Osteochondritis dissecans

Haley Rucker

What is Osteochondritis dissecans? Who does this usually affect?

Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone. Osteochondritis dissecans occurs most often in young men, particularly after an injury to a joint.

Signs, Symptoms, and Tests

  • Pain. The most common symptom of Osteochondritis dissecans, pain may be triggered by physical activity — walking up stairs, climbing a hill or playing sports.
  • Joint popping or locking. Your joint may pop or get stuck in one position if a loose fragment gets caught between bones during movement.
  • Joint weakness. You may feel that your joint is "giving way" or weakening.
  • Decreased range of motion. You may be unable to straighten your leg or arm completely.
  • Swelling and tenderness. The skin around your joint may become swollen and tender. Tests:
  • X-rays. X-rays can show abnormalities in the joint's bones.
  • Magnetic resonance imaging (MRI). Utilizing radio waves and a strong magnetic field, MRIs can provide detailed images of both hard and soft tissues.
  • Computerized tomography (CT). This technique combines X-ray images taken from many different angles to produce cross-sectional images of internal structures.

What body parts are commonly affected by Osteochondritis dissecans?

Prognosis and Treatments

Surgical Intervention

Arthroscopy versus open treatment

Arthroscopy is preferred so that arthrotomy can be avoided.

Drilling of the defect may be performed, with the hope that revascularization will occur.

Pinning may be performed to stabilize the fragment. Stainless-steel pins usually require removal to avoid additional chondral injury. Resorbable pins can be used to avoid the need for removal; however, they may not be rigid enough or may not last long enough to allow healing.

Excision of the fragment and removal of loose bodies may be necessary.

Screw fixation may be performed for fragment stabilization. In this method, usually a specialized screw or Herbert-type screw, as shown in the images below, is used.



  • Osteochondral autograft transplantation (OATS) involves harvesting cylindrical osteochondral grafts from other areas of the knee to reconstruct a weight-bearing surface. A maximum 1-cm lesion (crater) depth is allowed for use of this treatment method.
  • Osteochondral allograft transplantation is similar to OATS except that a freshly harvested allograft condyle is used. The advantages are that the exact condyle curvature can be reconstructed and no further defect is created during autograft harvest.
  • Autologous chondrocyte implantation (ACI), by Carticel, requires a diagnostic arthroscopy, harvesting of a small amount of cartilage cells for cloning, and subsequent arthrotomy for reimplantation. Bone grafting of the OCD crater is often necessary prior to implantation.
  • Newer surgical treatments, including single-stage cell-based procedures, use mesenchymal stem cells and matrix augmentation. Any decision about appropriate surgery requires evaluation of both lesional (size, depth, stability) and patient (age, athletic level) characteristics.


Other Treatment

In children with nondisplaced fragments, initial treatment includes limitation of activity with the use of crutches and restricted range of motion (eg, knee immobilizer, range-of-motion brace).

Statistics of OCD

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 remodelingability (bone's ability to repair dead or damaged bone tissue and cartilage).

Approximately three-quarters of all OCD cases involve the knee.

Term Chart

Joint-a structure in the human or animal body at which two parts of the skeleton are fitted together.

Abnormality-an abnormal feature, characteristic, or occurrence, typically in a medical context.

Tissue-An aggregation of morphologically similar cells and associated intercellular matter acting together to perform specific functions in the body.

Arthroscopy-a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision.

Arthrotomy-incision into a joint.

Revascularization-revascularization is the restoration of perfusion to a body part or organ that has suffered ischemia.

Excision-the act or procedure of removing by or as if by cutting out; especially : surgical removal or resection.

Fragment-a small part broken or separated off something.

Transplantation-to remove from one place or context and settle or introduce elsewhere : relocate.


Citations

"Knee Osteochondritis Dissecans Treatment & Management." Knee Osteochondritis Dissecans Treatment & Management. N.p., n.d. Web. 10 Dec. 2014.

"Osteochondritis Dissecans Treatment & Management." Osteochondritis Dissecans Treatment & Management. N.p., n.d. Web. 10 Dec. 2014.

"Osteochondritis Dissecans | Doctor | Patient.co.uk." Patient.co.uk. N.p., n.d. Web. 10 Dec. 2014.

"Osteochondritis Dissecans-OrthoInfo - AAOS." Osteochondritis Dissecans-OrthoInfo - AAOS. N.p., n.d. Web. 10 Dec. 2014.