HSS spring osteochondritis dissecans

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Author:
shmvii
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216716
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HSS spring osteochondritis dissecans
Updated:
2013-04-29 22:57:03
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HSS spring osteochondritis dissecans
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HSS spring osteochondritis dissecans
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  1. osteochondritis dissecans is what?
    • lesion of subchondral bone
    • occurs w/wo articular cartilage involvement
    • acquired, reversible if caught early
    • idiopathic
  2. diffy diag for osteochondritis dissecans
    • stress fx
    • synovial chonromatosis (disease affecting synovium around joint)
    • torn meniscus
    • tumor
    • bone spur (osteophytes)
  3. 2 types of osteochondritis dissecans
    • stable - the affected bone stays in place, causes no problems
    • unstable - fragment loosens, painful, limits ROM
  4. possible causes for osteochondritis dissecans
    • trauma or intense wt bearing activities
    • ischemia, AVN,
    • hereditary (doubful)
  5. epidemiology of osteochondritis dissecans
    • 6/100,000 males, 3/100,000 females
    • 12-17 y/o
    • commonly in athletes - baseball, tennis, gymnasts, golf wtlifting, football
    • 30-40% cases bilat
  6. osteochondritis dissecans most common sites
    • knee -┬ámedial fem condyle> lat> patella
    • elbow - atnerolat capitellum
    • ankle - talus
  7. how to dx osteochondritis dissecans
    • hx
    • physical
    • x-ray
    • mri
  8. sx of osteochondritis dissecans
    • pain (>1 yr is common) in joint, esp w activity
    • swelling & tenderness
    • clicking w unstable lesion during ROM
    • catching and locking if loose body is present ... diminished ROM
    • limping
    • Wilson's sign at knee - tibia IR w knee ext = pain
  9. what's Wilson's sign at the knee?
    osteochondritis dissecans may be present if it's painful when you do IR on the tibia while knee is extended
  10. osteochondritis dissecans (OCD) classification system
    • open vs closed epiphyseal plate
    • stable vs unstable lesion -- unstable if > 5 mm
  11. grading of osteochondritis dissecans
    • Grade 1 - depressed osteochondral fx
    • grade 2 - osteochondral fragment attached by an osseous bridge
    • grade 3 - detached
    • grade for - displaced
  12. osteochondritis dissecans tx goal
    preserve articular cartilage!!!
  13. tx for osteochondritis dissecans is based on (4)
    • age / skeletal maturity
    • fragment size
    • location
    • stability
  14. osteochondritis dissecans non-oop tx
    • phase 1 (4-6 wks) immobilize, PWB
    • phase 2 (6-12 wks) WBAT, rehab ROM, quad + hammie strengthening, restricted sports, x-ray shows signs of healing
    • phase 3 (3-4 mo) sports readiness activities, gradual return to sport (can take 6-12 months to realy get back to sport)
  15. surgical tx for osteochondritis dissecans -- 3 options
    • done if 6 months of conservative tx failed
    • 1) drilling "oats" -- create a low grade lesion to increase blood supply. creates "vascular tunnels. the loose body is vixated or removed
    • 2) internal foxation - pinning - remove after 6-8 weeks
    • good for high grade (3 or 4) OCD lesions or loose bodies
    • 3) microfracture -- less common, longer rehab (>8 mo)
  16. what to do if large unsalvageable fragments (5)
    • debride, abrasion arthroplasty, microfracture
    • orif and bone grafting
    • osteochondral autograft transplantation
    • autologous chondrocyte implantation
    • osteochondral allograft

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