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Osteochondritis Dissecans

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Osteochondritis Dissecans

WHAT IS IT?

This is a disease displaying the separation of a fragment of cartilage from its sub-chondral bone. It has its origins in sub-chondral bone avascular necrosis, which causes fibrillation and softening of the cartilage. Without revascularisation, the bone fragment separates from the healthy bone. It is more frequently found in men of 15-20 years of age, and in 85% of cases it affects the inner femoral condyle. It is usually mostly unilateral.

CAUSES

Among other factors, we find bone infarction caused by embolisms and changes in the ossification process. In 45-50% of cases it results from previous traumas. The osteochondral fragment may be stable or unstable. It can also be found as a free articular body.

SYMPTOMS

Although it usually starts in adolescence, the first symptoms may not appear until early adulthood.

If the fragment is stable, during analgesic external rotation there may be pain and leakage with the presence of a stain. If the fragment is unstable, clicking, a feeling of instability and pseudolocking may be observed, which, if the fragment comes away from the joint as a free body, may cause joint locking.

TREATMENT

In the case of patients with open physes, conservative treatment is preferred, given that there is still the possibility of spontaneous healing.

In cases of unstable osteochondritis, arthroscopic treatment will be implemented, taking the viability or inviability of the fragment into account.

In the case of osteochondritis dissecans with a viable fragment, debridement of the osteochondral wound bed will be carried out. The fragment will be separated and the debridement, spongialisation, and reaming of the osteochondral bone surface performed. After this point, intra-osseous PRGF®-Endoret® injections will be administered in the wound bed, followed by the fixing of the osteochondral fragment in place and ensuring its stability. Once this attachment is carried out, another PRGF®-Endoret® injection is administered between the healthy bone and the osteochondral fragment using a fine needle.

If the lesion is not viable, the diseased tissue will be removed using debridement and spongialisation. Following this, Pridie drilling and Micro-fracturing will be applied, as well as an intra-osseous PRGF®-Endoret® injection to induce synthesis of the tissue which, though different from the original tissue, fulfils the same mechanical functions. Finally, another articular injection of free PRGF®-Endoret® will be administered following the aspiration of the cleaning fluid.

If there are free bodies, these are removed. To complement the arthroscopic treatment, it is recommended that the patient receive PRGF®-Endoret® injections after surgery on an outpatient basis, for the 2 or 3 weeks that follow, and a functional rehabilitation programme.


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