Osteochondritis
Osteochondritis is a bone and cartilage condition affecting an articular surface, meaning only a part of a joint.
What is osteochondritis?
Osteochondritis is a condition affecting the subchondral bone, which refers to the bone located beneath the articular cartilage. The affected bone loses its mechanical properties, thereby overloading the healthy peripheral bone. It is this overload of the healthy bone around the periphery that is responsible for the pain.
The cartilage may be softened above the bone lesion, which is known as chondromalacia. The cartilage may also lose its seal and present one or more cracks, allowing joint fluid to pass through into the bone lesion. This passage of fluid can worsen the bone lesion by a process of erosion.
The joint pain from osteochondritis lesions is deep and difficult for the patient to localize. Osteochondritis is more often symptomatic if it affects a weight-bearing joint such as the hip, knee, ankle, or foot.
These osteochondritis lesions tend to appear in childhood and may become symptomatic quickly or only after a period of time. Some osteochondritis lesions are not symptomatic and therefore require no treatment.
Osteochondritis may be due to defects in bone arterial perfusion, leading to impaired ossification or localized bone necrosis responsible for the lesion. Mechanical overloads on the bones can also lead to osteochondritis.
It is therefore a mechanical problem related to pressure distribution on the surface of a bone. For this reason, injections are of limited effectiveness, whether they are cortisone, hyaluronic acid, or PRP (platelet concentrates).
Osteochondritis of the foot
The diagnosis is suspected during the interview in the presence of pain of mechanical type, deep, and sometimes difficult to localize. In the foot, these lesions are usually at the level of the metatarsophalangeal joints of the 1st or 2nd ray.
The Freiberg's disease corresponds to an osteochondritis of the head of the 2nd metatarsal, and is relatively common. In the case of Freiberg's disease, it is important to look for excess load on the 2nd ray, especially in the context of a hallux valgus, or in the case of a long M2 morphotype or long M2M3.
How is it treated?
The first step in osteochondritis treatment is medical, involving joint rest and taking painkillers and anti-inflammatories. When there are anatomical factors promoting pain, it is possible to try to modify joint pressures using corrective orthopedic insoles.
Injections are of limited effectiveness because the problem is mechanical. Surgical treatment depends on the location and size of the lesion as well as the vitality of the affected subchondral bone.
Osteochondritis surgery
When the bone appears viable, surgical treatment consists in lifting the osteochondral lesion, revitalizing the surrounding bone, and repositioning the osteochondral lesion by fixing it to stabilize and allow bone consolidation.
If the osteochondral fragment is small and not viable, it is possible to remove the lesion and revitalize the surrounding bone to stimulate its reconstruction. If the lesion fragment is large and not viable, the procedure consists of removing the lesion and performing an autologous bone and cartilage graft called mosaicplasty.
Other possible osteochondritis
- Osteochondritis of the ankle : Osteochondritis lesions in the ankle are mainly located on the talar dome. These lesions can be accessed via arthroscopy.
- Osteochondritis of the hip : In the hip, these lesions generally involve the femoral head and can be accessed via arthroscopy.
- Osteochondritis of the knee : Osteochondritis in the knee affects the femoral condyles.
FAQ
Osteochondritis is thought to result from a defect in bone arterial perfusion during childhood, leading to a lack of ossification or localized bone necrosis. Mechanical overload on the bones can also lead to osteochondritis.
Joint rest through temporary immobilization, taking painkillers and anti-inflammatories can help relieve pain. Modifying mechanical stresses by wearing corrective orthopedic insoles can improve painful symptoms, especially in cases of associated lower limb deformity.
Lesions that are resistant to functional treatment may be treated surgically. The type of surgical treatment depends on the size of the bone lesion, its location, and the viability of the subchondral bone.
Not all osteochondritis lesions are painful. Painless lesions do not require treatment. Osteochondritis lesions do not tend to heal spontaneously. Only surgical treatment, if necessary, can allow the healing of these osteochondral lesions.