Juvenile Osteochondritis Dissecans of the Ankle
Due to the rapid growth of children participating in sports at higher levels of competition at younger ages, this condition is becoming more common. Young boys are predominantly affected by this disease, however, it is seen in many young female athletes as well.
Juvenile osteochondritis dissecans is an acquired disease that is potentially reversible if caught and treated early. An idopathic lesion of subchondral bone resulting in delimitation and eventual sequestration in the ankle joint is often identified with xray, MRI, or CT. Depending on the severity of the lesion, articular instability may exist as well.
This condition is more commonly seen in the knee joint, however, the prevalence of ankle incidences are rising, accounting for approximately 4% of all OCD cases. This condition if left undiagnosed and untreated can become very complicated.
The exact cause of this disease of the joint cartilage is unknown, however, it is widely agreed that the condition is often associated with repetitive trauma to the affected joint. Other hypothesized causes include inflammation, ischemia, genetics and ossification. Many patients suffering from this condition present with vague joint pain and biomechanical symptoms.
TREATMENT:
- Immobilization in brace, CAM walker or Cast.
- Periods of Non Weight Bearing until symptoms improve clinically and radiographically. Patients are often non weightbearing 4-12 weeks depending on the extent of the cartilage damage, stage of the lesion, and location of the lesion in the ankle joint.
- Surgery is recommended when cartilage damage is severe, or cartilage defects are unstable, detached and/or free floating in the ankle joint. Surgery is also indicated if conservative treatment fails to alleviate the patients pain.
- Post operative course is often dependent upon how extensive the surgery was
- Physical Therapy is necessary after immobilization to regain ankle range of motion, balance and muscle strength