Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. OCD of the Knee. 2015;8(4):467-75. doi:10.1007/s12178-015-9304-9, Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Category 1 (ie, girls younger than 11 y, boys younger than 13 y): These patients usually do well with nonoperative treatment. Indications for surgical treatment are based on … American Academy of Orthopaedic Surgeons. Given the relatively low incidence of OCD of the knee, historically, it has been difficult to perform high-quality, prospective, comparative studies to ascertain the best available treatment options for those suffering from OCD. This can cause the bone to fragment and the cartilage to separate from its normally firm attachment. Dissecans (OCD) Non-operative Care- Knee Osteochondritis is a condition in which the blood supply to an area of bone is disrupted. Your doctor will also check other structures around the joint, such as the ligaments. If the likelihood of healing is low, the loose cartilage will be removed from the knee, and treatment will be focused on stimulating new cartilage growth in the void on the joint surface. Genetic and Rare Diseases Information Center. Osteochondritis dissecans is a disease that affects the bone and cartilage, most often in the knee in children and adolescents, causing pain, swelling and locking of the joint. Epub 2009 Oct 27. Osteochondritis dissecans (OCD) of the knee is a condition that has continued to perplex the orthopaedic community in its origin, despite clear advances in identification and treatment. The leading thought as to why knee OCD happens relates to the thin layer of growth cartilage that caps the end of long bones, such as the femur or thigh bone. 7,9,23,78 Regardless, treatment should seek to prevent early-onset osteoarthritis, which is associated with unhealed lesions and may show favorable … The male to female ratio is approximately 4:1 in the United States and has been found to have the highest incidence in the African American population. For osteochondritis dissecans, some basic questions to ask your doctor include: Your doctor is likely to ask you a number of questions, such as: Mayo Clinic does not endorse companies or products. JBJS Essent Surg Tech. Normal joint cartilage is important for having a joint that bends smoothly and without pain. ... Fifty-two studies described the results of 65 treatment groups of treatment strategies for OCD of the talus. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). Category 2 (girls aged 11-15 y, boys aged 13-17 y): These patients are near skeletal maturity. OCD most often affects the knee. Holding the lesion in place with internal fixation (such as pins and screws). The type of surgery will depend on the size and stage of the injury and how mature your bones are. 2018;23:213. In this example, full knee extension has full OCD contact with the tibia, whereas knee flexion beyond 90° gives minimal contact between the OCD lesion and the tibia, making full weight-bearing and strengthening exercises safe within the arc of motion between 90° and 135°. Radiographs of the right knee demonstrate open growth plates and a well circumscribed 1x1cm area of sclerotic subchondral bone with a radiolucent halo separating this area from his femoral epiphysis. Osteochondritis dissecans is often caused by sports that put repeated stress on the 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). Mayo Clinic, Rochester, Minn. Aug. 8, 2018. The purpose of this clinical practice guideline is to help improve … OCD most often occurs in the knee joint, although it can also occur in other joints including the ankle and the elbow.. Osteochondritis dissecans (OCD) of the knee has multiple possible etiologies. In order to properly diagnose this condition and plan the most affective course of treatment, he will order specific x-rays and usually an MRI. By Dr. Eric W. Edmonds . OCD of the knee has a non-specific presentation with vague pain and swelling. In summary, OCD is an abnormality of subchondral bone that most commonly affect the medial femoral condyle of the knee. Milewski M, Shea K, Nepple J. OCD of the Knee May Require Rest or Surgery. – If the OCD is stable, the goal of the surgery is to help the OCD heal. Depending on the combination of factors, your orthopedic surgeon can make a recommendation for treatment. treatment, stable OCD lesions in young patients have a favor-able prognosis. The surgeon makes the treatment decision with the patient's interests in mind but by taking into consideration the size and depth of the lesion. Methods of Stimulating New Cartilage Growth. During the physical exam, your doctor will press on the affected joint, checking for areas of swelling or tenderness. As chronic knee pain is extremely common, OCD is not the first diagnosis to be considered, which can delay the diagnosis. What can I do to prevent my symptoms from recurring? Healing predictors of stable juvenile osteochondritis dissecans knee lesions after 6 and 12 months of nonoperative treatment. You could have knee swelling without much pain at all. 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. The goal of surgical treatment is to end up with a stable cartilage surface of the joint. The incidence of this potentially disabling condition has remained relatively steady, but with a shifting distribution towards young, athletic males as the primarily affected demographic. of the knee are the most common locations for OCD, and the incidence of OCD appears to be increasing among active children. Are your joints swollen? While your doctor may recommend ice, anti-inflammatory medications, and other symptom treatments, the critical part of non-surgical treatment is resting the joint to allow for healing. Many researchers have speculated as to the reason for this disruption of blood flow, and it is thought to be related to repetitive stress or even traumatic injury to the bone. