Continuous passive motion following cartilage surgery: does a common protocol exist? FIGURE 8 presents a nomogram developed from the regression analysis with a case-control series that can be used to predict a patient's outcome based on normalized width, normalized length, and symptoms.124FIGURES 9 and 10 provide examples of how lesion size is measured and how it corresponds with the probability of a healing or failing outcome. 8, Journal of Pediatric Orthopaedics, Vol. . , Harty M. De Smet De Smet et al26 provided the first system for assessing stability of a JOCD lesion using T2-weighted MRI. 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. CC The comparative effectiveness of treatments for JOCD also remains unknown due to a lack of well-controlled studies.1 Furthermore, clinical practice guidelines still need to be established regarding proper treatment of JOCD lesions based on relative size, location, stability of the lesion on magnetic resonance imaging (MRI), patient age, and status of growth plates.19,20. For unstable lesions and stable lesions that fail nonoperative treatment, a variety of surgical interventions can be utilized to stimulate bony healing and address articular cartilage lesions. Long-term results of excision of the fragment, Familial osteochondritis dissecans and dwarfism, Biochemical changes in articular cartilage after joint immobilization by casting or external fixation, Transchondral fractures (osteochondritis dissecans) of the talus, Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification, Functional and radiographic outcomes of juvenile osteochondritis dissecans of the knee treated with extra-articular retrograde drilling, Results of drilling osteochondritis dissecans before skeletal maturity, Articular cartilage: injuries and potential for healing, Osteochondral repair of primate knee femoral and patellar articular surfaces: implications for preventing post-traumatic osteoarthritis, Treatment of juvenile osteochondritis dissecans and osteochondritis dissecans of the knee, Osteochondritis dissecans of the knee: treatment of juvenile and adult forms, The three critical components in the conservative treatment of juvenile osteochondritis dissecans (JOCD). Linden We discussed a plan to progress her exercise program next visit and began discharge planning. Williams OCD affects the knee most often and develops in active teens between the ages of 10 and 15 years old. Although commonly used for diagnosis, plain radiographs are not recommended for classification of JOCD lesions. The athlete's elbow. Osteochondritis Dissecans Treatment Options for a PT (2, 3) • Rest, Physical Activity Modification to Limitation of Weight Bearing • Postural/Functional Training • ROM exercises (see videos 14a, 14b & 16 for hip/groin/knee) • Stretching (see videos 31 & 28 for hip/groin/knee) This may allow safe, progressive exercises for the quadriceps, hamstrings, and gastrocnemius with increasingly stronger resistance. CR The dosage was consistent with that recommended by Costello and Jeske.39 Upon completion of the iontophoresis, the skin under the active and dispersive electrodes was examined for any abnormal reactions to the direct current stimulation. After the 6 months his pain was gone, which was a blessing, however, he still has issues with function. Dipaola These lesions are located within the intercondylar notch of the femur (non–weight bearing surface) and thus are subject to less loading over time. . , Stratford PW, Mayo N. Norkin Some authors have argued that several factors are responsible for the increased potential of DEX-P diffusion into the underlying tissues with iontophoresis: polarity of the active electrode,42–45 localized cutaneous blood flow,43,46 pH level in the skin,47 and current intensity.43 Although use of the anode as the active electrode was originally posited by Glass et al,48 many authors42–45 have recently provided persuasive arguments for the use of the cathode. Osteochondritis dissecans causes irregularity and fragility of affected cartilage. Physiotherapy is a successful treatment for osteochondritis dissecans. Modified straight-leg-raising exercises were performed with the knee held in approximately 30 degrees of flexion. On the fourth visit, 11 days after her initial visit, the patient reported minimal, intermittent right knee pain (0–1/10) and increased tolerance of all activities. JC OCD usually causes pain during and after sports. Ulett Over time, OCD lesions can lead to further degenerative changes in the elbow. BACKGROUND: Osteochondritis dissecans (OCD) is a disorder of subchondral bone that causes adverse effects on the overlying cartilage and commonly affects the knee. 10, No. Her right knee pain, at worst, had decreased by 50% (5/10 versus 10/10) by the second visit, it was rated as 0/10 to 1/10 (on average) by the fourth visit, and she experienced no pain with any functional activities at discharge. GA Drilling juvenile osteochondritis dissecans: retro- or transarticular? RA WF A joint surface damaged by OCD doesn't heal naturally. He can walk okay but he has problems on steps, stairs, hills, and inclines. The patient then was instructed in joint protection strategies to decrease loading across the right tibiofemoral joint. Best Exercises/Activities For Osteochondritis Dissecans. Wall, Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH 45229. 62, No. , Nelson DW, Colville MR. Berndt Once your diagnostic examination is complete, the Physical Therapists at Rocky Mountain Therapy Services have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle. Limited quality evidence is available on the level of agreement between MRI and arthroscopy for the diagnosis of knee JOCD,101 with 1 study indicating a moderate level of agreement (κ = 0.70)73 that improved with the addition of information on the medical history, clinical exam, and plain radiographs (κ = 0.90).73. CJ Although widely accepted, there is minimal research evidence to support repetitive trauma as the cause. Its role in clinical decision-making, Guided growth for the treatment of limb length discrepancy: a comparative study of the three most commonly used surgical techniques, Retro-articular drilling and bone grafting of juvenile knee osteochondritis dissecans: a technical description. Signs of OCD in dogs typically begin between the ages of four and eight months, but this can vary depending on the growth rate of the affected dog. Iontophoresis was discontinued given her 0/10 pain rating maintained over a 10-day period. Valgus alignment was associated with lateral condyle lesions, whereas varus alignment was associated with medial condyle lesions, although the amount of valgus/varus remained within normal physiological ranges.54 This increased loading on the affected knee compartment may have implications for the use of an unloader brace. J She reported only mild tenderness along the anteromedial femoral condyle on the right knee (pain rating 4/10) with direct palpation to the area. JM B Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. How does the condition develop? CC Bioabsorbable or metal pins and screws can also be used to reattach a partially or completely detached JOCD lesion (FIGURE 12B).65 Fragment fixation has been reported to have a similar success rate to drilling (75%–100%) based on radiographs, 60 MRI,29,78 or both.118,125 Studies have also shown significant improvement in functional outcomes60,77,78 and patient satisfaction.29 Fragment fixation can also include bone grafting between the OCD lesion and its bed, along with curettage and drilling of the recipient bed.75 The effectiveness of these techniques has not been established. Arthroscopic fixation of osteochondritis dissecans of the knee: clinical, magnetic resonance imaging, and arthroscopic follow-up, Osteochondritis dissecans: analysis of mechanical stability with radiography, scintigraphy, and MR imaging, Articular cartilage defects of the distal femur in children and adolescents: treatment with autologous chondrocyte implantation, Radiological and pathological manifestations of osteochondritis dissecans of the distal femur. NN A study by Jacobi et al54 identified the presence of mechanical-axis deviation in both adolescents and adults with knee OCD.