Osteochondritis Dissecans Treatment Options
In many cases when the child is still growing the affected bone and cartilage can heal without treatment. Skeletal maturity and lesion stability are important factors when making treatment decisions. Stable lesions are those with a softened area but intact cartilage. Unstable lesions are the loose bodies that cause mechanical symptoms of catching and locking. Arthroscopy is the gold standard for determining lesion stability.
What are the non-surgical treatments for Osteochondritis Dissecans?
In mild cases of osteochondritis dissecans, a skeletally immature patient with stable lesions and only minimal symptoms is typically treated with non-surgical management for 3-6 months followed by a gradual return to activity. Non-surgical success rates are between 49% and 100% in patients with mild cases.
Non-surgical management includes a combination of:
- Rest and activity modification: Reducing physical activity and avoiding activities that can exacerbate symptoms can help manage pain and promote healing.
- Oral anti-inflammatory medications: Over the counter and prescription pain medications to reduce pain and inflammation.
- Immobilization: Bracing or a cast to allow the bones and cartilage to heal.
- Weight-bearing restrictions.
- Platelet rich plasma therapy: This involves injecting a concentrated solution of the patient’s own blood platelets into the knee joint to promote healing.
- Shockwave therapy: This involves the use of high energy sound waves to stimulate healing in the affected areas.
- Physical therapy to improve range of motion and strength, and close follow-up.
What are the surgical treatment options?
More severe cases of osteochondritis dissecans, where there are unstable lesions, and failed nonsurgical treatment, surgery is the best treatment option. The technique employed depends on the characteristics of the lesions.
Where the damage is substantial and irreparable, Dr. Godin will remove unsalvageable lesions and consider cartilage salvage and resurfacing procedures including bone marrow stimulation (microfracture), autologous chondrocyte implantation (ACI), osteochondral autograft transplants and allograft transplants (OATS).
Surgical treatment options for OCD of the knee may include:
- Arthroscopic debridement: In this minimally invasive procedure, the surgeon removes any loose fragments of bone and cartilage from the knee joint.
- Microfracture surgery: This involves making small holes in the bone beneath the OCD lesion to stimulate the formation of new cartilage.
- Autologous chondrocyte implantation (ACI): ACI is a surgical procedure that involves the transplantation of healthy cartilage cells from the patient’s own body to replace the damaged cartilage in the knee joint. This is a two-step procedure over months.
- Osteochondral autograft or allograft transplantation (OATS): This involves transferring healthy cartilage and bone from another part of the patient’s knee or donated cartilage and bone to replace the damaged area.
During surgery, Dr. Godin will remove the damaged cartilage and bone lesions; secure bone fragments with metal pins and screws to stabilize the joint; and stimulate bone healing and blood supply with microfracture, drilling of the bone to stimulate the flow of stem cells and growth factors to heal the lesions. In some cases, bone grafting may be necessary.
Dr. Jonathan Godin is an orthopedic surgeon and sports medicine physician. He specializes in advanced arthroscopic and reconstructive surgical techniques for the treatment of complex disorders of the knee including cartilage and resurfacing procedures. He has cared for professional athletes from the NFL, MLB, NHL, ATP/WTA, PGA and was team physician for the US Men’s and Women’s Alpine Ski Teams. Contact Dr. Godin at Vail Orthopedic Surgery with offices in Vail, Frisco or Edwards, Colorado to schedule a consultation where you can receive the correct diagnosis and all your treatment options.