Defect > Treatments
ome minor osteochondral defects can
heal on their own, without casting or surgery. If your
physician has determined that this is the case, he may
recommend rest and physical therapy while he observes
your knee's recovery. Most patients are scheduled to
visit their physician once every four to six weeks until
the osteochondral defect heals. Your physician usually
takes X-rays and gives you a physical exam to check
your symptoms. The decision as to whether your knee
will heal or if you need further treatment can usually
be made within the first six weeks. For six to eight
weeks, physicians generally suggest that you avoid impact
activities like running, jumping, or sports. You may
also be asked to keep weight off your knee. There are
several ways to reduce your pain and discomfort if you
have suffered an osteochondral defect.
pain medication - Physicians prescribe their own regimen.
Patients may be prescribed a narcotic painkiller, along
with a once-a-day anti-inflammatory.
your knee for about 20 minutes every three or four hours
for the first few days, or until pain and swelling have
your knee elevated above your heart level to restrict
the flow of blood into the joint.
compression, such as an elastic wrap or bandage, to
keep swelling down.
a knee immobilizer, which is a stiff removable brace,
to stabilize the knee and prevent further injury.
crutches to keep weight off your knee.
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. Some patients find
that visiting a physical therapist helps them to perform
rehab exercises properly and more frequently than they
would on their own. It usually takes about eight weeks
of light rehab to let the osteochondral defect heal
before more rigorous stretching and strengthening exercises
can begin. Physical therapy 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.
| PARTIAL WEIGHT BEARING
- FOUR TO SIX WEEKS
To restore movement and basic coordination,
your physical therapist will help you begin moving your
leg and teach you an exercise program you may 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
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 machines. Most patients
continue rehab until osteochondral defect symptoms go
away, they have a full range of motion in their knee,
and there is good muscle tone in the leg. Once the muscles
of your injured leg are about 90 percent as strong as
the uninjured leg, you can usually resume activities.
strengthening exercises: Cartilage injuries
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 under observation and that you
may need further treatment. Large osteochondral defects
may make it difficult for some people to return to competitive