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Osteochondritis Dissecans (OCD or OD)
Osteochondritis Dissecans, also known as OCD or OD occurs
when a fragment of bone in a joint separates from the rest
of the bone because its blood supply was faulty - it was not
getting enough blood to keep it alive. Sometimes, the
separated fragment of bone stays in place; if it falls into
the joint space, however, there will be pain and the joint
may not work properly. The joint, usually the knee or elbow
becomes inflamed, sore and painful and will 'give way' - it
catches and locks during movement.
Osteochondritis dissecans can occur in different joints,
including the hip and ankle. The knee is most commonly
affected. According to health authorities in the UK and USA,
OCD more commonly affects males aged between 10 and 20 years
who do a lot of sports. OCD is more common among males and
females who take part in active sports regularly.
Causes
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Ischemia - a restriction of blood supply which
starves the bone of essential nutrients. The restricted
blood supply is usually caused by some problem with
blood vessels (vascular problem). The bone undergoes
avascular necrosis - deterioration caused by lack of
blood supply). Ischemia usually occurs in conjunction
with a history of trauma.
-
Genes - some studies have shown that the
appearance of OCD in several family members may mean
that the susceptibility to the condition is inherited.
Others, however, argue that it could be more due to
family members having similar sporty lifestyles.
-
Repeated stress - repeated stress to the
bone/joint can significantly increase the risk of
developing OCD. Individuals involved in competitive
sports are more likely to regularly stress their joints
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. OCD is a type of osteochondrosis in which a
lesion has formed within the cartilage layer itself, giving
rise to secondary inflammation.
People with OCD report activity-related pain that develops
gradually. Individual complaints usually consist of
mechanical symptoms including pain, swelling, catching,
locking, popping noises and giving way; the primary
presenting symptom may be a restriction in the range of
movement. Symptoms typically present within the initial
weeks of stage I; however, the onset of stage II occurs
within months and offers little time for diagnosis. The
disease progresses rapidly beyond stage II, as OCD lesions
quickly move from stable cysts or fissures to unstable
fragments. Non-specific symptoms, caused by similar injuries
such as sprains and strains, can delay a definitive
diagnosis.
Physical examination typically reveals an effusion,
tenderness, and crepitus. The tenderness may initially
spread, but often reverts to a well-defined focal point as
the lesion progresses. Just as OCD shares symptoms with
common maladies, acute osteochondral fracture has a similar
presentation with tenderness in the affected joint, but is
usually associated with a fatty hemarthrosis. Although there
is no significant pathologic gait or characteristic
alignment abnormality associated with OCD, the patient may
walk with the involved leg externally rotated in an attempt
to avoid tibial spine impingement on the lateral aspect of
the medial condyle of the femur.
-
X-ray examination: a typical injury clearly
showed the outline of the limitations of subchondral
bone sclerosis, and separated from the surrounding
normal bone. Complete exfoliation and displaced persons
can be seen in the femoral condyle defect translucent
areas, intra-articular loose bodies can be seen.
Although the X-ray examination at the disease more
common in use, but the X-ray diagnosis of OCD has
greatly value the very least, because X-ray can not
directly show the cartilage, and is often left out of
small bone lesions or bone has not yet been stripped of
lesions, that is, should not the early detection of
Osteochondritis dissecans, is not conducive to the
disease stages.
-
MRI test: MRI can demonstrate detailed anatomy of
knee joint, in particular, direct imaging showed no
cartilage structure and the unique ability of bone
marrow lesions showed a very sensitive, has become the
early diagnosis of osteochondritis dissecans of the
phased and effective method. Noninvasive MRI can clearly
show the articular cartilage and subchondral bone shape
and signal change.
-
Arthroscopy: Arthroscopic surgery as a less
traumatic surgical approach has been to evaluate the
articular cartilage consider the best standard. However,
in clinical use was found, arthroscopy and MRI
examination of the relative lack of must have.
Arthroscopic not happen Can not detect early changes in
the general form of osteochondral lesions, which led to
MRI and arthroscopy on Know the difference between type
Ⅰ OCD in performance, particularly in lesions. In
addition, MRI can reflect the surface contour and
thickness of cartilage.
Whenever possible arthroscopic surgery is used to treat
osteochondritis dissecans. This minimally invasive
approach to surgery usually means less pain, a faster
recovery and fewer complications. The goal of surgery is
to restore normal blood flow and improve the joint's
ability to work normally.
When arthroscopic surgery is done, the surgeon inserts a
thin scope into the joint space. The image seen by the scope
is transmitted to a television monitor. This allows the
surgeon to see inside the body, pinpointing the damaged area
and identifying the best type of procedure to use.
Tiny instruments are then inserted into small incisions.
Using these instruments, the surgeon can either reattach or
remove the loose fragments of bone. If the cartilage is
still attached to the bone, it can be secured with pins or
screws.
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