairly common in athletes. See osteochondritis dissecans article for a general discussion. Recovery and surgery for an OCD lesion of the knee. 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 degenerative arthritis and osteoarthritis. Like most joint surfaces, the femoral condyles are covered in articular cartilage. Even if imaging tests show that growth has already stopped, it is usually worth trying nonsurgical treatments. For this reason, the treatment and prognosis of OCD and JOCD can be very different. Even with surgery, OCD usually leads to future joint problems, including  osteoarthritis. There are two methods of treating JOCD: nonsurgical treatment to help the lesions heal, and surgery. A joint surface damaged by OCD doesn’t heal naturally. Children with the better prognosis can be treated conservatively at first. The damaged fragment often doesn’t fit perfectly into the bone anymore. This means that the problem area is under constant stress and doesn’t get time to heal. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. Osteochondritis dissecans (OCD) is a disease that originates in the subchondral bone that affects the articular cartilage. Some patients may be encouraged to modify their activity choices, especially if an allograft was used. They are similar to the symptoms of sprains, strains, and other knee problems. Osteochondritis dissecans (OCD) most commonly affects the knee. Open surgery is needed when Dr. Kiritsis can’t get a picture of the entire lesion, when it is unclear how the fragment would best fit into the bone, or when it would be too difficult to replace the fragment using the arthroscope. AP films alone may miss a lesion on the posterior aspect of the medial femoral condyle. He will then examine the painful knee by feeling it and moving it. 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. It is based on a systematic review of published studies on the diagnosis and treatment of osteochondritis dissecans (OCD) of the knee. For unstable yet salvageable OCD lesions, the senior author's preferred treatment is fixation with bone grafting. Doctors aren’t sure what causes OCD. When this happens, JOCD develops into OCD. OCD of the knee is thought to be bilateral, or in both knees, about 1 out of 4 times. 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. Allografts have risks, including graft rejection and infection. The doctor says I have a 19mm indentation on the weight bearing portion of my knee. Introduction. Very rarely it affects articula… 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. 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 AthletiCo Bulls' Injury Report. It involves using cartilage cells (chondrocytes) to help regenerate articular cartilage. The damage to the joint surface affects the way that the joint works. Even with the treatment, some patients continue to have symptoms or their bone scans show signs that the damage is getting worse. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. In this case, bone material is transplanted into the hole left in the bone. Could you please tell me how long the recovery time would be for the surgery because … 3. An allograft is an actual transplant of bone and cartilage from a donor into your knee. Dr. Kiritsis has seen excellent results with this surgery and has seen many athletes return to their pre-injury level of activity. OCD will probably never completely heal, but it can be treated. Patients are strongly advised to follow the recommendations about how much weight is safe. In this case, Dr. Kiritsis grafts a small amount of bone (osteo) and cartilage (chondral) from the donor site to put into the lesion. Osteochondritis Dissecans of Knee (OCD) What is osteochondritis dissecans (OCD)? In the adult, the bones are not growing. 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. Dr. Kiritsis will have you work with a physical therapist for four to six to twelve weeks. 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. 1 Although not necessarily an inflammatory process, the name has remained throughout the literature. I plan to go out of town to see a specialist and so I can get surgery on it. Osteochondritis dissecans (OCD) is an abnormality in the development of bone from cartilage. 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. Usually, the donor site for this procedure is on the joint surface of the injured knee. These tests may help determine the extent of damage from OCD and JOCD, and they also help rule out other problems. Dr. Kiritsis will ask many questions about your medical history. If I have an OCD of my knee, what is the chance that I will have an OCD of another joint? It most commonly affects the knee joint (75% of cases). Like a machine that is out of balance, over time this imbalance can lead to abnormal wear and tear on the joint. I was recently diagnosed with OCD of the left knee. Physical therapists will also work with patients to make sure they are only putting a safe amount of weight on the affected leg. OCD most often occurs in the knee joint, although it can also occur in other joints including the ankle and the elbow. 