ICD-10: M93.26

Osteochondritis dissecans (OCD) of the knee is a condition characterized by the separation of a segment of cartilage and underlying bone from the surrounding tissue, typically occurring in the knee joint. This condition is particularly prevalent in adolescents and young adults, often associated with repetitive stress or trauma to the joint.

Clinical Description of Osteochondritis Dissecans

Pathophysiology

Osteochondritis dissecans involves a disruption in the blood supply to a specific area of bone, leading to necrosis and subsequent detachment of the cartilage and bone fragment. This detachment can result in joint pain, swelling, and mechanical symptoms such as locking or catching during movement. The exact etiology remains unclear, but factors such as genetics, sports activities, and previous injuries may contribute to its development[1].

Symptoms

Patients with OCD of the knee typically present with:
- Knee Pain: Often localized to the area of the lesion, exacerbated by activity.
- Swelling: Due to inflammation in the joint.
- Joint Stiffness: Particularly after periods of inactivity.
- Mechanical Symptoms: Such as locking or giving way of the knee, which may indicate loose bodies within the joint[1][2].

Diagnosis

Diagnosis is primarily clinical, supported by imaging studies. Key diagnostic tools include:
- X-rays: To identify any visible changes in bone structure or the presence of loose bodies.
- MRI: Provides detailed images of the cartilage and bone, helping to assess the extent of the lesion and any associated changes in the surrounding tissues[1][2].

Classification

Osteochondritis dissecans is often classified based on the stability of the lesion:
- Stable Lesions: Where the fragment remains attached and is not displaced.
- Unstable Lesions: Where the fragment is partially or completely detached, which may require surgical intervention[1].

ICD-10 Code M93.26

The ICD-10 code M93.26 specifically refers to "Osteochondritis dissecans, knee." This code is used for billing and documentation purposes in healthcare settings. It falls under the broader category of osteochondritis dissecans, which can affect various joints, but M93.26 is specifically designated for the knee joint.

Treatment Options

Treatment for OCD of the knee varies based on the age of the patient, the stability of the lesion, and the severity of symptoms:
- Conservative Management: Includes rest, physical therapy, and anti-inflammatory medications for stable lesions.
- Surgical Intervention: May be necessary for unstable lesions or when conservative measures fail. Options include:
- Arthroscopic Debridement: Removal of loose bodies and damaged tissue.
- Bone Grafting: To promote healing of the affected area.
- Chondrocyte Implantation: In cases where significant cartilage loss has occurred[2][3].

Conclusion

Osteochondritis dissecans of the knee is a significant condition that can impact the quality of life, particularly in active individuals. Early diagnosis and appropriate management are crucial to prevent long-term complications such as osteoarthritis. The ICD-10 code M93.26 serves as a vital tool for healthcare providers in documenting and treating this condition effectively. For individuals experiencing knee pain, especially those involved in sports, it is essential to seek medical evaluation to rule out OCD and other potential knee injuries.

References

1. Osteochondritis Dissecans | 5-Minute Clinical Consult.
2. Clinical Policy: Articular Cartilage Defect Repairs.
3. Autologous Chondrocyte Implantation.

Osteochondritis dissecans (OCD) of the knee, classified under ICD-10 code M93.26, is a condition characterized by the separation of a fragment of cartilage and underlying bone from the surrounding tissue. This condition primarily affects the knee joint and is most commonly seen in adolescents and young adults, particularly those involved in sports. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Patient Demographics

• Age: Osteochondritis dissecans typically occurs in children and adolescents, particularly between the ages of 10 and 20 years. It is more prevalent in males than females, with a ratio of approximately 2:1[6].
• Activity Level: The condition is often associated with individuals who participate in high-impact sports, such as basketball, football, and gymnastics, which can lead to repetitive stress on the knee joint[6].

Signs and Symptoms

• Knee Pain: The most common symptom is localized pain in the knee, which may worsen with activity and improve with rest. Patients often report a dull ache that can become sharp during physical activity[6].
• Swelling: Swelling around the knee joint may occur, particularly after activity. This can be due to inflammation or the presence of effusion (fluid accumulation) in the joint[6].
• Joint Stiffness: Patients may experience stiffness, especially after periods of inactivity or upon waking in the morning. This stiffness can limit the range of motion in the knee[6].
• Locking or Catching Sensation: Some patients report a sensation of the knee locking or catching, which can occur if a loose fragment of bone or cartilage interferes with normal joint movement[6].
• Instability: In more severe cases, patients may feel that their knee is unstable or giving way, which can affect their ability to participate in sports or daily activities[6].

