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When present, OCD lesions usually become symptomatic during a child’s development. By Dr. Eric W. Edmonds . If neglected, the OCD may come loose, catch in the joint, (causing pain, locking, clicking, etc.) The ankle OCD lesion is rare in the pediatric population, mainly occurring in adults with the average age being 21 years of age. OCD is one of the more significant causes of pain – and has been discussed already. In summary, OCD is an abnormality of subchondral bone that most commonly affect the medial femoral condyle of the knee. It most commonly affects the shoulder joint but the elbow, hip, or knee (stifle) may also be involved. In situ fixation of lesions can be performed using various types of metallic screws, bioabsorbable implants, or osteochondral plugs. After a clinical examination of the knee with the patient under anesthesia and a formal arthroscopic evaluation of the knee, the OCD lesion is identified. Sometimes it is necessary to incise the overlying cartilage to liberate the lesion. It is an important diagnosis to consider in an active pediatric/adolescent patient presenting with knee pain with or without mechanical symptoms. promote OCD lesion healing, fixation methods, and salvage techniques. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. This has been shown to no longer be true. Once a patient reaches maturity, these lesions rarely heal on their own. Osteochondritis Dissecans (OCD) is a condition that affects the articular cartilage and the subchondral bone of the knee. The affected area of subchondral bone and its attached articular cartilage can become loose and separate into the joint. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. However, when the OCD lesion is more mature and has separated from the rest of the bone, either with the overlying cartilage intact, partially separated or completely separated (loose body), surgery is often needed to stimulate, graft, stabilize, or remove the OCD fragment. In these cases, no additional treatment is necessary. For an ankle OCD lesion, your child may be placed in a boot or cast for up to 6 weeks. Key Points: • High-intensity T2-signal behind the progeny fragment of the OCD lesion is suggestive of instability. Most areas of scientific inquiry concerning the knee revolve around the major ligaments and our knowledge of these injuries is so far advanced that often the remaining questions are minor fine-tuning. The starved bone tissue starts to weaken and crumble, and, without this scaffold to support it, the cartilage can weaken as well. Over time, the cartilage can fragment as well, leaving a loose piece of bone and cartilage. … Figure 2 MRI view of an OCD lesion of the knee. For unstable yet salvageable OCD lesions, the senior author’s preferred treatment is fixation with bone grafting. Each of these did have appropriate bite and were buried beneath the articular surface. In the world of childhood knee injuries and complaints, there are few mysteries that still persist. Osteochondritis dissecans (OCD) is a focal lesion of the subchondral bone that can result in fragmentation, instability, and if untreated, loose body formation with progression to early degenerative changes. The authors’ preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. Without early treatment, the lesion can become unstable or completely detached. The knee is the location most often requiring surgery, with 58% of procedures for OCD lesions being performed on the knee. OCD Lesion: Diagnosis, Evaluation and Management - Geoffrey Van Thiel, MD (CSMS #45, 2018) Knee & Sports - Osteochondritis Dissecans The lesion, which has multiple causes, has a loss of blood supply to a small portion of the bone. For a knee OCD lesion, your child may be placed on crutches for up to 6 weeks. Theories range from abnormal vascular anatomy (leading to ischemic injury of the bone), abnormal ossification of the epiphysis, trauma, endocrine imbalances or some combination of the above. lesion of the knee. * This results in a spectrum of pathology beginning with a lesion to the bone only,… Osteochondritis Dissecans (OCD) of the knee is an acquired, reversible, idiopathic condition of the subchondral bone. Various modalities and techniques exist, such as fixation, debridement, microfracture, and cartilage grafting/transplantation. Particularly in adolescent male athletes, OCD of the knee is a common source of pain, effusion, and mechanical symptoms with sporting activities. The OCD lesion is a condition/injury that develops in joints, most often in children. Sometimes, high impact activities, like basketball, can be difficult to play after OCD. It is more common in boys and is generally bilateral. The lesion usually occurs in the knee on the lateral and posterior aspect of the medial femoral condyle (70% of lesions are in the posterolateral aspect of the knee). The OCD lesion can remain in contact with the adjacent bone, maybe partially separated or completely separated. An OCD lesion is an area within the knee where the bone underneath a small area of cartilage starts to die. Theodore Ganley MD, Kevin Shea MD. Surgical Treatment . For an elbow OCD, your child may be placed into a sling for up to 6 weeks. Etiology of this lesion is not known. OCD lesions may occur in any joint, but are most common in the knee. Other lesions may be more appropriately treated with surgery. OCD is characterized by the separation of an osteochondral fragment from its surrounding bone and cartilage tissues. OCD of the Knee May Require Rest or Surgery. Once the OCD is hinged open, the bed of the lesion is prepared. We did drill several holes at the base of OCD lesion prior to re-fixation. Cartilage damage is most frequently seen between the ages of 15 and 30 or above the age of 50. 