How is OCD classified?
1. Juvenile OCD >10
-Excellent prognosis for spontaneous healing.
2. Adult OCD >20 - trauma plays some role
-Poor prognosis for healing; usually requires surgery due to instability of segment.
OCD lesions occur most often on the (medial/lateral) side.
medial - 85%
What are 4 additional sites for OCD?
1. Patella (Inferomedial surface) - 5%
2. Trochlea of Talus
3. Femoral Head
4. Humeral Capitellum
What is the OCD classification based on Pappas?
1. Category I - Females up to 11 y/o; Males up to 13 y/o.
-Excellent prognosis with conservative care.
2. Category II - Females 12-20 y/o; Males 14-20 y/o.
-Good prognosis if cartilage intact.
3. Category III - Females and Males > 20 y/o.
-Poor prognosis for conservative care; surgery required.
What is the special test for OCD? How do you do it?
- knee @ 90
-Extend knee to 30° (concordant symptom reproduced)
- knee @ 90
-Extend knee to 30° (no pain)
Exercises in directly distal vs. posterior
Distal - OKC
Posterior - CKC
What are surgical options for OCD?
1. Arthroscopic Drilling: stable segments not healing. First attempt to promote healing; best in juveniles.
2. Fragment Excision:
-Small fragments away from WB surface.
3. Fixation of Fragment: large, unstable, WB area; in adult patient.
- Wires, Pins, Screws, Bone Pegs
- Bone Pegs - Cast immobilization, non WB until X-Ray healing observed
What is Wilk's phase approach?
1.Phase I - Acute, Protection
→Limited Joint Loading.
2.Phase II - Subacute
→Gradual Joint Loading.
3.Phase III - Advanced Exercise
4. Phase IV - Return-to-Activity
What is Reinold's phase approach?
Progression based upon the 4 biological phases of cartilage maturation: