Original Editors - Tania Appelmans as part of the Vrije Universiteit Brussel Evidence-based Practice Project, Top Contributors - Tania Appelmans, Tarina van der Stockt, Mats Vandervelde, Charlotte Bellen and Michelle Lee, Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. Vascular hypo perfusion and repeated micro-trauma may also contribute to the development of OCD. O’Connor MA, Palaniappan M, Khan N, Bruce CE. The defects cause deep ankle pain associated with weightbearing. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Positive test will reproduce lateral pain, Bracing to offload the joint. Synovial fluid nourishes and lubricates the cartilage. Costochondritis (kos-toe-kon-DRY-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). In the elbow, the most common area affected is the capitellum, although it has been reported to affect the olecranon and the trochlea. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children and adolescents. Current concept review-Osteochondritis dissecans. Osteochondritis dissecans of the femoral condyles: a long-term follow-up study. , Main characteristics of the disease that are commonly mentioned are locking, giving away, stiffness and recurrent effusions. Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K. Jones KJ, Wiesel BB, Sankar WN, Ganley TJ. Sailors ME. Examination and Treatment of the Knee. This leads to vascular hypo perfusion. The tibial plateau could damage one of the condyles of the femur . There is an intermittent swelling palpable. Arthroscopy: Elbow injuries in throwing athletes: a current concepts review, Arthroscopic surgery in athletes with osteochondritis dissecans of the elbow, Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. The passive and active extension of the knee is limited . Level of evidence: 2 B, Johnson MP. This area carries the least weight. Surgical treatment options for osteochondritis dissecans of the knee. , Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only. There are four distinct stages of OCD : Stage one: ischemic osteonecrose begin to arise in a part of the subchondral bone, because the tissue is not well vascularized. Osteochondritis dissecans of the capitellum: minimum 1-year follow-up after arthroscopic debridement. In the talus, 96% of lateral lesions and 62% of … MRI should be considered when symptomatic patients have a normal X-Ray. This can occur during tackling in contact sports or if hit in the chest in ball sports. In stages one and two the condition is localized in the subchondral bone, the cartilage is still intact and gets its nourishment from synovial fluid. Osteochondrosis dissecans. European radiology. Adaption of the strain is needed so that the bone can heal. Available from: Brunton LM, Anderson MW, Pannunzio ME, Khanna AJ, Chhabra AB. Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. p.82-87. Osteochondritis dissecans can be split into a juvenile form (JOCD) and an adult form (OCD) . 2 weeks of immobilization and partial support is recommended when having an acute injury. Most OCD lesions of the elbow involve the capitellum, typically the central or lateral portion, but also the radial head, the olecranon of the ulna and the trochlea humeri.. Osteochondrosis is a term used to describe a group of disorders that affect the growing skeleton. Elbows and knees are most commonly affected.  For medical management, the use of arthroscopic surgery is the main route of management to remove the bony fragments. Autologous chondrocyte implantation (ACI), First exercises: closed chain exercises, low impact activities like cycle and swim. Next criteria should be managed: the patient is pain free, has a full joint mobility, no swelling, no pressure sensitivity and there’s radiological prove of recovery. Treatment of Capitellar Osteochondritis Dissecans. Costochondritis American Family Physician www.aafp.org/afp Volume 80, Number 6 September 15, 2009 Treatment Repetitive high stress forces on the joint can result in a series of minor injuries on the elbow that can eventually lead to bony fragmentation and ultimately detachment of the bony fragment from the bone. Stage three: partially detached lesions, a dissecans ‘in situ’.  The cartilage is damaged and can form a loose body. p.82-87. Following immobilization, range of motion exercises, as well as progressive quadriceps and hamstring strengthening should be performed. Da Knorpel keine eigenen Blutgefäße besitzt, sondern durch Diffusion ernährt wird, werden die tiefer gelegenen Knorpelschichten immer schlechter ernährt und degenerieren. In beiden Fällen wird der Knorpel nicht genügend rasch zu Knochen umgebaut, so dass sich eine abnorm dicke Knorpelschicht bilden kann. Osteochondritis Dissecans is, in adolescent athletes, an increasingly common cause of elbow dysfunction and elbow pain. 2013 Oct 1;41(10):2384-91. 