Defect > Treatments
The preparations you make before your
cast is put on can be as important as the treatment
itself in ensuring a healthy recovery.
a second opinion from a physician who is as qualified
as the physician who gave the initial diagnosis is advisable
in any case.
possible, practice walking with your crutches so you
can use them easily while wearing your cast.
generally recommend that patients wear loose shorts
or sweatpants with buttons or a zipper on the side so
you have room for the cast.
should arrange ahead of time for someone to drive them
home. Depending on the height of the patient and the
size of the car, some patients may have difficulty getting
into a small car because a knee in a cast cannot bend.
Fitting a cast to most people's legs
usually takes about 15 minutes. Physicians generally
immobilize your knee in a slightly bent position. The
amount of bend in your knee varies depending on the
location and severity of the osteochondral defect. You
usually can leave the hospital or doctor's office as
soon as your physician gives you instructions for caring
for your specific type of cast or brace at home. You
may be able to walk using crutches; however, your physician
may recommend that some people, especially older patients,
use a wheelchair while their knee is immobilized. Physicians
generally do not prescribe narcotic painkillers after
an osteochondral defect. Keeping weight off your knee
may help to control your pain.
Here is what you can expect and how
you can cope with a cast immobilizing your leg:
varies for each person. Most people experience some
pain during the first seven to 10 days while wearing
first concern is to monitor swelling for the first 48
hours while wearing your cast. If your swelling decreases
dramatically, the cast may become too loose, and not
support your leg. If swelling increases, circulation
can be cut off. In both cases, you should see your physician
for a new cast.
patients can handle home recovery alone. But older patients
or people who feel they need help bathing, cooking,
or performing household work may feel more comfortable
if they have someone visit them regularly to provide
your plaster cast dry. Wrap it in a plastic shower bag
whenever you may come in contact with water. Ask your
physician about the best place to buy plastic shower
bags in your area.
most knee injuries, treat with RICE (rest, ice, compression,
elevation). Try to avoid putting weight on your injured
leg. Wrap ice into a well-sealed plastic bag and drape
around the cast at knee level for 20 to 30 minutes,
two or three times a day.
the injured leg above heart level to help blood drain
towards your body. It often helps to sleep with pillows
under your ankles.
your toes as much as possible to help circulate blood.
you develop a rash or irritated skin around your cast,
call your physician.
you have any discomfort, contact your physician as early
as possible. Do not try to "grin and bear it"
if discomfort does not go away within a few days.
avoid complications, only your doctor should remove
the cast with a special vibrating cast saw. The cast
is usually removed in four to six weeks.
After wearing a cast for four to six
weeks, your injured leg is generally much weaker than
the other leg. Both legs may have lost strength compared
to your condition before the osteochondral defect. Rehabilitation
generally progresses slowly, moving from low-impact
stretches to light exercises. It is important not to
twist or bend in ways that may grind cartilage together,
until your physician is certain the osteochondral defect
has healed. Try to avoid bending the knee more than
90 degrees (hyperflexion) for about eight weeks Physical
therapy after the cast comes off generally helps return
healthy young athletes to sports at full strength. Arthritis
may complicate the rehab process, especially for older
athletes, but the physical therapy program generally
recommended by physicians can be broken into three basic
phases for everyone:
| NON-WEIGHT BEARING -
FOUR TO SIX WEEKS
movement and basic coordination, your physical therapist
will help you begin moving your leg and teach you an
exercise program to perform on your own.
| RESTORING RANGE OF MOTION
- ONE TO THREE MONTHS
Rehab progresses into stretching and
strengthening exercises that focus on the quadriceps
and hamstrings - the main stabilizing muscles for your
knee. Physicians suggest you gradually increase the
amount of weight as your leg muscles get stronger. Strengthening
exercises require dedication because results often take
weeks and pain may recur.
RETURNING TO ACTIVITIES - THREE TO SIX MONTHS
Once the muscles of your injured leg are about as strong
as the uninjured leg, the focus of rehab turns to increasing
your coordination. After a few months of rehab, physical
therapy can become activity oriented as you regain the
ability to perform complicated movements, using stationary
bikes, elliptical machines, and cross-country skiing
Physicians usually suggest that you
continue strength training even after your knee has
been rehabilitated. Adequate leg muscle strength is
the best way to prevent the recurrence of osteochondral
defect. Have your physician periodically check your
knee. Weight control is also important. One extra pound
of body weight translates into three or four pounds
of weight across your knee every time you take a step.
Lightening the load on your knees helps them to last
longer. After an osteochondral defect, you may be at
risk of suffering arthritis later in life. Depending
on how well your knee heals, you may want to consider
cutting back or avoiding repetitive-impact activities,
like long-distance running, and contact sports, like
football. Many of the exercises and activities that
are popular for fitness put stress on your knees. To
prevent osteochondral defects it is important to learn
knee-sparing exercise techniques by dividing your activities
into three components:
living - The average person takes between 12,000 and
15,000 steps a day, with each step exerting a force
between two and five times your body weight on your
knees. After a knee injury, take it easy on your knees
during the day whenever possible to save them for activities
and exercise. Avoid stairs when there is an elevator,
take the shortest path when walking, and consider wearing
athletic shoes designed to absorb shock rather than
strengthening and conditioning - Activities themselves
are not a substitute for conditioning. Your need for
special conditioning to prepare for activities increases
with age. The best strengthening programs are low-impact
and non-weight-bearing, like stationary bikes and certain
weightlifting programs, so that the knees do not have
to absorb shock.
- Sports that require twisting and quick direction changes
put great strain on your knee. To prevent injury, stick
to light, non-impact activities for your recreation.
If you decide to return to sports like football and
basketball, a physician should carefully examine your
knee to make sure you have a proper coating of cartilage
over your bones.
If pain recurs after rehab, physicians usually suggest
you stop your activities and return for a check-up.
Pain could be a sign that your osteochondral defect
has not healed properly after casting and that you may
need further treatment.
| Treatment Introduction
Since movement alone may cause rough
cartilage and bone to irritate your knee, immobilizing
your leg in a cast sometimes is the best treatment for
osteochondral defect. Physicians generally recommend
that you wear a cast for about four weeks. The greater
the damage to your cartilage and bone, the longer you
may have to remain in the cast. Most people are instructed
to use crutches and keep weight off their knee until
the cast is removed. Casts usually are applied as soon
as the final diagnosis is made, which may require your
physician to take a closer look at your knee with an
arthroscope. There are different ways to immobilize
your knee and your physician will prescribe the most
appropriate cast or brace to fit your needs. The most
common type of cast is made of plaster and padded with
cotton. These casts are effective for immobilizing your
knee, but they must remain dry and require attention
and care while bathing or during daily activities that
cause you to sweat. Waterproof casts made with fiberglass
shells and synthetic padding offer the same immobilization
and allow you to sweat, swim, and bathe. There also
are many types of removable braces that can effectively
immobilize your knee. Your general goal while wearing
a cast is to completely rest your knee joint, avoiding
movement and weight-bearing strain. Your leg may become
weak while wearing a cast.