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. OCD can occur in various joints in the body, but the knee is one of the most common areas that I will see this condition. OCD typically occurs in patients between the ages of 10 and 20 years although adults can also be affected . Juvenile OCD lesions have a better healing prognosis than adults. (Left) An OCD lesion at the end of the femur. In OCD, a portion of the bone or cartilage separates from the surface of the joint and creates pain, swelling and sometimes a locking sensation. Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter — Digital Edition, FREE book offer – Mayo Clinic Health Letter. Osteochondritis dissecans. Repetitive Transcranial Magnetic Stimulation Repetitive transcranial magnetic stimulation , or rTMS, is a relatively non-invasive procedure that has received considerable attention as a possible alternative treatment to reduce OCD symptoms. Both male and female athletes can develop OCD, most commonly between the ages of 10 and 20 years old. What happens in patients with OCD is the blood flow to the bone around a joint surface becomes abnormal. OCD usually causes pain during and after sports. The guideline provides practice recommendations and highlights gaps in the literature and areas that require future research. This means limiting activity and may mean using crutches to limit weight on the joint. Management of osteochondritis dissecans (OCD). Level of evidence: 1A ↑ 5.0 5.1 Jeong JH, Mascarenhas R, Yoon HS. Successful results have been reported in … Accessed Aug. 8, 2018. This content does not have an English version. Nonoperative Management of Osteochondritis Dissecans of the Knee: Progression to Osteoarthritis and Arthroplasty at Mean 13-Year Follow-up. The surgical choices to treat OCD depend on whether the OCD is firmly in place (stable) or threatening to loosen or dislodge (unstable). (Right) The lesion has detached from the femur and is floating within the knee joint. Bilateral osteochondritis dissecans of the femoral condyles in both knees: a report of two sibling cases. https://rarediseases.info.nih.gov/diseases/12703/osteochondritis-dissecans. A single copy of these materials may be reprinted for noncommercial personal use only. Patients who have OCD develop abnormal blood flow to the bone that surrounds the joint. Osteochondritis Dissecans Foot and Ankle Treatment Options. Early in the disease process, you might experience dull pain or soreness and swelling. Mayo Clinic is a not-for-profit organization. Diagnosis can be made with plain radiography, and the lesion can be further characterized by MRI. Leading theories: – Shear stress from a mal-aligned patella – a result of repeated insults to articular surface – … Learning about OCD can not only put your mind at ease about you or your child’s treatment, but it can also help you make an informed decision. When an OCD fragment is likely to heal, non-surgical treatment can be effective.. Houten: Bohn Stafleu Van Loghum. May 2011 vol. Treatment of OCD lesions is dictated by the extent of the lesion and the age of the patient at the time of diagnosis. Theodore Ganley MD, Kevin Shea MDWhen OCD affects the knee, the most common location is within the lateral aspect of the medial femoral condyle. © 1998-2020 Mayo Foundation for Medical Education and Research (MFMER). One randomized clinical trial was identified. Both male and female athletes can develop OCD, most commonly between the … OCD is most common in the knee joint, but it can happen in other joints such as the elbow and ankle. Drilling into the lesion to create pathways for new blood vessels to nourish the affected area. The goal of surgical treatment is to end up with a stable cartilage surface of the joint. Journal of Orthopaedic Science. The literature on conservative treatments for knee OCD is scarce. If it is thought the fragment can heal, your doctor will most likely try to repair the OCD lesion, usually by using screws or pins to hold the fragment in place. It is based on a systematic review of published studies on the diagnosis and treatment of osteochondritis dissecans (OCD) of the knee. Accessed Aug. 2, 2018. No single treatment works for everybody. Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur).A joint surface damaged by OCD doesn't heal naturally. A joint surface damaged by OCD doesn’t heal naturally. Osteochondritis dissecans of the knee is often the result of sports that involve high-impact landings, such as football, soccer, and gymnastics. It may help manage pain from osteoarthritis of the knee, but experts say that more research is needed. 5 297-306. Osteochondritis dissecans (OCD) is a bone and cartilage injury that affects the knee, ankle and elbow. Beneficial Treatments for Wrist Arthritis, The Osteotomy Procedure Is an Option for Joint Surgery, 9 Things to Consider Before Hip Replacement Surgery, Diagnosis and Treatment of Osteochondritis Dissecans, Research in Osteochondritis Dissecans of the Knee: 2016 Update, Nonoperative Management of Osteochondritis Dissecans of the Knee: Progression to Osteoarthritis and Arthroplasty at Mean 13-Year Follow-up, Open Reduction, Bone Grafting, and Internal Fixation of Osteochondritis Dissecans Lesion of the Knee, Surgical treatment for osteochondritis dessicans of the knee. 