Osteochondritis Repair and Reconstruction
What is osteochondritis repair and reconstruction?
Osteochondritis repair and reconstruction is surgery to treat osteochondritis dessicans (OCD), a joint condition in which a piece of bone and cartilage separates from the end of a bone. The condition is most common in children and adolescents and usually affects the knees. It is typically an overuse injury. Trauma, genetics and rapid growth can also lead to OCD.
Surgical options vary according to a patient's age and the location and size of the bone fragment. The surgeon may do one of the following:
- Drill small holes into the underlying bone to stimulate healing
- Hold the lesion in place with internal fixation such as pins or screws
- Remove the loose piece of bone and cartilage and replace it with a graft
In addition, autologous chondrocyte implantation (ACI) has shown promise for treating OCD. This procedure is a two-step process. Using an arthroscope to see inside the knee joint, the surgeon identifies the area of cartilage damage and removes a small sample of healthy cells. These cells are sent to a lab, where they are duplicated over the next four to six weeks. A second procedure is then performed to implant the cultured cells into the joint. By implanting healthy cartilage cells in the traumatized area, the cells often incorporate with the surrounding healthy cartilage to heal the injured area and restore joint function.
The knee is the largest joint in the body and one of the most complex. It is made up of the femur, tibia and patella. Damage can result from injury, deformity or arthritis, when the articular cartilage that cushions the ends of the bones gradually erodes.
When is surgery recommended?
If the bone fragment is very large (greater than one centimeter in diameter) or has detached and is moving around within the joint, surgical treatment is recommended. Smaller lesions may respond to non-operative measures such as over-the-counter pain medications and a period of non-weight bearing rest to allow the bony fragment to heal. Left untreated, OCD can increase the risk of developing early-onset arthritis in the knee joint.
What is the recovery time?
Recovery varies by patient and the type of surgery performed. In general, patients use crutches for about six weeks, followed by two to four months of physical therapy to regain strength and motion in the knee. A gradual return to sports may be possible after about six months.