Arthroscopic Repair of Osteochondritis
Osteochondritis dissecans (OCD) is a disorder in which a piece of cartilage and subchondral bone separate from the surface of a joint. The knee is the most commonly affected joint, but the elbow and ankle may also be involved. Although less common, it may also occur in the shoulder, hand, wrist, and hip joints. OCD occurs for unknown reasons and generally affects adolescents and young adults. Symptoms include nonspecific poorly localized knee pain and swelling that worsens with activity. As the disease progresses, symptoms of knee locking or giving way may develop. Surgery is performed to promote healing, to restore a normal, smooth articular surface, and prevent future degenerative joint disease. In young people, surgical treatment depends on the patient's skeletal maturity and the stability, location, and size of the separation or lesion. Surgical repair is almost always recommended for adult patients, regardless of the stability of the lesion. Surgery is also recommended for treatment of unstable fragments regardless of the patients age. Initial surgical management is through arthroscopy which can be for diagnostic as well as treatment purposes. Arthroscopy permits a small camera and instruments to be inserted into the joint through several small incisions made by the surgeon. The arthroscopic surgery camera is attached to a fiberoptic light source and shows a picture of the inside of the joint on a television monitor. One or more other incisions are made to insert instruments that can treat the underlying problem. The procedure may be done in an outpatient surgical center under local anesthesia with IV sedation, or under general anesthesia with the patient asleep. Patients should consult their surgeon for a complete explanation of the procedure and its associated risks and complications.