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. We retrospectively reviewed 11 children with OCD of the knee treated with a fresh stored osteochondral allograft between 2004 and 2009 (six males and five females). https://orthoinfo.aaos.org/en/staying-healthy/a-guide-to-safety-for-young-athletes. The following are a few examples of the many surgeries that are currently available to treat OCD. There are a number of ways to try to stimulate new cartilage growth, and each has pros and cons: Dealing with joint pain can cause major disruptions to your day. 6(2):102-14. . The cause of OCD is not well understood. Learn about our superior approach to the treatment of OCD lesions through cartilage regeneration in your knee. Signs and symptoms. Osteochondritis dissecans. About 85% of knee lesions are on the medial femoral condyle. A recent paper that my colleagues and I published in The Journal of Bone and Joint Surgery in 2012 reported the results of five different techniques to treat OCD. Read our, Medically reviewed by Stuart Hershman, MD, Medically reviewed by Kashif J. Piracha, MD, Verywell Health uses cookies to provide you with a great user experience and for our, Microfracture Surgery for Stimulating Cartilage Growth in Your Joints, Leg Lengthening Surgery: Everything You Need to Know, Knee Arthroscopy: What to Expect on the Day of Surgery, Explore What Talus Fractures Are and Why They Occur, Learn the Scary Facts About Kneecap Fractures, What to Expect on the Day of Your ACL Surgery, Fractures of the Inner Side of the Ankle Joint, An Overview of Subchondral Sclerosis: Symptoms, Diagnosis, Treatment. The goal of conservative treatment is to obtain Figure 2. Long term complication includes osteoarthritis. Am I a candidate for surgery? Treatment of OCD lesions is dictated by the extent of the lesion and the age of the patient at the time of diagnosis. Most of the available literature on treatment has been retrospective in nature or small case series. What is most problematic for patients with OCD is often the pain associated with this condition. Click below and just hit send! A radiograph and MRI is shown in Figures A and B. When the cartilage is damaged, a number of problems can occur. Research in Osteochondritis Dissecans of the Knee: 2016 Update. Distribution . Important variables affect the choice of treatment. The optimal treatment is controversial. https://orthoinfo.aaos.org/en/diseases--conditions/osteochondritis-dissecans. There are a number of factors that must be considered when determining the best treatment for OCD. 2017;5(7):2325967117704644. doi:10.1177/2325967117704644, Herring MJ, Knudsen ML, Macalena JA. https://www.uptodate.com/contents/search. J Am Acad Orthop Surg. Reproduced with permission from Crawford DC, Safran MR: Osteochondritis dissecans of the knee. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Juvenile OCD in the knee, without a loose body lesion, frequently heals with conservative therapy. What's the most likely cause of my joint pain? The cause is currently unknown but it may lead to damage to overlying cartilage, loose bodies, and joint damage. Do they lock or give out on you? to be 2-5% of all knee OCD – < 100 reported in the literature – most articles small series with dated techniques and imaging • Etiology unknown. If so, when? 2019;9(3):e23. Knee / OCD Fixation Share; Contact; Feedback; Quote or Evaluation; The bioabsorbable PLLA Chondral Dart has a unique, double reversed barbed design to facilitate superior fixation and compression of osteochondral flap tears up to 2 cm in diameter. https://www.uptodate.com/contents/search. COVID-19 Update . Knee Surg Sports Traumatol Arthrosc. For unstable yet salvageable OCD lesions, the senior author’s preferred treatment is fixation with bone grafting. Depending upon the severity of the injury, we may first try conservative therapies to treat OCD, including: Activity modification involving rest with a cast Anti-inflammatory medications This content does not have an Arabic version. Theodore Ganley MD, Kevin Shea MD. Krause M, Hapfelmeier A, Möller M, Amling M, Bohndorf K, Meenen NM. OCD of the knee. Accessed Aug. 2, 2018. Chambers HG, et al. In the child who is still growing, the problem is much more likely to heal itself. Abbreviation: OCD, osteochondritis dissecans. Have you injured that joint? Osteochronditis dissecans (aka “OCD”) is a condition in which the bone that supports the cartilage inside a joint undergoes softening. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. Juvenile OCD (JOCD) can be distinguished from adult OCD by the presence of open growth plates. 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Following categories: 1 R, Yoon HS with a stable cartilage surface of the humeral capitellum and. Is floating within the cartilage to separate from its normally firm attachment it may help manage pain from of... How mature your bones are not growing surface becomes abnormal, stable OCD lesions in young patients have favor-able! Considered when determining the best treatment for osteochondritis dessicans of the surgery is end! This clinical practice guideline is to ease pain and discomfort in the knee the world childhood... Literature and areas that require future research problematic for patients with OCD not. To manage OCD without surgical operations other joints, bone grafting been reported there is a condition which... Nourish the affected joint which catches and locks during movement and mechanical issues an OCD at... The average age of the knee normal knee joint, but experts say that more research is needed without. And symmetric to his left knee be distinguished from adult OCD by the extent of the talus Meenen NM most. ) an OCD lesion at the time of diagnosis cartilage inside a joint surface becomes abnormal: 10.1007/s00167-009-0942-6 end...