Osteochondritis Dissecans

Osteochondritis dissecans is an injury or condition affecting a surface of the joint that involves separation of a segment of cartilage and the underlying bone. This can occur in any joint, it is most common in the knee, followed by the ankle, elbow, and shoulder. It occurs more often in males.

Common Signs and Symptoms

  • Swelling, pain, aching, giving way, and locking or catching of joints
  • Feeling a piece of bone floating in the joint
  • Tendency to walk with foot of injured leg pointed outward in cases involving the knee
  • Crepitation (a crackling sound) within the joint with motion
  • Often, no symptoms (condition is diagnosed when x-rays are taken for other reasons)

Causes

Unknown, although many theories include: traumatic injury (direct force), repetitive stress (overuse), loss of blood supply to the bone and cartilage, and abnormal bone formation.

Risk Increases With

  • Sports involving repetitive force (distance running)
  • Year round sports
  • Obesity
  • Family history of osteochondritis dissecans
  • Bowlegs or knock knees
  • Other joints affected with osteochondritis dissecans

Preventative Measures

  • Maintain appropriate body weight

Sports Medicine

  • Appropriately warm up and stretch before and after practice or competition
  • Maintain appropriate conditioning, muscle strength, flexibility, endurance, and cardiovascular fitness

Expected Outcome

The best success occurs when treatment happens before skeletal maturity. If the cartilage is intact, conservative (nonoperative) treatment is more likely to be successful when the person is still growing. After the patient is fully grown, there is a greater likelihood of non-healing and surgery may be required (especially if the piece breaks off and becomes loose within the joint).

Possible Complications

  • Frequent recurrence of symptoms, chronic pain and swelling
  • Arthritis of the affected joint
  • Loose bodies with locking of the affected joint

General Treatment Considerations

Initial treatment consists of medications and ice to relieve pain and reduce the swelling of the affected joint. For the knee or ankle, walking with crutches until you walk without a limp is often recommended. Range-of-motion, stretching, and strengthening exercises may be done at home, although referral to a physical therapist or athletic trainer may be recommended. Occasionally your physician may recommend a brace, cast, or crutches (for the knee or ankle) to immobilize or protect the joint. Patients with persistent pain after initial treatment or with loose fragments within the joint often require surgery. Surgery may include arthroscopy (a small camera inserted into the joint) to remove the loose fragments, stimulate healing, and procedures to reattach the fragment (if large enough and not deformed). After immobilization or surgery, strengthening and stretching of the stiff, weakened joint, and surrounding muscles are necessary. These may be done with or without the assistance of a physical therapist or trainer.

Medication

Nonsteroidal anti-inflammatory medications, such as ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

Heat and Cold

Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity, which aggravates your symptoms. Use ice packs or an ice massage.

Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

Notify Our Office If

  • Symptoms get worse or do not improve in 2 weeks despite treatment
  • New, unexplained symptoms develop

Nationwide Children’s Hospital Sports Medicine specializes in diagnosing and treating sports-related injuries in youth, adolescent, and collegiate athletes. Services are available in multiple locations throughout central Ohio. To make an appointment, call 614-355-6000 or request an appointment online.