Osteochondritis Dissecans (OCD)

by / Wednesday, 11 September 2019 / Published in Blog, Sports Medicine

Osteochondritis dissecans (OCD) is a joint disease characterized by loss of bone under a piece of cartilage. It primarily occurs because of loss of blood supply to the area which leads to loosening of the thin layer of bone and cartilage. This results in overall joint instability and the typical symptoms include pain and feelings that the joint “sticks” or is “giving way”. The most typically affected joint is the knee but can involve other joints, such as elbows, ankles, shoulders, and hips. It is most common in children and adolescents.

Symptoms of OCD include pain in the joint, especially after activity, swelling of the affected joint, decreased joint movement, joint stiffness after resting, feeling that joint “sticks” or “locks” in one position, a clicking sound when you move the joint, and weakening of the joint that makes it feel like it is “giving way”. If these symptoms are being experienced, one should consult a doctor.

X-ray imaging is performed to check all sides of the joint

What causes OCD is unclear. It could be a cumulative effect of several minor injuries to the joint otherwise unnoticed clinically. Persistent, rigorous sports/physical activities may precipitate that. Anyone can get osteochondritis dissecans. It is seen more commonly in males between 10 and 20 years of age who are physically very active, but it is becoming fairly common in females as well. It tends to be more common in athletes, especially gymnasts and baseball players.

The diagnosis begins with a proper history and physical exam. The joint stability is assessed, and other more common causes of joint pain and related symptoms, such as fractures, sprains are ruled out. If OCD is clinically suspected, X-ray imaging is performed to check all sides of the joint. Additional imaging, specifically MRI (magnetic resonance imaging) or CT (computerized tomography) imaging tests may be done as needed, especially to evaluate if the loose piece is still in place or whether it has moved into the joint space.

It may be difficult to prevent OCD from developing or stopping it in its ranks. Being generally careful when involved in rigorous physical activity is a good idea – this includes learning the proper techniques and mechanics of the sport/physical activity. Using proper techniques, and protective gear along with participating in strength and stability exercises are all advisable.

The treatment of OCD depends on the clinical scenario at hand. A child with OCD might not require any significant treatment, as the bone and cartilage will probably heal on their own. They may just require rest and avoid sports until their symptoms improve. They may even require wearing a brace, cast, or crutches for a while. However, for adolescents and adults, it can be complicated. If the loose piece is stable, conservative management with rest, bracing, painkillers will likely suffice. But If the loose piece is unstable (meaning it has moved into the joint space), it will likely need to be removed surgically.