The term osteochondrosis dissecans is used in medicine to describe a bone disease. This can result in bone decomposition or the formation of an unnaturally large layer of cartilage. Osteochondrosis dissecans is manifested by severe pain and cause wear. The term itself is actually already outdated. It is now referred to as an osteochondral lesion. In about 75 percent of all cases, the knee is affected by osteochondrosis dissecans, but the ankle and hip can also be affected by the disease.
What is osteochondrosis dissecans?
Osteochondrosis dissecans is a degenerative disease of the bones of the ankle or knee joint. It is manifested by severe pain in the joints, which worsens as the disease progresses. The causes are very diverse; among other things, insufficient movement or also an incorrect load can be triggers. The development of osteochondrosis dissecans is favored by risk factors such as obesity and is more common in advanced age. It is no longer possible to reverse a change in the bone substance that has already occurred. Therapeutic approaches only help to alleviate the symptoms.
Causes
In most cases, the cause of osteochondrosis dissecans is natural wear and tear that occurs as affected individuals age. This is mainly due to the fact that in younger years, overloads or even incorrect loads can often still be compensated well. As the body ages, bones, cartilage and muscles weaken. The consequence of this weakening is the detachment of small bone particles, which leads to increasing movement pain. Permanent incorrect loading often increases the risk of developing osteochondrosis dissecans. Rheumatic diseases can also be a possible cause. Particularly in osteochondrosis dissecans, which occurs comparatively rarely, the body cannot convert its cartilage cells into bone material, so the joints become severely cartilaginous.
Symptoms, complaints, and signs
Osteochondrosis dissecans is most common in young people who play sports. All joints can be affected. However, the disease is most commonly observed in the knee or ankle joints. As a rule, the disease process initially proceeds without symptoms. At this stage, osteochondrosis dissecans can only be diagnosed as an incidental finding. Later, patients aged eight to fifteen experience the first load-dependent diffuse pain that cannot yet be localized. There is not yet a pain point that hurts when touched. The pain in the joints occurs regularly during sports activities or other stress on the joints. At rest, the discomfort also subsides. Therefore, morning joint pain does not usually occur. The complaints always develop during the course of the day in the context of physical activity. However, there are also completely painless courses of the disease. However, the disease usually progresses until the joint mouse is finally rejected. Then very severe pain can suddenly occur in the affected joints. If, in addition to the pain, stretching inhibitions and blockages occur, there is a clear indication of osteochondrosis dissecans, which is close to detachment of the joint mouse. However, even with very clear findings for dissection, some cases may still progress without pain.
Diagnosis and course
The typical symptoms of osteochondrosis dissecans include primarily joint and bone pain. It is not noticed by the affected person himself until inflammatory pain formation is already present. In addition to a detailed discussion, the doctor will also take an X-ray to establish the diagnosis. In most cases, this already provides information about whether and how severe the wear of the joints is. If the disease is still at an early stage, the doctor will probably not be able to make any definite statements about possible changes. In this case, a magnetic resonance imaging (MRI) is performed to further confirm the diagnosis. If osteochondrosis dissecans is not treated, the pain becomes much more severe as the disease progresses. Movement restrictions occur, which lead to a massive reduction in the patient’s quality of life.Especially when children and adolescents show symptoms of osteochondrosis dissecans, these are often interpreted as growth pains or consequences of an injury. Especially children and adolescents who are active in sports always suffer from pain during and/ or after sports activities, which is why sports must then be discontinued.
Complications
In osteochondrosis dissecans, those affected suffer primarily from discomfort in the bones. Bone fractures also occur much more frequently due to the disease and can significantly reduce the patient’s quality of life. Pain occurs primarily during exertion, especially at the joints. However, many sufferers of osteochondrosis dissecans also suffer from pain at rest, so that sleep problems and thus depression can occur, especially at night. Furthermore, it can also block scars, so that patients can suffer from paralysis or other disorders of sensitivity. The joints wear out relatively quickly and there are restrictions in movement. If osteochondrosis dissecans already occurs in children, it can lead to growth disorders and thus to delayed development. The child may then no longer be able to perform sports. The treatment of the disease is carried out without complications. With the help of medication and various therapies, the symptoms can be alleviated. In some cases, however, patients may require surgical intervention.
When should you go to the doctor?
