Generality
Osteochondrosis is a degenerative syndrome of the bones, which fragments the extremities. Also known as osteochondritis, it occurs mainly in the joints and affects especially young people, sportsmen and those who, in general, are subject to continuous and repeated trauma.
There has been much debate on the causes of osteochondritis and it has been concluded that at the base there is a process of necrosis (death of tissues).
What is osteochondrosis
The term osteochondrosis identifies a series of long or short bone pathologies, in which a small portion of the extremity, bone or cartilage, detaches from the remaining healthy bone. In other words, a small end of the bone is fragmented.
Osteochondrosis can affect all bones with an "epiphysis or" apophysis, but it mostly affects those that make up a "cartilage joint. In the joint joints, the bony lesion separates a fragment consisting of subchondral bone and adjacent cartilage (the term subchondral bone identifies the bone layer underneath the cartilage). Thus a free osteocartilaginous body is formed. This fragment generates pain and is medically referred to as a joint mouse.
The articular joints most affected by osteochondrosis are located at the level of:
- Knee.
- Hip.
- Astragalus.
- Elbow.
For years there has been discussions about what determines this separation. Today, it seems established that at the origin there is a process of necrotic degeneration. Necrosis is the death of the cell. It causes first the weakening and then the fragmentation of the affected bone portion.
The osteocartilaginous lesion follows a slow course, characterized by 4 stages. In the first two stages, the lesions are considered stable and the prognosis is good. In the third and fourth stages, however, the lesions have become unstable and the prognosis is not favorable. The distinctive features of the 4 stages are summarized as follows:
- Stage 1. Small flattening of the bone at the injury site.
- Stage 2. The fragment begins to stand out. We appreciate a little rhyme under it.
- Stage 3. The rhyme becomes more pronounced. The fragment is almost completely detached.
- Stage 4. The osteocartilaginous fragment has detached from the remaining bone and is "free" in the joint.
Epidemiology
Osteochondrosis mainly affects men and its incidence in the general population is 1.7%. It is a typical pathology of the developmental age (first and second decade of life), due to the intense ossification activity. Usually, in these cases, the problem resolves spontaneously at the end of skeletal maturity.
When osteochondrosis occurs in adults, such individuals often play sports or engage in heavy work activities. This explains, in part, why men are most affected.
Causes
Necrosis of an "epiphysis or" bone process is the main cause of osteochondrosis. It arises as a result of an interruption in the flow of blood. It is, in fact, an avascular necrosis. The factors that determine the occlusion of the vessels are:
- ischemia.
- Trauma or multiple repetitive trauma, due to:
- Sport activity.
- Heavy work activity.
- Intense ossification, typical of the developmental age.
- Genetic predisposition.
- Endocrine factors.
Very often these factors act in concert. For example, osteochondrosis is very common in young athletes.
Symptoms
For further information: Osteochondrosis Symptoms
The main symptoms of osteochondrosis are:
- Pain in the affected joint.
- Swelling.
- Joint effusion (or hydrarthrosis).
- Progressive joint block.
At the beginning, this symptomatology is tolerable. In fact, osteochondrosis follows a very slow course: when it occurs, the pain is of low intensity and of intermittent duration; similarly, joint functions are only partially impeded. From the anatomical-pathological point of view, this is the moment in which the future ostecartilaginous fragments begin to emerge.
The deterioration takes months, in some cases even years. In this period of time, the osteocartilegenous fragments become real free bodies inside the joint. The pain, therefore, becomes more intense and continuous. The joint block greatly reduces the motion of the joint. The hydrarthrosis is remarkable.
Diagnosis
Important, as in all pathologies, is early diagnosis. This makes it possible to intervene in a non-invasive way and to stop the evolution of bone lesions.
The joint motility analysis is the first possible diagnostic test: the suspicion arises if the angle of extension of a joint is reduced compared to normal.
The fundamental instrumental examination, which shows the stage of osteochondrosis, is the magnetic resonance. It shows the extent of the lesion and allows, therefore, to plan an effective therapy. Another advantage: it is not invasive.
The other diagnostic tests are:
- X-ray.
- Bone ultrasound.
- Computed Axial Tomography (CT).
X-ray. It shows the formation of the osteocartilaginous fragment and, in more advanced cases, the free bodies, or joint mice. This is a moderately invasive test (involves exposure to ionizing radiation).
Bone ultrasound. Provides useful information on the health of the bone. A negative result indicates that the bone is at risk of fragmentation. It is not invasive.
Computed axial tomography. It shows the size and precise site where the bone fragmentation occurred. Disadvantage: it is an invasive technique (involves exposure to ionizing radiation).
Therapy
The stage of the lesion is essential for setting the therapy.
It can be:
- Conservative.
- Surgical.
- Pharmacological.
Conservative therapy is more likely to be successful when the lesion is stable (stage 1 and stage 2). Consists of:
- Rest from physical / work activity (if intense) for 6-8 weeks.
- Physiotherapy.
- Immobilization with plaster; use of crutches (if a lower limb is affected).
Conservative therapy is also adopted for the forms of osteochondrosis of the young age. These tend to heal spontaneously, but, sometimes, supportive therapeutic treatment is needed.
Surgical therapy is reserved for unstable stages, or for stable ones that have not benefited from conservative treatment. It consists of an arthroscopic intervention. The purpose is to:
- Retrieve the fragment, if it is not yet completely detached (stage 3). To do this, micro-perforations are made in the affected portion, in order to promote vascularization.
- Eliminate fragments detached from healthy bone (stage 4). The affected bone end must be reconstructed and the cartilage component reconstituted by means of a chondrocyte transplant. Chondrocytes are the cells that produce cartilage.
Pharmacological therapy is useful for relieving the sensation of pain and must be associated with the two therapeutic interventions. Alone, in fact, it is not enough. It is based on the administration of:
- Analgesics.
- Non-steroidal anti-inflammatory drugs (NSAIDs).
Complications
Possible post-operative complications are:
- Chronic pain.
- Reduced function of the affected joint.
- Osteoarthritis.
Prognosis
The prognosis depends on several factors, such as:
- Age of the patient.
- It causes.
- Joint affected and degree of injury at the time of diagnosis.
- If conservative therapy was used in the presence of "osteochondritis at stages 3 and 4.
Youthful forms of osteochondrosis tend to resolve spontaneously. The prognosis is therefore good.
If the origin is trauma and the diagnosis is late, the prognosis becomes worse. Recovery, in fact, is very slow and the surgical operation, as we have seen, has its complications.
