Osteochondritis dessicans is a big phrase to describe a problem with the surface of a joint that often occurs in young people. It typically affects the knee and sometimes the elbow. For some reason, a portion of the joint surface deteriorates and breaks down. The bone beneath the surface also breaks away. This can happen to different levels of severity, from mild breakdown to complete separation of a section of the joint surface.
Children and young adults with this problem usually come in to see me with pain in their knee. Occasionally there is a intermittent sense of something getting stuck in the joint limiting motion. The problem may worsen with a minor injury to the knee or elbow.
X-rays of the joint, if the region of damage is large enough, will confirm the diagnosis. Sometimes an MRI is needed to see it carefully and completely determine how severe the problem can be.
Even an MRI does not always provide enough information to fully describe the problem.
Treatments are based on how much pain you are in and how much it is affecting your activities. Nonoperative treatment is always the first choice, including simple anti-inflammatory medications, icing, a period of rest, followed by strengthening. When these are not helpful, the next option of arthroscopy must be considered.
The type of surgery you might need depends on many factors and is something that you and I, or you and your surgeon, must decide together. I would like to outline a few options that have been helpful to many.
An arthroscopic procedure is usually the first choice. This procedure is done as an outpatient. The damaged cartilage area is examined and treated based on what I see. This may be a cartilage flap can be reattached, or possibly a highly unstable area of cartilage that must be removed. If it is removed, there are a few options for attempting to help it heal.
A microfracture’ involves the creation of many small holes in the bone beneath the damaged cartilage region. These holes allow the area to be filled with cells that have the potential to become cartilage if they heal properly. This is done at the same time of the initial arthroscopic procedure.
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Another option is to transfer cartilage from one area of the knee into the defective area. Like a hair transplant, cartilage plugs are harvested and then placed into the damaged cartilage area to fill it with tissue of good quality.
The last option is to use cartilage from a donor. This is usually done as a separate surgery as it involves a small incision on your knee. Cartilage and bone are taken from a donor and grafted into the defective area completely filling the area and creating a new surface to bear weight.
Each of these carries its own benefits and potential pitfalls. It is important to understand the procedure and what the recovery will involve. This usually includes a period of no weight on your leg for about 6-8 weeks (a long time!)
If you have questions about this unusual condition feel free to contact me at Ask Dr. Hacker through my office.
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