Clinic and diagnostics | Osteochondrosis dissecans Knee

Clinic and diagnostics

Typical for osteochondrosis dissecans are the stress-related pains, which increase in strength as the disease progresses and can become so severe that any kind of sports activity is no longer possible. In addition, joint blockages can occur due to the freely moving joint fragments. The knee joint can also be inflamed and swollen.

Joint effusion is also known to be associated with the clinical picture. The diagnostic tool of first choice is MRI (magnetic resonance imaging). In combination with X-rays, it can be diagnosed with a reasonable degree of certainty whether osteochondrosis dissecans is present and if so, at what stage.

It should be mentioned here that X-rays do not detect osteochondrosis dissecans until a later stage; this tends to be the case only when a joint dissection is visible, which has detached from the joint surface and may be floating freely in the joint space. The radiographs confirm osteochondrosis dissecans by a reduced bone density, sclerosing, osteolysis, and finally the visible joint dissection. This allows us to draw the correct causal consequences for the therapy.

The degree of cartilage injury as well as the stability can be precisely determined and assessed by diagnostic means. Today, sonography (ultrasound) can also be used to diagnose osteochondrosis dissecans. However, imaging techniques are generally used when the patient is already suffering from pain, because only then does he or she decide to see a doctor. By this time, osteochondrosis dissecans is usually already well advanced (stage III or IV). An early stage is usually only diagnosed as a chance finding.

Therapy

The main goal of the therapy is to make patients pain-free again and to restore the functionality and anatomy of the knee. The choice of a suitable therapy is based on 3 questions: 1. at what stage of the disease process is the knee?2. is it a stable or unstable osteochondrosis dissecans?

3. how old is the patient? In stage 1, an arthroscopy (Greek arthrosis: joint and scopein: to look) is performed, i.e. an arthroscopy in which the condyles are drilled to improve blood circulation. In stage 1 the drilling is retrograde, in stage 2 it is antegrade through the cartilage.

If a joint fragment has already detached, i.e. in stage 3, the articular mouse must be reattached to its original position. This can be done with a screw, an absorbable pin or simply with fibrin glue. Depending on the extent of the cartilage damage, a choice is made between osteochondral transplantation (OCT) or autologous chondrocyte transplantation (ACT).

If the defect is relatively small, the OCT procedure allows cartilage tissue to be removed from the outside (lateral side) of the patella (kneecap) and transplanted into the resulting necrotic lesions using previously drilled holes. In case of more extensive damage, ACT is performed, a two-stage operation, which means that two interventions are necessary. In the first procedure, cartilage cells are harvested from a suitable site, which are then cultivated and reimplanted to fill the cartilage damage.

If the X-ray and MRI images show that the patient is suffering from unstable osteochondrosis dissecans, surgery is more likely to be indicated, as conservative therapy would no longer be sufficient. Signs of instability are the fact that a joint mouse is located in the joint space and that there is already joint damage. The age of the patient plays a very important role.

Children who have open growth joints until about the age of 13 have very good chances of recovery even without surgery. The conservative therapy includes the relief and immobilization of the knee. Since it is mainly children suffering from osteochondrosis dissecans who do a lot of or even performance-oriented sports that suffer from osteochondrosis dissecans, it must be avoided completely in order to give the knee the opportunity to regenerate.

Compliance (cooperation) between doctor and patient therefore plays a decisive role. Forearm crutches can be used to support relief; immobilization with a plaster cast is not part of conservative treatment. In general, the healing process takes a relatively long time, since the destroyed tissue has to be completely replaced.

This process of bone remodeling is made possible by the work of osteoclasts and osteoblasts (bone cells) and takes several months. Even spontaneous healing in young patients by conservative therapy takes up to a year. Until then, instructions must be followed so that ultimately all structural deficits could be restored and the affected bone area is adequately supplied with blood and regains its old stability. It remains to be mentioned that the choice of therapy is discussed time and again, especially depending on the age of the patient.