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Juvenile Osteochondritis Dissecans (JOCD) is one of the recognized entities for over 100 years now. Inspite of long recognition of this typical joint deformity, its natural history and effective therapies are not understood properly.
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Juvenile Osteochondritis Dissecans (JOCD) is one of the recognized entities for over 100 years now. Inspite of long recognition of this typical joint deformity, its natural history and effective therapies are not understood properly. Even though conclusive evidence of the exact cause of this disease is lacking, there is pervasive agreement that this condition is associated with repetitive trauma. Patients suffering from the disease have vague pain and some mechanical symptoms. The diagnosis of the condition can only be formulated through plain radiographs.
Juvenile Osteochondritis Dissecans can become a complicated condition if left undiagnosed and treatment. Proper diagnosis will ensure that appropriate management measures can be taken to deal with the complications related to this condition.
Background Information Juvenile Osteochondritis Dissecans is an acquired disease, potentially reversible, having an idiopathic lesion of subcondral bone that results in delimitation as well as sequestration, in the instance of articular instability or involvement, or may be without. It refers to one such condition that commonly affects children as a result of their growing participation in various kinds of competitive sports at a tender age. There is definitely a steady gender bias, with young boys being predominantly affected by the disease.
While most of the cases of Juvenile Osteochondritis Dissecans affect the knee, in at least 65 to 75 percent of the cases, 70 percent of the cases affect the overall postero-lateral aspect of the medial femoral condoyle. There are many reported causes of the condition, which includes inflammation, ischemia, genetics, repeated trauma and ossification.
Classification As stated earlier, Juvenile Osteochondritis Dissecans commonly affects children, though it can also be seen in young adults and grown adults. Osteochondritis Dissecans can be classified as a case of maturation status of distal femoral physis.
Treatment Experts agree that the only methodic treatment for Juvenile Osteochondritis Dissecans is physiotherapy management. Patients generally respond very well to this treatment and further aggravation is not seen. The treatment initially begins with methods of knee immobilization using a brace or cast. Crutches may be given for additional support. The most important criteria for further progression are to ensure that the child is pain free.
Once pain is relieved, the cast or brace support needs to be removed. Rehabilitation will begin with low impact strength training like hams and quads. However, sports will be restricted. During this stage of treatment, it is important to note radiographic and clinical signs of wound healing. Once the wound is healed, the treatment will graduate to loading, which included participation in running and jumping. Gradually, sports will also begin. Complete healing of the symptoms is must in order to increase activities and intensity. Repeating an MRI is the key to learn more about the lesion healing.
Surgical Management While most of the pain should be healed by physical therapy management, Juvenile Osteochondritis Dissecans may require surgical management at certain point. For instance, patients with immature skeleton having unstable or detached lesions will need a surgery. When non-operative methods of management fail, it may be necessary to opt for surgical methods.