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. As knee symptoms ease, exercises can be started that don’t involve placing weight through your foot. Even in JOCD, surgery may eventually be required. My doctor preformed the OATS (osteoarticular transfer system) procedure on July 1st. Range-of-motion and stretching exercises are used to improve knee motion. This video demonstrates the treatment of an unstable osteochondritis dissecans (OCD) lesion of the knee. The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. The place where the graft is taken is called the donor site. The cases of OCD that are first diagnosed in early adulthood probably began as JOCD. It is more common for the lesions to occur on the medial femoral condyle, because the inside of the knee bears more weight. In some cases, Dr. Kiritsis will be able to use the arthroscope to do the 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 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). Midlothian Orthopedic Surgeon, Dr. Paul Kiritsis, is dedicated to providing you with a pleasant visit. Without blood flow, the area of damaged bone actually dies. Sometimes JOCD is not treated or does not heal completely. Many cases of JOCD can be completely healed with careful treatment. About 85% of knee lesions are on the medial femoral condyle. As the condition becomes worse, the area of bone that is affected may collapse, causing a notch to form in the smooth joint surface. © 2020 Rady Children's Hospital–San Diego, OCD of the Knee May Require Rest or Surgery, COVID-19 Updates: Latest Information for Parents. In some cases, other muscle or bone problems can cause extra stress and contribute to JOCD. 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. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). 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). Exercises are chosen to help improve knee motion and to get the muscles toned and active again. Children as young as nine or ten can develop this condition. 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. What is osteochondritis dissecans (OCD)? OCD and JOCD cause the same kind of damage to the knee, but they are separate diseases. Dr. Kiritsis will need to gather lots of information about your knee and your problem before surgery. 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 … Moving the knee becomes painful, and it may be swollen and sore to the touch. Dr. Kiritsis will order an X-ray of your knee. 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. Even with surgery, OCD often requires a long period of rest from sports to allow for healing. In osteochondritis dissecans, fragments of cartilage or bone become loose within a joint, leading to pain and inflammation.These fragments are sometimes referred to as joint mice. This can cause a snapping or catching feeling as the knee joint moves across the notched area. The review was conducted between May 2009 and March 2010. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. 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. Many doctors think that JOCD is caused by repeated stress to the bone. Moreover, if the OCD is large or unstable, then surgery is a good first choice of treatment. 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. The savviest of surgeons will take into consideration the age of the child, activity level and the radiographic findings. 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. Dr. Kiritsis may try to fill in the hole using an allograft. This gives the area time to heal. Call Paul Kiritsis, MD Phone Number 804-379-2414 with any questions or to make an appointment. 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 these treatments work, the knee seems as good as new, and the JOCD doesn’t seem to lead to arthritis. The next test is a magnetic resonance imaging (MRI). If the lesion becomes totally or partially detached, surgery is needed to remove the loose body or to fix it in place. Even with surgery, OCD usually leads to future joint problems, including osteoarthritis. OCD is a type of osteochondrosis in which a lesion has formed within the cartilage layer itself, giving rise to secondary inflammation. OCD mostly affects the femoral condyles of the knee. The elbow and ankle are the next most common joints affected. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. The knee may catch or lock when it is moved if the loose body gets in the way. In the elbow, it affects the capitellum of the humerus and, in the ankle, it affects the talar dome. The American Academy of Orthopaedic Surgeons (AAOS) approved this clinical practice guideline on December 4, 2010. The bone is usually obtained from a bone and tissue bank. In rare cases, the lesion must be removed from a weight-bearing area. If the OCD does not heal or if it is unstable, surgery will be recommended. Any loose bodies and bo… But they can be very successful in returning function to the knee. As the program evolves, more challenging exercises are chosen to safely advance the knee’s strength and function. This may hurt, but it is important that Dr. Kiritsis knows exactly where and when your knee hurts. It is a process that evolves over a few years. 