yoga book / pathologie / osteochondrosis dissecans

Definition

Osteochondrosis dissecans (OCD) is a subchondral aseptic bone necrosis of a circumscribed area below a articular cartilage. It is usually caused by trauma. The juvenile occurrence with an unclosed epiphyseal groove is referred to as juvenile osteochondrosis dissecans JOCD. The most common form is juvenile osteochondrosis dissecans of the knee. The cause of this disorder has not been sufficiently clarified. Macrotraumas or iterated microtraumas are suspected, which lead to disorders of subchondral vascularisation and ultimately osteolysis and sclerosis, facilitated by aggravating factors such as ischaemia, hyperthyroidism or hypothyroidism. While the longitudinal growth of the bone takes place evenly in the epiphyseal groove, epiphyseal growth takes place apositionally starting from the articular cartilage in the AECC (articular-epiphyseal cartilage complex), which surrounds the epiphyseal core. This area is particularly susceptible to trauma as the arteries are end arteries without significant collateral connections. The damaged part consisting of bone and cartilage detaches as a dissecat (a joint mouse or free joint body). The defect site (mouse bed) is later filled with fibrous tissue. The initial pain results from synovial inflammation caused by changing cartilage. If a free joint body (joint mouse) is later present, this can cause pinching pain and painful joint locking. Even the beginning of the detachment can cause pinching pain and is an indication of the need for immediate treatment. Radiographically, a distinction is made between three stages:

1. Dormant stage with onset of demarcation (rejection) in the subchondral bone
2. Completion of demarcation, possibly slightly degenerated or oedematous cartilage
3. Articulated mouse (free articulated body) and remaining mouse bed

OCD occurs almost exclusively on convex joint partners, not on their concave counterparts. In principle, it only occurs in unclosed epiphyseal joints. The apparent adult form of OCD is infantile or juvenile OCD that is discovered too late. Pronounced OCD without or with only very mild pain symptoms is mainly found in the cortisone-induced form. In stages 1 and 2, OCD is a bone disease, in stage 3 it is a joint disease.

Epidemiology

The prevalence is 9 / 100,000 (6-11 years) and 22 / 100,000 (12-19 years) for the femur and 2 / 100,000 for the medial talus shoulder, for the lateral it is only 0.5 / 100,000. OCD of the elbow is even rarer, but can reach over 3% in baseball players.

Cause

1. Unknown: probably trauma or overuse
2. Cortisone-induced osteonecrosis, for example in ALL therapy or asthma therapy

Predisposing

1. Ischaemia
2. Hyperthyroidism
3. Hypothyreose
4. Trampoline jumping (OCD of the medial femoral condyle)
5. RA
6. Disc meniscus
7. Supination trauma (OCD of the medial talus shoulder in the OSG)
8. Arm-straining sports such as baseball, handball and volleyball and playing the guitar (OCD of the elbow joint)
9. Vitamin D3 deficiency (for development and healing disorder)

Diagnose

1. X-ray

Symptome

1. Early symptom: pain on exertion, especially during sport, and corresponding pain after exertion
2. Usually no joint effusion in stages 1 and 2
3. Dull, pulling pain, localised deep in the bone
4. From stage 2: cracking or jumping in the joint (auscultatory and palpatory)

Complications

1. Arthrose
2. Joint blockage

DD

1. paediatric epiphysial ossification disorders
2. Stage 3: pinching pain such as plica syndrome or meniscus entrapment

Therapie

1. For children with a dissekat that has not yet completely resolved: 3 months of immobilisation
2. There are conservative and surgical approaches for adolescents. Conservative approaches include strengthening the relevant muscles, in some cases sport is permitted, but without rash trauma (massive impact of kinetic energy).
3. In adults: already in early stage 1: cancellous bone sweepplasty. If possible, joint mice that have already developed (stage 3) are replanted; alternatively, the joint mouse is removed and the mouse bed is filled with a transplant.
4. Spontaneous healing in stages 1 and 2 is possible.

External links