Osteochondritis Dissecans (OCD)

Osteochondritis Dissecans (OCD) occurs when a loose piece of bone and cartilage separates from the end of the knee or elbow. This piece may stay in place or fall into the joint space, making the joint unstable.

Children usually present with pain, which is often poorly localized and associated with activity. Swelling may be present, and particularly in a case of an unstable piece, the patient may describe mechanical symptoms such as locking or catching. If a loose body or bodies have developed, mechanical symptoms and episodic locking may predominate. Localization of symptoms depends to some extent on the location of the lesion.

While anyone may present with OCD, it occurs most often in males 10 to 20 years of age, while they are still growing. It affects athletes disproportionately, especially gymnasts and football players, and has been increasingly seen in adolescent girls as that group has become more active in team sports. While the etiology of OCD is still debated, its apparent increased prevalence in the knees of children involved in organized sports suggests repetitive impact training as a major factor.

Dr Balakumar believes that successful treatment is begun with early diagnosis. Dr Balakumar maintains that any sports-active child with unexplained knee pain should be thoroughly assessed. “If there is swelling or effusion,” he adds, “that should be a red flag.”

Another problem Dr Balakumar sees is that some physiotherapists and primary care physicians aren’t aware that in many circumstances OCD can be treated effectively. Effective treatment of OCD is treatment with an immobilized joint with bracing so the lesion could heal properly.

Today, paediatric orthopaedic surgeons have a wide range of treatment options depending on the age and relative maturity of the patient, the size and location of the lesion, whether the lesion is open or closed and whether it is mechanically unstable or involves a loose body.

Cast or brace immobilization is a viable but relatively conservative strategy, often used initially in younger patients. Active adolescents for whom prolonged immobilization and activity restriction are unacceptable and have a lower rate of success, benefit from more aggressive approaches, such as transarticular drilling, which creates channels for revascularization (new blood vessels) and healing within the articular cartilage, antegrade debridement with replacement and fixation, or retrograde grafting and stabilization. When the fragment is very unstable Dr Balakumar will apply transarticular compression screws to reconnect the articular cartilage to the bone.