Osteochondritis dissecans (OCD) is a localized injury or condition affecting the bone just below the cartilage surface of a joint. It is often associated with repetitive trauma and sports.
With OCD, the bone beneath the joint surface can fail and fracture from repetitive stress or interruption of its local blood supply. Eventually, the overlying cartilage may separate, and a fragment of bone and cartilage can break loose.
What Is Knee OCD?
Osteochondritis dissecans (OCD) affects the bone just below the cartilage surface of the knee joint.
The involved bone may fail and fracture because of repetitive stress or interruption of its local blood supply. As the underlying bone becomes unable to properly support the cartilage, the overlying cartilage may remain intact, partially separate, or completely separate and become a loose body within the joint.
If a stable OCD occurs in a patient who is still growing, rest and protected weight bearing sometimes can allow the injury to heal. More mature lesions or those that have separated from the surrounding bone often require surgery.
If neglected, an OCD fragment may come loose and catch within the joint, leaving a defect in the joint surface that can accelerate wear and arthritis of the knee.
Causes and Risk Factors
The exact cause of OCD is unknown. Possible causes include:
- Traumatic injury
- Repetitive stress
- Loss of blood supply to the bone
- Abnormal bone formation
Risk factors include:
- High-intensity sports and frequent athletic activity
- Competitive sports participation, especially among highly active adolescent athletes
- Poor physical conditioning
- Genetics
Symptoms
Signs and symptoms may include:
- Swelling and pain
- Giving way of the knee
- Locking or catching
- A sensation of something moving or floating freely within the joint
- Painful crepitation, or a crackling sound, with movement
Treatment
Treatment depends on the size, location, severity of the OCD lesion, and the age of the patient.
If the patient is young and the OCD lesion appears stable, conservative treatment often is the first choice. This generally includes decreased weight bearing and activity modification to allow the underlying bone time to heal.
After a period of rest, referral to a physical therapist or athletic trainer often is recommended to gradually load the bone and restore strength and range of motion before returning to activities. Restriction of activities, particularly sports, may be required for more than six months in some cases.
Surgery usually is recommended for:
- Persistent swelling, pain, or functional limitations despite conservative treatment
- Larger or more mature lesions
- Loose fragments within the joint
- Symptomatic cartilage injury identified on MRI
Some OCD lesions can be repaired while others cannot, depending on factors such as the size, location, and age of the lesion.
Dr. Chudik evaluates and treats OCD lesions through small arthroscopic incisions using specialized instruments of his own design. Lesions that cannot be repaired may be removed, and the remaining defect can be smoothed of rough or loose edges and stimulated to fill with reparative tissue.
Other OCD lesions may be repaired in different ways depending on the location and size of the lesion.
Nonsteroidal anti-inflammatory medications such as aspirin and ibuprofen, or minor pain relievers such as acetaminophen, are often recommended as directed by a physician. Stronger pain medication may be prescribed following surgery when necessary.
Recovery and Outcomes
Small, stable OCD lesions may not cause problems or symptoms.
Larger, more mature, or loose OCD fragments can be more difficult to heal and typically cause swelling, pain, and functional limitations. These injuries may compromise the joint surface and lead to symptomatic arthritis over time.
Appropriate treatment can improve swelling, pain, and functional limitations, help maintain the joint surface, and allow a return to activity.
With conservative treatment, restriction of activities, particularly sports, may be required for more than six months in some cases.
Potential complications may include persistent pain and swelling, progression to arthritis, loose bodies that cause locking, and incomplete or failed healing of the OCD fragment.
When to See Dr. Chudik
Contact Dr. Chudik’s office if symptoms worsen or if knee pain, swelling, giving way, locking, catching, or other symptoms persist.
Call 630-324-0402, request an appointment online, or email contactus@chudikmd.com.