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Osteochondritis Dissecans

What is osteochondritis dissecans?

Osteochondritis dissecans (OCD) is a small area of dying bone tissue (bone necrosis) that results from poor blood supply. It occurs when bone and cartilage separate from one another inside a joint.

OCD can occur in any joint, but most often it affects knees, elbows, hips and ankles. If the condition is not treated, a chunk of bone can come loose inside the joint.

Osteochondritis dissecans. These are the stages of the disease.
Osteochondritis dissecans. These are the stages of the disease.

With OCD, your child may have pain when he moves or puts weight on his leg. His knee may make a “clunking” sound when he bends it, or it may catch or give way.

Your child may have the feeling that something is moving around inside the joint.

How do you evaluate osteochondritis dissecans?

When you come to our clinic, we will ask about pain: How bad is it? When did it begin? How has it affected your child’s activities?

Then we will examine your child’s joint. We may take a radiograph to see if the joint surface appears rough or if a fragment of bone seems to be separating.

We may ask your child to have an MRI so we can look at the cartilage on the surface of the joint and check for fluid between the bone and cartilage, which can slow healing.

The doctor also may ask for a bone scan to see whether your child’s body is trying to heal the OCD.

All of these imaging tests can help doctors, patients and their families decide on the best treatment.

Who gets osteochondritis dissecans?

Children of all ages get OCD, but it is more common in teenagers.

Some doctors think OCD happens after an injury, such as a twisting and bending incident that causes the shinbone (tibia) to come in contact with the thighbone (femur). Often, it is not clear what has caused the problem.

What is your experience with osteochondritis dissecans?

At Children’s Hospital, we specialize in treating injuries to the bones and joints of children and teenagers who are still growing.

We understand that in treating any joint problem, doctors must take into account the stage of your child’s growth plates. These are the areas of growing tissue near the end of each long bone that determine the size and shape of your child’s bones once he is grown up.

Growing children have a better chance of healing from OCD without surgery than those who have stopped growing. So we are extremely careful to monitor our patients’ growth to make sure that they have the best chance of healing.

How do you treat osteochondritis dissecans?

Many growing children can heal without surgery. For these children, we offer physical therapy programs designed to keep their muscles strong while protecting their joints. Our therapists teach your child exercises to help keep him strong while he is healing.

Often, it takes between six and 18 months for children to heal. We offer rehabilitation services in our on-site sports lab.

In cases that require additional treatment, we may provide a non-surgical therapy called unloader bracing. In this treatment, your child wears a brace to push his knee into a position that decreases the stresses on the OCD.

Surgery for osteochondritis dissecans

If your child needs surgery, we often begin treatment with procedures using special tools (arthroscopes) that can reach the joint through very small incisions.

In procedures called arthroscopic drilling and microfracture operations, doctors punch tiny holes in the bone near the spot where the cartilage and bone have separated. As the bone heals, it forms cells that have the potential to make new cartilage (scar cartilage).

In more persistent cases, we can perform transplants of bone or cartilage to your child’s knee to help in healing. In this procedure, we take plugs of bone topped with cartilage from your child’s knee or from a similarly shaped knee from the bone bank, the Northwest Tissue Center.