Diagnostic Considerations

• Imaging Studies: Diagnosis is often confirmed through imaging techniques such as X-rays, MRI, or CT scans, which can reveal the presence of osteochondral lesions, the degree of fragmentation, and any associated joint effusion[6].
• Physical Examination: A thorough physical examination is crucial, focusing on the range of motion, tenderness, and any mechanical symptoms during movement[6].

Patient Characteristics

• Sports Participation: Many patients with OCD of the knee are active in sports that involve jumping, pivoting, or running, which can contribute to the development of the condition due to repetitive stress on the knee joint[6].
• Previous Injuries: A history of knee injuries, such as ligament tears or fractures, may predispose individuals to develop OCD[6].
• Genetic Factors: There may be a genetic predisposition to developing osteochondritis dissecans, as it can sometimes run in families[6].

Conclusion

Osteochondritis dissecans of the knee (ICD-10 code M93.26) is a significant condition that primarily affects young, active individuals. The clinical presentation typically includes knee pain, swelling, stiffness, and mechanical symptoms such as locking. Early diagnosis and management are crucial to prevent further joint damage and to facilitate recovery, particularly in young athletes. If you suspect OCD, it is essential to consult a healthcare professional for a comprehensive evaluation and appropriate treatment options.

Osteochondritis dissecans (OCD) is a joint condition that primarily affects the knee, particularly in adolescents and young adults. The ICD-10 code M93.26 specifically refers to osteochondritis dissecans of the knee. Here, we will explore alternative names and related terms associated with this condition.

Alternative Names for Osteochondritis Dissecans

1. Osteochondritis Dissecans of the Knee: This is the full term that describes the condition affecting the knee joint.
2. Knee OCD: A common abbreviation used in clinical settings to refer to osteochondritis dissecans specifically in the knee.
3. Knee Cartilage Lesion: This term may be used to describe the cartilage damage associated with OCD.
4. Knee Joint Osteochondritis: A broader term that encompasses the condition affecting the knee joint.
5. Osteochondral Lesion of the Knee: This term refers to the damage to both the cartilage and the underlying bone, which is characteristic of OCD.

Related Terms

1. Chondral Injury: Refers to damage to the cartilage, which can be a result of or related to osteochondritis dissecans.
2. Osteochondropathy: A general term for diseases of the bone and cartilage, which includes osteochondritis dissecans.
3. Subchondral Bone: The layer of bone just below the cartilage, which can be affected in cases of OCD.
4. Knee Pain: A common symptom associated with osteochondritis dissecans, often leading to diagnosis.
5. Joint Dysfunction: A term that may describe the impaired function of the knee joint due to OCD.

Clinical Context

Osteochondritis dissecans is often characterized by the separation of a fragment of cartilage and underlying bone, leading to joint pain and potential mobility issues. It is commonly seen in young athletes and can be associated with repetitive stress on the knee joint. Understanding the various terms related to this condition can aid in better communication among healthcare providers and enhance patient education.

In summary, while the ICD-10 code M93.26 specifically identifies osteochondritis dissecans of the knee, various alternative names and related terms exist that describe the condition and its implications in clinical practice.

Osteochondritis dissecans (OCD) of the knee, classified under ICD-10 code M93.26, is a condition characterized by the separation of a segment of cartilage and underlying bone from the surrounding tissue. Diagnosing this condition involves a combination of clinical evaluation, imaging studies, and specific criteria. Below is a detailed overview of the criteria used for diagnosis.

Clinical Evaluation

Symptoms

1. Pain: Patients typically report localized pain in the knee, which may worsen with activity and improve with rest.
2. Swelling: There may be noticeable swelling around the knee joint.
3. Joint Locking or Catching: Patients may experience episodes of the knee locking or catching, indicating loose bodies within the joint.
4. Reduced Range of Motion: There may be a limitation in the range of motion due to pain or mechanical blockage.

Physical Examination

• Tenderness: Palpation of the knee may reveal tenderness over the affected area, particularly over the medial or lateral femoral condyle.
• Joint Stability Tests: Assessing the stability of the knee joint can help rule out other conditions, such as ligament injuries.

