Prolotherapy as an Alternative Treatment for Osteochondritis Dissecans: Two Cases of Young Baseball PlayersAuthor: Ross A. Hauser, MD |
Introduction
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Osteochondritis dissecans involves the separation of a segment of cartilage and subchondral bone, found most commonly in the knee, elbow, ankle and hip. Repetitive microtrauma from sports is a common cause especially among older adolescents and teenagers. To provide stability of the articular cartilage fragment, rest, splinting to surgery is often prescribed. While Prolotherapy has a long history for being used for osteoarthritis and other cartilage problems, this is the first dual case report on its use in osteochondritis dissecans. Both patients were young teenagers who, because of sports, developed osteochondritis dissecans. One case involved the knee and the other involved the elbow. The patients’ abilities to continue to play sports while receiving Prolotherapy and after completing the treatment series, as well as MRI evidence of resolution of the osteochondritis dissecans speaks to the success of the Prolotherapy. Because this represents just two cases of osteochondritis dissecans, larger, more controlled studies are suggested to determine if Prolotherapy should be a first line therapy to consider in cases of osteochondritis dissecans. Journal of Prolotherapy. 2011;3(1):568-571. KEYWORDS: articular cartilage repair, osteochondritis dissecans, osteochondral defect, Prolotherapy. |
Osteochondritis dissecans (OD) is a localized injury or condition affecting an articular surface of a joint, that involves separation of a segment of cartilage and subchondral bone. It is found most commonly in the knee although other joints can be affected, notably the elbow, ankle and hip. OD affects two distinct populations of patients as differentiated by the status of the physes (growth plates). Children and adolescents between the ages of five and approximately 16 years old, who have open physes, are classified with as having the juvenile form of the disease. Older adolescents, who have closed physes, and adults are classified as having the adult form.1 The incidence of this condition has increased recently because of the growing participation in competitive sports.2 Repetitive microtrauma is thought to be the primary mechanism responsible for the development of OD, however, other causes including acute trauma, ischemia, ossification abnormalities and genetic factors have also been proposed.3, 4
The symptoms of OD of the knee depend on the stage of presentation. Lesions early in their course are associated with poorly defined symptoms including pain and swelling. As the lesion progresses, catching, locking, and giving way are noted. The presence of loose bodies is associated with more constant symptoms of catching or locking, swelling, and pain.5
While the presenting symptom of OD is typically unresolved pain, the diagnosis, is made by either plain radiograph or MRI, showing the breaks in the cartilage and whether lesions are partially or firmly attached to the underlying bone.6, 7 The stability of the articular cartilage fragment is typically what determines treatment. It varies from observation, splintage and rest to drilling, fixation or excision of the lesion, and osteochondral autogenous grafting.8-10 While Prolotherapy has a long history of being used for osteochondral injuries and to stimulate cartilage healing,11-13 this is the first case report of its use in osteochondritis dissecans.
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