Treatment - How can I help

Osteochontritis Dissecans (OCD)

Other popular names

None

Who does it affect?

Adolescents usually.

Why does it happen?

Osteochondritis dissecans (OCD) is a fragmentation and possible separation of a portion of the cartilage of the joint. This usually presents during adolescence.  It may be caused by injury, but not always.  

Symptoms

Symptoms are pain aggravated by motion, limited motion, clicking, and swelling.

Diagnosis

The osteochondral fragment may remain in situ, be slightly displaced or become loose within the joint cavity.   If the fragment remains attached to the underlying bone, healing can occur.  If completely detached, complete healing does not occur.  The loose cartilage body may increase in size and cause locking and clicking of the joint.  In some cases, the fragment may become absorbed.  Treatment depends on the status of the fragment which is graded via an MRI scan.

Grade 1:  intact cartilage with signal changes in subchondral bone
Grade 2:  a high signal breach of the cartilage; low signal posterior to the lesion
Grade 3:  thin high signal rim extending behind the osteochondral fragment indicating synovial fluid around the fragment
Grade 4:  mixed or low signal loose body in the center of the lesion or free within the joint

Non-surgical treatment

Only Grade 1 lesions do not require surgical treatment and are left untouched.

Surgical treatment

The type of lesion will determine the surgical approach required:

Grade 2 lesions are usually drilled in an attempt to aid healing of the fragment.
Grade 3 lesions although attached by a rim of articular cartilage, require internal fixation.
Grade 4 lesions require removal and debridement of the bony bed.

Surgery is carried out as a day case procedure usually either under local or general anaesthetic and takes about 15-30 minutes.

Post-surgery rehabilitation

You can go home soon after the operation.  The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The arm should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers and elbow from day 1. The dressing will be removed soon after your operation.  The wound is cleaned and redressed with a simple dressing.  Avoid forced gripping or lifting heavy objects for 2-3 weeks.  The sutures are removed at about 10 days.  You should notice an improvement in symptoms within a few weeks but the final result may take some 3-6 months.

Return to normal routine

Keep the wound dry until the stitches are out at 10 days.

Return to driving:

The hand needs to have full control of the steering wheel and left hand the gear stick.  You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.

Return to work:

Everyone has different work environments.  Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament.  You will be given advice on your own particular situation.

Risks

Overall over 95% are happy with the result. However complications can occur.

General risks (less than 1% each):

Infection
Neuroma (nerve pain)
Numbness
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).

Specific risks:

Failure to completely resolve the symptoms (approximately 1%) - this may be due to failure to completely release the area. This is rare, but may be released again.

 

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