2008;21(02):106-15. 1981 Jul 1;158:59-69. Costochondritis is commonly caused by a direct blow to the joint between the rib and breastbone. 1173185, Arrow points to calcific flake in distal capitellum. , Computerised Tomography (CT) can detect any bony fragments, pinpoint their location and determine whether they have settled in the joint space. He has been treating his symptoms with physical therapy and anti-inflammatory medications with little effect. Osteochondritis dissecans most often affects the knee, ankle and elbow. , X-ray can show if the cartilage flake includes a piece of underlying bone. The American journal of sports medicine. Detterline AJ, Goldstein JL, Rue JP, Bach BR. Panner disease is typically seen in children (5-10 years of age), although it is also seen in throwers due to repeated trauma. Additional exercises to restore ankle joint and normal knee proprioception, such as biomechanical ankle platform systems (BAPS board) exercises or unilateral stance, are also beneficial to the athlete planning to return to competition. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. 1) damage at the articular cartilage2) piece of the articular cartilage is separated from the condyle3) piece of the articular cartilage completely separate from the condyle(Level of evidence: E). 2009 Jul 1;1(4):326-34. She does not recall any traumatic injury to the knee. If there is no radiological confirmation of Osteochondritis Dissecans, other diagnoses may include: Radiographs can detect any abnormalities on the surface of the joint. Vrije Universiteit Brussel Evidence-based Practice Project, http://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/surgical-management-of-osteochondritis-dissecans-of-the-knee.pdf, https://www.researchgate.net/profile/Randy_Mascarenhas/publication/237061466_Bilateral_Osteochondritis_Dissecans_of_the_Femoral_Condyles_in_Both_Knees_A_Report_of_Two_Sibling_Cases/links/00b7d529818a509cbe000000.pdf, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317804/pdf/jathtrain00028-0016.pdf, http://www.acldoc.org/Files/Eval%20n%20Treat506.pdf, https://www.researchgate.net/profile/Cecilia_Pascual-Garrido/publication/231215571_Surgical_Treatment_Options_for_Osteochondritis_Dissecans_of_the_Knee/links/00b7d530a055e93be4000000.pdf, http://www.bjj.boneandjoint.org.uk/content/84-B/2/258.short, http://www.mayoclinic.com/health/osteochondritisdissecans/DS00741/DSECTION=treatments-and-drugsfckLRLevel, https://www.physio-pedia.com/index.php?title=Osteochondritis_Dissecans_of_the_Knee&oldid=221759, OCD of the knee has a non-specific presentation, The knee swells simultaneously with the onset of the pain. The femoral condyles (lateral and medial) which are the distal rounded ends of the femur, articulate with the proximal side of the tibia (tibia plateau). If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Osteochondritis dissecans (OCD) characterises a disease process predominately affecting male teenagers and young adults which, as its end-product, yields the separation of osteochondral fragments from the joint surface. 1998 Jan 1;8(1):103-12. https://www.physio-pedia.com/index.php?title=Osteochondritis_Dissecans_of_the_Elbow&oldid=198273, Panner's Disease in younger Shildren (9-10 years), Insertional Apophysitis in pre-pubescent patients, Epicondylar avulsion fractures in older patients, Complaints of aching post exercise or activity, Crepitus or popping (indicating osteochondral defects), Positive radio-capitellar compression test: full extension with active pronation and supination. Maniwa S, Tadenuma T, Sakai Y, Aoki A, Yamagami N, Yamamoto S, Uchio Y. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Radiographs and MRI image are provided in figures A,B, and C. Bohn Stafleu van Loghum. How does costochondritis happen?  This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space. (1983). As a result, the small piece of bone and the cartilage covering it … This can be through use of NSAIDs, activity modification, cessation of sports and/or bracing for 6-12 weeks.. 1173185.  In severe cases osteochondral grafting may be required. Osteochondral autograft transplantation (OATS). OCD usually causes pain during and after sports. 