Knee - Articular Cartilage (defects of the knee)
Description
Osteochondritis Dissecans (OCD) is a condition in which fragments of joint cartilage become separated from the bone. These fragments may peel from the bone and remain intact or completely separate from the bone, forming loose bodies that float in the joint. These fragments usually originate from the femoral (thigh bone) side of the joint but can originate from any compartment.
What are the causes?
It is currently thought that most OCD lesions occur as a result of a traumatic injury that occurred in the patient's past. They can also occur in the athlete as a result of overuse. Some lesions do not have an identifiable cause.
What are the symptoms?
OCD causes pain at a specific area in the knee. Patients will complain of clicking and locking in the knee, particularly if the fragment has separated and is floating around the joint. Patients are often unable to fully flex and extend their knee.
How is it diagnosed?
Dr. Liu will perform a thorough history and physical exam, which typically includes X-rays. Your surgeon will evaluate the range of motion. The origin of the fragment may be tender to the touch. X-rays may or may not identify OCD. MRI is standard for OCD diagnosis. Fluid seen behind the fragment on MRI is an indicator of OCD.
Non-operative
Stable OCD lesions, those not likely to displace, are treated with anti-inflammatory medication, cryotherapy, activity modification and observation.
Platelet-rich plasma (PRP) injection is another non operative option for treating pain. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. The goal is to promote an anti-inflammatory effect, reduce pain, and stimulate healing. There is also the potential for joint preservation by slowing down arthritic process. Although one injection may help, studies support a series of 2 injections, 1 x Week/2 weeks. Not covered by insurance.
Bone Marrow Concentrate "Stem Cell" Injections is another non operative option for treating pain. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate stem cells, which are then re-injected into the joint. The goals are to change the living micro-environment of the joint to a positive one, and to decrease inflammation and cartilage cell death. Will promote healing of cartilage, will not re-grow cartilage, restore joint space, or remove bone spurs. There is also great potential for joint preservation by slowing down the arthritic process in early stages. Not covered by insurance.
Operative
Unstable OCD lesions are evaluated by a minimally-invasive arthroscopic procedure. Sometimes the fragment can be repaired with small screws/tacks if it is still attached to the bone. If the fragment has separated from the bone and cannot be repaired, it will be removed and a cartilage regeneration or replacement procedure may be performed in the lesion. A microfracture procedure can be performed in the lesion to allow blood to soak the lesion. A cartilage graft, typically from a donor, can then be placed at the site. Over time, new cartilage will be formed over the lesion. Alternatively, your surgeon may choose to take a piece of cartilage from one area of the knee where it is not necessary and place it into the defect (autograft cartilage transplant procedure) .
Microfracture procedure
Can I shower after surgery?
If you have a bulky dry dressing you can remove it on postop day #3; you may then shower allowing water to run over steri-strips or sutures; towel pat dry and keep clean; NO soaking or submerging operative body part. If you have a waterproof dressing, please leave it on until you follow up in the office. You can shower over the dressing, no soaking or submerging the shoulder
How long do I need to wear the compression stockings?
Dr. Liu wants you to keep the compression stockings on for 3 weeks. Compression stockings are the best way to help the swelling to go down after surgery.
Should I use ice or heat?
Ice can provide analgesic effects and control swelling for the first 3-5 days; after that we recommend ice after exercises or PT.
How do I use an ice machine or CPM?
if either device is part of your recovery, treat this as an assistance to your recovery. Use either as directed, allowing only the machine to move or do the work. Remember, you should not be doing the work or moving the operative body part on your own.
How do I decrease my pain after surgery?
You may take your pain medication as prescribed; if pain continues, you may add ibuprofen or naproxen in between pain medication doses: (8am pain med, 10am ibuprofen 600-800mg or naproxen 500mg, 12p pain med).
Who schedules my first post operative appointment?
You are responsible for scheduling this appointment. This can be done prior to your surgery or within 1-3 days following. Please call the office, at 702-740-5327, provide your date of surgery, and you will be provided your appointment time and date.
When can I drive?
This depends on your surgery. Please wait until your first post op visit to discuss with your provider.
When can I go swimming?
Please wait at least 4 weeks until you submerge your incision into baths or pools. When your incision is submerged, it can open up and increase risk of infection. We ask that you wait 4 weeks when the incision is healed to soak in tubs or pools.
When do I start Physical Therapy?
Physical Therapy will be discussed at your first postoperative visit 10-14 days after surgery.
I have questions that have not been answered.
Please re-read your postoperative instructions handout. If questions remain, please contact the surgery line that has been provided to you on your post surgical handout.