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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 21 for some reason and results in local tissue damage and tissue death (necrosis). There is evidence that a discoid meniscus can contribute to the development of OCD. A discoid meniscus refers to the shape of the meniscus of the knee. A normal medial meniscus is somewhat round when the individual is very young, and then it opens up into a "C" shape as the person ages. A discoid meniscus maintains much more of its round or "O" shape, affecting how the femoral condyle tracks with the meniscus. In some cases, MRI investigations have shown evidence of meniscal damage in patients with OCD. OCD in the knee is easy to mistake for other knee problems. X-rays or MRIs are the most reliable tests for OCD. There are other signs and symptoms, however. With active or passive range of motion in the knee, clicking or crepitus may be evident with fl exion or extension. Pain may occur along with the clicking movements if a loose piece of cartilage is fl oating in the knee. Pain will be described as deep within the knee joint. Other knee complaints have similar symptoms and should be considered. Meniscal tears, internal ligament sprains, and injury to the coronary ligaments that hold the menisci in place may produce pain felt deep in the joint, similar to OCD. Chondromalacia patellae may also cause crepitus and grinding sensations during knee movements. Patellar tracking disorders and osteoarthritis are also likely to cause diffuse anterior knee pain like that of OCD. Because the labrum is designed to hold the humeral head in position, a tear or disruption in the labral complex can lead to shoulder instability. Increased shoulder instability may predispose the person to dislocations or other shoulder pathologies, such as impingement or rotator cuff pathology. OSTEOCHONDRITIS DISSECANS The second cartilage injury we'll explore is something called osteochondritis dissecans (OCD). It can occur in several locations but is most common in the knee. Knee cartilage injuries commonly involve the lateral and medial menisci of the knee. However, OCD is different because it is associated with the articular cartilage at the tibiofemoral joint and not the meniscal fi brocartilage between the bones. OCD is not a common condition. It is, however, something the massage practitioner should be aware of as a possible cause of knee pain. OCD is most often seen in younger patients, generally between 13 and 21 years old, and is present in males more often than females. A layer of hyaline cartilage covers the tibia and femur on their ends, which reduces friction and wear at the joint. In OCD, a section of hyaline cartilage (and sometimes the underlying bone, called subchondral bone) separates from the remainder of the deeper bone. This separated fragment can fl oat freely within the joint, causing locking, pain, clicking, or crepitus during movement. The lateral side of the medial condyle of the femur is affected most commonly in OCD. During various knee motions, repetitive contact of the medial condyle against the tibial spine causes irritation (Image 4). The tibial spine is a slight ridge of bone on the tibial plateau where the anterior cruciate ligament attaches to the tibia. It is unclear exactly how the process of cartilage degeneration and separation from the bone starts. There is some evidence that it occurs from previous trauma, repetitive impact loading, or abnormal ossifi cation of the bone. In addition, it is thought that tensile forces of the cruciate ligament attachment may pull on the bone enough to weaken the osteochondral interface. Most likely, it is due to multiple causes occurring at the same time. In some cases, avascular necrosis may develop and precede cartilage separation. Avascular necrosis is a process in which the blood supply to an area is decreased Contact points in the knee leading to OCD. Mediclip image copyright (1998) Williams & Wilkins. All rights reserved. 4 Side of condyle with contact Tibial spine