Osteochondritis Dissecans

Osteochondritis Dissecans

 

Osteochondritis Dissecans (OCD) is a relatively rare dysfunction with 15-30 cases per 100,000 people.  It is the most common cause of a loose body in the knee joint space.  It is most commonly found in young adolescent adults ages between 10-20 years old.  Boys have been shown to be 3-4x more likely to have OCD then girls. Limited ROM is the most notable clinical sign.  There are two types of OCD:

Adult form: occurs after the physis closes
Juvenile form: occurs in patients with open epiphyseal plate
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OCD occurs when subchondral bone becomes necrotic.  The cartilage may stay intact to varying degrees.  As the bone becomes necrotic, the cartilage loses its support structure and subsequently the cartilage and bone may become a loose body in the joint space. Pathophysiology of OCD is relatively unknown. Overall, it is believed to be multifactual in nature as genetic predisposition may play a role along with ischemia, repetitive trauma. 

OCD is typically initially diagnosed with radiographs.  Patient present between the age of 12-20 years and are usually active.  Symptoms include vague knee pain with subtle loss in ROM and complaints of catching or knee giving way. 

 

OCD is categorized into stages by an MRI:

Stage I and II are stable and treated with conservative treatment.
Stages III and IV are unstable loose body and will require knee arthroscopy.

Conservative treatment consists of activity medication, gentle stretching/ROM exercises.  Quadricep strengthening and conditioning should be performed.  Splinting or immobilization may be necessary, although not for long periods of time.  Unfortunately, no prospective randomized clinical studies have been formed at this time to evaluate treatment measures.