About Osteochondritis Dissecans (OCD)
Osteochondritis Dissecans (OCD) is a disease in which localized osteocartilaginous separation at the level of the subchondral bone causes damage to the protective articular cartilage cover, subsequently producing pain and swelling. Unless the lesion repairs spontaneously or it is treated, the disease process progresses. The affected area of subchondral bone and its attached articular cartilage can become loose and separate into the joint. In fact, this is the most common source of loose bodies in the knee joint. OCD lesions may occur in any joint, but are most common in the knee. OCD is most common in people between the ages of 10 - 50 years old, with more men being afflicted than women.
Causes of OCD
The exact cause of OCD is unknown. Popular theories include:
• Direct trauma to the joint
• Joint instability
• Injured structures of the joint such as meniscal tears and patellar dislocations
• A decrease or absence of blood flow to the subchondral area
• Abnormal bone development
• A predisposition to develop OCD, genetic or otherwise
• Direct trauma to the joint
• Joint instability
• Injured structures of the joint such as meniscal tears and patellar dislocations
• A decrease or absence of blood flow to the subchondral area
• Abnormal bone development
• A predisposition to develop OCD, genetic or otherwise
Signs & Symptoms of OCD
OCD patients may experience:
• Chronic knee aching or swelling
• A sensation of popping or catching in the knee
• A palpable loose body in the joint
OCD patients may experience:
• Chronic knee aching or swelling
• A sensation of popping or catching in the knee
• A palpable loose body in the joint
Diagnosis of OCD
Proper diagnosis of OCD often requires x-rays and an MRI in addition to a physical examination.
At arthroscopy, lesions are classified into four groups:
Group 1: Intact lesion with a continuous, yet mildly irregular, articular cartilaginous surface
Group 2: Signs of early separation with the articular surface showing increasing irregularity
Group 3: Lesion is partially detached
Group 4: A crater is revealed at the surface of the bone and a loose body is present
At arthroscopy, lesions are classified into four groups:
Group 1: Intact lesion with a continuous, yet mildly irregular, articular cartilaginous surface
Group 2: Signs of early separation with the articular surface showing increasing irregularity
Group 3: Lesion is partially detached
Group 4: A crater is revealed at the surface of the bone and a loose body is present
Treatment for OCD Presentation
(Swipe image to advance if using a mobile device.)
(Swipe image to advance if using a mobile device.)
Surgical Treatment
Surgical procedures to treat OCD lesions include reduction and fixation, open or arthroscopic drilling, debridement, bone grafting, autologous chondrocyte implantation, osteochondral autografts, periosteal/perichondral autografts, and osteochondral allografts.
If treatment using a fixation device fails, an even larger lesion may result. In this case, orthopedists are faced with difficult questions regarding future therapy. Treatment options include another trial of the surgical treatments listed above or knee replacement with metal and plastic parts (arthroplasty). Knee replacement is not a desirable option in young patients because knee replacements require revision surgery within 10 – 20 years.
Arthroscopic Articular Cartilage Paste Grafting has been used by Dr. Stone for the past 20 years to treat arthritic and traumatic lesions of the knee in over 200 cases with excellent pain relief. A study of the 2 - 12-year outcomes of Articular Cartilage Paste Grafting to treat arthritic lesions was published and can be found here. The goal in treating arthritic lesions, traumatic lesions, and failed OCD lesions with Articular Cartilage Paste Grafting is the same. The intent is to stimulate a healing response that covers the lesion with a protective layer of fibrocartilage and/or hyaline cartilage. The regenerate cartilage protects the underlying bone and serves to reduce pain and swelling. Articular Cartilage Paste Grafting has been successfully applied to OCD lesions as both a primary treatment and as a salvage procedure for defects that fail other attempts at repair.
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Surgical procedures to treat OCD lesions include reduction and fixation, open or arthroscopic drilling, debridement, bone grafting, autologous chondrocyte implantation, osteochondral autografts, periosteal/perichondral autografts, and osteochondral allografts.
If treatment using a fixation device fails, an even larger lesion may result. In this case, orthopedists are faced with difficult questions regarding future therapy. Treatment options include another trial of the surgical treatments listed above or knee replacement with metal and plastic parts (arthroplasty). Knee replacement is not a desirable option in young patients because knee replacements require revision surgery within 10 – 20 years.
Arthroscopic Articular Cartilage Paste Grafting has been used by Dr. Stone for the past 20 years to treat arthritic and traumatic lesions of the knee in over 200 cases with excellent pain relief. A study of the 2 - 12-year outcomes of Articular Cartilage Paste Grafting to treat arthritic lesions was published and can be found here. The goal in treating arthritic lesions, traumatic lesions, and failed OCD lesions with Articular Cartilage Paste Grafting is the same. The intent is to stimulate a healing response that covers the lesion with a protective layer of fibrocartilage and/or hyaline cartilage. The regenerate cartilage protects the underlying bone and serves to reduce pain and swelling. Articular Cartilage Paste Grafting has been successfully applied to OCD lesions as both a primary treatment and as a salvage procedure for defects that fail other attempts at repair.
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