Focal necrosis (OCD)

Focal osteochondral necrosis (OCD)


In dissecating osteochondritis the cartilage along with the underlying subchondral bone is focally separated from the surrounding tissues due to severe necrotic changes. 

   This peculiar disease of the articular cartilage has been reported in many different joint, but most frequently it occurs in the knee, the ankle and the elbow. In the knee it is located on the medial condyle of the knee. The explanation for this pathological change is missing, but trauma to the joint is certainly suspected to be a major factor.     

Prevalence: young, school or high school-age patients.  


Complaints: usually insidiously developing moderate pain is present, with swelling of the affected joint. Occasionally besides the dull pain the joint locks and even a loose body in the joint can be palpated. Painkillers offer only limited success.


Usual protocol for examination:


·        Assessment of the axis of the extremities


·        Checking stability, range of motion


·        Assessing retro patellar sensitivity


·        Measuring muscle strength of the limb


·        Checking for any hypersensitivity


·        Taking x-ray if appropriate


                  ·        Magnetic resonance imaging (MRI) offers the best diagnostic value and very helpful for follow up as well.    

Options for treatment

  In young growing patients usually modification of the physical activity is sufficient. Nonsteroid anti-inflammatory drugs and dietary supplements are recommended. If severe effusion and loose body is present arthroscopic removal and treatment of the damage may be necessary. Full recovery in the young patients is expected. Similar osteochondral defects in adolescent and adult patients have a lot worse expectation for spontaneous healing. In this case additional cartilage repair methods must be applied, such as microfracture, mosaicplasty, cartilage cell implantation or large allograft implantation.     

Rehabilitation: once the pain is tolerable and the swelling disappeared gradual return to the physical activity is advised. Supervision of a physiotherapist is favorable. If surgery is necessary the postoperative rehabilitation must be conducted by specialist physiotherapist to regain full function of the joint.     

[Osteonecrosis: a different entity with similar pathological changes is called osteonecrosis. The osteochondral defect, however, occurs in middle age to elderly patients. The primary defect is the aseptic necrosis of the bone underlying the cartilage and the cartilage is affected only secondarily. Steroid treatment and alcohol abuse are the major triggering factors. Besides the drilling or microfracturing in the very early stages usually arthroplasty is the only solution for these patients. ]



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