Knee > Osteochondral Defect > Treatments

   Casting

Preparing for Casting

The preparations you make before your cast is put on can be as important as the treatment itself in ensuring a healthy recovery.

   Getting a second opinion from a physician who is as qualified as the physician who gave the initial diagnosis is advisable in any case.

   If possible, practice walking with your crutches so you can use them easily while wearing your cast.

   Physicians generally recommend that patients wear loose shorts or sweatpants with buttons or a zipper on the side so you have room for the cast.

   Patients should arrange ahead of time for someone to drive them home. Depending on the height of the patient and the size of the car, some patients may have difficulty getting into a small car because a knee in a cast cannot bend.

Fitting a cast to most people's legs usually takes about 15 minutes. Physicians generally immobilize your knee in a slightly bent position. The amount of bend in your knee varies depending on the location and severity of the osteochondral defect. You usually can leave the hospital or doctor's office as soon as your physician gives you instructions for caring for your specific type of cast or brace at home. You may be able to walk using crutches; however, your physician may recommend that some people, especially older patients, use a wheelchair while their knee is immobilized. Physicians generally do not prescribe narcotic painkillers after an osteochondral defect. Keeping weight off your knee may help to control your pain.

Here is what you can expect and how you can cope with a cast immobilizing your leg:

   Pain varies for each person. Most people experience some pain during the first seven to 10 days while wearing a cast.

   The first concern is to monitor swelling for the first 48 hours while wearing your cast. If your swelling decreases dramatically, the cast may become too loose, and not support your leg. If swelling increases, circulation can be cut off. In both cases, you should see your physician for a new cast.

   Many patients can handle home recovery alone. But older patients or people who feel they need help bathing, cooking, or performing household work may feel more comfortable if they have someone visit them regularly to provide some assistance.

   Keep your plaster cast dry. Wrap it in a plastic shower bag whenever you may come in contact with water. Ask your physician about the best place to buy plastic shower bags in your area.

   Like most knee injuries, treat with RICE (rest, ice, compression, elevation). Try to avoid putting weight on your injured leg. Wrap ice into a well-sealed plastic bag and drape around the cast at knee level for 20 to 30 minutes, two or three times a day.

   Elevate the injured leg above heart level to help blood drain towards your body. It often helps to sleep with pillows under your ankles.

   Move your toes as much as possible to help circulate blood.

   If you develop a rash or irritated skin around your cast, call your physician.

   If you have any discomfort, contact your physician as early as possible. Do not try to "grin and bear it" if discomfort does not go away within a few days.

   To avoid complications, only your doctor should remove the cast with a special vibrating cast saw. The cast is usually removed in four to six weeks.

After wearing a cast for four to six weeks, your injured leg is generally much weaker than the other leg. Both legs may have lost strength compared to your condition before the osteochondral defect. 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. Try to avoid bending the knee more than 90 degrees (hyperflexion) for about eight weeks Physical therapy after the cast comes off 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 to 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

Once the muscles of your injured leg are about as strong as the uninjured leg, 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.

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 after casting and that you may need further treatment.

Since movement alone may cause rough cartilage and bone to irritate your knee, immobilizing your leg in a cast sometimes is the best treatment for osteochondral defect. Physicians generally recommend that you wear a cast for about four weeks. The greater the damage to your cartilage and bone, the longer you may have to remain in the cast. Most people are instructed to use crutches and keep weight off their knee until the cast is removed. Casts usually are applied as soon as the final diagnosis is made, which may require your physician to take a closer look at your knee with an arthroscope. There are different ways to immobilize your knee and your physician will prescribe the most appropriate cast or brace to fit your needs. The most common type of cast is made of plaster and padded with cotton. These casts are effective for immobilizing your knee, but they must remain dry and require attention and care while bathing or during daily activities that cause you to sweat. Waterproof casts made with fiberglass shells and synthetic padding offer the same immobilization and allow you to sweat, swim, and bathe. There also are many types of removable braces that can effectively immobilize your knee. Your general goal while wearing a cast is to completely rest your knee joint, avoiding movement and weight-bearing strain. Your leg may become weak while wearing a cast.