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Author Topic: Is a 2mm growth of my OCD lesion a lot?  (Read 3175 times)

Offline casey2291

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Is a 2mm growth of my OCD lesion a lot?
« on: November 18, 2005, 08:04:31 PM »
Hey everybody,

I am now 8 months post-op for microfracture on my left knee for an OCD lesion.  I also have an OCD defect on my other knee. I had a MRI in July which stated that I had a 5 mm OCD lesion.  I just had a new MRI and the radiologist report said that the lesion is now 7mm.  Is this a big amount of growth in a four month time period?  It doesn't seem like much to me, but I don't really know much about the growth of these lesions.  The articular cartilage is not being affected at this time which is a good thing.  Any insight would be helpful.  Thanks.

Casey
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

Offline stgiles16

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #1 on: November 19, 2005, 02:49:54 AM »
Hey casey, how can you have an OCD lesion and it not involve your articular cart.??? I thought that is what it was, a defect in the articular cart.

I cant answer your question, I have no idea.

have a good weekend.
missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline casey2291

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #2 on: November 19, 2005, 01:42:10 PM »
Hello,

Here are the two reports, at least what is important from them.  The one says that the overlying cortex is intact and that there is no degenerative articular cartilage loss.  I guess from this I assumed that the articular cartilage was not being affected.  I know on my other knee, when I first got an MRI, my OS said that the articular cartilage was not being affected so she wanted to wait before operating.  Once an MRI showed that the articular cartilage was being affected, then she wanted to scope the knee.  Maybe, I don't understand the osteochondritis dissecans diagnosis afterall.  I'll take insight from anyone who gives it to me.  I put the MRI from July first and the most recent MRI results second. 


JULY MRI

There is s 5 mm subchondral lesion involving the posteromedial aspect of the weightberaring portion of the medial femoral condyle...The appearance is consistent with an osteochondral defect to include osteochondritis dissecans versus osteonecrosis.  There is no evidence of a loose fragment.  There is no evidence of adjacent bony edema.  There are no joint effusions or evidence of synovitis.
IMPRESSION:  There is a small focus of increased signal within the medial femoral condyle consistent with an area of osteonecrosis or osteochondritits dissecans. 


NOVEMBER MRI

There is a 7 mm subchondral focus of increased signal seen on T2 involving the posteromedial weightbearing portion of the medial femoral condyle....overlying cortex is intact.  This is consistent with a focus of osteochondritis dissecans versus nondisplaced osteochondral fracture...There is no degenerative change with no articular cartilage loss...There is a tiny effusion.
IMPRESSION:  A 7 mm subchondral focus of abnormal signal involves the posterolateral weightbearing portion of the medial femoral condyle, and is consistent with osteochondritis dissecans verses osteochondral fracture.  There is no evidence of displaced fragment.   There is a small associated joint effusion.   There is no additional abnormality.



Thanks for taking a look at these and letting me know what you think.

Casey  :)
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

Offline stgiles16

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #3 on: November 19, 2005, 04:32:38 PM »
Casey, I always thought that if you have a lesion then you automatically had articular cart damage. How can you have a defect and it NOT affect the cart. ?? I just dont understand either. I hope someone can enlighten us both.

missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline kittent1211

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #4 on: November 19, 2005, 08:08:23 PM »
I think you have something mixed up.  Mirofracture is a treatment for dammage to the articular cartilage of the knee, it has no other purpose.  What you are talking about is damage to the articular cartilidge.  First off, for the leasions to even show up on an MRI they have to be quite large to begin with so I'd say that any increase is not a very good thing.  That's why most microfracture surgeries are a surprise, because the damage  doesn't show up on an MRI and the doctor only discovers it through arthriscopic exam. 

Teresa
« Last Edit: November 19, 2005, 08:59:35 PM by kittent1211 »

cholt

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #5 on: November 19, 2005, 08:48:05 PM »
This site may help us all understand. 

http://www.orthocenter-si.com/cor.htm
I can understand this one better than any of the others (I think).  I may be interpreting it wrong, but what I get out of it is that an osteochondral defect is when there is a chunk of articular cartilage missing due to trauma and osteochondritis dissecans is when your body, (for unknown reasons) quits supplying bood to a part of bone with articular cartilage on it and the whole piece of bone with the articular cartilage (intact) on it begins to separate from the rest of the condyle.
I have studied osteochondral defects extensively since that is what I have on both knees because of a fall.  I may have it all wrong though.

http://www.physsportsmed.com/issues/1996/06_96/ralston.htm
Take note in the section under the pictures called, "A Question of Stability: mainly the first sentence: The OCD fragment consists of intact articular cartilage attached to a piece of subchondral bone of variable thickness. The fragment may be in its normal anatomic location with a smooth articular surface (stable), or the lesion may become loosely attached to its bony base or may detach to become a loose body within the joint space (unstable).

http://www.aafp.org/afp/20020901/photo.html
Noted in this site: "An osteochondral defect is complete or incomplete separation of the joint cartilage and subchondral bone. It is by definition intra-articular. One should not confuse osteochondral defect with osteochondritis dissecans. The former is a traumatic injury usually in skeletally mature people, while the latter is a condition of adolescents caused by an interaction between repetitive trauma and a genetic predisposition to the problem.4 The most common location for both conditions in the knee is the medial femoral condyle. The usual presentation is pain, swelling, and intermittent locking or catching."


