Osteochondritis Dissecans (OCD) is a condition where a piece of cartilage becomes damaged or detached from the surface of the bone, often at the level of the joint. Imagine a pothole on the surface of the bone. There are varying degrees of severity from damage, to a flap present, to detachment. The joints most commonly affected are the shoulder, elbow, stifle (knee), and tarsus (ankle). The exact cause of OCD lesions is unknown, but nutrition, rapid growth, and genetics may all be factors. OCD lesions generally occur in young large breed dogs.
Berndt and Harty35 described 4 stages of OCD on plain radiographs:
The first sign of an OCD lesion is typically lameness in the affected limb, causing reduced weight bearing through this limb. In the front limbs, this may look like a head bob at a walk or trot, where the dog’s head will go up when the affected limb makes contact with the ground. We often describe this as “down on the sound”. The pet may also hold the limb in a different position away from its body or with toes rotated out. The lameness may wax and wane depending on rest and impact exercise.
Diagnosis for OCD often requires imaging. We can perform radiographs as a great first line screening tool for OCD lesions. More advanced diagnostics such as CT, MRI, or even arthroscopy may be needed to visualize an OCD lesion. A hands-on exam of the affected limb can also help guide which particular joint and tissue type may be the source of discomfort for your dog. This test is performed by applying pressure to the joint (scouring).
Arthroscopic surgery is often recommended to remove the damaged fragment of cartilage. Cartilage cannot repair itself, and keeping damaged cartilage in the joint can cause further joint injury. Joint injections such as stem cells or platelet-rich plasma (PRP) may be used in conjunction with surgery to promote college regeneration at the lesion, to improve blood flow, and to reduce inflammation. Dogs with an OCD lesion may develop arthritis with or without surgery. Following surgery we get started on physical therapy to ensure healthy healing of tissues and to get back to weight bearing again.
Our goals of rehabilitation for treating OCD lesions are to decrease pain, decrease inflammation, and promote cartilage regeneration. We will utilize modalities such as laser to bring in blood flow to the cartilage to give it a chance to heal. We then work on relaxing muscles and improving range of motion. Lastly, we focus on improving strength around the joint to help stabilize it and prevent compressive forces on the bony ends.