2 UWSPORTSMEDICINE.ORG 621 SCIENCE DRIVE • MADISON, WI 53711 4602 EASTPARK BLVD. Following this, I was able to range the knee. Osteochondritis dissecans is an inflammatory condition that occurs when diseased cartilage separates from the underlying bone. In fact, this is the a common source of loose bodies in the knee joint. This video demonstrates the treatment of an unstable osteochondritis dissecans (OCD) lesion of the knee. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. Chapter 29 Treatment of Juvenile Osteochondritis Dissecans of the Knee Matthew Leidl, Jon K. Sekiya Juvenile osteochondritis dissecans (JOCD) is a condition in which a portion of subchondral bone and its overlying cartilage become damaged; it usually affects the knee. Epidemiology: Incidence reported around 9/100,000 in children under 11 years old and 22/100,000 in adolescents 12-19 years old. When OCD affects the knee, the most common location is within the lateral aspect of the medial femoral condyle. An osteochondritis dissecans, or OCD, knee injury usually occurs when there is an underlying OCD lesion which was asymptomatic and it becomes symptomatic due to an injury or just because the lesion did not heal and it eventually falls off the bone. OCD of the Knee. If OCD of the knee is suspected, AP, lateral, notch-view (knee in flexion) and skyline patella xrays should be ordered. An OCD Lesion occurs usually in the knee, elbow, and ankle. OCD of the knee has a non-specific presentation with vague pain and swelling. Then we were able to place 3 BioComposite headless screws in a triangular type fashion. A lesion of the cartilage and bone due to necrosis and loss of continuity of the underlying bone. If a lesion is seen the contralateral knee should also be xrayed. Adults are less … Diagnosis can be made with plain radiography, and the lesion can be further characterized by MRI. Multiple theories have been proposed for the cause of an OCD lesion in the knee, including trauma or repetitive microtrauma, local vascular insufficiency, and family history. • Retroarticular or transarticular drilling of a non-healing, stable OCD lesion in the pediatric knee … Cartilage can also come loose due to damage in the underlying bone, OCD, or osteonecrosis. This is a developmental disease that occurs in rapidly growing large breed dogs typically between 6 and 9 months of age and tends to occur more often in male dogs. Osgood-Schlatter disease This ‘traction apophysitis’ is a very common cause of knee pain in adolescent athletes. To determine if mechanical axis deviation correlates with OCD lesion location in the knee, if degree of mechanical axis deviation correlates with size of OCD lesion, and if the deformity was primarily in the distal femur or proximal tibia. Study Design: Cross-sectional study; Level of evidence, 3. There is an association with trauma to the ankle, particularly in lateral talar dome lesions. The most "classic" location for OCD lesions of the knee is the lateral aspect of the medial femoral condyle of the distal femur. Generally, OCD seems to affect males more commonly than females (between 2:1 and 3:1). Knee Osteochondritis Dissecans (OCD) An unusual cause of knee pain is that of osteochondritis dissecans (OCD). The surgeon treated the OCD lesion by implanting a biomimetic osteochondral scaffold onto the lesion site, which was properly prepared. The lesion is then hinged open. Sometimes cartilage damage occurs as part of degeneration, called osteoarthritis, which is the overall loss of tissue quality that occurs with aging. There was no evidence of rocking of the lesion or of catching within the knee. Osteochondritis dissecans (OCD) of the knee is a debilitating disorder primarily affecting adolescents and young adults at a rate between 15 and 30 per 100,000 , . Patients may have an OLT that is present and doesn't cause pain or limitations or a lesion that becomes painful but improves. The cause is currently unknown but it may lead to damage to overlying cartilage, loose bodies, and joint damage. Diagram shows the classic four signs of instability in an OCD lesion: 1, high signal intensity rim at the interface between the fragment and the adjacent bone on T2-weighted MR images; 2, fluid-filled cysts beneath the lesion; 3, a high-signal-intensity line extending through the articular cartilage overlying the lesion; and 4, a focal osteochondral defect filled with joint fluid. Knee pain (especially anterior knee pain) is common in the young athlete. Osteochondritis Dissecans of Knee (OCD) What is osteochondritis dissecans (OCD)? This will need surgery to repair. • MADISON, WI 53718 The younger you are, the better chance you have of healing the OCD and getting back to the activities you enjoy. Juvenile OCD lesions have a better healing prognosis than adults. AP films alone may miss a lesion on the posterior aspect of the medial femoral condyle. If the lesion is loose and floating around in the knee, the loose piece needs to be removed via a scope. 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