OSTEOCHONDRITIS DISSECANS
Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply
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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.
QUESTIONS AND ANSWERS
What is Osteochondritis Dissecans (OCD), and how does it affect my child's health?
Osteochondritis Dissecans is a joint disorder that primarily affects children and adolescents. It occurs when a small piece of bone and cartilage, typically in a joint, becomes loose. This can lead to pain, limited joint movement, and in some cases, the formation of loose bodies within the joint. OCD is most commonly found in the knee, but it can also affect other joints. It can cause pain and discomfort, particularly during physical activities
What are the common symptoms of OCD in children, and how is it diagnosed?
Common symptoms of OCD in children can include:
- Joint pain, especially during and after physical activity.
- Swelling, tenderness, and warmth around the affected joint.
- Limited range of motion in the joint. To diagnose OCD, a healthcare provider may perform a physical examination, review the child’s medical history, and order imaging studies such as X-rays or MRI scans. These imaging studies can reveal the presence and extent of the lesion, aiding in diagnosis.
How is Osteochondritis Dissecans treated in children, and what can parents do to support their child's recovery?
- The treatment of OCD depends on the size and stability of the lesion, as well as the child’s age. Treatment options may include:
- Conservative management: In mild cases, conservative treatment may involve rest, physical therapy, and activity modification to reduce stress on the affected joint.
- Surgery: If the lesion is large, unstable, or not responding to conservative measures, surgical intervention may be necessary. Surgery can involve repairing or removing the loose fragment, or drilling into the bone to stimulate the formation of new, more stable cartilage.
- Rehabilitation: After surgery, physical therapy and rehabilitation are often recommended to regain strength, flexibility, and range of motion in the affected joint.
- Lifestyle modifications: Encourage a balanced diet, maintain a healthy weight, and follow healthcare provider recommendations for activity and joint protection.
It’s important for parents to work closely with healthcare providers, orthopedic specialists, and physical therapists to develop a personalized treatment plan for their child’s OCD. Early diagnosis and appropriate management can help children recover and lead an active, healthy life while minimizing the impact of the condition on their joint health.
The doctors at Medical City Children’s Orthopedics and Spine Specialists treat children with Osteochondritis dissecans (OCD), which is a joint disorder in which a segment of bone and cartilage starts to separate from the rest of the bone after repeated stress or trauma.
What Causes Osteochondritis Dissecans?
It is not precisely clear why blood flow may be lacking 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 and who may get a sports injury.
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.
Selecting the Right Doctors for Your Child’s Condition
Selecting a pediatric orthopedic doctor for your child is a crucial decision that requires careful consideration. By seeking recommendations, researching credentials, assessing hospital affiliations, reviewing patient testimonials, evaluating communication and bedside manner, considering the supportive team, discussing treatment options, seeking second opinions, prioritizing accessibility, and trusting your instincts, you can make an informed choice. Remember, finding the right orthopedic doctor will ensure that your child receives the best possible care, leading to optimal outcomes and a healthier, happier future. The Medical City Children’s Orthopedics and Spine Specialists doctors only treat children. With offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. Doctors Shyam Kishan, Richard Hostin, and Kathryn Wiesman have spent years studying children’s health and have devoted their lives to treating them. Call the best doctors in North Texas. We are taking new patients and would love to see you.
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Footnote:
American Academy of Orthopaedic Surgeons: Osteochondritis Dissecans
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