If athletically active people experience bone structure discomfort, they should undergo a checkup. Professionals who have to perform intensive physical work and experience irregularities of their skeletal system should also consult a doctor. In most cases, the complaints continuously increase in intensity and extent in the course of life. If misalignment or poor posture of the body occurs, the affected person needs help. Corrections are necessary to prevent the development of serious physical impairments that lead to lifelong limitations. Therefore, a doctor should be consulted in time and a treatment plan should be created. Pain in the joints, an unusual decrease in physical performance, and low resilience should be discussed with a physician. If additional emotional problems arise as a result of the physical losses, a visit to the doctor is necessary. A decrease in well-being, a reduced quality of life and behavioral problems should be discussed with a doctor. If severe pain suddenly occurs, a doctor should be consulted as soon as possible. Pain medication should not be taken on one’s own responsibility, as complications and sequelae may occur. If daily activities can no longer be performed as usual or without pain, consultation with a physician is recommended. In many cases, a restructuring of lifestyle habits as well as an optimization of movement patterns must take place for an improvement in health to occur.
Treatment and therapy
Once osteochondrosis dissecans has been diagnosed, appropriate treatment is given. Because it is a degenerative disease, the damage to bone tissue cannot be completely reversed. The treatment always depends on the relative size of the respective changes as well as the localization. Early diagnosis is important for targeted treatment. First, the symptoms of the affected person are treated. Initially, conservative therapy should always be preferred. Pain relief is achieved with appropriate medication. In addition to painkillers, the doctor can also use so-called muscle relaxants. The discomfort can also be alleviated by massage, heat or stimulation current applications. Physiotherapy can also provide relief. If osteochondrosis dissecans is already in an advanced stage, surgical intervention can also help. Hardened cartilage tissue is removed and – if necessary – a joint prosthesis is inserted. After the surgical intervention, overloading and incorrect loading should be avoided as completely as possible.
Outlook and prognosis
The outdated term osteochondrosis dissecans describes an osteochondral lesion at weight-bearing joints. It is a joint disease that is present in the knee joint, ankle joint, or hip joint.Without treatment, osteochondrosis dissecans causes osteoarthritis. Osteochondral lesion primarily affects athletic people of younger and middle age. Surgical measures can reduce ankle or knee joint damage Often, if surgery is performed early, former athletic ability can be completely restored. However, the prognosis can be positive – in young patients under twelve years of age – without surgery. Spontaneous healing occurs in half of the cases. Doctors therefore wait to see what develops in very young patients. Surgery of the affected joint is only considered if self-healing is not evident. Otherwise, the prognosis is positive if the affected bone area can be revitalized by appropriate measures. As a result, detachment of the dissecting bone does not occur. The prognosis is worse if other procedures are used. Attempts to fix the so-called bone mouse, or to insert a cartilage graft, are usually less successful. Particularly in the joints of the lower extremities, sensitive reactions are to be expected in the long term if changes occur in the cartilage apparatus. These do not even have to be severe.
Prevention
Osteochondroses dissecans can usually only be prevented to a limited extent. In general, a balanced diet rich in vitamin D is important. Sufficient exercise also strengthens the muscles, which in turn prevents wear and tear. In all movements, however, care should be taken to avoid incorrect and excessive strain on the joints. If the pain occurs during sporting activity, consistent rest or relief can help to reduce the discomfort. Mechanical symptoms such as blockages or stretching inhibitions are also a clear warning signal, because in this case there is usually already a change in the joint surfaces. Under certain circumstances, participation in a back school can help to find a permanently correct posture and thus prevent painful complaints from the outset.
Aftercare
In most cases of osteochondrosis dissecans, only a few measures of direct aftercare are available to the patient. In this case, the affected person should ideally contact a physician at the first symptoms and signs of the disease, so that further complaints and complications can be prevented. It is also not possible for the disease to heal on its own, so medical help is usually necessary. In most cases, those affected are dependent on the measures of physiotherapy or physical therapy to properly and permanently alleviate the symptoms. Here, many of the exercises can also be performed in the patient’s own home to accelerate healing and improve the movement of the body. However, in some cases, the disease must also be treated by surgery. In this case, the affected person should in any case rest and take care of his body after the operation. Efforts or stressful and physical activities should be avoided. The affected person may also be dependent on the help of his family in everyday life due to osteochondrosis dissecans. As a rule, however, the life expectancy of the affected person is not reduced.
What you can do yourself
In addition to medical treatment of osteochondrosis dissecans, there are different ways to help yourself. There are different recommendations about what load an affected joint should be exposed to. The focus of therapeutic measures is on maintaining muscular balance as well as muscle building. However, it is important to focus on the individual course of the disease as well as the patient’s stage of disease. Physicians and physiotherapists can provide instructions for physical exercises that should be performed regularly at home. Only through continuous repetition in conjunction with professional guidance can maintenance or an increase in performance be achieved. In addition to active exercise, relaxation and stretching exercises can be performed. Various options such as yoga or progressive muscle relaxation are taught in courses and are easy to integrate into everyday life. A few minutes of such exercises every day can help improve the quality of life of affected patients and reveal new ways of dealing with symptoms.Such measures can also include the social environment of the person with the disease, since, unlike medical therapy, they can also be carried out by healthy family members. This support can help affected individuals accept the disease and feel less excluded.
