Knee > Osteochondral Defect > Treatments

   Observation

ome minor osteochondral defects can heal on their own, without casting or surgery. If your physician has determined that this is the case, he may recommend rest and physical therapy while he observes your knee's recovery. Most patients are scheduled to visit their physician once every four to six weeks until the osteochondral defect heals. Your physician usually takes X-rays and gives you a physical exam to check your symptoms. The decision as to whether your knee will heal or if you need further treatment can usually be made within the first six weeks. For six to eight weeks, physicians generally suggest that you avoid impact activities like running, jumping, or sports. You may also be asked to keep weight off your knee. There are several ways to reduce your pain and discomfort if you have suffered an osteochondral defect.

   Take pain medication - Physicians prescribe their own regimen. Patients may be prescribed a narcotic painkiller, along with a once-a-day anti-inflammatory.

   Ice your knee for about 20 minutes every three or four hours for the first few days, or until pain and swelling have lessened.

   Keep your knee elevated above your heart level to restrict the flow of blood into the joint.

   Use compression, such as an elastic wrap or bandage, to keep swelling down.

   Wear a knee immobilizer, which is a stiff removable brace, to stabilize the knee and prevent further injury.

   Use crutches to keep weight off your knee.

Rehabilitation generally progresses slowly, moving from low-impact stretches to light exercises. It is important not to twist or bend in ways that may grind cartilage together until your physician is certain the osteochondral defect has healed. Some patients find that visiting a physical therapist helps them to perform rehab exercises properly and more frequently than they would on their own. It usually takes about eight weeks of light rehab to let the osteochondral defect heal before more rigorous stretching and strengthening exercises can begin. Physical therapy generally helps return healthy young athletes to sports at full strength. Arthritis may complicate the rehab process, especially for older athletes, but the physical therapy program generally recommended by physicians can be broken into three basic phases for everyone.

To restore movement and basic coordination, your physical therapist will help you begin moving your leg and teach you an exercise program you may perform on your own.

Rehab progresses into stretching and strengthening exercises that focus on the quadriceps and hamstrings - the main stabilizing muscles for your knee. Physicians suggest you gradually increase the amount of weight as your leg muscles get stronger. Strengthening exercises require dedication because results often take weeks and pain may recur.

RETURNING TO ACTIVITIES - THREE TO SIX MONTHS

The focus of rehab turns to increasing your coordination. After a few months of rehab, physical therapy can become activity oriented as you regain the ability to perform complicated movements, using stationary bikes, elliptical machines, and cross-country skiing machines. Most patients continue rehab until osteochondral defect symptoms go away, they have a full range of motion in their knee, and there is good muscle tone in the leg. Once the muscles of your injured leg are about 90 percent as strong as the uninjured leg, you can usually resume activities.

RELATED TOPICS

   Knee strengthening exercises: Cartilage injuries

Physicians usually suggest that you continue strength training even after your knee has been rehabilitated. Adequate leg muscle strength is the best way to prevent the recurrence of osteochondral defect. Have your physician periodically check your knee. Weight control is also important. One extra pound of body weight translates into three or four pounds of weight across your knee every time you take a step. Lightening the load on your knees helps them to last longer. After an osteochondral defect, you may be at risk of suffering arthritis later in life. Depending on how well your knee heals, you may want to consider cutting back or avoiding repetitive-impact activities, like long-distance running, and contact sports, like football. Many of the exercises and activities that are popular for fitness put stress on your knees. To prevent osteochondral defects it is important to learn knee-sparing exercise techniques by dividing your activities into three components:

   Daily living - The average person takes between 12,000 and 15,000 steps a day, with each step exerting a force between two and five times your body weight on your knees. After a knee injury, take it easy on your knees during the day whenever possible to save them for activities and exercise. Avoid stairs when there is an elevator, take the shortest path when walking, and consider wearing athletic shoes designed to absorb shock rather than hard-soled shoes.

   Muscle strengthening and conditioning - Activities themselves are not a substitute for conditioning. Your need for special conditioning to prepare for activities increases with age. The best strengthening programs are low-impact and non-weight-bearing, like stationary bikes and certain weightlifting programs, so that the knees do not have to absorb shock.

   Recreation - Sports that require twisting and quick direction changes put great strain on your knee. To prevent injury, stick to light, non-impact activities for your recreation. If you decide to return to sports like football and basketball, a physician should carefully examine your knee to make sure you have a proper coating of cartilage over your bones.

If pain recurs after rehab, physicians usually suggest you stop your activities and return for a check-up. Pain could be a sign that your osteochondral defect has not healed properly under observation and that you may need further treatment. Large osteochondral defects may make it difficult for some people to return to competitive athletic activity.