What Is Osteochondritis Dissecans? What Causes Osteochondritis Dissecans?

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

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The condition known as osteochondritis dissecans may develop when blood supply to the area at the end of the bone is interrupted. This might not cause any symptoms if the affected bone and its covering of cartilage stay in place. If a fragment progressively loosens and separates, it may provoke pain.

Osteochondritis dissecans can occur in different joints, including the elbow, hip and ankle. The knee is most commonly affected.

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."

Symptomatic osteochondritis dissecans is usually diagnosed in older children, teenagers and young adults. This is because they are particularly active in sports.

To minimize risk of long-term disability, early diagnosis and treatment of osteochondritis dissecans are essential. With prompt treatment, chances of recovery and going back to usual activities (such as sports) are good.

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.

The most common symptom is pain. It may be triggered by physical activity.

Signs and symptoms of osteochondritis dissecans may include:

• A "locking" of the joint. The joint does not move through its full range of motion


• Decreased joint movement. Inability to straighten the leg or arm fully. Limited range of movement


• Feeling that the joint is weakening


• Limping


• Pain


• Stiffness after resting


• Swelling and tenderness of the skin over your joint

What causes Osteochondritis dissecans?

The cause of osteochondritis dissecans remains unclear. However, several of factors may contribute to the disorder:

• Genetic composition. Some individuals may be genetically inclined to develop osteochondritis dissecans.


• Injury or stress. The most evident is repetitive force causing trauma or stress to the affected joint. In the case of very active individuals, they may experience small, multiple episodes of minor unrecognized injury. Over time it results in a tiny fracture that damages the overlying cartilage of a joint.


• Limited blood supply. Vascular insufficiency or the interruption of blood supply to the bone may also contribute to the condition. The altering of supply is due to a slight blockage of a small artery that gradually can cause a breaking down or death of bone tissue known as avascular necrosis.

Risk factors for osteochondritis dissecans

Increased risk of osteochondritis dissecans can result from the stress on the joints caused by physical activity, particularly when it involves repetitive impact movement, such as jumping.

Often young individuals between the ages of 10 and 20 are especially active. They are involved in organized sports and engage in jumping, cutting or pivoting, as may occur in tennis, gymnastics, basketball and wrestling.

Osteochondritis dissecans is uncommon in females. However as young women increasingly participate in organized sports, they are now more frequently diagnosed with the condition.

Diagnosis of osteochondritis dissecans

It is important to seek medical attention if there is pain, soreness, swelling, stiffness in a joint. Individuals who recently suffered a joint injury and experience worsening of pain during physical activity should also see their doctor, as this could be a further indication of possible osteochondritis dissecans.

Medical evaluation will include a detailed report of medical history, as well as past and present pain and symptoms. Exercise routines will also be discussed. This will be followed by a physical examination to test the solidity of the joint.

The following tests may be ordered:

• Imaging tests
  
  One or more imaging procedures to help diagnose and determine the severity of the disorder.
  
  
  
  • X-rays of the joint from different angles could show abnormalities in the surface of the joint. Comparison of x-rays from both joints might be useful (such as both knees..). Often the diagnosis can be made with X-rays alone.
  
  However, in order to detect breaks or cracks in the cartilage and problems in the stability of the joint, other imaging techniques may be used:
  
  
  • Computerized tomography (CT) provides computer-enhanced images of the joint structures. It can also detect any bone and cartilage fragments and identify their location.
  
  
  • Magnetic resonance imaging (MRI) uses a magnetic field to create detailed pictures of the joint. It provides useful information about its structure, the accumulation of fluid in the area. It allows the health care provider to visually identify loose fragments. An MRI is frequently used to determine whether the patient requires surgery or some other kind of treatment.
  
  
  • Bone scans. They involve injecting dye into the bloodstream, and then taking images of the bones.

If the patient does not receive effective treatment for osteochondritis dissecans there is a significant risk that degenerative osteoarthritis will eventually develop in the affected joint.

What are the treatment options for osteochondritis dissecans?

Treatment options and effectiveness vary with each individual case. The objective is to restore the normal functioning of the affected joint and to relieve pain; as well as minimizing the risk of developing osteoarthritis.

• Conservative treatment is initially recommended and effective in most cases. This may include:
  
  
  • Resting of the joint. Ceasing all impact activities such as jumping and cut-pivot activities. If injury is due to a throwing sport, the patient will be asked to refrain from throwing for a set period.
  
  
  • Immobilizing your joint. This could involve the use of a hinged brace or crutches.
  
  
  • Nonsteroidal anti-inflammatory medications (NSAIDs). These include aspirin, ibuprofen (Advil, Motrin and others) and naproxen sodium (Aleve, Naprosyn). For the treatment of pain.
  
  
  • Avoiding competitive sports and intense physical activity. All activities that may put a strain on the affected joint and cause pain. Rest for six to eight weeks. Limiting competitive activity helps ease signs and symptoms for most people.
  
  
  • Physical therapy (UK: physiotherapy). This therapy often includes stretching and range-of-motion exercises, strengthening exercises for the muscles that support the involved joint. Low-impact aerobic conditioning, such as use of a stationary bicycle, helps to maintain cardiovascular fitness.


• Surgery
  
  Usually most people see improvement with conservative measures. When problems persist for at least three months, when the joint motion is blocked and other treatment options have failed, then surgery is an option.
  
  The type of surgery used is minimally invasive and called arthroscopy. The surgeon inserts a thin scope into the joint space to visualize the area on a television monitor. He then determines the location of the damage and decides upon the best type of surgical procedure.
  
  Small surgical instruments are inserted into little incisions. Loose bone fragments may be re-attached or removed. When cartilage fragments are still attached to the bone, they can be firmly secured with pins or screws. The objective of this surgery is to re-establish normal blood flow and improve joint function.
  
  After surgery, physical therapy is necessary to reinforce strength, stability and function.
  
  Most people with osteochondritis dissecans are free of symptoms after appropriate treatment. However, in some cases it is recommended at first to restrict daily activities to help reduce the risk of recurrence. For instance, young athletes may be able to return to playing sports, but at first they should limit participation to light workouts, gradually working back into competition level after completing specific conditioning exercises.

Prevention of osteochondritis dissecans

Learning what the risks of overuse of the joints are may be beneficial for individuals participating in organized sports. It is important to learn the proper mechanics and techniques of the particular sport you are practicing. In addition, participating in strength workout and stability training exercises may help reduce the chance of injury.

Written by Stephanie Brunner
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today