When Your Child Has Osteochondritis Dissecans

Your child has been diagnosed with osteochondritis dissecans (OCD). This is when a small piece of bone and cartilage in a part of a joint separates from the bone around it. OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. The condition can be mild, moderate, or severe.

When a child has OCD, bone and cartilage break loose from the knee joint.

• Mild OCD. A piece of bone has begun to separate from the joint, but this piece is still firmly held in place by a covering of cartilage (dense elastic tissue that helps cushion the joint).

• Moderate OCD. The piece of bone separates more. The covering of cartilage may tear.

• Severe OCD. The piece of bone and covering of cartilage become loose and “float around” in the joint.

Your child may see an orthopedist. This is a doctor who treats bone and joint problems. They will evaluate and treat your child's joint.

What are the causes of osteochondritis dissecans?

Experts don't know exactly why some children develop OCD. But the most commonly accepted cause is repetitive microtrauma. They do know these things:

• The separation of bone from the joint may be due to loss of blood supply to that piece of bone (avascular necrosis).

• Overuse of the joint and repeated stress (from jumping or running, for example) make a child more likely to develop OCD.

• Children who are athletes develop OCD more often than nonathletes.

• OCD is most common in boys between the ages of  10 to 16. .

• OCD may run in families.

• It can occur from childhood through adult life. Most patients are ages 10 to 20 years.

What are the signs and symptoms of osteochondritis dissecans?

Common signs and symptoms of OCD include:

• Joint soreness.

• Joint swelling that can sometimes come and go.

• Pain when the joint is used. But children sometimes have trouble identifying where the pain is.

• Stiffness of the joint when it’s not being used.

• Feeling that the joint is “locking up” or “catching.”

• Limping (if the knee or ankle is affected).

How is osteochondritis dissecans diagnosed?

The health care provider will ask about your child’s health history and symptoms. If they think your child has OCD, an X-ray will be done. In some cases, a test called an MRI (magnetic resonance imaging) may also be done. During this test, strong magnets and radio waves are used to create a picture of the inside of the joint.

How is osteochondritis dissecans treated?

The goal of treatment for OCD is to heal the joint. The separated piece of bone and cartilage need to heal back onto the joint. This healing takes time, often up to  6 months. During this time:

• Relieve symptoms to help make your child more comfortable. To do this:

  • Ice the joint as needed for pain. This should be done for no more than  15 minutes at a time. Use an ice pack or bag of frozen peas wrapped in a thin towel. Never place ice directly on your child's skin.

  • If told to by your child’s health care provider, have your child take NSAIDs (nonsteroidal anti-inflammatory drugs). NSAIDs include ibuprofen and naproxen. Give these medicines to your child only as directed.

• Have your child rest the joint to allow it to heal. To do this:

  • Have your child stop any activity that causes pain. Don't let them run or jump.

  • If prescribed by your child's provider, have your child use crutches to reduce stress on the knee or ankle joint.

  • Have your child wear a brace or cast on the joint, if prescribed. A brace or cast keeps the joint still to help with healing.

  • If prescribed for your child by the provider, go to physical therapy to improve strength, mobility, and flexibility.

In severe cases, the provider may advise surgery. During surgery, a pin may be put into the loose piece of bone to secure it to the rest of the joint. Or, the loose piece of bone may be removed. After surgery, your child will use crutches for 1 to 3 months to allow the joint to heal.

What are long-term concerns?

With treatment, OCD often heals well. If the lesion doesn’t heal, your child may develop joint pain that doesn’t go away. An adult who had OCD as a child may be more likely to develop arthritis. Your child’s health care provider can tell you more about this.