Imaging Studies

X-rays

• Initial Assessment: Standard X-rays are often the first imaging modality used. They can reveal changes in bone structure, such as:
• Subchondral bone cysts
• Sclerosis (increased density) of the bone beneath the cartilage
• Loose bodies in the joint space

MRI

• Detailed Visualization: Magnetic Resonance Imaging (MRI) is crucial for a definitive diagnosis. It provides detailed images of both bone and soft tissue, allowing for:
• Identification of the size and location of the lesion
• Assessment of the integrity of the cartilage and underlying bone
• Evaluation of any associated joint effusion or other pathologies

Diagnostic Criteria

Specific Criteria for Osteochondritis Dissecans

1. Age Group: Typically affects adolescents and young adults, often during periods of skeletal maturity.
2. Lesion Characteristics: The presence of a well-defined lesion on imaging that shows:
   - A separation of the cartilage from the underlying bone
   - Possible involvement of the subchondral bone
3. Symptoms Correlation: The clinical symptoms must correlate with the imaging findings, indicating that the lesion is symptomatic.

Differential Diagnosis

• It is essential to differentiate OCD from other conditions that can cause similar symptoms, such as:
• Meniscal tears
• Ligament injuries
• Other osteochondropathies

Conclusion

The diagnosis of osteochondritis dissecans of the knee (ICD-10 code M93.26) relies on a combination of clinical symptoms, physical examination findings, and imaging studies, particularly MRI. Accurate diagnosis is crucial for determining the appropriate management and treatment options, which may range from conservative measures to surgical intervention, depending on the severity and symptoms associated with the condition. If you suspect OCD, it is advisable to consult a healthcare professional for a thorough evaluation and diagnosis.

Osteochondritis dissecans (OCD) of the knee, classified under ICD-10 code M93.26, is a condition characterized by the separation of a fragment of cartilage and underlying bone from the femur, typically due to inadequate blood supply. This condition primarily affects adolescents and young adults, often leading to knee pain, swelling, and mobility issues. The treatment approaches for OCD of the knee can vary based on the severity of the condition, the age of the patient, and the presence of symptoms. Below is a detailed overview of standard treatment strategies.

Non-Surgical Treatment Options

1. Activity Modification

• Rest and Activity Limitation: Patients are often advised to reduce or modify activities that exacerbate knee pain, particularly high-impact sports or activities that involve jumping or running. This helps alleviate stress on the affected joint and promotes healing[1].

2. Physical Therapy

• Rehabilitation Exercises: A physical therapist may design a rehabilitation program focusing on strengthening the muscles around the knee, improving flexibility, and restoring range of motion. This can help support the joint and reduce pain[1][2].

3. Medications

• Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can be used to manage pain and reduce inflammation associated with OCD[1].

4. Bracing

• Knee Braces: In some cases, a brace may be recommended to stabilize the knee and limit movement, which can help in reducing pain and preventing further injury[1].

Surgical Treatment Options

When conservative management fails to relieve symptoms or if the condition is severe, surgical intervention may be necessary. The choice of surgical procedure depends on factors such as the age of the patient, the size and location of the lesion, and whether the lesion is stable or unstable.

1. Arthroscopic Surgery

• Debridement: This minimally invasive procedure involves removing loose fragments of cartilage and bone from the knee joint. It can help alleviate symptoms and improve joint function[2].

2. Microfracture Technique

• Stimulating Cartilage Regeneration: In this procedure, small holes are made in the bone beneath the cartilage to promote the growth of new cartilage. This is often used for smaller lesions[1][2].

3. Autologous Chondrocyte Implantation (ACI)

• Cartilage Regeneration: ACI involves harvesting healthy cartilage cells from the patient, culturing them, and then implanting them back into the knee to repair the defect. This technique is typically reserved for larger lesions and can provide good long-term outcomes[1][2].

4. Osteochondral Autograft Transplantation

• Transplanting Healthy Tissue: This procedure involves taking a plug of healthy bone and cartilage from a non-weight-bearing area of the knee and transplanting it to the site of the defect. This can be effective for larger lesions[1][2].

5. Allograft Transplantation

• Using Donor Tissue: In cases where the defect is extensive, an allograft (donor tissue) may be used to replace the damaged cartilage and bone. This option is considered when other treatments are not viable[1][2].

Conclusion

The management of osteochondritis dissecans of the knee (ICD-10 code M93.26) involves a combination of non-surgical and surgical approaches tailored to the individual patient's needs. Early diagnosis and appropriate treatment are crucial to prevent long-term complications such as joint degeneration. Patients are encouraged to work closely with their healthcare providers to determine the most suitable treatment plan based on their specific circumstances and the severity of their condition. Regular follow-up and monitoring are essential to ensure optimal recovery and function of the knee joint.