A Comparative Analysis of Osteochondritis Dissecans and Avascular Necrosis: A Comprehensive Review

Abstract

Musculoskeletal disorders, standing as the fifth leading cause of disability-adjusted life years globally, present significant challenges in orthopedics. Osteochondritis dissecans (OCD) and avascular necrosis (AVN) are distinct but closely related conditions within this spectrum, impacting patients’ quality of life with pain, limited mobility, and dysfunction. OCD, involving cartilage and bone detachment in joints, predominantly affects young athletes, but its exact etiology and optimal management remain subjects of ongoing research. Conversely, AVN, marked by bone tissue death due to compromised blood supply, is linked to systemic factors like corticosteroid use and traumatic injuries. Diagnosis for both conditions relies on radiography and magnetic resonance imaging. Conservative treatment for AVN includes the use of a cane or crutches, pharmacological therapy, or physical therapy. On the other hand, in OCD, the primary approach is activity/sports restriction. Surgical treatment options for AVN patients encompass core decompression, bone grafting, or, in the most advanced cases, total hip arthroplasty. OCD may be surgically treated through subchondral drilling or fixation of unstable lesions. Advanced cases of OCD involve cartilage salvage with resurfacing techniques. The presentation of differences between these conditions enhances our understanding, facilitating improved diagnosis and management strategies.

Understanding Osteochondritis Dissecans: A Narrative Review of the Disease Commonly Affecting Children and Adolescents

“…In milder cases, a technique known as subchondral drilling, either through the joint (transarticular) or behind the joint (retroarticular), is frequently used. This approach ensures the flow of mesenchymal cells and growth factors, which results in the formation of new blood vessels and the transformation of the cartilage defect into health bone [43,60]. Numerous reports confirm the positive outcomes associated with subchondral drilling [61][62][63][64][65][66][67].…”

“…Magnetic resonance imaging (MRI) is the preferred diagnostic tool for OCD. It offers precise measurement of the lesion size, detection of bone edema, and identification of any intra-articular loose bodies [43].…”

“…The athlete is advised not to resume playing for a minimum of six months and should only consider returning to play once all symptoms have fully resolved [55]. Treatment methods include using casts, braces, or splints for immobilization, restricting weight-bearing activities, performing exercises to strengthen muscles, and physiotherapy such as extracorporeal shock wave therapy (ESWT) [17,28,43,56]. This nonsurgical treatment is typically applied for a period ranging from 3 to 6 months [17,28,43].…”

“…Treatment methods include using casts, braces, or splints for immobilization, restricting weight-bearing activities, performing exercises to strengthen muscles, and physiotherapy such as extracorporeal shock wave therapy (ESWT) [17,28,43,56]. This nonsurgical treatment is typically applied for a period ranging from 3 to 6 months [17,28,43]. In the systematic review by Andriolo et al [57], the authors summarized five distinct treatment approaches of conservative treatment: restricting physical activity, physiokinesitherapy with muscle-strengthening exercises, physical instrumental therapies (including iontophoresis and ESWT), limiting weight-bearing (either partial with crutches or total with a wheelchair), and immobilization (using a cast or brace).…”

“…An essential part of this process is the meticulous removal of fibrous tissue and the creation of vascular channels through drilling. This step aims to boost blood supply to the affected area and improve healing [2,43].…”