Introduction:
Osteochondritis Dissecans is a joint disorder where a segment of bone and its overlying cartilage particularly or completely separates from the surrounding bone due to a lack of blood supply.
- Commonly affected the knee, elbow and ankle, often occurring in active individuals or young athletes.
Definition:
- Osteochondritis Dissecans is characterized by the softening or death of subchondral bone (the bone beneath the cartilage) due to insufficient blood flow.
- This can lead to the formation of a lesion, where the affected bone and cartilage may crack, loosen and potentially death into the joint space, sometimes referred to as a “joint mouse”.
Cause:
- The exact cause is often unknown (idiopathic), but it is generally considered multifactorial.
- The primary contributing factor is believed to be repetitive stress or microtrauma to the joint, often associated with sports.
- Other suggested factors include genetic predisposition, inflammation, ischemia (restricted blood flow), and defects in bone formation.
Clinical Feature:
- Symptoms often develop gradually and may include localized pain and swelling in the affected joint, typically worsening with activity.
- Patient may experience a sensation of the joint “giving way” catching, or locking if a fragment has detached.
- Decreased range of motion and joint stiffness are also common.
Conservative Treatment:
- Often the first line of treatment, particularly for stable lesions in skeletally immature patients (those with open growth plates).
- Focuses on resting the affected joint and restricting high-impact activities (e.g., running, jumping).
- Immobilization using a brace or cast may be recommended.
Physiotherapy Management:
- A crucial component of recovery, aiming to restore function and minimize pain.
- Includes range-of –motion exercises to maintain joint flexibility.
- Muscle strengthening exercises, particularly for muscles supporting the joint (e.g., quadriceps and hamstrings for the knee), are vital for satiability.
- Manual therapy techniques may be used to improve joint mechanics and flexibility.
Surgical Treatment:
- Recommended for unstable lesions, when conservative treatment fails, or in skeletally mature patients (adults).
Surgical options include:
- Drilling: Stimulating blood flow to the lesion to promote healing.
- Grafting: Replacing the damaged area with healthy bone and cartilage (osteochondral autograft or allograft).
- Fixation: Using pains or screws to stabilize the detached fragment.
Conclusion:
Osteochondritis Dissecans requires a tailored approach to treatment, considering the patient’s age and the lesion’s stability. While conservative management is effective for many younger patients, surgical intervention may be necessary for advanced or persistent sasses to restore joint function and prevent long- term complications like osteoarthritis.