Osteochondritis Dessicans

The exact cause of osteochondritis dissecans is not fully understood, but it is believed to involve a combination of genetic predisposition, vascular insufficiency, repetitive microtrauma, and mechanical factors. Potential causes and risk factors include:

1. Repetitive Stress: Activities that involve repetitive impact or stress on the affected joint, such as running, jumping, or gymnastics, may increase the risk of developing OCD.
2. Trauma: Acute trauma or injury to the affected joint, such as a fall or direct blow, can disrupt the blood supply to the cartilage and bone, leading to the development of OCD lesions.
3. Genetics: There may be a genetic predisposition to developing OCD, as it tends to run in families.
4. Vascular Insufficiency: Impaired blood flow to the subchondral bone and cartilage may contribute to the development of OCD lesions, particularly in areas of high mechanical stress.

1. Pain: Persistent or intermittent pain in the affected joint, particularly with weight-bearing activities or movements that compress the joint surface.
2. Swelling: Swelling or joint effusion may be present, indicating inflammation and joint irritation associated with the OCD lesion.
3. Locking or Catching Sensations: Some individuals may experience locking, catching, or popping sensations in the affected joint during movement, particularly if the detached fragment becomes displaced and interferes with joint motion.
4. Decreased Range of Motion: Reduced range of motion in the affected joint, particularly with extension or rotation, may be observed due to pain or mechanical blockage from the OCD lesion.

Diagnosing osteochondritis dissecans typically involves a combination of clinical evaluation and imaging studies, including:

• Physical Examination: Assessment of joint range of motion, stability, and provocative tests to reproduce symptoms, such as joint line tenderness or clicking.
• Imaging Studies: X-rays, MRI scans, or CT scans may be ordered to visualize the size, location, and stability of the OCD lesion, as well as assess for associated joint effusion or loose bodies.

Conservative Management:

• Activity Modification: Avoiding high-impact or weight-bearing activities that exacerbate symptoms, such as running or jumping, to reduce stress on the affected joint.
• Physical Therapy: Strengthening exercises, stretching, and proprioceptive training to improve joint stability, range of motion, and functional capacity.

Surgical Intervention:

• Debridement and Microfracture: Arthroscopic debridement of the OCD lesion followed by microfracture of the subchondral bone to promote fibrocartilage formation and healing.
• Fragment Excision: Surgical removal of the detached fragment, particularly if it is unstable or causing persistent symptoms, followed by debridement of the defect.
• Fragment Fixation: Surgical fixation of the detached fragment using screws, pins, or other fixation devices to reattach it to the underlying bone and promote healing.
• Osteochondral Autograft Transplantation (OATS): Transfer of healthy cartilage and bone from a non-weight-bearing area of the joint to the OCD lesion to restore joint congruity and function.
• Osteochondral Allograft Transplantation: Transplantation of cadaveric donor tissue containing both cartilage and bone to replace the OCD lesion and restore joint integrity.

Recovery from osteochondritis dissecans depends on various factors, including the size and stability of the OCD lesion, chosen treatment approach, and individual patient factors. Physical therapy plays a crucial role in postoperative rehabilitation, focusing on restoring joint range of motion, strength, and proprioception while protecting healing tissues and minimizing the risk of complications. Rehabilitation protocols are tailored to the specific surgical procedure and patient needs, with a gradual progression of exercises aimed at achieving a safe return to activities and optimizing long-term outcomes.