Osteochondritis Dissecans

Osteochondritis dissecans (OCD) is a condition that develops in joints. It occurs when a small part of the bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and become loose.  Sometimes this loose cartilage and bone can separate completely and float around inside the joint. Most commonly OCD affects the knee, but can also occur in the ankle, elbow and even the hip. This condition has been seen with increased frequency with the rapid rise in younger athletes participating in competitive sports. 

What causes Osteochondritis Dissecans? 

The exact cause of osteochondritis dissecans is not known. It is suspected that OCDs result from overuse, repetitively using the same part of your body. Other causes can be related to genetic predisposition, problems with blood supply (vascular) and traumatic injury. None of these theories is universally accepted and none to date has completely explained all OCD lesions. 

What are the symptoms of Osteochondritis Dissecans? 

A child with OCD classically presents with nonspecific pain, which is often worse with activity. In more advanced cases symptoms include: 

• “Locking” or “catching” of the knee with movement 
• Swelling of the joint 
• Episodes of giving way with activities 
• Walking with a limp 
• Pain on examination of the joint line 

How is osteochondritis dissecans diagnosed? 

The diagnosis starts with a thorough history and physical exam. A specialized maneuver called a Wilson’s Test is performed to try and push on the OCD lesion with the shinbone. This is performed with the knee bent and by turning the knee inward while extending the knee. Then the same test is performed with the knee turned outward. If the pain is relieved with the knee outward then this may be positive for an osteochondritis dissecans lesion of the knee.  Other ways to diagnose: 

• Radiographs of the involved joint 
• MRI is the current imaging modality of choice, which allows the most accurate classification of the lesion   

A critical part of the workup and diagnosis of an OCD lesion in a growing athlete is determining if the lesion is stable or if it has displaced, and is floating around the joint (unstable). Whether the lesion is stable or not dictates the treatment recommendations. The age of your child is also incredibly important. In general, the younger the child the better chance they have of healing the OCD lesion without surgical intervention. 

Ok, my child has an OCD. Now what? 

In general, most children are able to get back to their previous activity level. Most OCD lesions are stable and between 50-66% respond favorably to rest and immobilization. This means cessation of sports and running activities. Sometimes a brace or cast can be used to ensure immobilization for a period of time. This will be determined by your doctor.  

The duration of activity restriction and rest from sports depends on the lesion, size and location. Unfortunately, it may take many months to get these lesions to heal on their own. 

What are the surgical treatment options to fix or repair the OCD? 

The type of treatment depends on many factors including the age of your child, size and stability of the lesion and any previous treatments to the lesion. Sometimes stable lesions do not heal. Painful swelling and locking may persist. In addition, some OCD lesions present as unstable and these require surgical fixation. For stable lesions that failed to heal, initial treatment involves arthroscopy to look inside the joint and then the surgeon may choose to put multiple drill holes into the lesion to stimulate healing. For unstable lesions, the primary goal of surgery is stabilization, performed by fixing the loose piece with a metallic or bioabsorable screw. 

Healing and Care after Surgery 

Your growing athlete will need to meet with a physiotherapist postoperatively to help gradually return to activities. In general, there is a good chance to return to previous activity level and sport. The timeline to get your child back on the field is usually around 6 months. 

Your doctor will also discuss with you and your athlete about the benefits of cross-training and incorporating some low impact exercises such as swimming to their routine.