Osteochondritis dissecans can occur in any joints, the knee is the most commonly involved joints.(1)
The fundamental method in the treatment of osteochondritis dissecans is the timely recognition as lesions in the early osteochondritis dissecans process can be treated successfully.(1)
Patients suffering from osteochondritis dissecans can be treated by conservative treatment or surgical procedures depending upon the severity and other factors related to the disease. Although in most cases, due to the immaturity of the joint affected it is managed conservatively because it is a disease belonging to a younger age group.(2)
What Is The Best Treatment For Osteochondritis Dissecans?
Conservative treatment which is the best mode of treatment for the osteochondritis dissecans is based upon the principle of giving the required period for the healing of the involved joint automatically. It is done by restricting the activity of the joint and immobilization of the same. It will result in the prevention of further damage and the healing process will fasten. Cast application and bed rest are the main components of conservative treatment. It is more commonly applied in the cases of children or adolescents where the complete epiphyseal fusion has not taken place.
In cases of adults where epiphyseal fusion has already taken place or about to take place, surgical treatment is preferred. Surgical treatment is also the treatment of choice if there is complete separation of a bone fragment from the surface of bone and lies within the joint cavity. But sometimes it can also be managed conservatively over a long period like 6 to 12 months.
Once the immobilization has been started then the activity resumption is done very slowly over some time to reduce the stress on the joint and do not hinder its healing. The starting of normal activity is done by performing the various exercises of the joint but is done only when the patient is not experiencing any pain during the exercises or rest.
It is almost very necessary to keep updating the knowledge about the joint involved by recommending time to time radiological investigations so that any new damage is not under the rule. It will also help to recognize the amount of healing that has occurred and what more is needed.
Surgical treatment of osteochondritis dissecans includes two types of approaches, one is the arthroscopic approach and the other is the radical or open approach.
Arthroscopic mode of treatment is the best because it is much smaller and easier operation as compared to open surgery. Removal of the bone fragments, curettage, and excision in the joint cavity, drilling, and stabilization of the bony fragment, etc. can be done using an endoscope known as arthroscope and putting it into the joint space via a small hole drilled from the surface. It also does not produce a large scar and help in healing the surgical damage very quickly (2).
But in many cases, the radical approach for the open surgery is also needed such as when there is a large fragment of subchondral bone broken down from the original long bone which cannot be removed from a small hole drilled in the arthroscopic approach and there is a high amount of activity hindrance occurring at the joint space.(3)
Surgical treatment is also based upon the findings of the radiological investigations especially the MRI. If the lesion is smaller than the size of 3 cm and a single fragment is present, it can be fixed by the arthroscopic drilling and nailing. If the lesion is of greater than 3 cm and multiple fragments are present then it can be taken out via the open approach. Debridement of sclerotic bone which is more than the size of 8cm is done by the radical approach and bone grafting is also required for such a large surgery because it creates a very large defect in the bone surface.
As most cases of osteochondritis dissecans are seen in the younger age group especially in the children and early adolescents, it is very prudent to follow the conservative mode of treatment because the condition will heal automatically.