Osteochondritis dissecans occurs when a fragment of bone in a joint separates from the rest of the bone because its blood supply is faulty, and there is not enough blood to maintain it. It often affects the knee or the elbow.
Sometimes, the separated fragment stays in place or repairs itself. However, in the later stages the bone can splinter and fall into the joint space, resulting in pain and dysfunction.
These fragments are sometimes called “joint mice.”
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It is more common in males, especially those between the ages of 10 and 20 years who are physically active. It usually affects teens and young adults, but it can occur in younger children who are active in sports.
Osteochondritis dissecans can occur in different joints, including the hip and ankle, but it most commonly affects the knee.
Signs and symptoms include:
- inflammation, swelling, and soreness in the joint
- catching and locking in the joint during movement
- reduced range of movement in the joint
- crepitus, a grating, cracking, or popping sound when moving the joint
- weakness in the joint
- limping
- effusion, or abnormal collection of fluid in the joint area, leading to swelling
- pain, especially after physical activity
- stiffness after a period of inactivity
The exact cause is not fully understood. However, healthcare professionals believe the condition to have a variety of causes, that
- Repeated stress to the bone or joint: Osteochondritis dissecans is common in young athletes, which implies that repetitive trauma is a possible cause.
- Ischemia: A restriction of blood supply starves the bone of essential nutrients. The restricted blood supply is usually caused by some problem with blood vessels, or vascular problems. The bone undergoes avascular necrosis, a deterioration caused by lack of blood supply. Ischemia usually occurs in conjunction with a history of trauma.
- Genetic factors: Osteochondritis dissecans sometimes affects more than one family member. This may indicate an inherited genetic susceptibility.
Other factors may include weak ligaments or meniscal lesions in the knee.
A person who experiences the symptoms of osteochondritis dissecans in a joint should seek medical advice. An early diagnosis can mean more effective treatment and a lower risk of complications.
The doctor will carry out a physical examination and ask the patient about their medical history, family history and lifestyle, including sporting activities.
There may be some imaging tests, such as an:
The imaging tests may show whether there is any necrosis, or tissue death, or loose fragments. It can also help to classify the stages.
In the early stages, tests will show that the cartilage is thickening. The early stages are considered stable, and treatment is more likely to be effective at this point. In the later stages, there will be loose fragments.
Conditions with similar symptoms need to be ruled out. These include inflammatory arthritis, osteoarthritis, bone cysts, and septic arthritis.
In young children, OCD normally heals with rest, as the bones are still growing. In older children and adults, the effects can be more severe.
The American Academy of Orthopaedic Surgeons notes that many cases heal without medical intervention. In the meantime, avoiding rigorous sports and resting can help to relieve any pain or swelling. Children can normally return to sports after 2 to 4 months.
If the symptoms do not resolve, a person may require the use of crutches or immobilising the limb with a splint or cast.
A non-steroidal anti-inflammatory medication (NSAID) can help with pain. A physical therapist may offer guidance with stretching and specific exercises.
Surgery
Surgery aims to restore normal bloodflow and get the joint to work normally again. A healthcare professional may recommend surgery for the following reasons:
- conservative measures have not worked
- the lesion is wobbly or shows signs of detaching from the surrounding bone
- the lesion measures over 1 centimeter in diameter
- the person is a teenager, who is nearing the end of their growth period
There are different surgical techniques, including:
- Holding the lesion in place: A surgeon can use pins and screws to hold the lesion in place.
- Drilling into the lesion: This can create pathways for new blood vessels to form, which allows the blood to flow and the bone to heal. Scar tissue may also develop and form a cartilage over the area where the bone died.
- Osteochondral autograft transfer (OATS): This uses healthy cartilage to replace damaged cartilage on the surface of the joint that receives weight-bearing stress. It is like a cartilage transplant, but the recipient and donor is the same person. Cadaver cartilage may also be used, which refers to cartilage taken from a deceased donor.
Recovery
After surgery the patient will undergo a rehabilitation program. After an initial period of immobilization, physical therapy can help regain joint strength and stability.
The person will probably need:
- crutches for about 6 weeks after surgery
- physical therapy for 2 to 4 months, to recover strength and motion
After 4 to 5 months, a gradual return to sports may be possible.
Without treatment, complications may occur. These include pain, functional impairment, recurrent swelling of the joint, and the formation of loose fragments.
People
Osteochondritis dissecans develops when a fragment of bone in a joint separates due to a lack of blood supply. This can cause inflammation, swelling, and soreness in the joint. The joint can also catch or lock during movement.
It usually develops in teenagers and young adults, but can also develop in younger children.
Conservative treatment involves resting the joint. In some cases, it might help to immobilize the joint with a cast or splint. In more severe cases, surgery may be necessary.