Osteochondritis dissecans

Overview

Osteochondritis dissecans (OCD) is a condition that most commonly affects young athletes. It occurs when there's damage to the cartilage and bone in a joint, usually the knee or elbow. This can lead to a fragment of bone and cartilage separating from the rest of the joint. Sometimes the fragment stays in place; sometimes it breaks off and falls into the joint space, where it can cause further damage.

The underlying cause of OCD isn't fully understood, though the condition is usually associated with traumatic injury or overuse. OCD of the knee typically occurs in sports that involve hard landings, such as football, soccer and gymnastics. OCD of the elbow can result from sports with repeated overhead throwing, such as baseball, or that require repetitive weight-bearing by the arms, such as gymnastics.

Symptoms of OCD can resemble those of other overuse injuries. It often first presents as pain with activity. Because of the risk of joint damage, it's important to see a doctor promptly for diagnosis and treatment.

Our approach to osteochondritis dissecans

Our sports medicine specialists understand the needs of pediatric patients and take into account the child's growing body in diagnosing and treating orthopedic problems, such as osteochondritis dissecans. Our team's goals are to relieve discomfort and get kids back to their normal activities.

Signs & symptoms

The first symptom of OCD may be joint pain, sometimes associated with a popping sensation. If the aggravating activity continues, the joint may become significantly inflamed and damaged, leading to other symptoms. These can include:

• Soreness or tenderness at the joint
• Swelling or stiffness around the joint
• Difficulty fully straightening the arm or leg
• A sense that the joint is catching or locking
• Fluid collecting around the joint

Diagnosis

To determine whether your child has OCD, the doctor will first perform a physical exam, checking for pain along the affected joint. But imaging tests are usually needed to confirm the diagnosis. These may include:

• X-rays. These images can show abnormalities in the joint's bones but won't reveal soft tissue damage. If X-rays appear normal yet your child's symptoms continue, additional tests may be ordered.
• Magnetic resonance imaging (MRI). An MRI scan can provide detailed images of bones, cartilage and other soft tissues.
• Computerized tomography (CT) scan. This technique combines X-rays taken from various angles to produce detailed cross-sectional images that help doctors pinpoint the location of loose fragments within a joint.

Treatment

If bone and cartilage haven't broken loose from the joint, the first-line treatment is usually nonsurgical. The plan will likely include a rest from high-impact activities that stress the joint; icing the injured area; and taking nonsteroidal anti-inflammatory drugs (NSAIDs) for pain, such as ibuprofen (Advil, Motrin). Your child may need to use crutches or wear a brace for a few weeks to reduce stress on the joint. Physical therapy may be ordered to strengthen the muscles that support the joint. During this period of rest and recovery, your child's healing progress will need to be closely monitored.

Your child may need surgery under the following circumstances:

• There's a loose fragment of bone and cartilage in the joint or the damaged part of the joint is in danger of breaking loose.
• The injured area hasn't healed after four to six months of rest and physical therapy.
• Symptoms are persisting and your child has reached the age when bones stop growing. (After the bones have stopped growing, the fragment is less likely to heal without surgery.)

Surgeons have a variety of procedures for repairing osteochondritis dissecans. Your child's surgeon will choose the best technique based on the size and stage of the injury, the maturity of your child's bones and other factors.