Osteochondral injury/ fracture

Osteochondral injury London refers to a type of joint injury that involves damage to the cartilage and underlying bone. The chondral cartilage is a smooth, rubbery tissue that lines the ends of bones where they meet to form a joint. It provides a cushion between the bones and allows for smooth movement of the joint.  The chondral cartilage is not to be confused with the meniscus cartilage of the knee.

MRI scan of normal knee

An osteochondral injury can occur due to a traumatic injury, such as a fall or a direct blow to the joint, a repetitive stress injury, or it may develop over time due to wear and tear on the joint. The exact cause of OCD is not fully understood, but it is thought to be a combination of genetic, environmental, and mechanical factors. Certain sports that place repetitive stress on the joints, such as gymnastics, football, or basketball, have been linked to an increased risk of developing OCD. Other factors include:

  • Rapid growth of skeleton in teenage years

  • Vitamin D deficiency

  • Family history and genetics

  • Direct impact injuries

The symptoms of an osteochondral injury can include:

pain,

  • swelling,

  • stiffness,

  • clicking locking or giving way

  • reduced range of motion in the affected joint.

Diagnosis

The most reliable test in confirming the presence of an osteochondral injury is an MRI scan.

MRI scan of osteochondral injury of the thigh bone (femoral trochlea):

Treatment

Treatment for an osteochondral injury will depend on many factors:

  • How long symptoms have been present

  • Whether there is locking, giving way or stiffness in the knee that is worsening

  • Size and appearances of the defect on MRI scan

  • Age of person

Mild injuries may be treated with rest from impact activity, and physiotherapy.  Healing can take 6-12 months and is usually confirmed with a MRI scans 3-9 months later.

More severe injuries that are not healing or loose may require surgery.

Which type of surgery depends on size and location of defect.

Different options include:

  • Drilling of defect

  • Fixing the defect back with either absorbable tacks, pins or screws

  • Fixing with metal screws

  • Replacing the defect with a membrane or osteochondral transplant

Most injuries can be treated with keyhole arthroscopy. Some large defects or those in the kneecap area may require an open procedure with a 3-5cm incision.

Example of drilling of defect:

Example of MRI scan after bone fixed back into position with absorbable screws:

Example of bone fixed back with metal screws.

 

Defect fixed back into position with metal screws:

Postoperative management

Most patients may need to use crutches without putting weight through the knee and a brace. This can be the case for between four and eight weeks.

Afterwards there are different phases of rehabilitation:

  • Regain a full range of movement in the knee.

  • Strength and conditioning of the muscles.

  • Coordination and balance.

  • Resuming impact activities and landing mechanics.

  • Full return to sport.  

Most patients require MRI scans between four and eight months after surgery.

Once full healing takes place (this can take 8-18 months), the success of return to full activities is 95%. A small proportion of patients may have a recurrent injury after return to play or an injury in another area, but the vast majority have full healing and return to sport with minimal pain.