Osteochondritis Dissecans (OCD)

Your knee is the largest joint in your body and it joins your leg with the thigh. Each knee has 2 joints, one between the femur and patella (patellofemoral joint) and one between the femur and tibia (tibiofemoral joint). 

The joint condition which occurs when your bone separates from cartilage and starts to die is known as osteochondritis dissecans (OCD). It is typically due to a lack of blood flow to the bone. When small pieces of the separated cartilage and bone start to break loose, it can reduce your range of motion in the affected area and cause pain. 

Although the majority of patients recover completely, having OCD can raise your chance of subsequently getting osteoarthritis in the affected joint. OCD usually requires you to rest the affected area for several weeks or might even require surgery in some cases (if the symptoms do not improve after 4 to 6 months). Your doctor will also likely recommend surgery if you have loose cartilage or bone fragments in your joints. 

What is Osteochondritis Dissecans (OCD)?

Osteochondritis dissecans is a disorder where the interior of the joints (where the ends of one bone meet the ends of another bone) become mushy due to a lack of blood flow. As a result, a tiny portion of the bone degenerates and splits away from the larger bone. The bone portion may then split and come free, along with the cartilage that covers and shields the bone.

The cartilage and loose bone may stay where they are or they may slide inside the joint, making the joint unstable. Where the bone and cartilage part ways, a lesion results from the disorder. The entire process may take many months or even years, and symptoms may not manifest for a long period.

Osteochondritis dissecans often affects the knee, elbow, ankle, and thigh bone (femur) area. Other joints, such as the hip and shoulder, are also susceptible to the illness.

Osteochondritis dissecans frequently affects just one joint. The condition, known medically as sporadic osteochondritis dissecans, presents as a single lesion in a single joint.

You May Also Read: Arthritis of Knee: Symptoms & treatment

What are the Symptoms of Osteochondritis Dissecans?

Depending on the affected joint, the following osteochondritis dissecans signs and symptoms may be present:

• Decreased range of motion – You might not be able to straighten the injured limb fully.
• Joint weakness – You can experience a “give way” or weakening sensation in your joint.
• Joint popping or locking – If a loose piece gets entangled between bones while you’re moving, your joint might pop or become stuck in one place.
• Swelling and tenderness – Possible swelling and tenderness of the skin around your joint. 
• Pain – Physical exertion, such as climbing stairs, or a hill, or participating in sports, may cause this osteochondritis dissecans symptom to flare up.

What are the Causes of Osteochondritis Dissecans?

Most of the time, there is no recognized aetiology for sporadic osteochondritis dissecans. One reason for the syndrome is that repetitive damage or stress to a joint over time, such as from participating in sports, can cause it.

The ACAN gene, which produces the aggrecan protein, is the source of the hereditary mutations (changes) that lead to familial osteochondritis dissecans. The protein cannot properly produce cartilage as a result of the mutation, leaving the cartilage weak and disorganized. It is unclear, nevertheless, how the brittle and disorderly cartilage contributes to lesions and bone separation. 

What is the Treatment for Osteochondritis Dissecans?

Sporadic osteochondritis dissecans in children and young adolescents will often go away on their own as they age. Rest and a break from physically demanding activities like jogging and jumping might help them reduce discomfort and swelling. The doctor could suggest using an over-the-counter painkiller or anti-inflammatory drug. 

The damaged joint will resume normal function within six to twelve weeks. The young athlete should ease back into sports activity with mild workouts (yoga, swimming, cycling, or stretching).

The doctor may advise using crutches or may apply a brace, splint, or cast to the joint if the recovery is taking too long. A recommendation for physical treatment from the doctor is also possible.

For patients with osteochondritis dissecans, the doctor could advise surgery if:

• The detached bone and cartilage are larger than 1 centimetre in diameter.
• According to tests, the cartilage and bone fragment that has come loose from the joint are moving around.
• Time and rest do not lessen discomfort and swelling.

A camera and small equipment are frequently used during arthroscopic surgery, which is done through very small incisions. There are three types of surgery:

• To restore healthy tissue to the injured location, the removed bone and cartilage are replaced with a transplant. Bone and cartilage are harvested from the patient’s own body or a cadaver. A healthy bone and cartilage sample taken from the patient can also be used in the lab to generate new bone and cartilage.
• Using pins and screws to fix the dislodged bone and cartilage in place.
• Drilling a hole through the damaged cartilage and bone. New blood vessels can then grow in this area, supplying the bone with oxygen and promoting healing.

Following surgery, the patient will use crutches for approximately six weeks before beginning physical therapy for two to four months to strengthen the body and regain the range of motion in the joint. Four to five months following surgery, the patient might be ready to start engaging in strenuous physical activity again.

You May Also Read: Chondromalacia Patella: Causes, Symptoms and Treatment

How can you Prevent Osteochondritis Dissecans?

Since its origins are unknown, osteochondritis dissecans can be challenging to prevent. By wearing pads and other protective gear, for example, young athletes can take precautions to safeguard their joints. They should also practise the required physical skills for their sport, stretch and warm up before engaging in strenuous exercise, and stretch and cool down afterwards.

Conclusion

Osteochondritis dissecans (OCD) is a disorder of the joints in which the bone begins to detach from the cartilage and die. It might make the afflicted region more painful and limit your range of motion. If you don’t feel better after resting, you could need surgery since OCD increases your risk of developing osteoarthritis later on. It is always advisable to seek medical help from an experienced orthopaedist. Timely care and help can ensure an appropriate diagnosis and treatment of your condition. 

At the CK Birla Hospital, we ensure patients get holistic medical support which includes treatment in a compassionate environment. This patient-centric approach not only helps patients heal better but also ensures they are aware of the preventive measures as well. In case you need to consult an orthopaedist, reach out to us, or book a direct appointment with Dr. Reetadyuti Mukhopadhyay at the CK Birla Hospital.

FAQs

What makes Osteochondritis Dissecans Worse?

Pain frequently becomes worse with exercise. If left untreated, the problem may result in arthritis and cause discomfort, swelling, catching or locking of the joint.

Can Osteochondritis Dissecans Come Back After Surgery?

Once the patient heals, osteochondritis dissecans often don’t reoccur. But occasionally the illness just looks to get better when the symptoms disappear. In such circumstances, symptoms may eventually reappear.