Osteochondritis Dissecans

What is osteochondritis dissecans?

Osteochondritis dissecans (OC) is a joint problem. It occurs when an area of bone under a piece of cartilage in the joint dies. This happens because of a loss of blood supply to the area. It can cause a thin layer of bone and the cartilage to break loose. The loose piece may stay in place or fall into the joint space. This makes the joint unstable. It causes pain and feelings that the joint “sticks” or is “giving way.”

Osteochondritis dissecans most often occurs in the knees. It also may occur in other joints, including elbows, ankles, shoulders, and hips. It is most common in children and adolescents. It typically affects only one joint, but can affect multiple joints in children.

Symptoms of osteochondritis dissecans

The symptoms of osteochondritis dissecans include:

• Pain in the joint, especially after activity
• Swelling of the affected joint
• Decreased joint movement, such as not being able to fully extend your arm or your leg
• Stiffness after resting
• A joint that “sticks” or “locks” in one position
• A clicking sound when you move the joint
• Weakening of the joint that makes it feel like it is “giving way”

These are all clues that you may have osteochondritis dissecans. See your doctor if you have any of these symptoms, or if you have persistent pain or soreness in a joint.

What causes osteochondritis dissecans?

Doctors aren’t sure what causes osteochondritis dissecans. The loss of blood supply could be caused by repeated minor injuries or stress to the bone that you don’t even notice. Children and teens can get the condition when they spend months doing high-impact activities, such as running or jumping.

Who gets osteochondritis dissecans?

Anyone can get osteochondritis dissecans. It happens more often in boys and young men 10 to 20 years of age who are very active. It is being diagnosed more often in girls as they become more active in sports. It affects athletes, especially gymnasts and baseball players.

How is osteochondritis dissecans diagnosed?

Your doctor will do a physical exam. They will ask you about your symptoms and your activities. They will check the joint to be sure it is stable. They will check for extra fluid in the joint. Your doctor will consider all the possible causes of joint pain. These could include fractures, sprains, damage to cartilage or ligaments, and osteochondritis dissecans.

If osteochondritis dissecans is suspected, your doctor will order X-rays to check all sides of the joint. If signs of osteochondritis dissecans are seen on X-rays of one joint, you may have X-rays of the other joint to compare them. After this, you may have MRI (magnetic resonance imaging) or CT (computerized tomography) imaging tests done. These tests can show whether the loose piece is still in place or whether it has moved into the joint space.

Can osteochondritis dissecans be prevented or avoided?

Since the cause of osteochondritis dissecans is unknown, it can be hard to avoid it. Children who are very active in sports can be taught how to reduce their chance of being injured. This includes learning the proper techniques and mechanics of their sport. It also includes using protective gear and participating in strength and stability exercises.

Osteochondritis dissecans treatment

A child with osteochondritis dissecans might not need much treatment. If the child is still growing, the bone and cartilage will probably heal on their own. Your child needs to rest their joint and avoid sports until their symptoms get better. This might mean they need to use a brace, a cast, or crutches for a while.

For grown children and young adults, the problems can be worse. If the loose piece is stable (still in place), home treatment can help with the symptoms. This can include:

• Resting the affected joint
• Bracing the joint when playing sports
• Treating pain and inflammation with an over-the-counter pain reliever and anti-inflammatory medicine, such as ibuprofen (brand name: Advil)

If the loose piece is unstable (meaning it has moved into the joint space), you might need surgery to remove it or secure it.

Do I have to stop sports activities?

If a nonsurgical treatment is recommended, you should avoid activities that cause discomfort. You should avoid competitive sports for 6 to 8 weeks. Your doctor may suggest stretching exercises or swimming instead as a means of physical therapy.

Living with osteochondritis dissecans

Young people have the best chance of returning to their usual activity levels. But they might not be able to keep playing sports with repetitive motions, such as pitching in baseball. Adults are more likely to need surgery. They are less likely to be completely cured of the condition. They are at higher risk of later developing osteoarthritis in the affected joint.

Questions to ask your doctor

• What could have caused my symptoms?
• What is the best treatment option for me?
• How long before I can expect relief from my symptoms?
• When can I return to my sport?
• Is it safe for me to exercise? What kind of exercise should I do?

Resources

American Academy of Orthopaedic Surgeons: Osteochondritis Dissecans

National Institutes of Health, MedlinePlus: Familial osteochondritis dissecans