As a result of lack of blood supply, osteochondritis dissecans occurs in the joint when a piece of bone and cartilage separates from the rest. This causes pain, swelling, and reduced joint movement. Although osteochondritis dissecans can affect any joint, it is most prevalent in the knee, elbow, and ankle. Children and adolescents are more likely to develop the condition, especially those who are active in sports. Depending on the severity and location of the lesion, osteochondritis dissecans can be treated conservatively or surgically. It can also be prevented by avoiding excessive stress on the joints and following a healthy lifestyle.
Causes
Osteochondritis dissecans is believed to be caused by reduced blood flow to the bone. This can result from:
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Traumatic or repetitive stress to the joint, such as from sports, injuries, or overuse
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A genetic factor, such as defects in the structure or metabolism of the bone or cartilage
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Puberty hormones, such as growth spurts or imbalances
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Inflammatory or infectious diseases, such as osteomyelitis or rheumatoid arthritis
Osteochondritis dissecans can be caused by a number of factors, including:
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Children and adolescents between the ages of 10 and 20 are more likely to suffer from this condition as their bones are still growing and developing
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The condition is more common in males than females, as males tend to be physically active and have larger bones.
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Those who participate in high-impact or repetitive sports, such as soccer, basketball, baseball, or gymnastics, are more likely to develop the condition.
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In joints with curved or irregular shapes, such as the knee, elbow, or ankle, the condition is more common
Symptoms
According to the size, location, and stage of the lesion, osteochondritis dissecans may cause the following symptoms:
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Joint pain or discomfort, especially after or during activity
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Joint swelling or inflammation, which may be red or warm
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Joint stiffness or reduced range of motion, which may limit certain movements or activities
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A popping, clicking, or locking sensation in the joint may indicate that a loose piece of bone or cartilage is interfering with the normal functioning of the joint
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Joint instability or weakness that may cause the joint to collapse or give way
Diagnosis
Based on a medical history, physical examination, and imaging tests, osteochondritis dissecans can be diagnosed. The doctor will ask about the symptoms, the onset and duration of the symptoms, the medical history, and the level of activity of the patient. In addition, the doctor will conduct a physical examination that will include:
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Checking the joint for swelling, redness, or tenderness
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Feeling for any bumps, lumps, or crepitus in the joint
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Examining the joint for pain, stiffness, or reduced range of motion
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Stability and strength testing of joints
Some imaging tests may also be ordered by the doctor, such as:
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The X-ray shows the bone structure and any abnormalities in the joint, such as fractures, dislocations, and lesions
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A magnetic resonance imaging (MRI) scan can reveal soft tissues and any damage or inflammation in bones, cartilage, ligaments, or tendons
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Cross-sectional images of the joint and any complications can be obtained from a CT scan
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In arthroscopy, a small camera and instruments are inserted through small incisions into the joint, allowing the doctor to examine and treat the joint directly
Treatment
Osteochondritis dissecans is treated based on age, health, and preferences of the patient, as well as the size, location, and stage of the lesion.
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Non-surgical conservative treatment methods include:
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Activity modification, such as avoiding or limiting the activities that cause or worsen the pain, such as running, jumping, and twisting
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To reduce swelling and pain, apply a cold pack or frozen peas to the joint for 15 to 20 minutes, several times a day, and elevate it above the heart level.
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Pain and inflammation can be relieved with medications, such as anti-inflammatory drugs, analgesics, or corticosteroids, that are available over-the-counter or by prescription
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With physical therapy, you learn specific exercises and techniques to strengthen the muscles and tendons around the joint and to improve joint mobility and stability.
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Wearing a cast or brace immobilizes or supports the joint, allowing the bones and cartilage to heal
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Treatments involving invasive methods, such as:
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Drilling or microfracturing the bone to stimulate blood flow and healing
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In fixation, bone and cartilage are secured to the underlying bone with screws, pins, or wires
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The process of debridement involves removing damaged or dead tissue from the joint
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A graft is a transplant of healthy bone and cartilage from another part of the body or from a donor
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A osteotomy involves cutting and reshaping the bone to improve joint alignment and function
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Prevention
Some measures can be taken to reduce the risk or severity of osteochondritis dissecans, such as:
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Preparing the muscles and tendons for stress and preventing injuries and strains by warming up and cooling down before and after physical activity
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Maintaining flexibility and elasticity of the muscles and tendons around the joints by stretching regularly
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Limiting the frequency, intensity, and duration of activities that involve the joint, such as running, jumping, or twisting, to prevent overuse or excessive stress on the joint
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Wearing appropriate equipment and techniques, such as shoes, pads, and helmets, and following the instructions and guidance of a coach or trainer, to prevent joint injuries
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To allow the muscles and tendons to recover and heal from fatigue and stress, take breaks and rest
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To support bone growth and cartilage health, eat a balanced diet rich in calcium and vitamin D
