Though our group is actively working to establish an evidence-based detailed guideline, below you can find a list of general guidelines for patients with osteochondritis dissecans.
What is OCD?
Osteochronditis dissecans [OCD] is a condition in which the bone that supports the cartilage of a joint softens. This softening is caused by an interruption in the blood flow to that portion of bone. Over time, if left untreated, this can lead to damage to the overlying cartilage of the joint. Loose pieces of bone and cartilage can even break off into joint. Long term ramifications may even include arthritis.
No one knows exactly what causes OCD, but it has been associated with acute injuries as well as long term repetitive impact to the joint (overuse injuries). It may also be related to problems with blood supply.
Cartilage injury is similar to OCD, but it is caused by an acute injury to the cartilage and underlying bone. It can happen in association with ligament injuries, such as tearing of the ACL.
The knee, ankle and elbow are the most commonly affected joints.
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What are the signs and symptoms?
The sign and symptoms of OCD are: insidious onset of knee pain, usually increased with activity, swelling and possibly clicking and popping sensations. These may be preceded by a small injury that seemed to resolve.
The signs and symptoms of an acute cartilage injury are more obvious. There is usually a known injury with rapid knee swelling and difficulty putting weight on the extremity. There may also be a sensation of clicking and locking of the involved joint.
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How do you diagnose OCD?
A careful history and physical exam by an experienced orthopedist are the first steps.OCD and cartilage injuries are diagnosed by x-rays and MRI.
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How can you treat it?
There are many treatments for OCD. In patients who are still growing, mild OCD's are treated with rest and decreasing running and jumping activities. These OCD's have a good chance of healing without surgery and have minimal long term risk of arthritis. More advanced OCD's or those in older adolescents are treated with surgery. Surgery ranges from minimally invasive drilling of the area to reestablish blood flow to advanced cartilage restoration and repair techniques, such as microfracture and osteochondral allograft and autograft techniques.
Osteochondral injury, if diagnosed early, can be treated by repairing the broken piece, in some cases. More chronic defects are treated by the more advanced techniques for cartilage restoration listed above.
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Who gets it, and can it be prevented?
Anyone can get an OCD or cartilage injury. Children and adolescents involved in sports with running and jumping are more susceptible. Gymnasts and baseball pitchers are especially susceptible to OCD's in the elbow.
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Learning about OCD can not only put your mind at ease about you or your child's treatment, but it can also help you make an informed decision. We have many case loads that reflect common scenarios patients face. We also have provided a list of resources to find more information.
