Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Osteochondritis Dissecans (OCD)

SYMPTOMS

There is gradual onset of diffuse or localised exercise-induced pain and soreness, often also at rest, usually in a young athlete without preceding trauma.

AETIOLOGY

The aetiology is unknown but is often thought to be due to repetitive minor trauma. The sub-chondral bone goes into avascular necrosis and the overlying cartilage cracks. This condition often presents as a result of sudden changes in training habits, such as an increase in intensity or amount of impact. It is therefore often misunderstood as an over-use condition. It is graded I (softening of cartilage), II (cracks and fibrillation), III (partial loosening) or IV (loose fragment in the joint).

CLINICAL FINDINGS

Symptoms depend on the grade and location of the OCD, from occasional soreness and minor effusion to a locked knee with major effusion.

INVESTIGATIONS

X-ray taken in 20 degrees of flexion on weight bearing is valuable if the OCD is on the femur condyle. MRI will show subchondral oedema and is valuable to outline the extent of the injury. Arthroscopy should be
performed to investigate the extent of the injury and treat it.

TREATMENT

Depends on severity and location but usually involves arthroscopic surgery. Loose bodies are excised, frail edges are trimmed or vaporised and the bare bone area is micro-fractured or drilled followed by non-weight-bearing exercise and physiotherapy over six to twelve months or more. REFERRALS Refer to physiotherapist for planning of a six to twelve months’ return programme back to sport. Refer to orthopaedic surgeon for arthroscopic treatment.

EXERCISE PRESCRIPTION

No or low impact is allowed over the first months to avoid turning a lower grade OCD into a higher. Cycling and water exercises are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and use repetitive X-rays, MRI and arthroscopy. Routine MRI may well show good healing and no bone oedema, whereas anthroscopy demonstrates that the fibrocartilage is soft and does not hold for impact. Cartilage-specific sequences on MRI are under development to improve this accuracy.

DIFFERENTIAL DIAGNOSES

Meniscal tear (locking and effusion after sprain), osteochondral fracture or chondral injury (acute onset after direct trauma).

PROGNOSIS

Unpredictable but many of these injuries respond well to micro-fracture. Since the injury usually takes a very long time to heal, many young professional players’ careers are ended.

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