OSTECHONDRITIS DISSECANS

Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply.  The separated fragments are sometimes called “joint mice”.  These fragments may be localised, or may detach and fall into the joint space causing pain and joint instability. 

Osteochondritis dissecans occurs can occur in any of the joints including your elbows, ankles, shoulders, knees and hips.

Osteochondritis dissecans is more common among boys and young men between 10 and 20 years who actively take part in sports, such as cricket, gymnastics and baseball may develop osteochondritis dissecans.

The exact cause for osteochondritis dissecans remains unknown and certain factors such as trauma, fractures, sprains, or injury to the joint are considered to increase the risk of developing the condition. Osteochondritis dissecans may be caused by restricted blood supply to the end of the affected bone that usually occurs in conjunction with repetitive trauma. Following the injury or trauma, the bones in the area may be deprived of blood flow leading to bone cell death and finally the bone fragment may break off. This may initiate the healing process. However, by this time, articular cartilage will be compressed, flattened, and a subchondral cyst will be developed. All these changes in addition to increased joint pressure cause failure of healing of the joint.

Patients with osteochondritis dissecans usually have elbow joint pain, swelling, stiffness, and decreased range of motion. Pain usually increases after activity.

Dr Bala will probably order an X-ray of the elbow to see the abnormality in the joint space. You may also have a CT or MRI scan that is useful in determining the location of loose fragments within the joint.

Treatment

Dr Bala may recommend various treatments depending on the reports of diagnostic scans, age, severity, stability of the cartilage and other factors. Goals of treatment are to relieve the symptoms and stop or impede the progression of degeneration of the joint. Conservative treatment approaches such as wait & watch approach, pain medications, and immobilisation for 1-2 weeks are recommended if the condition is diagnosed at an early stage and if the severity is mild. However, surgery is required if the condition is diagnosed at an advanced stage or if the condition is severe.

Surgical correction of osteochondritis dissecans can be done using open or arthroscopic techniques.

Some of the surgical procedures Dr Bala does include drilling, bone grafting, open reduction internal fixation, osteochondral grafting, or autologous chondrocyte implantation (ACI).

  • Drilling – In this method, multiple small holes are drilled into the bone which allows the growth of new blood vessels in the defect area. This promotes blood flow into defect area thereby initiating the healing response and formation of new cartilage cells inside the lesion
  • Open reduction internal fixation – Open surgery is performed in cases where the affected area is difficult to reach with an arthroscope. Hence an open incision may be required. In this procedure, an incision is made in front of the joint to allow the surgeon to see the joint and the loose bodies are removed. Internal fixation involves fixing the fragments using devices such as headless titanium screws, bioabsorbable pins, or wires
  • Bone grafting – It helps to fill the gap after removal of the dead or necrotic bone. In this procedure bone graft is placed on the damaged site. This procedure may be performed to repair the damaged area or replace the missing bone. Autograft (harvested from the same individual) or allograft (taken from bone bank) may be required to help in the growth of a new bone
  • Osteochondral grafting – The procedure involves transfer of healthy cartilage plugs from the non-weight bearing areas of other joints and transferring them into the damaged areas of the elbow joint in mosaic pattern (Mosaicplasty/ OATS procedure). It allows the newly implanted bone and cartilage to grow in the affected area. Grafts may be taken from the same individual (autograft) or from a donor or bone bank (allograft). Dr Bala may sometimes opt to harvest your own cells, have it differentiated into cartilage forming cells and grow in a special lab and implant it back into your elbow. This procedure is called Autologous Chondrocyte Implantation (ACI)

In the event you may have a tattoo on the elbow Dr Bala is well versed in suturing tattoos back accurately with absorbable sutures.