Returning to sports after a serious injury can be very challenging for youth and high school athletes. In this Ask Dr. Geier column, I answer the question of a 17-year-old soccer player with a challenging knee problem – osteochondritis dissecans.
Kalle Kawarea writes:
I am diagnosed with osteochondritis dissecans. I am a soccer player that plays at a very high level. I’m just wondering, will this affect my career? I’m just 17 years old, and I have to know more about this injury… please.
What is osteochondritis dissecans, or OCD?
Thanks for the question, Kalle. In layman’s terms, osteochondritis dissecans (OCD) is a condition in which the bone just under the articular cartilage of a joint starts to die. It most often occurs in the knee, but it can develop in the elbow. Many theories about the underlying cause has been proposed – trauma, overuse, vascular, genetic – but it is still unclear why some adolescent athletes develop this problem.
Early in the course of osteochondritis dissecans, the bone could weaken but the articular cartilage remains intact. If the cartilage breaks down, the lesion can become displaced.
Treatment options for OCD lesions
In a young athlete who has not finished his growth spurt, the surgeon might try a period of making him nonweightbearing and hold him out of sports.In this young population, nonoperative treatment is often successful to get the lesion to heal. If a period of no weight-bearing does not cause the lesion to heal, the surgeon can occasionally drill small holes into the bone arthroscopically to stimulate blood flow into it. If the OCD lesion starts to break free but it is still in place, the surgeon might try to fix the lesion in place with pins or screws.
Surgery for osteochondritis dissecans
In an adult or older adolescent who has finished puberty, nonoperative treatment is less often successful. Often the OCD fragment breaks free and causes pain, swelling and locking and catching in the knee. Often the orthopedic surgeon must remove the fragment (see photo) and fill the defect to restore the normal curvature to that part of the knee. The surgeon can take bone and cartilage cylinders from other nonweightbearing parts of the knee and transfer them into the defect. If the lesion is particularly large, he might take a cylinder of bone and cartilage from a donor (osteochondral allograft) and place it into the defect.
Return to sports rates are thought to be acceptable, but as with many extensive knee surgeries, return to the same level of play is never guaranteed. Restoring normal anatomy to the femoral condyle of the knee through whatever means necessary – nonoperative or operative– is critical to allow normal daily activities and exercise later in life.
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