Knee Osteochondritis dissecans (OCD)

Dr. Nakul Shah

Osteochondritis dissecans (OCD), by definition, is a disorder of one or more ossification (growth) centers, characterized by sequential degeneration or aseptic necrosis (break down) and recalcification.

Arthroscopy is preferred:Drilling of the defect may be performed, with the hope that revascularization (regrowth of blood vessels) will occur.
Pinning may be performed to stabilize the fragment. Stainless-steel pins usually require removal to avoid additional chondral injury. Resorbable pins can be used to avoid the need for removal; however, they may not be rigid enough or may not last long enough to allow healing.
Excision of the fragment and removal of loose bodies may be necessary.
Screw fixation may be performed for fragment stabilization. In this method, usually, a specialized screw or Herbert-type screw is used.
Osteochondral(bone and cartilage) autograft transplantation (OATS) involves harvesting cylindrical osteochondral grafts from other areas of the knee to reconstruct a weight-bearing surface. A maximum 1-cm lesion (crater) depth is allowed for use of this treatment method.
Bony PCL avulsion can be repaired surgically by fixing the avulsed bony fragment with restoration of PCL integrity and function. Even delayed diagnosis of avulsion injuries can be repaired with screw fixation, if the PCL substance is sufficient. Surgical reconstruction is important especially with multiple ligament injuries, posterolateral corner injury, or when there is persistent pain, instability, or disability. Acute reconstruction is more successful than reconstruction of chronic injuries. Stabilization may be performed with metal interference screws, bioabsorbable screws, endobuttons, and cross pins.
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