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Brown University OCD project
Transcript of Brown University OCD project
Sam Tompson is a 15 year old boy who has been complaining about knee pain for about a year now. Sam plays soccer and basketball and has noticed that sometimes his knee feels as if it will give out during games. He had thought it was simply a growing pain, yet, after persistent pain and noticing that his knee gets locked in one position sometimes, he has decided to see an orthopedist.
During the physical exam, the doctor notices that there is swelling of Sam's knee and felt a loose fragment in the joint. Also, when the doctor tried to move Sam's leg, he noticed that Sam couldn't fully extend it in one direction.
Surgery is often performed after non-surgical treatments don't seem to have helped. The loose fragment(s) will be removed or replaced depending on their size and condition. Also, the space may be filled with fibrocartilage or the person's own bone marrow to promote regrowth. The surgery is often done arthroscopically. This carries the risk of possible infection and complications with anesthesia. Also, physical therapy is recommended after surgery to help strengthen the muscles around the knee, as they may be weakened. Also, physical activity will be limited.
The doctor has confirmed a diagnosis of Osteochondritis Dissecans, or OCD. OCD is a disease, caused by low blood supply, in which cracks or lesions form in the articulate cartilage and underlying bone. The loss of blood causes avascular necrosis and, therefore, the body reabsorbs the dead bone, leaving the cartilage open to more damage. Then, bone and cartilage and bone can break off into the joint, causing pain. This is because Sam has risk factors for OCD, presents with many symptoms, and his MRI shows an obvious sign of OCD. Being a male between the ages of 10 and 20 and playing two high-impact and high-stress sports. He also presents with the symptoms of pain, swelling, joint weakness and locking, and a decreased range of motion. Finally, his MRI shows a low T1 signal, a sign that confirms OCD.
There are two common non-surgical treatments; physical therapy and rest. Physical therapy is used to help strengthen the muscles and ligaments around the joint in order to help support the joint and increase range of motion. The only complication is that the pain may still persist and there is a chance for the condition to worsen. Resting the joint is often used in younger patients. In this treatment, the patient may be placed in a cast or brace and on crutches for about a month or longer to allow the joint to heal itself. The only complications are that this leaves the patient with mobility issues and a chance for the condition to reoccur.
The doctor then ordered both an X-ray and an MRI for Sam. These tests showed a linear
low T1 level signal at the articular surfaces of the lateral aspects of the medial condyle of the femur (or the inner ridge of the femur). This shows a presence of a lesion (or a crack) in the articulate cartilage and subchondral bone.
Short term, Sam should expect to experience a decrease in mobility (the brace and crutches) and, once the crutches are gone, he will experience a strange gait and slight pain.
Long term, Sam should expect to be healed and be able to go back to playing sports as planned. However, pain may reoccur, so he should keep an eye on how much physical activity he does and pay close attention to pain levels.
Because of Sam's age and the condition of Sam's OCD lesion, the doctor has decided to put Sam in a leg brace that limits movement and on crutches, with no weight-bearing, for a month in hopes that Sam's lesion should heal on its own.