Yudu - sportEX medicine - 1999-2010

OCD

CASE STUDY: OSTEOCHONDRITIS DISSECANS OF THE KNEE IN A YOUNG ELITE TENNIS PLAYER

versus clinical assessment. The results con- firmed that the greatest diagnostic accura- cy for OCD occurred when MRI findings were considered in conjunction with inte- grated findings of the history, physical examination and plain radiographs.

TREATMENT Preferred treatment of OCD appears to depend on the state of the overlying carti- lage and the size and stability of the frag- ment (21). Surgical interventions for this condition are varied with the more severe stages of the condition being treated with drilling, fragment excision, debridement, fragment re-fixation or osteochondral grafting (23). Conservative methods are the treatment of choice for intact, small

TABLE 1:

Timing of assessment

Initial assessment (one week after initial injury reporting)

One month later – OCD diagnosed

Six months post diagnosis

Eight months post diagnosis

Ten months post diagnosis

Effusion

Moderate supra- patella effusion but cool after training

Significant supra- patella effusion but cool after training

Nil

Knee flexion (NWB)

Full range and pain free

Discomfort at >110o

Full range and pain free

Nil Nil

Full range and pain free

Knee extension (NWB)

Full range and pain free

Knee Flexion (WB)

Pain free Pain at >20o

Oxford grading

4/5 4 Functional pain pattern

No pain but a feeling of slight joint stiffness post activity

Discomfort when lunging during tennis activities and some vague discomfort for several hours post activity

Pain free but with coarse crepitus

Pain free but with fine crepitus

www.sportex.net 4/5

No pain on activities performed within significantly reduced training programme

5 5

Pain free with low impact exercises and low intensity tennis drills

Pain free on return to full tennis activities

and stable lesions (7) and for juvenile lesions, which tend to be self-limiting and have greater chance of healing spontaneously than in the skeletally mature population (19,9). However, Kibler, Herring, Press and Lee (24) predict that 80% of cases of OCD in a weightbearing condyle will progress to osteoarthritis of the knee within 20-30 years.

Conservative treatment methods to date consist of activity modification, protected weight bearing, immobilisation and physiotherapy / rehabilitation, although there is a paucity of any evidence on specific physiotherapy and rehabilitation approaches for this condition. Therefore, the purpose of this report is to present a

case of OCD in a young tennis player and to discuss the physiotherapy rehabilitation management of this particular condition.

CASE REPORT A 14-year-old male junior elite tennis player, who was a member of a regional tennis centre (RTC), was noted to have swelling affecting his right knee on a routine examination performed by a national governing body physiotherapist during a Lawn Tennis Association assess- ment and training weekend. The player was an effective communicator and he claimed that with the exception of the swelling the knee remained completely asymptomatic.

There was no specific history of injury, with