OSTEOCHONDRITIS DISSECANS

Osteochondritis Dissecans

Osteochondritis dissecans is a condition in which bone under the cartilage of a joint deteriorates because of the lack of blood flow. Consequently, the bone and cartilage start to break loose resulting in pain and hindering joint motion. Osteochondritis dissecans basically affect joints, especially the knee in adolescents and children. Also, the other joints it can affect are the elbows and ankles.

In OCD, as there is not enough blood circulation, the piece of the bone dies. And as a result, the cartilage covering it cracks. The part where the bone fragment breaks off is called a lesion which may occur in both of the paired joints. However, usually, only one is affected. The associated symptoms show up either after an injury to a joint or after months of high-impact activities including jumping and running, that affect the joints. The condition commonly occurs in the knee, elbows, ankles, and other joints.

Doctors categorize osteochondritis dissecans depending on the size of the injury. For classification, they consider whether the fragment is detached partially or completely, and whether or not the fragment is in place. Your child may have few or no symptoms if the loosened piece of cartilage and bone is in place. And luckily, the injury might heal all by itself, especially for young children since their bones are still developing. However, doctors may recommend surgery if the fragment seems loose and gets stuck between the moving parts of your joint or if your child experiences persistent pain.

Symptoms

Depending on the affected joint, the signs and symptoms of osteochondritis dissecans might be:

• Pain – Physical activity such as walking upstairs, climbing a hill, or playing sports, etc. can trigger this most common symptom of osteochondritis dissecans.
• Tenderness and Swelling – The skin around your joint might feel tender or swollen.
• Popping or locking of Joint – Your joint might lock in one position or pop if a loose fragment gets stuck between bones during movement.
• Weakness of joint – You might feel as if your joint is weakening or giving away.
• Restricted range of motion. Your child may not be able to straighten the affected limb completely.

What Causes Osteochondritis Dissecans?

It is not precisely clear why blood flow may lack in a part of the bone. However, osteochondritis dissecans often relates to:

• Repetitive trauma or stress on a joint as happens in playing sports – small, multiple episodes of minor injury that damage the bone
• Genetic predisposition

The most accurate cause of osteochondritis dissecans is not clear yet. Also, there might be a genetic component that makes some people more inclined to develop this disorder.

Doctor Examination

After knowing your child’s symptoms and discussing the medical history, our doctor will perform a thorough physical examination of the affected joint. Other tests that help doctors confirm a diagnosis are:

X-rays

These imaging tests help provide detailed images of dense structures of bone. Doing an x-ray of the affected joint is crucial for the primary OCD diagnosis. Also, this helps assess the location and size of the OCD lesion.

Magnetic resonance imaging (MRI) and ultrasound

These tests take better images of soft tissues such as cartilage. An MRI helps doctors evaluate the level of deterioration of the overlying cartilage.

Diagnosis and Treatment

For diagnosing osteochondritis dissecans, your orthopedic specialist may recommend X-rays and an MRI of the joint. The treatment approach doctors take depends on the size, location, and level of separation of the joint and cartilage.

Nonsurgical Options:

• Rest
• Modifying activities to reduce stress
• Brace, boot, or cast to restrict the affected joint

Specialists monitor the healing of the osteochondritis dissecans lesions by routine follow-up imaging tests.

Surgeries for Osteochondritis Dissecans

These will be necessary if nonsurgical treatment does not seem to be effective. Experts may recommend surgery for patients with large lesions or those separated from the bone. The surgery could:

• Encourage the affected area of the bone to heal
• Secure a loose fragment of bone allowing it to heal
• Reconstruct the cartilage (typically the last resort) by removing the osteochondritis dissecans lesion

Orthopedic Specialists May Recommend Surgery If:

• Nonsurgical treatment does not help relieve pain and swelling
• The lesion is detached from the surrounding bone and cartilage and is moving around within the joint
• The lesion is large

Depending on the individual case, there are different surgeries for treating OCD. Those are:

• Drilling into the lesion creates pathways for new blood vessels that help nourish the affected area. In turn, this stimulates the healing procedure of the surrounding bone.
• Using internal fixation (such as pins and screws) to hold the lesion in place.
• Replacing the damaged part with a new piece of bone and cartilage. This process is called a graft which helps regenerate healthy cartilage and bone in the area deteriorated by OCD.

Generally, crutches will be necessary for about six weeks after surgical treatment. Then your child will need a 2- to 4-month course of physical therapy to restore strength and motion in the joint affected by OCD. After about 4 to 5 months, it may be possible to gradually return to sports.

When to see a Doctor

It is time to see a doctor if your child has constant pain or soreness in the knee, elbow, or other joints. Other symptoms denoting that you should call or visit your doctor are joint swelling, inability to move a joint through a full range of motion, etc.

Risk Factors

Osteochondritis dissecans most commonly occurs in adolescents and children between the ages of 10 and 20 who are highly active in sports.

Associated Complications

Osteochondritis dissecans increase the risk of eventually developing osteoarthritis in that affected joint.

Prevention

Our doctors always suggest adolescents participate in organized sports. It might educate them on the risks overuse can pose to their joints. Learning the proper techniques and mechanics of their sport, using the right protective gear, and participating in strength and stability training exercises can play a vital role in reducing the chance of injury.

When Can A Child With Osteochondritis Dissecans Go Back to Sports?

Children having osteochondritis dissecans generally need a few months off from sports. However, kids who had surgery will obviously require more time to heal. Returning to sports too shortly without taking enough rest can lead to long-term problems such as pain and joint problems.

Children with OCD can only go back to sports if they:

• Have no pain in the area
• Have no trouble doing activities in daily life
• Have carefully followed their doctor’s recommendations regarding resting the joint and physical training
• Have been allowed for sports by their doctor

How Can Parents Help?

Children with osteochondritis dissecans heal best when they:

• Do all follow-up doctor visits.
• Follow the doctor’s advice for rest and physical training.
• Do not get back to sports until the specialist says it is OK.

Parents must check for all these so kids with OCD can heal better. Even after children get back to sports, they must:

• Do proper playing and use safety techniques for sport.
• Follow the pitching guidelines if playing baseball.
• Change the sports they play. In this way, one joint would not get overused.
• Stop playing immediately if something hurts during a game or physical training. If the pain is persistent, a coach, trainer, or health care provider must check it before they get back to sports.

No matter how critical the case is, we as a team come together to help your child recover safely and quickly so they can get back to sports asap.