Osteochondritis dissecans (OCD) is a joint condition in children and adolescents where a lack of blood supply in the affected joint causes bone and cartilage to crack and loosen.
The piece of bone actually dies, and the bone and cartilage can then break loose into the joint space, causing pain and swelling, and possibly hindering joint motion. OCD most commonly affects the knee, ankle and elbow, and it can also occur in other joints.
The likely causes of osteochondritis dissecans
Osteochondritis dissecans typically presents after an injury or after long-term, high-impact activity such as running and jumping. We believe repetitive trauma and stress on a joint may cause the disruption to the blood flow and the resulting fragments, called OCD lesions, but we still don’t know the exact cause of OCD.
Consult with a UCHealth provider
Make an appointment today with a UCHealth provider if your child is experiencing the common OCD symptoms: joint pain and swelling, often brought on by physical activity, and catching or locking of the joint.
We’ll diagnose the problem and work with your family on a customized treatment plan to get your child back in the game. In fact, your child may need only minimal treatment and a bit of time on the sideline.
Diagnosing osteochondritis dissecans
Physical exams and imaging will pinpoint the problem.
Your orthopedic or sports medicine specialist will take your child’s medical history, ask about any injuries, and conduct a physical exam of the joint and surrounding area:
- Your provider will press on the affected joint, checking for swelling, tenderness and any OCD lesions, the loose fragment inside the joint.
- The provider will also move the joint through its normal range of motion.
Optional imaging tests
Based on the exam, your provider may order imaging tests for a proper diagnosis:
- Computerized tomography (CT) scan. Produces cross-sectional images of internal structures to allow your provider to see bone in high detail and the location of OCD lesions.
- Magnetic resonance imaging (MRI). Provides detailed images of both hard and soft tissues, including the bone and cartilage
- X-ray. Shows abnormalities in the joint’s bones.
OCD typically affects only one joint, commonly the weight-bearing knee joint, but some children can develop OCD in several joints.
Your provider will stage your child’s OCD according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. This helps determine the best treatment plan for your child.
Fortunately, the affected bone and cartilage may heal on their own if your child is young and still growing.
In grown children and young adults, the OCD lesions have a greater chance of separating from the surrounding bone and cartilage, which causes worse symptoms.
Based on the diagnosis and staging, your child’s personalized treatment plan may include:
- Activity changes and observation. OCD lesions in children and young teens can heal on their own, so avoiding sports and resting can relieve symptoms while your child heals naturally.
- Bracing and orthopedic support. If symptoms do not go away, your treatment plan may include crutches, splinting or casting the affected joint for a short period.
- Physical therapy. A physical therapist will teach you and your child exercises to improve flexibility, strength and range of motion. You can help your child at home with any physical therapy.
Most children we treat for OCD feel better over two to four months with these treatments, and can return to all the sports and activities they love.
When surgery is called for
If symptoms aren’t improving, or your provider has diagnosed that the OCD lesion is loose and caught in your joint, or is very large, surgery might be necessary.
We offer different surgical techniques depending upon the case:
- Drilling into the lesion. Creates pathways for new blood vessels to nourish the affected area and heal the surrounding bone.
- Graft. Your surgeon replaces the damaged area with a new piece of bone and cartilage. A graft can help regenerate healthy bone and cartilage in the damaged area.
- Internal fixation. Holds the lesion in place with pins and screws.
Recovery and return to sports
If your child doesn’t need surgery, recovery time may be as little as two months.
If surgery was necessary, your child will need crutches or a cast for about six weeks, followed by physical therapy for two to four months. You can expect your child to be active in sports once again in four to five months total.
Orthoinfo: American Academy of Orthopaedic Surgeons. Osteochondritis Dissecans (https://orthoinfo.aaos.org/en/diseases–conditions/osteochondritis-dissecans/)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Osteochondritis Dissecans (https://www.ncbi.nlm.nih.gov/books/NBK526091/)
American Academy of Family Physicians. Osteochondritis Dissecans: A Diagnosis Not to Miss (https://www.aafp.org/pubs/afp/issues/2000/0101/p151.html)