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List of All Topics
Osteochondritis Dissecans
Introduction
Osteochondritis dissecans is a condition that results from a loss of blood supply to an area of bone beneath the surface of a joint. The knee is most commonly affected, although osteochondritis dissecans also can occur in other joints, including your elbow and ankle.
The affected bone and its covering of cartilage may stay in place and may not cause any symptoms. Or a fragment may gradually loosen and cause pain.
Most people diagnosed with osteochondritis dissecans are teenagers and young adults. The juvenile form affects growing bone, while the adult form affects mature bone. Osteochondritis dissecans is more common in males. Although osteochondritis dissecans is rare, it's becoming more common, particularly among girls and young women as their participation in youth and college sports increases.
Early diagnosis and treatment of osteochondritis dissecans are important to minimize your risk of long-term disability. Some people with osteochondritis dissecans eventually develop osteoarthritis. When the disorder is treated promptly, most people recover and return to their usual activities, including participation in sports.
Signs and symptoms
Pain is the most common symptom of osteochondritis dissecans. The pain tends to be sharp or aching, and is usually triggered by physical activity — for example, knee pain that occurs while walking up stairs, climbing a hill or playing sports. Other signs and symptoms include:
- A clicking sound when you move your joint.
- A "locking" of your joint — the joint "sticks" and won't move through its full range of motion .
- A feeling that your joint is "giving way" or weakening
- Decreased joint movement — an inability to straighten your leg or arm fully, or a limited range of motion
- Limping
- Swelling and tenderness of the skin over your joint
- Stiffness after resting
Causes
Doctors are unsure of the cause of osteochondritis dissecans. However, a number of factors may contribute to the disorder.
High on the list is repetitive force (trauma or stress) to the affected joint, particularly if you're very active. You may experience small, multiple episodes of minor unrecognized injury that, over time, cause a tiny fracture that damages the overlying cartilage of a joint. Researchers have reported a relationship between osteochondritis dissecans of the elbow and particular sports motions, such as baseball pitching.
An impaired blood supply to the bone (vascular insufficiency) also may play a role in the condition. The impaired supply is due to a slight blockage of a small artery and gradually can cause a breaking down or death of bone tissue (avascular necrosis).
Some family groups appear to have a genetic tendency to develop osteochondritis dissecans, although this is not believed to be a major factor in most cases.
Treatment
Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and to relieve pain, as well as reduce the risk of osteoarthritis. No single treatment, however, is effective for everybody.
Initially, your doctor will likely recommend conservative measures, which are effective in most cases. They may include:
- Resting your joint. Refrain from impact activities such as jumping and from cut-pivot activities in which you can put strain on your knee as you rotate the joint.
- Immobilizing your joint. This may involve using a hinged brace or crutches if your knee or ankle is affected.
- Using nonsteroidal anti-inflammatory medications. These include aspirin, ibuprofen (Motrin, Advil, others) and naproxen sodium (Aleve, Naprosyn).
- Avoiding competitive sports and intense physical activity. These may put a strain on your affected joint and cause pain. At least six to eight weeks of limited activity are helpful for most people.
- Adopting low-intensity physical therapy. Most often, this therapy includes stretching and range-of-motion exercises, and conditioning exercises to strengthen the muscles that support the involved joint. Low-impact aerobic conditioning, such as use of a stationary bicycle, helps to maintain cardiovascular fitness.
Although most people see improvement with conservative measures, surgery is an option when problems persist for at least three to six months. Adults have a greater likelihood of requiring an operation, but they also have a lower chance of successful post-surgical results than adolescents have.
Surgery called arthroscopy is minimally invasive. It begins when your surgeon inserts a thin scope into the joint space to visualize the area on a television monitor, determine the location of the damage and decide upon the best type of surgical procedure.
Then tiny surgical instruments are inserted into small incisions, and loose bone fragments may be reattached or removed. When cartilage fragments are still attached to the bone, they can be tightly secured with pins or screws. The goal of this surgery is to restore normal blood flow and improve joint function.
Physical therapy after surgery is necessary to optimize strength, stability and function.
Although most people with osteochondritis dissecans are free of symptoms after appropriate treatment, in some cases doctors may recommend restrictions on daily activities. For example, while young athletes may be able to return to playing sports, doctors may ask that they limit participation initially to light workouts, and then gradually work back into competition.
Prevention
You may be able to prevent osteochondritis dissecans by limiting the overuse of your joints. That may require reducing the time spent in certain athletic activities that place stress on your joints. Stretching and strengthening exercises also may help prevent osteochondritis dissecans.
Adolescents participating in organized sports can benefit from education on the risks to their joints associated with overuse, with emphasis on the proper mechanics and techniques of their sport, which can reduce the chances of injury.
Information obtained from National Institute of Health