Osteochondritis Dissecans
Introduction
Osteochondritis dissecans (OCD) is a condition that begins with repeated trauma or stress to a joint. This trauma leads to a lack of blood flow to the bone underneath the cartilage of the joint, causing the bone to die. As a result, a fragment of bone and cartilage starts to separate from the rest of the bone. This separation can then cause the bone and cartilage to break loose, leading to pain and hindering joint motion. The condition occurs more often in skeletal immaturity and adolescents, and the majority of OCD lesions occur in the knee; however, they may also form in other joints like the elbow or ankle. It’s common in sports like football, soccer, and gymnastics.
Causes
OCD in the knee is characterized by an idiopathic lesion of the subchondral bone, resulting in delamination (separation of layers) and sequestration (isolation of a fragment) with articular cartilage involvement. OCD can also affect the elbow, particularly the capitellum, the outer part of the humerus that articulates with the radius.
Symptoms
Some symptoms include:
Knee:
Pain: Persistent or irregular knee pain worsens with activity, especially during weight-bearing activities like running or jumping.
Swelling: Swelling and tenderness around the knee joint.
Locking: A locking or catching sensation in the knee where the joint feels stuck in a particular position.
Instability: A feeling of instability or weakness in the knee.
Limited Range of Motion: Reduced range of motion, making it difficult to fully extend or flex the knee.
Stiffness: Stiffness in the knee, particularly after periods of inactivity
Elbow:
Pain: Elbow pain that worsens with activity, especially during throwing motions or weight-bearing on the arm.
Swelling: Swelling and tenderness around the elbow joint.
Locking: A locking or catching sensation in the elbow where the joint feels stuck in a particular position.
Instability: A feeling of instability or weakness in the elbow.
Limited Range of Motion: Reduced range of motion, making it difficult to fully extend or flex the elbow.
Stiffness: Stiffness in the elbow, particularly after periods of inactivity.
Diagnosis
Diagnosis of OCD is often based on a physical exam where doctors assess the affected joint for swelling or tenderness. They will also test the range of motion of the joint using specialized tests, such as the Wilson Test. Other tests can also be performed to confirm the condition, such as X-rays, which are taken to verify the extent of the injury, and an MRI, which can show whether the loose piece is still in place or has moved into the joint space.
Treatment
Treatment varies based on the severity and individual patient factors. Non-surgical options include rest, activity modification, the RICE protocol (Rest, Ice, Compression, Elevation), and NSAIDs for pain management. Physical therapy may be recommended to strengthen and stabilize the joint. If conservative treatments fail or the lesion is unstable, surgical options such as arthroscopic drilling, fixation with pins or screws, debridement, or cartilage transplantation may be necessary. Post-treatment care may involve rehabilitation, gradual return to activities, and regular monitoring by healthcare providers.
Prevention
Young athletes can prevent these lesions by being educated about their joints associated with overuse; they may learn the proper techniques of their sports, using adequate gear, and participating in strength training and stability training exercises, which can help reduce the chance of injury.
Conclusion
Osteochondritis dissecans (OCD) is common in young athletes due to repetitive stress and trauma on their joints. Early diagnosis and appropriate treatment are essential for recovery and preventing further damage. By learning proper techniques, using suitable gear, and engaging in strength and stability training, athletes can reduce their risk of such lesions and maintain healthy joints.
Sources
Mayo Foundation for Medical Education and Research. (2022, August 25). Osteochondritis dissecans. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/symptoms-causes/syc-20375887#:~:text=Osteochondritis%20dissecans%20(os%2Dtee%2D,and%20possibly%20hindering%20joint%20motion.
Osteochondritis Dissecans.” Osteochondritis Dissecans | Boston Children’s Hospital, www.childrenshospital.org/conditions/osteochondritis-dissecans#:~:text=Osteochondritis%20dissecans%20of%20the%20knee,the%20arms%2C%20such%20as%20gymnastics. Accessed 29 June 2024.
Uozumi, Hiroaki, et al. “Histologic Findings and Possible Causes of Osteochondritis Dissecans of the Knee.” The American Journal of Sports Medicine, vol. 37, no. 10, 8 Sept. 2009, pp. 2003–2008, https://doi.org/10.1177/0363546509346542.