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. It also means that the lesions cause pain and problems when walking and putting weight on the knee. The OCD lesion can remain in contact with the adjacent bone, maybe partially separated or completely separated. There are a number of treatment options. This technology looks promising for treating JOCD and OCD but is still very much experimental. During that time, it is crucial to stop doing everything that causes pain to the knee. Most young people with JOCD have been involved in competitive sports since they were very young. Open surgery usually requires larger incisions than arthroscopic surgery to allow the Dr. Kiritsis to see into the knee and perform the operation. OCD Lesion – Knee Arthroscopy with Cartilage Repair and Regeneration. The OCD lesion can remain in contact with the adjacent bone, maybe partially separated or completely separated. A heavy schedule of training and competing can stress the femur in a way that leads to JOCD. To know more please visit http://www.hanyelrashidymd.com/ An autograft is a procedure for grafting tissue from the patient’s own body. For unstabl … This loose body may float around inside of the knee joint. Related Document: A Patient’s Guide to Osteoarthritis of the Knee. Dr. Kiritsis may want to reevaluate the knee and may suggest additional tests if your symptoms change. This may include new X-rays, MRI scan or a bone scan if your symptoms warrant additional testing. The MRI will tell us the true size of the lesion, location of the lesion, and demonstrate evidence of potential looseness. The summation of these MRI findings may be predictive of OCD progression or ability to heal without surgery. You will be asked about your current symptoms and about other knee or joint problems you have had in the past. Treatments & Surgery. The goal of nonsurgical rehabilitation is to help you learn ways to protect the injured area of cartilage while improving knee motion and strength. I have just had surgery to treat OCD (osteochondritis dissecans) of my left knee. 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. This sometimes proves difficult. 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. In some cases the dead area of bone may actually become detached from the rest of the femur, forming what is called a loose body. Once the piece has broken off, surgery is almost always necessary. The term OCD was first used by Koenig to explain the late formation of loose bodies in the knee joint. 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. Most OCD lesions will show up on an X-ray of the knee. Nonsurgical treatment of JOCD can take from 10 to 18 months. If OCD of the knee is suspected, AP, lateral, notch-view (knee in flexion) and skyline patella xrays should be ordered. When these problems develop, your Dr. Kiritsis may suggest surgery. Osteochondritis Dissecans Knee | Knee Specialist | Minnesota If the arthroscope can be used, the procedure requires smaller incisions than for an open surgery. If there is no improvement in the X-rays or the symptoms, then surgery may be beneficial. 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. OCD is a radiologic diagnosis. The MRI findings and child age play a large factor in prognosis. This means stopping exercise and sports. Eventually, there is too much pain to put full weight on that knee. The authors' preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. Ideally, patients will be able to resume their previous lifestyle activities. Doing exercises in a pool can help you stay limber and fit while protecting the knee during this period. How does Dr. Kiritsis identify this problem? The younger the patient and the smaller more stable appearing the OCD, the better the outcome and prognosis to heal. Some patients who are too near the end of bone growth may not benefit with nonsurgical treatment. Look for information on OCD, different OCD, cases & research on OCD. It may require using crutches or wearing a brace for a couple of months when symptoms are present. This is one cause of degenerative arthritis and osteoarthritis. Once the cartilage and/or bone breaks free, you will probably feel clicking, catching, or even locking of your knee. Articular cartilage is a smooth, rubbery covering that allows the bones of a joint to slide smoothly against one another. Patients often work with physical therapists to develop an exercise program. 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. Nonsurgical treatments help in about half the cases of JOCD. When a person gets OCD later in life, it is probably a brand new problem. When the lesion has become so bad that it detaches totally or partially from the bone, nonsurgical treatment will not work. 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. A decision to progress each patient to the next phase should be … Because OCD leads to damage to the surface of the joint, the condition can lead to problems with bone degeneration and osteoarthritis. Many people who develop OCD don’t have any particular risk factors. OCD and JOCD cause the same symptoms. In the world of childhood knee injuries and complaints, there are few mysteries that still persist. When you are well under way, regular visits to your therapist’s office will end. This requires a period of activity modification and even bracing or casting during this rest period. Share on Pinterest OCD can cause pain and discomfort in the knee and other joints. There is less of a link between strenuous, repetitive use and OCD. Surgery may include removing or fixing loose pieces, or stimulating the OCD to heal by drilling it with a small wire. This area of dead bone can be seen on an X-ray and is sometimes referred to as the osteochondritis lesion. This may require additional X-rays, or MRIs. You may be asked to walk, move, or stretch your knee. 