The timing of osteochondrosis dissecans disease is not predictable. The various stages of the disease can progress at different speeds depending on the individual. A sudden persistence in one stage of the disease is possible at any time.
Spontaneous healing is also occasionally observed. The chances of spontaneous healing are greater the younger the patient is (especially before the age of 12), but at most about 50%. Overall, the choice of therapy depends on the stage of osteochondrosis dissecans.
Conservative therapy of osteochondrosis dissecans is possible in young patients in an early stage of the disease. A dissecant solution must not yet have taken place. Arthroscopically, these dissecant areas show an intact but softened cartilage coating.
The therapy includes a period of rest from sports and, if necessary, partial relief of the affected leg for 6-16 weeks. MRI – follow-up examinations are necessary to evaluate the therapy. Physical therapy measures, physiotherapy, medication, infiltrations or nutritional factors have no detectable effect on the course of osteochondrosis dissecans.
They are used to treat secondary signs of the disease (secondary symptoms of osteochondrosis dissecans) such as pain and muscle wasting (muscle atrophy). Surgical therapy is the treatment of choice for advanced osteochondrosis dissecans. An absolute indication for surgery is the dissection of the dissecate.
Dissection of the dissecate represents the maximum damage to the knee joint. On the one hand, the dissecate leaves a hole in the cartilage compound at its original location, and on the other hand, as a free joint body, the dissecate damages the still intact knee joint cartilage. For these reasons, surgical treatment of osteochondrosis dissecans should be carried out at a stage prior to dissection if possible.
The primary goal of all efforts is to preserve an intact cartilage surface. Surgical option 1: The dissecant is not dissolved, the cartilage surface is intact. Surgical option 2: The dissected cartilage is partially or completely detached from the cartilage composite but intact.
- In this case, retrograde or anterograde drillings of the OD region are performed with a thin drill bit (2 mm). The goal is to break through the sclerotic zone and to revitalize the OD region. In anterograde drilling, thin holes are drilled through the intact cartilage from the knee joint side.
Retrograde drilling attempts to prevent any cartilage injury by drilling into the OD region from the outside. However, it is more difficult to hit the right spot. A postoperative partial load of 6 weeks is necessary.
- Another possibility is to replace the dead bone with the body’s own healthy bone.
For this purpose, for example, vital spongy bone (cancellous bone) is removed from the iliac crest or the head of the tibia and, after hollowing out the dead osteochondrosis dissecans area, is placed in this place. This should restore the cartilage to a vital, stable base.
- The Dissekat is refixed using various fastening systems (screws, pins, bolts). For this purpose the mouse bed is first freshened so that a later ingrowth is possible.
A postoperative partial load of at least 6 weeks is necessary. The screws must be removed in a second operation after the ingrowth of the dissectate.
Surgical option 3: The dissekat has come loose but is no longer suitable for refixation.
- In this case, the therapy can only consist of closing the existing hole in the knee joint cartilage as well as possible.
Various procedures are available here.
- Pridie DrillingMicrofracturingSmall drill holes (deep into healthy bone to stimulate the growth of replacement fibrous cartilage tissue. This fibrocartilage, which is of inferior quality compared to healthy cartilage, grows out of the bone and should close the hole.
- MosaicplastyCartilage-bone transplantationCartilage/bone cylinders are removed from an unloaded knee joint section and inserted into the mouse bed using a press-fit technique.
- Cartilage cell transplantationIn a first step, cartilage cells are harvested, grown, placed on a carrier medium and in a second step transplanted into the knee joint to fill the hole. The procedure is expensive and is not always fully covered by health insurance. However, osteochondrosis dissecans of the young person is the classic indication for this promising surgical method.
