PRP and Prolotherapy treatments for Osteochondritis dissecans
In this article we will cover research on Platelet Rich Plasma Therapy and treatment of Osteochondritis dissecans in youth athletes.
Before you continue reading, if you have a question about Osteochondritis dissecans, you can get help from our Caring Medical staff.
Osteochondritis dissecans is a condition of cartilage and subchondral (under the cartilage) bone damage, 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 and surgery is often prescribed. In this article we will examine other options including Prolotherapy and Platelet Rich Plasma Therapy.
In a paper that we will cite later in this article recently published research in the Journal of Prolotherapy explains Osteochondritis dissecans problems of the knee in this way:
Osteochondritis concerns the bone located just below the cartilage in general at the level of the femur. A fragment of bone breaks up, the fissure sometimes reaches the cartilage just above it, and at the extreme this osteo-cartilaginous (bone and cartilage) block detaches itself and is released in the joint, posing then the double problem of the presence of a foreign body and an articular lesion (a hole in the cartilage). While surgery can, in many cases, treat it, postoperative pain, long rehabilitation and the chance of not returning to sports participation, are reasons to consider Platelet Rich Plasma as an alternative.1
Pegs, Plugs, and Drills – Is there a surgical role for Osteochondritis dissecans?
Before we return to the above study, let’s examine another new study. In November 2017 in the publication Orthopaedics and traumatology, surgery and research, doctors in France gave a summary explanation of the standard treatment offered to patients with osteochondritis dissecans.
- When the radiographic diagnosis of osteochondritis dissecans is made early in a patient, healing can often be obtained simply by restricting sports activities.
- The degree of lesion instability (bone or catilage tears and cracks) can later be assessed by magnetic resonance imaging to see if healing with restricted sports occured.
- When the lesion remains unstable (bone and/or articular cartilage tear did not repair and is loose or may tear away) and the pain persists despite a period of rest, surgery is indicated.
- Arthroscopic exploration is always the first step.
- Drilling of the lesion produces excellent outcomes if the lesion is stable. (In this procedure, is the tear flap/bone is fixed, and not a threat to breaking away and floating in the joint, drilling into the bone will bring blood to the cartilage tear and instigate healing. Please see our article Knee articular cartilage surgery and non-surgical repair for a more detailed discussion of various surgical procedures and drilling).
- Unstable lesions require fixation and, in some cases, bone grafting. (The osteo-cartilaginous block spoken about above has broken away leaving a hole in cartilage or bone or both).2
The cartilage plug and the bone peg
Surgeons at the University Hospital of Montpellier suggest cartilage plugs for osteochondritis dissecans of the patella on a short-term basis. The plugs are inserted during an autologous osteochondral mosaicplasty. Cartilage is removed from a non-weight bearing part of the knee and used to replace cartilage defects in the patella. The technique has been found reliable on the short term to restore patellar joint surface and obtain satisfactory functional results.3 L Lengthy time off is a concern.
Doctors in Japan found that bone peg grafting, the removal of bone from a non-weight bearing bone and drilling them into a osteochondritis bone defect could get adolescent baseball players back on the field in 12 months.4
Osteochondritis dissecans surgical alternatives – two case studies on Platelet Rich Plasma
Research on Platelet Rich Plasma Therapy, an injection treatment which re-introduces your own concentrated blood platelets into areas of chronic joint and spine deterioration, more commonly referred to as PRP is gaining a lot of attention as a non-surgical option.
In the Journal of Prolotherapy Budak Akman, MD and his colleagues at Yeditepe University Faculty of Medicine, Orthopaedics and Traumatology Department Istanbul – Turkey reported on this case.
A 16-year-old male patient presented to our hospital with a six-month history of pain in his right knee, increasing in severity over time, after having encountered a traumatic fall in a football (soccer) match 6 months prior. He reported increasing pain especially with walking long distances and physical activities, and although rare, accompanied by a sense of stumbling, friction and limping.
Showing no positive development in symptoms and physical status for six months, our 16-year-old male patient received two intraarticular platelet rich plasma injections three months apart, focusing on the lesion of osteochondritis dissecans localized in the right knee.
At the end of the 18th month, the patient did not show any limitation in his physical activities and radiographic examination confirmed the successful treatment.
Having obtained positive results, we believe that PRP injections are a safe, simple, and minimally invasive treatment option for juvenile OCD which doesn’t respond to conservative therapy before a surgical approach.5
In the newest study mentioned at the top of this article, doctors presented the case of a 20-year-old soccer (footballer) patient with pain in his right knee during walking and playing soccer. The problem became progressively worse over time, with the appearance of an effusion of the knee.
Clinical examination found pain in the antero-internal (front-inner side) aspect of the knee, muscle strength was normal, and there was no limitation of joint movement. Initial CT scan and MRI demonstrated osteochondral lesion of the internal femoral condyle classified as grade III.
FIRST PRP SESSION January 21, 2017
One week prior to the first PRP session, the patient received an intra-articular injection of Prolotherapy and ozone.
PRP was injected into the knee under ultrasound guidance, anteriorly into the articular space and at the contact of the lesion, visible in ultrasound.
Following the procedure, the patient was advised to walk with crutches for 3 months.
MRI and CT scan at the end of the third month showed decreased lesion size compared with the initial size, appearance of revascularization and formation of bone bridges between the fragment and the femoral condyle.
SECOND PRP SESSION June 15, 2017
The same PRP procedure was repeated, with the same intra-articular Prolotherapy injection and ozone performed one week prior.
Six weeks after the PRP procedure, the patient was allowed to walk with a cane or single crutch. Then after two months, without any aids.
After another three months of follow-up, MRI and CT scan showed complete revascularization of the fragment and attachment of 95%.
PATIENT FOLLOW-UP December 12, 2017
The patient has completely returned to soccer for 1 month (matches and full training) without pain and without effusion (ultrasound).
If you have a question about Osteochondritis dissecans, you can get help from our Caring Medical staff.
1 Mekaouche M, Bekairi S, Merabet M, Koriche H. Platelet-Rich Plasma Therapy for Osteochondritis Dissecans. Journal of Prolotherapy. 2017;9:e978-e981.
2 Accadbled F, Vial J, de Gauzy JS. Osteochondritis Dissecans of the Knee. Orthopaedics & Traumatology: Surgery & Research. 2017 Nov 29.
3 Chadli L, Cottalorda J, Delpont M, Mazeau P, Thouvenin Y, Louahem D. Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents. Int Orthop. 2017 Jan;41(1):197-202. doi: 10.1007/s00264-016-3198-z. Epub 2016 Apr 27.
4 Oshiba H, Itsubo T, Ikegami S, Results of Bone Peg Grafting for Capitellar Osteochondritis Dissecans in Adolescent Baseball Players. Am J Sports Med. 2016 Dec;44(12):3171-3178. Epub 2016 Aug 11.
5 Akman B, Güven M, Bildik C, Şaylı U, Parnianfard A, Rahimli M. MRI Documented Improvement in Patient with Juvenile Osteochondritis Dissecans Treated with Platelet Rich Plasma. Journal of Prolotherapy. 2016;8:e966-70.