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. If a lesion is seen the contralateral knee should also be xrayed. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. Weight bearing is usually restricted for up to four months after transplant procedures. As a result, within joints such as the shoulder, elbow, knee, and hock (ankle), a flap of cartilage can develop causing lameness. came across ur ocd knee post and am kinda looking for some questions if u don't mind. Posted December 15, 2008. If not, Dr. Kiritsis may suggest an MRI. Signs and symptoms. A lesion of the cartilage and bone due to necrosis and loss of continuity of the underlying bone. Osteochondritis dissecans ( OCD ) can occur in different joints, including the … The exercises should be done carefully and should not cause any pain. Osteochondritis Dissecans (OCD) of the knee is an acquired, reversible, idiopathic condition of the subchondral bone. The purpose of this clinical practice guideline is to help improve … A lesion of the cartilage and bone due to necrosis and loss of continuity of the underlying bone. Both problems usually start with a mild aching pain. Stable lesions will be left alone to heal, although unstable lesions may be surgically fixed back in place. Osteochondritis dissecans, often called OCD for short, is a condition that causes loosening of cartilage and its supporting bone. I am currently stuck at home with my leg elevated, with ice on the ace bandage. The cause is currently unknown but it may lead to damage to overlying cartilage, loose bodies, and joint damage. Osteochondritis Dissecans (OCD) of the Knee Dr. David Geier is an orthopedic surgeon and sports medicine specialist in Charleston, South Carolina. 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 symptoms start out mild and grow worse with time. The condition can be mild, moderate, or severe. In the child who is still growing, the problem is much more likely to heal itself. 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. 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). 1. Dr. Kiritsis will have his patients take part in formal physical therapy after knee surgery for osteochondritis lesions. 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. The shoulder and elbow are more commonly affected. A new technology called autologous chondrocyte implantation is currently being developed. However, there is no known link between OCD of the knee and OCD of other joints. The problem occurs where the cartilage of the knee attaches to the bone underneath. You could have knee swelling without much pain at all. 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. In order to do that, the bone must be healthy and have enough blood supply. Related Document: A Patient’s Guide to Knee Anatomy. Your therapist may issue shock-absorbing shoe insoles to reduce impact and protect your knee joint. 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. Related Document: A Patient’s Guide to Articular Cartilage Problems of the Knee. Even then, people sometimes end up with problems around the donor site. A joint surface damaged by OCD doesn’t heal naturally. OCD can occur any time from early adulthood on, but most patients are adults under age 50. This may reduce the time needed for your recovery. 2. 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 articular cartilage surface may be intact or may be breached allowing communication of the joint fluid with the bone. The goal is to help the lesions heal before growth stops in the thighbone. Dr. Kiritsis may use tiny metal pins or screws to hold the fragment in place. The goal of surgery is to get the piece of bone to heal. And the bone around the fragment has often changed in ways that mean Dr. Kiritsis will need to rebuild it. You may be advised to avoid heavy sport or work activities for up to eight weeks. 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. Surgery is usually the only effective treatment for OCD. 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. OCD lesions may occur in any joint, but are most common in the knee. Hello, I am 14 years old, a freshman in high school, and am a Track and Cross Country runner. However, even though it was first described in 1888 by German surgeon Franz König, osteochondritis dissecans (OCD) of the knee remains an enigma. He loves discussing and writing about sports & exercise injuries, and has been featured in major media publications over … The lesions usually occur in the part of the joint that holds most of the body’s weight. The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. The cartilage over this dead section of bone (the lesion) may become damaged. 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 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 femoral condyle is the rounded end of the lower thighbone, or femur. Learn more about different pediatric orthopaedic treatments, procedures and surgery. Download a Guide to our Knee-Saving Procedures. How does Dr. Kiritsis treat the condition? 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. 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