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Osteochondritis Dissecans of the Knee: The Great Confounder

The management of osteochondritis dissecans (OCD) continues to baffle even the savviest of surgeons, with unclear etiology, unknown relationship of presentation to outcome, bewildering response to various treatments, and frustratingly difficult-to-predict prognosis. Whether skeletal immaturity may be indicative of surgical success, at least when it comes to lesions requiring screw fixation, remains debatable. Treatment may include activity modification, drilling, fixation, or osteochondral replacement of OCD lesions in the knee. Regardless, each OCD lesion must be followed until osseous integration is confirmed by imaging —otherwise, progression of disease to osteoarthritis is likely.

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 Osteochondritis Dissecans: A Diagnosis Not to Miss

Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. Because clinical findings are often subtle, diagnosis requires a high index of suspicion. Limited range of motion may be the only notable clinical sign. The diagnosis is made by radiographic examination, and magnetic resonance imaging has a key role in determining the stability of the lesion. Conservative management is the mainstay of treatment for stable lesions. While the majority of patients respond to conservative treatment, those with unstable lesions require arthroscopic management.

Articles of Interest

Osteochondritis Dissecans

The phenomenon of osteochondral loose bodies within a joint was termed osteochondritis dissecans (OCD) by König in 1887. OCD is conventionally defined as a focal idiopathic alteration of subchondral bone with risk of instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis.

Osteochondritis dissecans of the knee

Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. The diagnosis is usually made during adolescence.

An update on osteochondritis dissecans of the knee

Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis. Knee MRI is indicated in young, active patients who have knee pain and/or effusion, to make an early diagnosis and decide about treatment, according essentially to the MRI stability signs. The choice of treatment should be also tailored, based on the patient’s skeletal maturity, as well as the size and location of the lesion.

Avery runs into a healthy future

“It’s not a very common condition, but we’re starting to see it more and more in highly active young athletes,” Dr. Shea said. “Since it’s a rare condition, it frustrated me that there wasn’t a lot of data available to help us make the best recommendations to our patients. In 2010, I co-founded the Research on Osteochondritis Dissecans of the Knee (ROCK) study group, which now has more than 50 doctors and researchers around the world sharing their research so we can offer the best evidence-based treatment.”

How Mattias Janmark went from medical mystery to one of the NHL's best stories

Set to start his second NHL season, Janmark’s knee basically died. The blood stopped flowing, part of the bone just fell out of place, and his range of motion gone, the knee stuck at a 45-degree angle. You could say it’s more commonly known as Osteochondritis dissecans, but saying that is a common ailment that anyone outside of a medical professional would know about is laughable.

Management Strategies for Osteochondritis Dissecans of the Knee in the Skeletally Immature Athlete

Osteochondritis dissecans (OCD) is a disorder resulting in focal breakdown of the subchondral bone, with potential disruption of the overlying articular cartilage. The femoral condyles of the knee are the most common locations for OCD, and the incidence of OCD appears to be increasing among active children.

Osteochondritis Dissecans of the Knee

OCD mostly affects the femoral condyles of the knee. The femoral condyle is the rounded end of the lower thighbone, or femur. Each knee has two femoral condyles, referred to as the medial femoral condyle (on the inside of the knee) and the lateral femoral condyle (on the outside). Like most joint surfaces, the femoral condyles are covered in articular cartilage. Articular cartilage is a smooth, rubbery covering that allows the bones of a joint to slide smoothly against one another.

Saber-Toothed Tigers and Dire Wolves Suffered From Bone Disease

Saber-toothed cats and dire wolves, two predators that roamed the Earth during the last Ice Age, may have had a high rate of a developmental bone disease, according to a new study of their remains. For some types of bones, between 4 and 6 percent had signs of osteochondrosis dissecans (OCD), a joint condition in which the bone underneath cartilage dies and can break loose due to a lack of blood flow. The high rate of disease could suggest the animals were inbreeding as they went extinct...

The Diagnosis and Treatment of Osteochondritis Dissecans

The burden of disease from juvenile and adult Osteochondritis Dissecans is not known. Individuals affected by OCD limit activity and decrease sports participation to limit pain... Osteochondritis dissecans can occur in different joints, including the knee, elbow, hip and ankle. The knee is most commonly affected. Risk factors are theorized to include repetitive stress to the joint, trauma or joint injuries, age between 10 and 20 years and participation in sports.

Twisted Knee

This 15 year old female twisted her knee playing tennis. On exam, she's nontender but will not fully extend or bear weight. What's the diagnosis and management? Loose body in joint from subchondral fracture

Understanding Osteochondritis Dissecans: A Narrative Review of the Disease Commonly Affecting Children and Adolescents

Osteochondritis dissecans (OCD) is a joint disorder characterized by the acquired impact on both the articular surface and subchondral bone. In 1888, Koönig introduced the term OCD and hypothesized an inflammatory origin for the disease. While contemporary perspectives now associate OCD with mechanical stress, the exact etiology remains elusive.

What’s the Difference Between Osteochondrosis and Osteochondritis Dissecans?

Osteochondrosis is a group of conditions characterized by a loss of blood supply to a bone, leading to the breakdown and regrowth of bone tissue. Osteochondritis dissecans is one type.

Resources

ROCK (Research in OsteoChondritismof the Knee)

Part of ROCKs goal is to provide up to date information and research about OCD to physicians everywhere

OrthoBullets

Diagnosis may be made radiographically (notch view) but MRI usually required to determine size and stability of lesion, and to document the degree of cartilage injury.

OrthoInfo

Osteochondritis dissecans (OCD) is a condition that develops in joints in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. The most common joints affected by osteochondritis dissecans are the knee, ankle and elbow, although it can also occur in other joints. The condition typically affects just one joint; however, some children can develop OCD in several joints.

StatPearls

Osteochondritis dissecans (OCD), also known as an osteochondral lesion, is not a fully understood process, though it is believed to be multi-factorial in etiology. OCD is an idiopathic process and can occur from childhood through adult life, with the majority of patients presenting in their teenage years.