In osteochondritis dissecans (OCD), a loose piece of bone and cartilage separates from the end of the bone because of a loss of blood supply. The loose piece may stay in place or fall into the joint space, making the joint unstable. This causes pain and feelings that the joint is “catching” or “giving way.” These loose pieces are sometimes called “joint mice.” Osteochondritis dissecans usually affects the knees and elbows.
Who Gets Osteochondritis Dissecans?
Anyone can get osteochondritis dissecans, but it happens more often in boys and young men 10 to 20 years old, while they are still growing. Osteochondritis dissecans is being diagnosed more often in girls as they become more active in sports. It affects athletes, especially gymnasts and baseball players. The adult form occurs in mature bone, and the juvenile form occurs in growing bone.
How Do I Know My Joint Pain Is Osteochondritis Dissecans?
If you have a sore joint (especially your knee or elbow), see your doctor. You might have swelling, and you may not be able to extend your arm or leg fully. Your pain may or may not be related to an injury. You may have pain during activity and feel stiff after resting. These are all clues to your doctor that you may have osteochondritis dissecans. Your doctor will check you to be sure the joint is stable and check for extra fluid in the joint. Your doctor will consider the possible causes of joint pain, such as fractures, sprains and osteochondritis dissecans. If osteochondritis dissecans is suspected, your doctor will order x-rays to check all sides of the joint.
What Tests Should I Have?
If signs of osteochondritis dissecans are seen on x-rays of one joint, you may have a MRI (magnetic resonance imaging) done. A MRI can show whether the loose piece is still in place or whether it has moved into the joint space. If the loose piece is unstable, you may need surgery to remove or secure it. If the loose piece is stable you may not need surgery, but you may need other kinds of treatment.
Do I Have to Stop Sports Activities?
If a nonsurgical treatment is recommended, you should avoid activities that cause discomfort. You may need to avoid impact sports for 3 to 6 months. Your doctor may suggest stretching exercises or swimming instead.
Can Osteochondritis Dissecans Be Cured?
Young people have the best chance of returning to their usual activity levels, although they might not be able to keep playing sports with impact, such as basketball. Adults are more likely to need surgery and are less likely to be completely cured. They may later get arthritis in the joint.
Signs and Symptoms
You might experience a “popping” sensation when you have an OCD lesion of the knee. Most people can still walk on the injured knee and many athletes keep playing. When symptoms of inflammation set in, your knee feels painful and tight. For several days you have:
- Stiffness and swelling
- Tenderness in the joint line
- Collection of fluid (“water on the knee”)
Without treatment, a fragment of the bone and cartilage may loosen and drift into the joint, causing it to slip, pop or lock – your knee gets stuck, often at a 45-degree angle, until you manually move or otherwise manipulate it. If you think you have a OCD lesion, see Dr.Gambacorta right away for diagnosis and individualized treatment.
Initial treatment of an OCD lesion follows the basic RICE formula: rest, ice, compression and elevation, combined with nonsteroidal anti-inflammatory medications for pain and activity modification (i.e. no running or impact sports activity). Bracing may also be utilized.
If the piece is stable, this conservative treatment may be all you need. Blood vessels sometimes can feed the outer edges of the lesion, giving the piece the potential to heal on its own.
If your OCD lesion does not heal on its own and your knee becomes painful, stiff or locked, you may need surgical repair. Depending upon the type of OCD lesion, your age and other factors, Dr. Gambacorta may recommend surgery with use an arthroscope to make small drill holes into the underlying bone to stimulate healing, or securing a loose piece in place using a screw.
A brace immobilizes your knee after surgery. You must complete a course of rehabilitation exercises before gradually resuming your activity.
Preparing for Surgery
If you decide to have arthroscopy, you may be asked to have a complete physical with your family physician prior to surgery to assess your health and to rule out any conditions that could interfere with your surgery.
Before surgery, tell Dr. Gambacorta about any medications that you are taking. You will be informed which medications you should stop taking before surgery. This typically includes aspirin and anti-inflammatory medications such as Advil®, ibuprofen, Motrin®, Naprosyn® or Aleve®, all of which should be stopped 10 days before surgery. Tylenol is ok to take in the week preceding your surgery, but be sure not to exceed the recommended daily dose.
Tests, such as blood samples or a cardiogram, may be ordered by Dr. Gambacorta to help plan your procedure.
This information is intended for eduction of the reader about medical conditions and current treatments. It is not a substitute for examination, diagnosis, and care provided by your physician or a licensed healthcare provider. If you believe that you, your child, or someone you know has the condition described herein, please see your healthcare provider. Do not attempt to treat yourself or anyone else without proper medical attention.