Treatment of Osteochondritis Dissecans in children under 12 years of age is nonoperative. Arthroscopy is reserved for the cases in which the fragment has become detached.
If the lesion is in a non-weight bearing area or it involved only a portion of the weight-bearing area of a joint it is observed with serial radiograms made every six to eight weeks to determine its natural course.
Protection from weight-bearing is not required unless the lesion begins to separate and symptoms persist.
In case the weight bearing is prohibited, it is resumed gradually with aid of crutches providing partial support.
Generally, a period of three months is required for healing of the lesion.
In case of suspected seapration of fragment, bone imaging with technetium-99m and computed tomographic studies should be carried out.
If osteochondritis dissecans in a child fails to respond to nonsurgical management, arthroscopic examination and drilling of the osteochondritic lesion are recommended.
Indications of arthroscopy
Arthroscopy directly visualizes the involved area and determines its exact location and size, and the degree of articular cartilage separation.
Arthroscopy is indicated in osteochondritis dissecans in patients 12 years of age and older in whom the weight-bearing area is involved with a lesion over 1 cm. in diameter.
Arthroscopic examination is also indicated in case of late diagnosis.
In children under 12 years of age arthroscopy should be done when, there is no radiographic or clinical evidence of improvement after a reasonable period of non operative treatment, or if the lesion becomes partially or completely detached.
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