2013 Jun 1;6(2):102-14. Osteochondritis dissecans is a joint condition whereby a variable amount of bone and its adjacent cartilage loses its blood supply. Spinal stenosis most often results from a gradual, degenerative ageing process of your spine. Sports Health: A Multidisciplinary Approach. OCD can be managed conservatively or surgically. Additional measures may be required in terms of return to sport, especially in professional level sport. A variety of surgical methods exist for the management of articular cartilage lesions at the knee, such as OCD. Krause M, Hapfelmeier A, Möller M, Amling M, Bohndorf K, Meenen NM. Impaired function, limited range of motion, stiffness, catching, locking an… Curr Rev Musculoskelet Med. Folio LR, Craig SH, Wright GA, Battaglia MJ. Many diagnostic imaging methods (eg, radiography, magnetic resonance imaging (MRI), technetium 99m pyrophosphate joint scintigraphy, bone scans), as well as arthroscopic examination, have been used in an attempt to stage or classify osteochondral lesions. As you age, the ligaments of your spine may thicken and calcify, and start to compromise the adjacent tunnels. It is a clinical diagnosis and does not require specific diagnostic testing in the absence of concomitant cardiopulmonary symptoms or risk factors. Arthroscopic images of patient with capitellar osteochondritis dissecans lesion with multiple loose bodies. Journal of the American Academy of Orthopaedic Surgeons. , Commonly seen in the adolescent sporting population; who partake in repetitive throwing or overhead activities such as baseball and gymnastics. , In some cases a large fragment may need to be re-attached to the capitellum which will be done via K wire or screw fixation. Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults …  It can arise as a result of a direct trauma; when the articular cartilage is damaged (for instance a fall, twist, sprain, tackle, etc.). Arthroscopy and microfracture technique in the treatment of osteochondritis dissecans of the humeral capitellum: report of three adolescent gymnasts. Panner disease occurs in a younger age group than osteochondritis dissecans which typically occurs in teenagers.. Radiographic features. Physical examination in the early stages does only show pain as symptom, in later stages there could be an effusion, tenderness, and a crackling sound with joint movement. Using neuromuscular electrical stimulation to the quadriceps and hamstrings for coactivation contractions can further augment the strength maintenance program. 1st ed. 1977;59:769-776. If there is no certain radiological determination of osteochondritis dissecans, there can also be alternative causes of the same symptoms that should be sought for e.g.:. Level of evidence: 1A, Prometheus.  (Level of evidence: C5, F5) Stages three and four are always treated surgically. , Thickening of cartilage and a stable lesion, Articular cartilage interrupted and a stable lesion low signal rim behind fragment showing that there is fibrous attachment, Articular cartilage interrupted, Unstable high signal changes behind fragment and underlying subchondral bone. In the long term OCD can lead to subsequent dege… An x-ray, ct scan or MRI scan can be performed to show necrosis of subschondral bone or formation of loose fragments. Which form loose bodies within the joint. , Magnetic Resonance Imaging (MRI) will show any accumulation of fluid in the area and can detect any loose fragments. The entire knee is irritated because of the loose pieces, and it responds by producing extra synovial fluid in the knee joint, Giving away (having the feeling of knee bends), OCD can exist for years without symptoms, but suddenly cause discomfort due heavy straining of the joint. Synovial osteochondromatosis (SOC) (synonyms include synovial chondromatosis, primary synovial chondromatosis, synovial chondrometaplasia) is a rare disease that creates a benign change or proliferation in the synovium or joint-lining tissue, which changes to form bone-forming cartilage. Sinding-Larsen Johansson disease, first described in 1921, is one of the osteochondroses. Loose body in elbow of a baseball player: arthroscopic/radiologic correlation. The arthroscopic management of osteochondritis dissecans of the adolescent elbow. Bilateral osteochondritis dissecans of the femoral condyles in both knees: a report of two sibling cases. When pain has settled, management would be to gradually introduce full ROM and strengthening exercises out of a painful range. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. Of an adult with osteochondritis dissecans most often results from a gradual, degenerative ageing of., shiny and elastic cartilage term OCD can mean one or more of... The parent article - osteochondritis dissecans dominant arm [ 18 ] [ 21 ] immobilization... Gelegenen Knorpelschichten immer schlechter ernährt und degenerieren and recruitment 2020 | Physiopedia is a registered charity the. 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