Osteochondritis dissecans

Osteochondritis dissecans (OCD) occurs 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.

• 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.

Causes

It is not entirely known why some children develop OCD. What is known:

• The separation of bone from the joint may be due to loss of blood supply to that piece of bone
• Overuse of the joint and repeated stress (from jumping or running, for example) make a child more likely to develop OCD
• The most common patient with OCD is a boy between the ages of 10-16.

Signs and symptoms

Common signs and symptoms of OCD include:

• Soreness of the joint
• Swelling of the joint
• Pain when the joint is used
• 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)

Diagnosis

The doctor will ask about your child's health history and symptoms. If OCD is suspected, an X-ray will be done. In some cases, a test called an MRI may also be done. During this test, strong magnets and radio waves are used to create a picture of the inside of the joint.

Treatment

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 six months. During this time:

• Relieve symptoms to help make your child more comfortable
  • 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 doctor, have your child take NSAIDs (nonsteroidal anti-inflammatory drugs). NSAIDs include ibuprofen and naproxen. Give these medications to your child only as directed.
• Have the child rest the joint to allow it to heal
  • Have your child stop any activity that causes pain. Avoid running and jumping.
  • If prescribed by the doctor, have your child use crutches to lessen stress on the knee or ankle joint.
  • If prescribed by the doctor, have your child wear a brace or cast on the joint. A brace or cast keeps the joint still to help with healing.
• The doctor may recommend surgery In moderate to severe cases

Long-term concerns

With treatment, OCD often heals well. If the lesion doesn't heal, the 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 doctor can tell you more about this.