Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.
Osteochondritis dissecans occurs most often in children and adolescents. It can cause symptoms either after an injury to a joint or after several months of activity, especially high-impact activity such as jumping and running, that affects the joint. The condition occurs most commonly in the knee, but also occurs in elbows, ankles and other joints.
Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. For young children whose bones are still developing, the injury might heal by itself.
Surgery might be necessary if the fragment comes loose and gets caught between the moving parts of your joint or if you have persistent pain.
Depending on the joint that's affected, signs and symptoms of osteochondritis dissecans might include:
If you have persistent pain or soreness in your knee, elbow or another joint, see your doctor. Other signs and symptoms that should prompt a call or visit to your doctor include joint swelling or an inability to move a joint through its full range of motion.
The cause of osteochondritis dissecans is unknown. The reduced blood flow to the end of the affected bone might result from repetitive trauma — small, multiple episodes of minor, unrecognized injury that damage the bone. There might be a genetic component, making some people more inclined to develop the disorder.
Osteochondritis dissecans occurs most commonly in children and adolescents between the ages of 10 and 20 who are highly active in sports.
Osteochondritis dissecans can increase your risk of eventually developing osteoarthritis in that joint.
Adolescents participating in organized sports might benefit from education on the risks to their joints associated with overuse. Learning the proper mechanics and techniques of their sport, using the proper protective gear, and participating in strength training and stability training exercises can help reduce the chance of injury.
During the physical exam, your doctor will press on the affected joint, checking for areas of swelling or tenderness. In some cases, you or your doctor will be able to feel a loose fragment inside your joint. Your doctor will also check other structures around the joint, such as the ligaments.
Your doctor will also ask you to move your joint in different directions to see whether the joint can move smoothly through its normal range of motion.
Your doctor might order one or more of these tests:
Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and relieve pain, as well as reduce the risk of osteoarthritis. No single treatment works for everybody. In children whose bones are still growing, the bone defect may heal with a period of rest and protection.
Initially, your doctor will likely recommend conservative measures, which might include:
If you have a loose fragment in your joint, if the affected area is still present after your bones have stopped growing, or if conservative treatments don't help after four to six months, you might need surgery. The type of surgery will depend on the size and stage of the injury and how mature your bones are.
You might first consult with your family doctor, who might refer you to a doctor who specializes in sports medicine or orthopedic surgery.
For osteochondritis dissecans, some basic questions to ask your doctor include:
Don't hesitate to ask other questions.
Your doctor is likely to ask you a number of questions, such as:
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