Osteochondritis dissecans is a condition in which a segment of articular cartilage with its underlying subchondral bone graudually separates from the surrounding osteocartilaginous tissue.
The separation of the fragment may be partial or complete.
The osteochondral segment may remain in situ, it may become partially detached, or it may become completely detached and lodge in the contiguous joint as a loose body. It is important to differentiate the word dissecans from dessicans, the latter being derived from desiccare, “to dry up”.
The disease was first described in 1870 by Sir James Paget and the term osteochondritis dissecans was given in 1887 by Konig.
During the early part of this century various modalities of treatment of osteochondritis dissecans were recommended like
- Simple observation
- Restriction of physical activity
- Non-weight-bearing by crutch protection
- Immobilization
- Surgery
Various surgeries recommended wer drilling, transfixing with pins, bone grafting, and removal of the partially or completely detached osteochondral fragment.
However in osteochondritis dissecans children, the healing is excellent.
The advent of arthroscopic surgery has opened new vistas in management of osteochondritis dissecans.
Various options available are
- Direct visualization of the lesion.
- Drilling of the base of the osteochondral fragment.
- Stabilization of partially separated fragments.
- Atraumatic removal of loose bodies.
Causes of Osteochondritis Dissecans
Etiology
The exact cause of osteochondritis dissecans is not known yet. There are various theories that try to explain the causation. There appears multiple factor that decide this conditionThe etiology is most probably multifactorial.
Predisposition
Multiple joint involvement in the same patient are known in osteochondritis dissecans, indicating a constitutional factor in its etiology. Diseaseslike Legg-Calve-Perthes disease and tibia vara also associated with this condition.
Ischemia
Interruption in the blood supply to an area of subchondral bone has been proposed as the cause
Trauma
Injury plays a principal role in the causation of osteochondritis dissecans. A direct relationship between injury and the development of osteochondritis dissecans has been noted.
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