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Osteochondritis Dissecans
Wednesday, 20 October 2004
Wednesday, 20 October 2004

What

Osteochondritis dissecans (OCD) is a rare disorder characterized by inflammation of a bone and it’s cartilage resulting in detachment of pieces of the joint cartilage and associated bone. These pieces then form loose bodies in the joint. OCD is a common cause of joint pain in active adolescents. The knee is most commonly affect in children with OCD, followed by the elbow and then the ankle.

Who

OCD affects about 1 in 3,000 children every year. Boys are affected 3 to 4 times as often as girls. OCD commonly affects children between the ages of 10 and 20 years. Children of all races and ethnicities are affected equally. Sixty percent of OCD cases involve children who participate in competitive sports, such as baseball and gymnastics.

Signs and Symptoms

Children with OCD often complain of a vague and aching pain in the affected joint. They often have difficulty pin-pointing the exact location of the pain. They are often unable to fully extend the joint because it worsens the pain. Weight-bearing exercises and twisting of the joint also causes pain. Children with OCD of the knee may walk with the leg turned outward to minimize this pain. A limp may be present and with prolonged favoring of one leg the muscles may decrease in size. Commonly, children complain of “catching,” “locking,” “giving away” or “grinding” of the joint. The joint may be slightly swollen and warm, with tenderness to touch along the joint line. The elbow is a common site for OCD in baseball pitchers and gymnasts. Gymnasts are also at risk for OCD of the wrist. Less common sites for OCD include the hip, shoulder and hand joints. The child with OCD is otherwise well. Fever, weight loss, loss of appetite and fatigue are absent.

Possible Causes

The cause of OCD is not well understood. It is likely that many factors contribute to the development of OCD. Approximately 30% of children have a history of major injury to the joint before to the onset of symptoms. In the remaining 70%, small and repetitive injury, such as that seen in children who play sports, may be the cause. In either case, injury causes a small piece of bone to detach from the joint surface, which then, having lost its blood supply, slowly dies. This disorder is not contagious or infectious.

Diagnosis

The Wilson’s sign, a special maneuver your doctor may use as a test, may be positive in patients with OCD. X-rays will often show the bone fragments. If the X-ray is normal, OCD is very unlikely and further imaging is not required. A CT scan is better than an x-ray in determining the severity of OCD; however, MRI is the most accurate imaging test for diagnosing OCD. Findings on imaging will vary from slight irregularity of the joint cartilage in mild disease, to a loose, bony fragment in the joint space in severe cases of OCD. A bone scan is only useful early in the disease and may show abnormalities in the joint that are not specific to OCD.

Treatment

The goal of treatment is to preserve joint function and prevent early development of arthritis. Strenuous activity and competitive sports must be stopped for 6-8 weeks. Physical therapy is very important and will teach the child to strengthen the muscles around the affected joint, thus minimizing stress on the joint, promoting healing and preventing further injury. Non-steroidal anti-inflammatory medications are useful in pain control. Surgery may be required if symptoms persist or if the bony fragment is large or unstable. Bone fragments that are at least partially detached are classified as unstable. An arthroscopy is performed by an orthopedic surgeon (bone doctor) to remove the loose bony fragment. Following surgery, physical therapy is prescribed to expedite recovery.

Prognosis

Early diagnosis and appropriate treatment are critical in preventing long-term complications, the most common of which is arthritis. Younger children, whose growth plates have not yet fused, have the greatest healing potential. This includes girls younger than 11 and boys younger than 13 years of age. Patients over 20 years of age have worse outcomes. Mild cases, i.e. those not requiring surgery, will resolve with joint protection in approximately 1 year.

Connect with other parents

In the spirit of community and support, Madisons Foundation offers the unique service of connecting parents of children with rare diseases. If you would like to be connected to other parents of children with this disease, please fill out this brief form.

Weblinks

Family doctor
Contains information for parents and kids.

Google Search for Osteochondritis Dissecans

References and Sources

www.aafp.org/afp/20000101/151.html www.emedicine.com/radio/topic495.htm www.physsportsmed.com/issues/1996/06_96/ralston.htm