Osteochondritis dissecans (OCD) is a condition affecting the cartilage of joints, more commonly in the knee. It affects active teenagers and young adults, leading to pain and swelling. What causes Osteochondritis Dissecans Knee, and how do we diagnose and treat it.
What is Osteochondritis dissecans?
OCD is caused by a loss of blood supply to one part of the joint, leading to the separation of the cartilage and bone. The inside of the knee is the most commonly affected joint, but it can affect any joint. This condition is frequently seen in teenagers and young adults participating in high-impact sports. If left untreated, OCD can cause persistent knee pain, locking, giving way, and early-onset osteoarthritis.
Causes of Osteochondritis Dissecans
The exact cause of OCD is not fully understood. However, we believe it results from a combination of repetitive trauma and inadequate blood supply to the affected bone. Repetitive stress from activities that involve impact and twisting motions can gradually weaken the bone beneath the cartilage. Some individuals may also have a genetic predisposition to OCD, and Vitamin D deficiency has also been implicated.
Symptoms of Osteochondritis Dissecans
The most common symptom is knee pain that worsens with activity or sport. Athletes may also experience swelling and stiffness. Sometimes, the knee may lock or catch if the loose fragment develops.
Assessment and Diagnosis
During a physical examination, a sports medicine specialist assesses knee function, looking for localised tenderness, reduced movement, and generalised swelling. One commonly used test is Wilson’s test, in which the knee is internally rotated and extended to see if it reproduces pain.
Imaging studies are crucial in detecting and assessing the severity of the lesion. X-rays can reveal bone irregularities, but in the early stages of OCD, they may not show significant changes. Magnetic resonance imaging (MRI) is the gold standard for evaluating bone and cartilage. It can detect early-stage lesions and determine whether the fragment is stable or unstable.
Treatment of Osteochondritis Dissecans
Treatment choice depends on several factors, including the patient’s age, the size and stability of the lesion, and the severity of symptoms.
In teenagers with stable lesions, non-surgical treatment is the preferred approach. Activity modification is essential to allow the bone to heal. Athletes may need to rest from sports and engage in alternative low-impact activities such as swimming or cycling.
Physical therapy plays a key role in rehabilitation by strengthening the quadriceps and hamstrings. Some people may benefit from wearing a brace to offload the knee. Ensuring adequate calcium and vitamin D intake is also essential to support bone healing. Blood tests to measure calcium and vitamin D may be needed.
Surgery for OCD Knee
If conservative treatment fails or if the lesion is unstable, surgical intervention may be necessary.
For stable lesions, surgeons use arthroscopic drilling, which stimulates healing by promoting new blood vessel growth in the affected area. In cases where the cartilage fragment is loose but still viable, fixation using screws or bioabsorbable pins may help stabilise the lesion. For more extensive defects where the cartilage is not feasible, cartilage restoration procedures may be considered to regenerate new cartilage.
Recovery and Return to Sport for Osteochondritis Dissecans
Recovery from OCD varies depending on the severity of the lesion and treatment approach. Under conservative management, healing can take three to six months, with a gradual return to sports. Surgery may take longer, requiring six to twelve months before athletes can safely resume full activity. During recovery, a structured rehabilitation program is essential to prevent recurrence.
Other frequently asked questions about Osteochondritis Dissecans knee
How long should teenagers with OCD knee rest for?
The duration of rest from sport has not been established. However, we think a minimum of 3 months rest is needed with a maximal time of 6 months. An MRI scan must be repeated to ensure healing before return to sport.
What part of the knee is most commonly affected by OCD?
The inside of the knee (medial femoral condyle) is most commonly affected, while lesions on the outside of the knee have the worst outlook.
Can OCD affect both knees?
Yes, studies suggest that about 15% of cases are bilateral. So, it’s essential to perform an X-ray of both knees.
Final Word from Sportdoctorlondon about Osteochondritis Dissecans Knee
Osteochondritis dissecans of the knee is a serious condition that requires early diagnosis to prevent long-term joint damage. People experiencing persistent knee pain should seek evaluation by a sports medicine specialist to determine the best treatment approach.
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