KNEE OCD
Osteochronditis dissecans (aka “OCD”) is a condition in which the bone that supports the cartilage inside a joint undergoes softening. This softening is caused by an interruption in the blood flow to that portion of bone. Over time, if left untreated, this can lead to damage to the overlying cartilage of the joint. Loose pieces of bone and cartilage can even break off into joint. Long term ramifications may even include arthritis.
Osteochondral fracture (when a piece of bone that also contains joint cartilage breaks off in the joint) or chondral injury (an injury just to the cartilage in the joint) is similar to OCD, but it is generally caused by an acute injury to the cartilage and underlying bone. It can happen in association with ligament injuries, such as tearing of the ACL. OCD (osteochondritis dissecans), on the other hand, is considered a chronic process that can go on for months to years before any symptoms are felt.
OCD is a relatively rare problem, likely affecting far less than 1 percent of the population.
Not all OCDs cause signs or symptoms (i.e. you may not know anything is wrong with the knee for much of the time), but can include knee pain, usually worse with increased activity, knee swelling, and possibly clicking and popping sensations. These may be preceded by a small injury that seemed to get better on its own.
The signs and symptoms of an acute injury to cartilage, on the other hand, are more obvious. There is usually a known twisting or contact injury to the knee, with rapid knee swelling and difficulty putting weight on the extremity. There may also be a sensation of clicking and locking of the involved joint.
If your doctor has recommended that you or your child modify activity, all activities that involve running or jumping should be avoided. These include activities and sports like soccer, basketball, lacrosse, baseball, tennis, volleyball, softball, racket sports, gymnastics, and dance. Safer alternatives that your doctor may allow include swimming, biking, and yoga.
The surgical choices to treat OCD depend on whether the OCD is firmly in place (stable) or threatening to loosen or dislodge (unstable). The following are a few examples of the many surgeries that are currently available to treat OCD.
X-Ray looks at bone. If the OCD involved the bone (which is under the cartilage), then the OCD will show up on X-Ray. There are special X-Ray views that your doctor may order to best see the OCD.
If the OCD does not show up on X-Ray, it may be because it only involves the cartilage. In this case, MRI scan will best show the OCD. MRI will also give more detail about the OCD, and may show whether the OCD is firmly in place (‘stable’) or not (‘unstable’), and whether it is healing or not.
Once an OCD is healed, we do not believe that they can “come back.” However, sometimes an OCD acts like it has healed, or looks like it has healed, when in fact it has not. In this case, there may be a misconception that the OCD has “come back.”
OCD of the knee is thought to be bilateral, or in both knees, about 1 out of 4 times. However, there is no known link between OCD of the knee and OCD of other joints.
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