OSTEOCHONDRITIS DISSECANS

How Has Our Understanding of Osteochondritis Dissecans Changed Over Time?

Osteochondritis dissecans isn’t a newly recognized condition.  It’s been on the medical radar for more than a century. Despite this long history, our understanding of the condition has evolved only gradually. For decades, medical experts debated the possible causes, from trauma and repetitive stress to genetic and vascular factors. Only in recent years has research in osteochondritis of the knee begun to see more comprehensive treatment approaches.

Over time, improvements in MRI imaging has allow doctors to detect bone and cartilage changes earlier and more accurately. As a result, today’s approach to osteochondritis dissecans is far more nuanced than even a generation ago. Treatment plans are increasingly tailored based on age,  location, stability of the lesion, and advances in minimally invasive surgery.

So while the central challenge  — restoring joint health and function — remains, our toolkit for diagnosis and management continues to expand.  This helps more kids and teens preserve active, healthy joints for life.

Osteochondritis Dissecans 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 symptom of osteochondritis dissecans.
• Tenderness and Swelling – The skin around your joint might feel tender or swollen.
• Popping or locking of the Joint – Your joint might lock in one position or pop if a loose fragment gets stuck between bones during movement.
• Weakness of a joint – You might feel as if your joint is weakening or giving way.
• 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 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 yet clear. 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. 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. X-rays are especially useful for identifying any loose fragments or changes in the bone that indicate instability.  This is a key factor in determining the best course of treatment.

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. MRI is also valuable for assessing the stability of the lesion and the health of the surrounding bone and cartilage. In certain cases, ultrasound may be used to provide additional information about the problem joint.  This is especially true in younger children where growth plates are still developing.

Magnetic resonance imaging (MRI) isn’t just helpful for confirming a diagnosis of osteochondritis dissecans.  It can also give your doctor valuable insight into how well your child might respond to nonsurgical treatments. Healthcare providers can interpret MRI results alongside key clinical factors, such as joint stability and symptom duration.  With that data, they can often predict whether conservative management (like rest and limited activity) will lead to healing.

• Stable lesions: If the MRI shows that the affected bone and cartilage are still stable, children are more likely to recover with nonoperative care.
• Other clinical signs: Minimal swelling, pain only with strenuous activity, and preserved range of motion also indicate a positive response to conservative treatment.

In short, a combination of detailed MRI images and the child’s clinical presentation helps doctors tailor a treatment plan. The plan will offer the best chance for recovery without surgery.

Understanding Lesion Stability

Determining whether the OCD lesion is stable or unstable is an important part of the diagnostic process. Stable lesions are more likely to heal with conservative treatment, while unstable or displaced fragments may require surgical intervention. Imaging plays a significant role in evaluating the potential for healing and guiding treatment decisions.

What are the Expected Healing Rates and Prognosis for Pediatric Patients With OCD of the Knee Following Treatment?

The outlook for children and adolescents with osteochondritis dissecans of the knee varies, depending largely on the size and stability of the lesion as well as how their body responds to treatment.

• Non-Surgical Recovery: About half of the young patients with OCD lesions may experience healing with conservative, non-surgical treatment methods, such as rest and modified activity, throughout 12 to 18 months. Factors like smaller lesion size and the absence of mechanical symptoms (such as joint locking or catching) increase the likelihood of a positive outcome without surgery.
• When Surgery Might Be Needed: If the affected area is larger or your child has persistent mechanical symptoms, the chances of successful healing without surgery tend to decrease. In these cases, surgical intervention may be recommended sooner to restore joint function and alleviate discomfort.
• Lesion Size Matters: Generally, smaller lesions have a better chance of healing with nonoperative care, while larger lesions or those causing ongoing pain and instability may require surgical repair to promote the best long-term joint health.

Throughout this process, regular follow-up appointments, imaging studies, and close monitoring by your orthopedic team play key roles in tracking healing and adjusting treatment if needed. This individualized approach helps ensure each child receives the care best suited for their situation and supports a return to an active, healthy lifestyle.

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.

Most children and teens with stable lesions and minimal symptoms will start with a nonoperative approach. This usually means stopping all sports and impact activities.  Furthermore, sometimes a knee brace or even a cast to help immobilize the joint while it heals. The length of nonsurgical treatment typically ranges from three to six months.  This gives the bone and cartilage enough time to recover.

Follow-Up Visits

During this period, your child’s doctor will likely schedule regular follow-up visits.  X-rays or MRI scans will be conducted to check for signs of healing. Healing differs in all individuals and therefore immobolization can be different for each child.

