What Is Osteochondritis Dissecans? What Causes Osteochondritis Dissecans?

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Main Category: Bones / Orthopedics
Also Included In: Sports Medicine / Fitness;  Pediatrics / Children's Health
Article Date: 08 Oct 2009 - 7:00 PDT

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Osteochondritis Dissecans, also known as OCD or OD occurs when a fragment of bone in a joint separates from the rest of the bone because its blood supply was faulty - it was not getting enough blood to keep it alive. Sometimes, the separated fragment of bone stays in place; if it falls into the joint space, however, there will be pain and the joint may not work properly. The joint, usually the knee or elbow becomes inflamed, sore and painful and will 'give way' - it catches and locks during movement.

Osteochondritis dissecans can occur in different joints, including the hip and ankle. The knee is most commonly affected. According to health authorities in the UK and USA, OCD more commonly affects males aged between 10 and 20 years who do a lot of sports. OCD is more common among males and females who take part in active sports regularly.

According to the National Health Service (NHS), UK, osteochondritis dissecans affects approximately 20 in every 100,000 British people annually, making it a fairly rare condition.

Doctors say teenagers are more likely to recover from OCD compared to adults because of their bone remodeling ability (bone's ability to repair dead or damaged bone tissue and cartilage).

Approximately three-quarters of all OCD cases involve the knee.
According to Medilexicon's medical dictionary:

Osteochondritis dissecans is complete or incomplete separation of a portion of joint cartilage and underlying bone, usually involving the knee, associated with epiphyseal aseptic necrosis.

If the patient receives proper and prompt treatment the chances of making a good recovery are generally excellent.

What are the signs and symptoms of osteochondritis dissecans?

A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, a headache may be a symptom while a rash may be a sign.

Signs and symptoms of osteochondritis dissecans may include:

• The joint catches and locks during movement
• The affected joint loses its range of movement.
• Crepitus - when moving the joint makes a grating, cracking or popping sound.
• Tenderness in the affected area
• Joint feels weak
• Limping
• Effusion - abnormal collection of fluid in the joint area (swelling)Pain, which is usually more severe after physical activity.
• Stiffness after a period of inactivity

What causes Osteochondritis dissecans?

Even though there has been a great deal of research into the causes of OCD, experts are not completely sure.

• Ischemia - a restriction of blood supply which starves the bone of essential nutrients. The restricted blood supply is usually caused by some problem with blood vessels (vascular problem). The bone undergoes avascular necrosis - deterioration caused by lack of blood supply). Ischemia usually occurs in conjunction with a history of trauma.
• Genes - some studies have shown that the appearance of OCD in several family members may mean that the susceptibility to the condition is inherited. Others, however, argue that it could be more due to family members having similar sporty lifestyles.
• Repeated stress - repeated stress to the bone/joint can significantly increase the risk of developing OCD. Individuals involved in competitive sports are more likely to regularly stress their joints

Diagnosis of osteochondritis dissecans

An individual who experiences OCD symptoms in a joint should seek medical advice as soon as possible. The earlier the condition is diagnosed and treated, the more effective treatment will be and the lower the risk of any complications.

The doctor carries out a physical examination and asks the patient questions about his/her medical history, possibly family history and lifestyle, including sporting activities.

The doctor may order some imaging tests, such as an X-ray, CT or MRI scan to find out whether there is any necrosis (death of tissue) or loose fragments. A bone scan may also be recommended.

The following conditions, which have similar symptoms, need to be rules out: inflammatory arthritides, osteoarthritis, bone cysts and septic arthritis.

What are the treatment options for osteochondritis dissecans?

Conservative measures - such as activity modification or immobilization (rest). The aim of conservative measure is to get the subchondral bone to heal and to prevent future fracture, crater formation or chondral collapse ('chondral' means, relating to, or consisting of cartilage).

If the patient has been involved in some sport they will most likely be told to stop for a while. Immobilizing the joint may require a medical device, such as a brace, or even crutches. If there is pain the doctor may recommend an NSAID (non-steroidal anti-inflammatory medication). Children under the age of 16 should not take aspirin. A physical therapist (UK: physiotherapist) may help with stretching and specific exercises.

Children respond to conservative measures much better than adults.

Surgery - may be recommended if conservative measures have not worked.

• Arthroscopic surgery - the surgeon will aim for minimally invasive arthroscopic surgery, which is less painful and has a faster recovery, as well as a much lower risk of complications. The aim of surgery is twofold: 1. To restore normal bloodflow. 2. Get the joint to work normally again. The surgeon makes a small incision, and inserts some long, thin instruments. With these instruments loose fragments of bone can either be removed or reattached. If the cartilage is still attached to the bone, pins or screws can be used to secure it.
• Osteochondral autograft transfer (OATS) - healthy cartilage is used to replace damaged cartilage on the surface of the joint that receives weight-bearing stresses; it is like a cartilage transplant, but the recipient and donor is the same person (the patient).

After surgery the patient will undergo a rehabilitation program. After an initial period of immobilization physical therapy can help regain joint strength and stability.

Prevention of osteochondritis dissecans

Often, the individual has to make a decision regarding the benefits of their competitive sport and the cost to their joints. A competitive karate sportsperson may find that his/her weekly, fortnightly or monthly tournaments, with the excitement and camaraderie they offer, are worth the risk. However, revising proper posture, movements and protective techniques, as well as doing strength training exercises may help lower the risk of developing OCD.

Many sporting organizations around the world are becoming more aware of the hazards of their sport, and are getting better at educating their members on techniques to protect bones and joints.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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