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Two of our six boys have a problem called osteochondritis dissecans. One has it in the elbow, the other has it in the knee. We try to watch the Internet for any new information that might help us understand this problem and how to treat it. We saw there were some new guidelines but can't find the specifics. Can you help us?
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You are correct that the American Academy of Orthopaedic Surgeons (AAOS) recently released Clinical Practice Guidelines for the diagnosis and treatment of osteochondritis dissecans (OCD). Althought OCD can affect other joints, the knee is involved most often, so the guidelines are specifically directed at that particular joint.
Osteochondritis dissecans (OCD) is a problem that can affect joints such as the elbow and knee. It is much more common in the knee than anywhere else. In this condition, a piece of cartilage and the underlying bone have been damaged. In some cases, the damaged fragment separates from the bone and floats freely within the joint.
Shear stresses from repeated motions probably start the problem. Poor mechanics and fatigue of the muscles and ligaments are added to the shear load. Combined together, these forces cause the cartilage to separate from the bone, taking a piece of the underlying layer of bone with it.
OCD is not self-limiting condition. In other words, it doesn't get better on its own. In any joint, the joint surface damaged by OCD doesn't heal naturally. But other than that bit of information, the natural history (what happens over time) and the best way to treat this condition isn't known.
There are some studies that show over time, OCD lesions can lead to further degenerative changes in the elbow. Even with surgery, OCD usually leads to future joint problems, including degenerative arthritis and osteoarthritis. That's why proper treatment (based on evidence of what works and what doesn't) is so important.
To read the full report and summary of clinical practice guidelines for the diagnosis and treatment of osteochondritis dissecans, you can go to: http://www.aaos.org/research/guidelines/OCD_guideline.pdf
Here's a brief summary of their findings. Most of the recommendations made by this group were graded as inconclusive -- meaning there's not enough evidence to say for sure. Based on clinical experience combined with data from the studies collected, the panel was able to agree (consensus) on four recommendations.
Surgery should be offered to children with unstable or displaced osteochondritis dissecans (OCD) lesions that can be salvaged (saved).
Likewise, the same treatment recommendation can be made for those patients who have the same condition (unstable or displaced OCD) but who have reached skeletal maturity (bone is no longer growing).
For those patients who do receive treatment for OCD but who don't get better (pain persists), follow-up is recommended. The surgeon should complete a history, physical examination, and order imaging studies (X-rays, MRIs) to see what kind of healing response is present.
Physical therapy is advised after surgery for OCD.
As to the specific type of cartilage repair to perform for unstable or displaced but still salvageable OCD lesions...well, that's an area of great debate and controversy. There are many different surgical techniques currently available but no consensus as to which one works best.
Likewise, when it comes to nonsurgical treatment of OCD, there simply isn't enough evidence to support one approach over another. Splinting, bracing, electrical stimulation of the bone, and activity restriction may be prescribed but the effectiveness of any of these techniques is unknown. This is true for both those individuals who are still growing (skeletally immature) and those who have reached full bone maturity.
Although there is much more we don't know about the treatment of OCD (compared with what we do know), reviewing the published data from time-to-time helps identify areas where further research is needed.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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