Osteochondritis Dissecans Disease

BASICS

DESCRIPTION

Condition in which segment of articular and underlying subchondral bone becomes separated from surrounding bone.

System(s) affected: Musculoskeletal
Genetics: No distinct genetic pattern known
Incidence/Prevalence in USA: Unknown
Predominant age: 2 main age groups; children under 12 years old and young adults
Predominant sex: Male > Female (3:1)

SIGNS AND SYMPTOMS

Intermittent joint pain, clicking, swelling, locking, and stiffness
May be asymptomatic until the fragment detaches, then experience locking of the joint or giving way in the knee
Focal tenderness over involved part of joint
May have effusion, atrophy of supporting musculature, crepitus, decreased range of motion

CAUSES

Most widely accepted theories are:

Trauma (direct or indirect)

versus

Ischemic theory due to focal insufficiency in end-arterial blood supply leading to necrosis
Accessory growth centers that may have arterial supply disrupted, leading to typical osteochondritis dissecans lesion (unlikely)

RISK FACTORS

No apparent genetic predisposition

DIAGNOSIS

LABORATORY

No specific tests
Drugs that may alter lab results: N/A
Disorders that may alter lab results: Hypothyroidism

PATHOLOGICAL FINDINGS

Primary change in the bone
Avascular necrosis occurs in a focal area
Overlying cartilage changes are secondary to the bony changes
Loss of subchondral bone support leads to degenerative cartilage changes – softening, fibromatous, fissuring
Fragment may detach and become loose body with traumatic event
Healing occurs by revascularization and "creeping substitution"

SPECIAL TESTS

N/A

IMAGING

Plain radiographs - AP, lateral and "tunnel" view, first study to confirm diagnosis. Appears as a well-demarcated fragment of bone surrounded by a radiolucent zone. If separated, the fragment may be seen elsewhere in the joint and a defect is present in the articular surface.
Technetium 99 bone scan - now of historic value; was used to evaluate healing potential.
CT scan - provides architectural description of lesion. Essentially replaced by MRI.
MRI
- Very useful to delineate bony lesion
- Difficult to assess and identify the status of overlying articular cartilage. Healing progression difficult to follow.

DIAGNOSTIC PROCEDURES

Arthroscopy - definitive procedure to assess the underlying cartilage and for definitive treatment

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient usually; inpatient for surgery

GENERAL MEASURES

Goals of treatment- maintain smooth congruous joint surface. alleviate pain. prevent degenerative joint disease. promote revascularization of necrotic fragment.
Splinting, crutches, non-weight bearing with active range of motion is the norm

SURGICAL MEASURES

On occasion, early surgical intervention is needed. Orthopedic consultation recommended.

ACTIVITY

Non-weight bearing, immobilization with intermittent maintenance of range of motion
Follow closely for 12 weeks for healing; fragment displacement may occur, in which case arthroscopy is indicated

DIET

No specific diet recommended

PATIENT EDUCATION

Compliance with immobilization and possibility of further trauma should be emphasized
Most lesions heal without surgical intervention

FOLLOW UP

PREVENTION/AVOIDANCE

No clear way to avoid its development.

POSSIBLE COMPLICATIONS

Failure to revascularize and heal
Displacement of fragment becoming loose body within a joint

EXPECTED COURSE AND PROGNOSIS

Most will heal without morbidity
An incongruous joint surface may lead to degenerative changes if not managed adequately

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.