Here are a few more I have found:
http://www.orthocenter-si.com/cor.htm
http://www.emedicine.com/radio/topic495.htm
http://www.amershamhealth.com/medcyclopaedia/medical/article.asp?vol=Volume+III+1&article=OSTEOCHONDRITIS

Cindy


Offline John1

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #6 on: November 19, 2005, 09:10:57 PM »
Hi Casey,

I don't think it's possible to be this exact about the size of the defect based on an MRI. A 2mm difference is hard to measure on an MRI. I'd bet there's a chance that it's the same size, but it's also possible that it increased in size.

John
4/12/05 Arthroscopy: plica removal and medial femoral condyle microfracture (2 cm^2)
11/9/05 Arthroscopy: complete removal of plica, removal of scar tissue on fat pad behind patella tendon and on medial side.

cholt

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #7 on: November 19, 2005, 09:18:53 PM »
Look at this site for one more thing I read.  Lesions are not the same as a defect.  It sounds like your lesion is lengthening but has not separated yet.  Also 2 mm doesn't seem like much but it may be getting worse or they may just have a better view this time on MRI.  I am not a Doctor though, so don't take my word for it.  Only my impression.

http://www.stoneclinic.com/ocd/ocd.htm

Cindy

Offline casey2291

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #8 on: November 22, 2005, 03:51:19 PM »
Hey everyone,

Thanks for your responses and for the websites.  They were helpful.  I'm still not sure that I completely understand but I will go back and look at the articles again more closely.   

Teresa, you said that the only way articular cartilage damage can be found is by scoping the knee.  For my operated knee, it actually showed up on my MRI that the articular cartilage was being affected. Because of this, I went into my surgery knowing that I was probably coming out of the OR with microfracture.  So, I think you are right that it often doesn't show up, but sometimes it does.  However, my MRI did not show the piece of cartilage that was flapping around in the knee.  My OS discovered that when she went in. 

Thanks all for responding. 

Casey  :)
   
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

cholt

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #9 on: November 22, 2005, 07:31:37 PM »
Casey,

Hi my MRI didn't show the osteochondral defect in my MFC (which was all the way to the bone) but did show degeneration, swelling and narrowing between bones in my x-rays and MRI.  I was told this means OA.  It also did not show my meniscus tear.  It was torn all the way across too.  2 OS's saw my x-rays and said I had severe OA, by just looking at them.  On my other knee, they could tell I had OA by x-rays (didn't have an MRI) but could not see osteochondral flap on MFC. When he went in there, he said I had grade 4 OA over half of my patella on left and nickel size on right. 

Cindy

Offline casey2291

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #10 on: November 22, 2005, 07:52:55 PM »
Cindy,

I don't quite understand what procedures you had done.  Did you have microfracture to both knees?  How are you doing now?  Were you in a lot of pain prior to surgery?

Casey  :)
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

cholt

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Re: Is a 2mm growth of my OCD lesion a lot?
« Reply #11 on: November 22, 2005, 08:21:14 PM »
Casey,

I fell on both knees ion Jan 5th.  I was in severe pain on my right immediately.  It would just give out on me.  I later found out this was from the meniscus tear but also the MFC defects on both knees could have caused this also.  My left hurt, but didn't start hurting severely until about 1 week later.  I didn't have surgery on my right until May.  He found OA grade IV on back of patella, about nickel size.  He did microfracture to it.  I had a lot of little bone spurs from the OA, and he did debridement and condroplasty on all the knee.  I had an osteochondral defect, or hole, on my medial femoral condyle.  He cleaned it up and did microfracture on it.  I had a lateral fat pad impingement.  He removed that.  I had a medial meniscus tear, & he removed the posterior portion.

 I had surgery on my left in July.  I had an osteochondral flap on the medial femoral condyle down to bone.  He removed the flap and did microfracture on it.  I had OA grade IV over 50% of my patella on lateral side.  He did chondroplasty and debridement just like left, but couldn't do microfracture, because it didn't have enough good cartilage left.  So he left it alone after cleaning it up.  My kneecap was tilted so he cut my lateral retinaculum (a tendon running along outside of knee) about 5 " down to let my kneecap move over more to medial side so it would not put so much weight on my lateral side of kneecap anymore. 

My left knee took longer to recoup from from, but my right knee is still giving me problems during PT as well as my left and it has been awhile.  I hurt all around both knees.  I am still getting shots in the lateral side of my right knee for politeal tendonitis.  Since I had so much done, I am not really the one to ask about pain issues.  I don't know from what procedure I am still feeling pain from.  I do know that microfracture is great but it will still not get back the old cartilage that is damaged.  Only gives you a good substitute for a while. 

I wish I could help you more.  I'm not sure I understand your condition.  From the MRI results, it doesn't look like much has changed, if any.  I read on one of the sites I sent you that the lesion can heal itself.  Make sure you have a vrey good OS that is specialized in knees.  I have found that to be the most important thing!  Then just trust him, unless you don't start feeling any relief or it gets in the way of your everyday living.  You're doing the right thing by getting educated.  You know your body better than anyone.  If you can understand what may be going on, you will be better off. 

Good Luck, and if I can help in any way just let me know.

Cindy