> Osteochondral Defect
What is Osteochondral Defect?
The word osteochondral refers to anything
relating to cartilage and bone. Your thighbone (femur),
shinbone (tibia), and kneecap (patella) fit tightly
together and move smoothly because the bone surface
is covered with a thick coating of articular (hyaline)
cartilage. An osteochondral defect is any type of damage
to articular cartilage and underlying (subchondral)
bone. Usually, osteochondral defects appear on specific
weight-bearing spots at the ends of the thighbone and
shinbone and the back of the kneecap. Osteochondral
defects can range from:
cartilage that causes slight pain.
bone and cartilage fragments that hinder movement.
cartilage loss that leaves your bones grinding against
Twisting forces combined with direct
impact, like being tackled in football, commonly cause
osteochondral defects. Sports that put you at risk of
accidental collisions and require quick changes of direction,
like soccer, basketball, and skiing, may put you at
risk of damage to your articular cartilage. Osteochondral
defects frequently accompany injuries that twist or
tear other knee structures, such as ligaments and meniscus
cartilage. Articular cartilage also tends to wear out
with overuse. Many osteochondral defects in older active
people are caused by slow cartilage deterioration.
Like arthritis, osteochondral defects generally continue
to spread unless they are treated. Your articular cartilage
has no direct blood supply and usually cannot heal on
its own. Osteochondral defects may deteriorate your
articular cartilage until bones are grinding against
each other and your knee joint becomes permanently deformed.
Depending on the grade of your articular cartilage damage
caused by osteochondral defects, the following treatments
are generally prescribed:
1 - Cut back on sports activities and possibly a cast
to prevent movement.
2 - Arthroscopic drilling of frayed cartilage.
3 - Removal of damaged bone and cartilage and possible
transplant of new tissue.
In the case of chip fractures, physicians may suggest
arthroscopic surgery to fix the chipped piece back into
its original position. The links to the left describe
standard osteochondral defect treatments in detail.
| Orthopedic Evaluation
There are usually three parts to an
orthopedic evaluation: medical history, physical examination,
and tests your physician may order.
will likely ask you when you noticed your knee pain,
how it has been feeling since the pain began, and if
your knee has been previously injured. Physicians also
typically ask about other conditions, such as diabetes
and allergies, and medications currently being taken.
The doctor may also ask about your physical and athletic
goals - information that will help him decide what treatment
might be best for you in achieving those goals.
A physician usually can make an early
assessment of an injury by feeling around the area.
While asking you questions to pinpoint your pain, physicians
typically test ligament and tendon strength by checking
your knee's range of motion. To test for osteochondral
defects, physicians may extract a sample of fluid from
your swollen knee with a small needle. Damage to the
bone and cartilage may cause a certain amount of blood
and fatty tissue to appear in your knee fluid.
Should your physician require a closer look, these tests
may be conducted:
taken from different angles can sometimes show signs
of loose bodies, small fractures, or other bone damage.
X-rays typically do not provide a good view of articular
(magnetic resonance imaging), CT scan (commonly referred
to as a CAT scan), or bone scan may be used to see if
your pain is due to bone, cartilage, or muscle problems.
Results from MRI, CT scans, and bone scans are usually
available in two days.
in which the doctor inserts a tiny camera into your
knee, may be used to determine the diagnosis in more
detail. This is done on an outpatient basis and usually
does not require a hospital stay.
Because some osteochondral defects develop slowly,
you may have recurring mild pain and swelling even though
imaging techniques may show no signs of cartilage or
bone damage. Your physician may need to view multiple
images to compare over time to reach a diagnosis.