It’s important to note that while many children respond well to nonsurgical treatment, not all lesions will heal this way. Studies indicate that about half of juvenile OCD lesions successfully heal within 12 to 18 months using these conservative methods. The likelihood of healing can depend on the size of the lesion.  Smaller lesions are more likely to respond to nonoperative care, while larger or unstable lesions may require surgical intervention.

If your child continues to experience pain, develops mechanical symptoms, or has a large lesion, your doctor may discuss surgery.

Comparing Nonsurgical Treatments for Juvenile OCD of the Knee

When it comes to juvenile osteochondritis dissecans (OCD) of the knee, several nonsurgical options are often considered. Studies examined the different conservative approaches. They found that outcomes largely depend on the size and stability of the lesion as well as patient compliance.

• Rest and Activity Modification: Children with stable and smaller lesions tend to respond well to simply modifying their activities.  This includes avoiding high-impact sports until healing is confirmed.
• Protective Bracing or Casting: In some cases, using a brace or cast to reduce joint load can enhance recovery.  Especially, for those who find it hard to avoid physical activity.
• Physical Therapy: Guided exercises help maintain strength and flexibility without putting unnecessary pressure on the healing joint.
• Regular Imaging: No matter the approach, routine follow-up with imaging (like MRI or X-rays) is crucial to track the healing process.

Ultimately, there isn’t a one-size-fits-all answer.  Success with different nonsurgical treatments varies from child to child.  This emphasizes the need for an individualized, closely monitored plan. Parents and patients should work closely with their orthopedic care team to determine which approach is most appropriate.

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

Surgical Approaches:

If the lesion is unstable, fails to heal with conservative treatment, or if there is a loose fragment interfering with joint movement, surgery may be recommended. Surgical options include:

• Drilling: Creating small holes in the bone beneath the lesion to stimulate new blood vessel growth and healing.
• Internal Fixation: Using pins or screws to secure a loose fragment in place, especially if it is still viable.
• Grafting: Replacing the damaged area with healthy bone and cartilage from another part of the body (autograft) or a donor (allograft).
• Cartilage Restoration: In selected cases, advanced techniques such as autologous chondrocyte implantation or osteochondral mosaicplasty may be considered for larger defects.

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 process of the surrounding bone. Drilling can be performed using various techniques, including transarticular (through the joint surface) or retroarticular (from behind the joint), and your surgeon will select the best option based on the lesion’s location and your child’s age.
• Internal fixation (such as pins and screws) is used to hold the lesion in place. This is especially helpful for unstable or detached fragments, and both metal and bioabsorbable materials may be used. Fixation helps promote healing and maintains the integrity of the joint surface. In some cases, suture-bridge fixation techniques are also utilized, which have shown promising results for achieving fragment stability and bone healing.
• Grafting involves 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. Options include osteochondral autograft (using the patient’s tissue) or allograft (using donor tissue), and in select cases, autologous chondrocyte implantation may be considered, particularly for larger or unsalvageable lesions.

Other advanced cartilage restoration procedures, such as microfracture or third-generation chondrocyte implantation, may be considered for adolescents with persistent symptoms or when other surgical options are not suitable.

Recovery and Rehabilitation:

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. Close monitoring and follow-up with your orthopedic specialist are essential throughout this process, as healing times and success rates can vary depending on your child’s age, the lesion’s stability, and the specific surgical technique used.

Monitoring and Long-Term Outlook:

Most children with stable lesions and prompt treatment recover well and return to their previous activity levels. However, larger or unstable lesions—especially those requiring surgery—may need longer rehabilitation and careful monitoring to prevent complications such as early osteoarthritis. Regular follow-up appointments and imaging help ensure the joint is healing properly and that your child’s return to activity is safe.

With early recognition and a combination of rest, rehabilitation, and—when needed—surgical expertise, most children and teens with osteochondritis dissecans can look forward to getting back to their favorite activities pain-free.

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 affects adolescents and children between the ages of 10 and 20 who are highly active in sports and may experience repetitive microtrauma to their joints. Certain sports, such as baseball, soccer, and basketball, are associated with a higher risk due to the repetitive loading and twisting of joints that cause sports injuries.

Associated Complications

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

Prevention

Our doctors always suggest that adolescents participate in organized sports. It might educate them on the risks that 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 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 that kids with OCD can heal better. Even after children get back to sports, they must:

• Do proper playing and use safety techniques for the 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 Dallas, Arlington, 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