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Knee

Osteochondritis Dissecans

Osteochondritis dissecans (OCD) is a joint condition in which a segment of bone and the overlying cartilage becomes damaged and may separate from the surrounding tissue. This condition occurs most commonly in the knee, but can also affect the elbow, ankle, or other joints.

OCD often affects children and adolescents who are active in sports, though adults can also be affected. The condition can range from a stable lesion that heals with rest to a loose fragment that causes pain, swelling, and mechanical symptoms like catching or locking.

Treatment depends on the age of the patient, severity of the lesion, and whether the bone and cartilage have detached. Many cases can be treated nonoperatively, but surgical intervention may be needed in unstable or persistent cases.

The joint surface is composed of two key parts:

  • Articular cartilage: A smooth, white tissue covering the ends of bones to allow painless joint motion.
  • Subchondral bone: The layer of bone just beneath the cartilage that supports the joint surface.

In OCD, a small section of subchondral bone loses blood supply. Without adequate blood flow, this bone weakens and may die, leading to separation of the bone and cartilage above it. If the overlying cartilage is also affected, it may break loose, creating a loose body inside the joint.

  • Knee (especially the femoral condyles, typically the lateral aspect of the medial femoral condyle)
  • Elbow (capitellum)
  • Ankle (talus)
  • Less commonly, the shoulder or hip

The exact cause of OCD is unknown, but it likely involves a combination of factors, including:

Repetitive stress or trauma

  • Overuse injuries, particularly in athletes
  • Repetitive impact or shearing forces across the joint

Poor blood supply

  • A temporary loss of blood flow (ischemia) to the bone beneath the cartilage

Genetic predisposition

  • OCD can occur in families, suggesting a hereditary component

Growth factors

  • Occurs more frequently in children and teens during periods of rapid bone growth

Symptoms of OCD vary depending on the location and severity, but common signs include:

  • Pain during activity, particularly with weight bearing or joint motion
  • Swelling or tenderness around the affected joint
  • Locking or catching in the joint, especially if a loose fragment is present
  • Stiffness or reduced range of motion
  • Joint instability or weakness
  • In chronic or advanced cases, signs of joint degeneration or arthritis

In early stages, symptoms may be vague and intermittent, making diagnosis difficult without imaging.

Diagnosis is made through a combination of clinical exam and imaging.

History and Physical Exam

  • Review of symptoms, sports/activity history, and prior injuries
  • Joint tenderness, swelling, or limited motion may be present

X-rays

  • May show a lucent (dark) area in the subchondral bone or loose cartilage fragments
  • Useful for staging and monitoring over time

MRI (Magnetic Resonance Imaging)

  • Best tool for assessing the stability of the lesion
  • Reveals bone damage, cartilage integrity, and presence of loose fragments
  • Useful to dictate treatment based severity of the defect

CT scan

Occasionally used to define bone involvement or for surgical planning

OCD is often categorized by:

Stability:

  • Stable lesion: Cartilage remains attached and intact
  • Unstable lesion: Fragment is loose or detached

Skeletal maturity:

  • Juvenile OCD: Occurs in children with open growth plates (higher healing potential)
  • Adult OCD: Occurs after growth plates have closed (less healing potential)

Lesion stage (based on imaging):

  • Stage I: Small area of bone softening
  • Stage II: Partially detached fragment
  • Stage III: Fully detached but in place
  • Stage IV: Loose fragment within the joint

Stable OCD lesions, especially in growing children, are often successfully treated without surgery.

Indications for Nonoperative Management:

  • Lesion is stable and intact
  • Patient is skeletally immature
  • Symptoms are mild
  • No mechanical symptoms (e.g., locking or catching)

Nonoperative Options:

Activity modification

  • Avoid sports and impact activities for 3–6 months
  • Focus on low-impact activities like swimming or cycling

Unloader bracing or casting

  • Used to offload the joint and support healing
  • Common in knee OCD to reduce compressive forces

Physical therapy

  • To maintain joint mobility and strengthen surrounding muscles
  • Especially important during activity restriction

Outcomes:

  • Juvenile OCD lesions have high healing potential
  • Success rates of 50–90% for stable lesions
  • Healing may take 6–12 months, with gradual return to sports

Surgery is recommended when:

  • The lesion is unstable or has become a loose body
  • Nonoperative treatment has failed after 3–6 months
  • The patient is skeletally mature with a large or symptomatic lesion
  • There are mechanical symptoms like catching, locking, or significant joint dysfunction

Surgical Options

Arthroscopic drilling or microfracture

  • Stimulates healing by creating small holes in the subchondral bone to promote blood flow and new tissue formation
  • Effective for small, stable lesions

Fixation of the fragment

  • Uses screws, pins, or biodegradable implants to reattach a loose but salvageable fragment
  • Ideal when the fragment is large and viable

Osteochondral autograft transfer (OATS)

  • Transfers healthy cartilage and bone from a non-weightbearing area to the defect
  • Often used for larger or unsalvageable lesions

Autologous chondrocyte implantation (ACI)

  • Cultured cartilage cells are implanted into the defect to regenerate cartilage when the defect cannot be fixed
  • Considered for large lesions in adults

Removal of loose bodies

  • Loose fragments that are causing mechanical symptoms can be removed arthroscopically

Recovery and Rehabilitation

  • Weight-bearing restrictions for 6–12 weeks depending on procedure
  • Physical therapy to regain range of motion and strength
  • Return to sports typically in 4–6 months, longer for complex procedures

Nonoperative Outcomes:

  • High success in children and adolescents
  • Healing expected in 3–6 months, though some cases take longer
  • Regular follow-up is needed to monitor for worsening

Surgical Outcomes:

  • 70–90% success rate, depending on the procedure and lesion severity
  • Best outcomes in patients with early intervention and no advanced joint degeneration
  • Some patients may have long-term joint stiffness or develop early osteoarthritis, particularly with large lesions

  • Early diagnosis and treatment improve outcomes
  • Most patients return to sports and normal activities after recovery
  • Advanced or neglected cases can lead to joint damage, arthritis, and chronic pain

See a healthcare provider if you or your child experience:

  • Persistent joint pain during or after activity
  • Swelling, tenderness, or decreased joint movement
  • Clicking, catching, or locking of the joint
  • Symptoms that do not improve with rest and activity modification

Osteochondritis dissecans is a joint condition that primarily affects young athletes, involving damage to the bone and cartilage beneath a joint surface. Stable lesions often heal with rest and activity changes, especially in children. Unstable or persistent lesions may require surgery to restore joint function and prevent long-term damage. With early diagnosis and proper treatment, the majority of patients can achieve good outcomes and return to their normal activities.

At a Glance

Dr. Hasani Swindell

  • Fellowship-Trained Sports Medicine Specialist
  • Board-Certified Orthopedic Surgeon
  • Summa Cum Laude Graduate from the University of Pittsburgh
  • Medical Degree from Columbia University
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