The most common joints affected by osteochondritis dissecans are the elbow, ankle, and knee. (1)
Osteochondritis dissecans is a condition caused due to decreased blood flow in the subchondral bone which occurs due to repetitive stress at the same joint. It can be encountered very early in the age and its treatment is consisting of a conservative approach with rest and immobilization as the most important parts. After the initial immobilization period for 4 to 6 weeks has passed, physical exercises and walking with complete weight bearing can be started. (2)
Coping Methods For Osteochondritis Dissecans
If the treatment of the condition has been done non-surgically then there may be incomplete healing and loose bone fragments that may remain in the joint space for a long period. These can hinder with joint movement and may cause pain occasionally. Patients may have to live with these symptoms for a long period. But it can be coped easily if it is occasional only (2).
Sometimes there may be the necessity of surgical treatment for the complete cure of osteochondritis dissecans. Once the surgical treatment has taken place, it may require a long period of bed rest and immobilization to give the time required for complete healing. After the immobilization period is over, a rehabilitation process can be started for the regaining of strength and movement of the joint.
The rehabilitation program consists of continuous passive motion (CPM) for the increased healing rate of the articular surface of the joint especially in the cases of full-thickness lesions. According to a study done to find the efficiency of CPM, the result was very good. It suggested that CPM for 6 hours a day for continuous 8 weeks can be very helpful in the cure of osteochondritis dissecans and may also even prevent the need for surgical treatment in the future.
Various isometric exercises in which is the length of the muscle is constant can be started as soon as the immobilization period is over. It helps to get back the strength of the muscle groups such as quadriceps and hamstrings etc. Straight leg raises and bends overs etc. are the initial exercises to be started in a rehabilitation program and are specifically designated for improvement in quadriceps group of muscles.
A few weeks of physical activity program usually ranging from 6 to 8 weeks can also be started in the rehabilitation phase consisting of stretching exercises and sport-specific training. It will lead to regaining the momentum lost during the immobilization period (3).
High intensity and more stressful activities are usually avoided during this period such as jumping and squatting because it may produce a lot of pain and also hinders the healing process. Less stressful activities like walking and swimming are allowed because they do not increase the progression of the condition.
If the patient is still having pain then pain medication can be started. Nonsteroidal anti-inflammatory group of drugs is usually prescribed because they have high analgesic action and lower side effect potential. Drugs such as paracetamol, ibuprofen, ketorolac, celecoxib, etoricoxib, etc. can be given to such patients.
Conclusion
For improving the quality of life of the patient suffering from osteochondritis dissecans, it is very important to monitor the progression of the disease. The regular radiological investigation must be done to find out the condition of the joint. Regular follow up with the orthopedic physician is required for efficient treatment of this condition. There may be few of the cases in which the patient has to give up the sport with which they were associated previously but the rest of them can you pursue in the later stage after the treatment is over.
Medical treatment in the form of pain medications may also be required if the condition persists for a longer period but usually, there is only physical training program required to completely rehabilitate the joint involved.
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