Date of Award

2015

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Schawnn Decker

Keywords

Osteochondritis Dissecans -- rehabilitation; Osteochondritis Dissecans -- therapy; Case Reports

Abstract

Background and Purpose: Osteochondritis Diseccans, (OCD) is the separation of articular cartilage and its adjacent underlying subchondral bone from the articular surface of a joint. Multiple hypotheses have been put forward regarding the cause of OCD including inflammation, ossification abnormalities, ischemia, and repetitive microtrauma. At this time, there is no single cause regarding the etiology of OCD. The purpose of this case study is to describe the physical therapy interventions performed on a college athlete for non-operative treatment of OCD. To also look at the non-operative treatment that the patient underwent, and determine if treatment could delay or stop surgical repair of the lesion in the future.

Methods/Case Description: A 20 year-old male was referred to physical therapy by his athletic trainer. He had intermittent pain while participating in college baseball. As his condition worsened, he went to his primary physician for the unknown left knee pain, and an MRI was performed. The MRI results concluded that he had a grade 3 OCD lesion of the left femoral condyle. The orthopedic surgeon performed an arthroscopic chondroplasty to remove torn cartilage in his left knee. The surgeon decided not to repair the oeD lesion as it was still 50% intact and would have probably prolonged rehabilitation recovery, limiting the patient from playing baseball in the upcoming spring.

Intervention/Findings: Based on the patient's diagnosis and examination findings, a rehabilitation program was developed to address his weakness and areas for improvement to further progress him toward his prior level of function (PLOF) and return to baseball. The treatment sessions consisted of patient education, directional preference exercises, range of motion, a progressive strengthening program, balance and early agility exercises, modalities for pain and inflammation control, and a home exercise program (HEP). Grastin technique was also performed on his left quadriceps muscle with majority of the time concentrated on mobilizing the VMO.

Clinical Relevance/Outcomes: The patient showed consistent improvement throughout his rehabilitation including decreased inflammation and pain, increase in strength and endurance, increase in AROM/PROM, increase in balance and proprioception, and overall functional capacity.

Discussion/Conclusion: The patient made good gains in overall functional capacity throughout six weeks. He was on track and making appropriate progress towards his long term goal of being able to play baseball in the spring with minor to no limitations. The limitation about OCD is the unknown etiology. Further research is needed to determine the cause. Current hypotheses regarding the cause of OCD include inflammation, ossification abnormalities, ischemia, and repetitive microtrauma. These causes are all treatable through physical therapy and in this case were treated by physical therapy, while avoiding surgical reattachment of the OCD lesion, and obtaining the patient's PLOF.

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