An osteochondral fracture (OCF) occurs when a piece of the smooth surface on the end of the bone fractures. This takes place in a joint when the articulating cartilage (chondro) and part of the underlying bone (osteo) breaks off of the bone itself and become a fragment. If the fragment stays in place it is considered stable, but if it breaks loose then it is labeled as unstable. Unstable fractures can move around in the joint and cause pain as well as other symptoms. These fragments, or loose bodies, can vary in size. Typically as the size of the fragment increases the more symptomatic a person will become. This injury most commonly occurs in young adults or adolescents due to the bone being softer and more likely to fracture in this way. An osteochondral fracture can theoretically take place in any joint, but typically the elbow, knee, or ankle are the joints where this injury occurs most often. The mechanism of injury most often occurs in a weight-bearing position with a twisting or torquing force on the joint. Another possible cause of the OCF happens with a lateral dislocation of the patella. When the patella is pushed back into place, the quadriceps will fire and this can cause a compressive force as the patella moves of over the lateral femoral condyle and cause a piece of the bone to fracture off.
Typically if a patient complains of the symptoms listed above, a physical exam will be performed by a physician. Then an X-Ray will be performed to determine if an osteochondral fracture occurred. Sometimes the physician will order an MRI or CT scan to get a more in-depth look at the fracture to determine the exact location, size, and possible relocation of the fragment to determine the next course of action.
Depending on the extent of the fracture, the activity level of the patient, and symptoms that are present, the options for treatment are either conservative or surgical.
For an osteochondral fracture that requires surgery, most likely it will be arthroscopic repair of the fracture site and removal of the loose body. One example of arthroscopic surgery would be microfracture surgery. What is microfracture surgery? This article explains more, but it is designed to improve cartilage defects in the knee. After surgery, a person could expect to go through a rehab program designed to improve ROM, decreased pain, and strengthen around the joint to allow them to return to their prior level of function. Athletes can expect a longer rehab process to ensure that they are prepared to return to sport.
Sometimes in younger patients whose growth plates have not closed yet, can avoid surgery and can treat the osteochondral fracture through physical therapy. This type of treatment usually begins with rest and ice to decrease pain and inflammation. The therapeutic interventions are implemented to promote the return of full range of motion, then work to strengthen the muscles around the injured joint to provide stability with everyday activities. Further therapy would be indicated if the patient needed to be able to play a sport to ensure that they are safe to do so.
Author: Bridget Carey, PTA