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Osteochondrosis Dissecans: Causes, Symptoms and Treatment

Osteochondrosis dissecans is a joint condition in which a fragment of bone and cartilage separates from the surrounding tissue. It commonly affects the knee, elbow, and ankle joints.

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Things worth knowing about "Osteochondrosis dissecans"

Osteochondrosis dissecans is a joint condition in which a fragment of bone and cartilage separates from the surrounding tissue. It commonly affects the knee, elbow, and ankle joints.

What is Osteochondrosis Dissecans?

Osteochondrosis dissecans (OCD) is a condition affecting the joints in which a localized area of bone beneath the articular cartilage (the subchondral bone) loses its blood supply, begins to die, and may eventually detach together with the overlying cartilage. This detached piece is known as a loose body and can cause significant joint pain, swelling, and restricted movement.

Causes

The exact cause of osteochondrosis dissecans is not fully understood. Several contributing factors have been identified:

Impaired blood supply: Inadequate circulation to the subchondral bone is considered the primary driver of bone tissue death.
Repetitive mechanical stress: Overuse and repeated microtrauma, particularly in athletes, can increase the risk of developing OCD.
Genetic predisposition: Familial clustering suggests that genetic factors may play a role.
Growth phase: The condition predominantly occurs in adolescents and young adults, indicating a link to skeletal growth and development.

Symptoms

Symptoms typically develop gradually and vary depending on the stage of the disease:

Activity-related joint pain, especially during or after physical exertion
Joint swelling
Stiffness or reduced range of motion
Locking or clicking of the joint (if a loose body is present)
Localized tenderness over the affected cartilage area

The most commonly affected joints are the knee (most frequent location), the elbow, and the ankle.

Diagnosis

Several imaging methods are used to diagnose osteochondrosis dissecans:

X-ray: The initial imaging modality; can reveal changes in the subchondral bone.
Magnetic Resonance Imaging (MRI): The preferred method for detailed assessment of both cartilage and bone, and for evaluating fragment stability.
Computed Tomography (CT): Used as a supplementary tool to assess bone structure in specific cases.
Arthroscopy: A minimally invasive procedure allowing direct visualization of the joint and the extent of cartilage damage.

Stages

OCD is commonly classified by the degree of fragment separation:

Stage I: Subchondral lesion with no fragment detachment
Stage II: Partial detachment of the fragment
Stage III: Complete separation of the fragment, still in place
Stage IV: Loose body freely floating within the joint space

Treatment

Conservative Treatment

In early stages, particularly in children and adolescents with open growth plates, conservative management is often effective:

Rest and reduction of weight-bearing activity
Physiotherapy to strengthen the muscles surrounding the joint
Regular monitoring with MRI to assess healing progress

Surgical Treatment

When conservative measures fail or the disease is at an advanced stage, surgical options may be considered:

Drilling (Pridie drilling): Stimulates blood flow to the affected area by creating small channels in the subchondral bone
Fragment fixation: Reattachment of the detached fragment using screws or pins
Cartilage transplantation (MACI, OATS): Replacement of damaged cartilage using the patient's own tissue or cell-based therapies
Loose body removal: Removal of the detached fragment when reconstruction is not possible

Prognosis

The outlook depends on the age of the patient, the stage of the condition, and the joint affected. Children and adolescents have significantly better healing potential than adults, especially with conservative treatment. If left untreated, OCD can lead to early-onset osteoarthritis in the affected joint.

References

German Society for Orthopaedics and Orthopaedic Surgery (DGOOC): Clinical Guideline on Osteochondrosis Dissecans (2022).
Edmonds EW, Polousky J. A review of knowledge in osteochondritis dissecans: 123 years of minimal evolution from König to the ROCK study group. Clinical Orthopaedics and Related Research, 2013; 471(4): 1118-1126. PubMed PMID: 22895710.
Kessler JI, Nikizad H, Shea KG, et al. The demographics and epidemiology of osteochondritis dissecans of the knee in children and adolescents. The American Journal of Sports Medicine, 2014; 42(2): 320-326. PubMed PMID: 24280909.

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