Osteochondritis Dissecans

What is osteochondritis dissecans?

Osteochondritis dissecans is a joint problem that occurs when a piece of cartilage and a thin layer of bone separate from the end of a bone because of a loss of blood supply.

The loose piece may stay in place or fall into the joint space, making the joint unstable. This causes pain and feelings that the joint “sticks” or is “giving way.” These loose pieces are sometimes called “joint mice.”

Osteochondritis dissecans refers to a fragmented portion of subchondral bone along an articular surface. The exact etiology is still unknown but repetitive trauma is thought to be at least partially responsible.

In the knee, the most common site of involvement is the lateral aspect of the medial femoral condyle along its non-weight-bearing surface. This is most commonly seen in young male patients.

Osteochondritis dissecans most often occurs in the knees, but also may occur in other joints, including elbows, ankles, shoulders and hips.

Symptoms of osteochondritis dissecans

How do I know whether my joint pain is osteochondritis dissecans?

The symptoms of osteochondritis dissecans include:

These are all clues that you may have osteochondritis dissecans. Your doctor will check you to be sure the joint is stable and check for extra fluid in the joint. Your doctor will consider all the possible causes of joint pain, including fractures, sprains and osteochondritis dissecans.

• Swelling of the affected joint
• Decreased joint movement, such as not being able to fully extend your arm or your leg
• Pain, especially after activity
• Stiffness after resting
• A joint that “sticks” or “locks”
• A clicking sound when you move the joint

What increases the risk of osteochondritis dissecans?

The following factors may make you more likely to develop this condition:

• Being a child or adolescent. Having bones that are still growing makes osteochondritis dissecans more likely to occur.
• Participating in sports that put repeated force on the joints, such as distance running.
• Being obese.
• Having a family history of osteochondritis dissecans.
• Having posture problems, such as bowlegs or knock knees.

Causes of osteochondritis dissecans

Who is at risk for osteochondritis dissecans?

Anyone can get osteochondritis dissecans, but it happens more often in boys and young men 10 to 20 years of age who are very active. Osteochondritis dissecans is being diagnosed more often in girls as they become more active in sports. It affects athletes, especially gymnasts and baseball players. The adult form occurs in mature bone, and the juvenile form occurs in growing bone.

How is osteochondritis dissecans Diagnosed

What tests should I have?

If osteochondritis dissecans is suspected, your doctor will order X-rays to check all sides of the joint. If signs of osteochondritis dissecans are seen on X-rays of one joint, you’ll have X-rays of the other joint to compare them. After this, you may have an MRI (magnetic resonance imaging) or a CT (computerized tomography) done. These tests can show whether the loose piece is still in place or whether it has moved into the joint space.

How is osteochondritis dissecans treated

If the loose piece is unstable (meaning it has moved into the joint space), you might need surgery to remove it or secure it. If the loose piece is stable (still in place) you may not need surgery, but you may need other kinds of treatment, such as resting the affected joint, bracing the joint when playing sports and treating pain and inflammation with ibuprofen.

Do I need to stop sports activities?

If a nonsurgical treatment is recommended, you should avoid activities that cause discomfort. You should avoid competitive sports for 6 to 8 weeks. Your doctor may suggest stretching exercises or swimming instead as a means of physical therapy.

Can osteochondritis dissecans be cured?

Young people have the best chance of returning to their usual activity levels, although they might not be able to keep playing sports with repetitive motions, such as pitching in baseball. Adults are more likely to need surgery and are less likely to be completely cured. They may later develop arthritis in the affected joint.

Follow these instructions at home:

If you have a splint:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint if your fingers or toes tingle, become numb, or turn cold and blue.
• Do not let your splint get wet if it is not waterproof.
• Keep the splint clean.

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Do not let your cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• If you have a cast or splint, do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If you have a cast or splint that is not waterproof, cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers or toes often to avoid stiffness and to lessen swelling in your affected limb.
• If possible, raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine, unless your health care provider approves.
• Ask your health care provider when it is safe to drive if you have a cast or splint on an arm or a leg.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• If physical therapy was prescribed, do exercises as told by your health care provider.

Safety

• Do not use the affected limb to support your body weight until your health care provider says that you can. Use crutches as told by your health care provider.

General instructions

• If you have a cast or splint, do not put pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Avoid high-impact sports and sports that involve repetitive motions. Try to choose physical activities that are low-impact and put less stress on your joints.

Contact a health care provider if:

• You have symptoms that get worse or do not improve after 2 weeks of treatment.

Get help right away if:

• You have severe pain.

Questions

• What could have caused my symptoms?
• What is the best treatment option for me?
• How long before I can expect relief from my symptoms?
• When can I return to my sport?
• Is it safe for me to exercise? What kind of exercise should I do?

Citations

• Osteochondritis Dissecans: A Diagnosis Not to Miss by AL Hixon, M.D. and LM Gibbs, M.D.( 01/01/00,http://www.aafp.org/afp/20000101/151.html  )

Summary

Osteochondritis dissecans (OCD) is a joint disorder that primarily affects the subchondral bone (the bone just beneath the cartilage) and the overlying articular cartilage. It can occur in various joints but is most commonly found in the knee, particularly in the lateral aspect of the medial femoral condyle.

Here are some key points about osteochondritis dissecans:

1. Etiology: The exact cause of OCD is not always clear, but it is thought to result from a combination of factors, including repetitive trauma to the affected joint, genetic predisposition, and issues with blood supply to the subchondral bone.

2. Presentation: OCD typically presents with pain, swelling, and limited range of motion in the affected joint. It often affects young individuals, particularly those who are physically active and involved in sports.

3. Diagnosis: Diagnosis involves a combination of physical examination, medical history, and imaging studies such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans. These tests help assess the extent of joint damage.

4. Staging: OCD lesions are often classified into different stages based on their severity. Staging can help determine the appropriate treatment strategy.

5. Treatment Options:

• Conservative Management: In the early stages of OCD, non-surgical treatment options may be considered. These can include rest, physical therapy, and the use of assistive devices (e.g., crutches) to relieve joint stress.
• Surgical Intervention: In more severe cases, especially if the OCD lesion is large or unstable, surgery may be required. Surgical options can include:
  • Drilling or microfracture: This involves creating small holes in the bone to stimulate the growth of new, healthy cartilage.
  • Osteochondral grafting: Healthy cartilage and bone are transplanted from one area of the joint to the affected area.
  • Autologous chondrocyte implantation (ACI): This involves taking a sample of the patient’s own cartilage cells, growing them in a lab, and then implanting them into the lesion.
  • Fixation of loose fragments: If there are loose bone or cartilage fragments, they may be reattached or removed.

6. Prognosis: The prognosis for OCD can vary depending on the size and location of the lesion, the age of the patient, and the chosen treatment. Early diagnosis and appropriate management can lead to good outcomes.

It’s essential for individuals experiencing joint pain, especially in the knee, to seek medical attention for a proper evaluation and diagnosis. Treatment options can be tailored to the specific characteristics of the OCD lesion and the patient’s individual needs.