Osteochondrosis dissecans knee

definition

Osteochondrosis dissecans is a clinical picture that is associated with bone necrosis (lat .: Osteonecrosis) is described on a specific joint surface. In the further course, this osteonecrosis is accompanied by splitting off of joint fragments. The detached fragment is also referred to as the so-called "joint mouse" or "joint dissection". The knee is an extremely predisposed (vulnerable) site for osteochondrosis dissecans. Other locations such as the upper extremity (elbow joint) or the foot (ankle joint) can also occur.

Read more about this under Osteonecrosis of the knee and cartilage flake

root cause

Despite today's medical advances, the exact causesthat one Osteochondrosis dissecans underlying still not clear and not further defined. However, it is agreed that the most common reason is Overloading the knee joint is; for example through competitive sport. This is compatible with the fact that children and young people in particular are affected. Because the sporting phase of competitive sport begins at a young age, which quickly becomes one chronic, mechanical overload can lead. Often it happens on End of the growth phase to that clinical picture. So this implies that Children very often affected are.

In principle, the knee is an anatomical structure that is exposed to extreme loads, as it is exposed to pressure or tensile loads in almost every sport, apart from swimming. Either Cartilage and bone damage as well as Meniscus and cruciate ligament tears are not atypical. In addition to mechanical overload, a poor blood circulation or traumatic events (Fractures, Upsets etc.) be the trigger for bone necrosis with a joint dissection.

The Knee joint is mainly due to the medial femoral condyles (lat. Femur: Thigh bone, Latin condyles: Articular process) prone to the occurrence of a Osteochondrosis dissecans.

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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The knee joint is one of the joints with the greatest stress.

Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Stages

The course of the disease can be seen in four successive stages structure.

• By doing first stage the bone necrosis is subchondral (under the cartilage) and the cartilage is not involved yet.
• in the Stage 2 is a Differentiation of healthy and diseased bone tissue (= Demarcation) recognizable. This goes with the Softening of the joint capsule and a sclerosing border.
• in the third stage If the damage then progresses so far that it leads to Detachment of a joint fragment comes from the joint bed, which now has free space in the joint fluid of the joint space.
• in the fourth stage caused this "Joint mouse" now one Joint defect.

The severity of the clinical picture thus increases with the stages.

Clinic and diagnostics

Typical for a Osteochondrosis dissecans are the load-dependent pains which increase in strength as the disease progresses and can become so strong that any sporting activity is no longer possible. Besides, it can too Joint blockages come, due to the freely movable joint fragments. The Knee joint can also inflamed and swollen be. Also the Joint effusion is known in connection with the clinical picture.

The diagnostic means the first choice is that MRI (Magnetic resonance imaging). In combination with X-rays can almost certainly be diagnosed as having a Osteochondrosis dissecans is present and if so, at what stage. It should be mentioned here that the x-ray does not detect osteochondrosis dissecans until a later stage; tends to only occur when a joint dissection can be seen, which has detached itself from the joint surface and possibly floats freely in the joint space. The x-rays show the osteochondrosis dissecans by a decreased bone density, Sclerotherapy, Osteolysis and ultimately that visible joint dissection. Thus, correct, causal consequences for the therapy can be made.

Of the Degree of cartilage injury as well as the stability can be precisely determined and estimated with the diagnostic means. Nowadays, the Sonography (Ultrasonic) osteochondrosis dissecans are also diagnosed. In general, however, the imaging methods are used when the patient is already suffering from pain, because only then does he decide to see a doctor. At this point, the osteochondrosis dissecans is usually well advanced (stage III or IV). An early stage is usually diagnosed only as an incidental finding.

therapy

Main goal of therapy is that the patients are again pain-free and that Functionality and anatomy of the knee is restored.

The choice of a suitable therapy is based on 3 questions:

1. At what stage of the disease is the knee?

2. Is it a stable or unstable osteochondrosis dissecans?

3. How old is the patient?

in the Stage 1 becomes a Arthroscopy (Greek arthros: joint and skopein: look) so a joint reflection was made, in which the Condyles to Improvement of the blood circulation become. The drilling takes place in Stage 1 retrograde, in Stage 2 however, antegrade through the cartilage through. If it's already a Detachment of a joint fragment came, so im Stage 3, the articulated mouse must be fixed back in its original position. This can be done through a screw, one absorbable stick or simply through Fibrin glue respectively. Depending on how big the Cartilage damage is, you choose between the osteochondral transplant (OCT) or the autologous chondrocyte transplant (ACT).

If the Defect relatively small is, the intervention of the OCT Cartilage tissue from the Outside (Lateral side) the patella (kneecap) removed to it using previously drilled holes in the originated Necrosis to transplant.

At major damage takes place the ACT, one two-stage operation, it means that two interventions are necessary. The first procedure will be in a suitable place Cartilage cells removedthat are then bred or cultivated in order to subsequently use them Reimplant to the Refill cartilage damage.

Is based on the X-ray and MRI images to realize that it is a unstable osteochondrosis dissecans acts, the Indication of an operation more likely, since conservative therapy would no longer be sufficient. Signs of instability are the fact that a Joint mouse in the joint space is located and already a Joint damage present.

The Age of patients plays a very big role. childrenwho are around 13 years of age open growth plates have a very good chance of recovery even without surgery. The conservative therapy includes the Relief and immobilization of the knee. There especially children suffer from osteochondrosis dissecansThose who do a lot of or even performance-oriented sport must be avoided entirely in order to give the knee the opportunity to regenerate. Therefore, compliance (cooperation) between doctor and patient plays a crucial role. To support the discharge you can Forearm crutches to be used; an immobilization by one plaster cast does not provide for conservative treatment.

Generally it lasts Relatively long healing processsince that destroyed Fabric completely new replaced must become. That process of Bone remodeling (= Remodeling) is achieved through the work of Osteoclasts and osteoblasts (Bone cells) enables and lasts some months.

Even the Spontaneous healing in young patients by conservative therapy up to one year. Until then, instructions must be followed so that ultimately all structural deficits could be restored and that affected bone area again adequate blood supply and regains its old stability.

It should be mentioned that the choice of therapy is discussed again and again, especially depending on the age of the patient.