Osteochondritis Dissecans

What is osteochondritis dissecans?

Osteochondritis dissecans (OCD) is a condition that affects your joints. It usually develops in children, teens and young adults.

A joint is any place in your body where two bones meet. Osteochondritis dissecans affects the end of one bone in a joint. It cuts off blood supply to a section of the bone which makes it soften and weaken. Eventually, the affected section of bone dies and separates from the rest of your bone. This can pull some cartilage with it. OCD leaves a lesion (mark) where the bone and cartilage break off.

The loose bone and cartilage might remain in place or move into another area of your joint. This can make the joint unsteady or painful. You might not feel any symptoms for a long time. It can take months or even years for osteochondritis dissecans to develop.

OCD usually affects joints like your:

• Knees.
• Elbows.
• Ankles.
• Shoulders.
• Hips.

It’s most common to develop OCD in your knee, specifically at the inside edge at the bottom of your femur (thigh bone) — the medial femoral condyle.

Types of osteochondritis dissecans

There are two types of osteochondritis dissecans:

• Sporadic osteochondritis dissecans: This is OCD that happens in one joint, usually without a known cause.
• Familial osteochondritis dissecans: This type of OCD is an inherited genetic disorder. Biological parents may pass it on to their children. It can affect multiple joints throughout your lifetime. People with familial OD usually have a shorter stature and develop osteoarthritis earlier than usual.

What are osteochondritis dissecans symptoms?

You might not experience symptoms early on or if the separated piece of bone and cartilage don’t drift far out of place.

If you do have osteochondritis dissecans symptoms, they can include:

• Joint pain.
• Weakness.
• Swelling.
• Stiffness.
• A reduced range of motion (how far you can move a joint).
• A clicking sound when you move a joint.
• Feeling like your joint is unstable or giving out.

These symptoms usually only happen if the piece of bone breaks off and drifts into other areas of your joint.

You might feel symptoms more often or more intensely during or after physical activity or exercise.

What causes osteochondritis dissecans?

Researchers are still studying sporadic osteochondritis dissecans and haven’t been able to find or prove one single cause. Because it’s more common in athletes, experts think repeated stress on a joint may cause OCD. Healthcare providers call these microtraumas — high-stress events that don’t damage a joint right away, but that can add up over time to cause injuries. Jumping, running and throwing can all cause microtraumas in your joints.

Familial osteochondritis dissecans is caused by a genetic change. A change in the ACAN gene causes familial OCD. The ACAN gene carries the code for your body to make a cartilage-building protein called aggrecan. The mutation causes your aggrecan to build weak or disorganized cartilage.

What are the risk factors?

Anyone can develop OCD, but some people are more likely to, including:

• People 10 to 20 years old.
• People assigned male at birth (AMAB).
• Athletes.
• People whose close biological relatives have OCD.

What are osteochondritis dissecans complications?

Untreated osteochondritis dissecans can cause worsening symptoms over time. Eventually, you might develop chronic pain or arthritis.

If you have familial OD, you’re more likely to develop osteoarthritis much earlier than usual (when you’re younger than 50).

How do providers diagnose osteochondritis dissecans?

A healthcare provider will diagnose osteochondritis dissecans with a physical exam and imaging tests.

They’ll examine your affected joint and ask about your symptoms. Tell your provider when you first noticed symptoms like pain and stiffness, or if any activities seem to make them worse.

Your provider will check your range of motion and compare it to your other, unaffected joints — one knee against the other, for example.

Your provider will use X-rays or an MRI (magnetic resonance imaging) to take pictures of your joints. You might need genetic testing to confirm or rule out familial OCD.

What is the treatment for osteochondritis dissecans?

Your provider will suggest treatments that help your joint heal and restore blood flow to your affected bone. The most common OCD treatments include:

• Rest: Avoiding more stress on your joint is the best way to help it heal. You may need to stop playing sports or doing intense physical activities for a month or two.
• Medication: Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) and acetaminophen reduce swelling and relieve pain. Don’t take pain relievers for more than 10 days in a row without talking to your provider.
• Immobilization: You might need to wear a brace, splint or cast on your joint. These devices will hold your joint in a neutral position while it heals. Your provider might suggest using crutches to take pressure off your knee or ankle.
• Physical therapy: A physical therapist will help you strengthen the muscles around your joint. They’ll suggest exercises, stretches and movements that help restore your range of motion.

Osteochondritis dissecans surgery

Your provider might suggest surgery if you’ve tried other treatments and still have severe symptoms after a few months.

Your surgeon might:

• Drill a small, precise hole into your affected bone and cartilage. This will stimulate your body to resupply the area with fresh blood to help it heal.
• Reattach the bone and cartilage with pins and screws.
• Replace damaged tissue with a bone graft from somewhere else in your body or a matching donor.

Which type of surgery you need depends on which joint has OCD, how severe the damage is and how far out of place the detached tissue is. Your surgeon will tell you what to expect.

How do you treat osteochondritis dissecans naturally?

The term “natural” doesn’t have a set medical definition. Most people can manage osteochondritis dissecans symptoms with conservative or at-home treatments. Remember, there’s nothing “unnatural” about needing medication or surgery to treat a medical condition, including OCD. The best treatment for you is the one that works and helps your joint heal.

Can osteochondritis dissecans heal on its own?

Kids and teens with osteochondritis dissecans are more likely to heal with only rest and time.

But don’t take a chance with your child’s joints. Visit a healthcare provider if your child has joint pain or other symptoms for more than a week.

The sooner a provider diagnoses and treats a joint issue, the less likely it is your child will experience complications.

How soon after treatment will I feel better?

Most people need a few months to heal. Your provider will tell you which kinds of physical activities are safe to do while you’re recovering.

Recovering from osteochondritis dissecans surgery usually takes around two months. You’ll need physical therapy for a few months after that to regain your strength and range of motion.

Can I prevent osteochondritis dissecans?

You probably can’t prevent osteochondritis dissecans because experts aren’t sure what causes it. The best way to take care of your joints is to maintain good overall health, including:

• Following an eating plan that’s healthy for you.
• Exercising and moving. Cycling, strength training, swimming, low-impact cardio or water aerobics are all great options. Which type of exercise is best for you depends on your joint health and fitness level. Take breaks and rest if your joints hurt during or after physical activities.
• Wearing the right protective equipment for any activity, sport or work you’re doing.

Talk to your provider about genetic screening if one of your close biological relatives (like a biological parent or grandparent) has OCD.

What can I expect if I have osteochondritis dissecans?

Kids and teens usually don’t have long-term effects after a provider diagnoses and treats osteochondritis dissecans.

Your child might have to change sports or avoid certain repetitive motions to prevent future joint injuries. For example, some kids with OCD in their elbows can resume playing baseball once they’ve healed, but they have to avoid pitching.

Adults have a higher risk of developing osteoarthritis in their affected joints and are more likely to need OCD surgery.

Osteochondritis dissecans usually doesn’t come back (recur) once you’ve healed. But you’re more likely to develop OCD again in the future if you have familial OCD.

When should I see my healthcare provider?

Visit a healthcare provider if you have joint pain that lasts for more than a week. Go to the emergency room if you experience a trauma or can’t move a joint.

What questions should I ask my provider?

You may want to ask your provider:

• Which type of osteochondritis dissecans do I have?
• What are the best treatments for me?
• Will I need surgery?
• When can I resume playing sports or doing intense physical activities?