Osteochondritis dissecans (OCD) in children

What are the signs and symptoms of osteochondritis dissecans (OCD) in children?

Osteochondritis dissecans is a joint injury that occurs in children and teens because of their active lifestyles — especially those who play sports.

While the exact cause of osteochondritis dissecans is unknown, physicians believe repetitive, high-impact strain or stress to the bone may be a factor. It’s commonly found in the knee, ankle and elbow, though it can affect any joint in the body.

Osteochondritis dissecans affects different children in different ways. Some children with mild cases may not experience symptoms, while others with loose bone or cartilage fragments may experience significant and persistent pain.

Signs and symptoms of osteochondritis dissecans include:

• Pain
• Swelling
• Tenderness
• Limited range of motion in the joint
• Feeling as if the joint is giving out, “popping,” “locking” or “catching”

How is osteochondritis dissecans (OCD) in children diagnosed?

If your child is experiencing joint pain, swelling and limited range of motion, our physicians will conduct a thorough diagnosis to determine if osteochondritis dissecans is the problem.

Diagnostic testing may include:

• Physical exam - Looks at your child’s injured joint, checking for any loose fragments inside
• X-ray - Uses invisible electromagnetic energy beams to take detailed images of bones inside the joint
• MRI (magnetic resonance imaging) scan - Uses magnetic fields to take detailed pictures of the bones and cartilage

After these tests, your physician will meet with you and your child to review results and discuss the best, least-invasive treatment plan.

How is osteochondritis dissecans (OCD) in children treated?

At the Children's Health Andrews Institute, we’re among the most experienced OCD care teams in our county. We use the most advanced technologies and therapies to diagnose and treat patients, so they can get back to sports and other activities.

The treatment process starts with a thorough examination of each patient’s affected joint. For patients with minor OCD, we typically help them modify their activities in ways that rest the joint so it can heal. We also use physical therapy and rehabilitation to help each patient recover and stay strong.

For patients who need more extensive treatment, we create a custom care plan based on their age and how serious their OCD is.

Treatment options include:

• Bracing - For kids who are still growing and who have a stable lesion (the damage in their cartilage isn’t getting worse), we often use a knee brace that allows their knee to move, while removing pressure from the injured area. This helps the knee heal. 
• Drilling to stimulate healing - For children who are still growing and have more severe OCD, we often do minor surgery, using a technique called “arthroscopic drilling.” Using an arthroscope (a thin tube which we put into the knee through a small incision) we create a path for blood and bone marrow to move to the knee. This improves blood flow and helps the bone heal.
• Surgery to repair the lesion - Some patients need a minimally invasive surgery to mend their knee. For these patients, we use an arthroscope to remove damaged tissue, then use a bone graft, plates or screws to repair the lesion.
• Cartilage replacement therapy - Replacing damaged cartilage may be the best option for some kids and teens with severe OCD. We’re one of a handful of hospitals in our region that offers this procedure. We use one of two methods for cartilage replacement therapy:
  • New cartilage from a donor (osteochondral allograft) - In this procedure, we’ll remove damaged cartilage and replace it with healthy cartilage from a donor. We often use this method for patients who need large areas of cartilage replaced.
  • New cartilage from the patient (matrix autologous chondrocyte implantation) - This advanced procedure allows doctors to replace damaged areas of cartilage with a patient’s own cartilage. We typically use this procedure for larger sections of cartilage that need to be replaced. To do this, doctors take a small sample of the patient’s cartilage cells and send them to a laboratory where they grow a small section of the patient’s own cartilage.
    
    Then, in a second surgery, doctors replace damaged cartilage with this new, healthy cartilage. Until recently this procedure was only available for adults and adolescents who have stopped growing — but our team is part of a clinical trial that’s working to make this procedure available for all kids. This gives some kids who come to us access to a therapy that’s only available at a handful of hospitals in the country.

Preparing for OCD Treatment

Because OCD typically affects very active kids and teens, it can be hard for them to slow down while their injury is treated and healing. It's crucial to rest and heal fully, because moving back into activities too soon can make the injury worse, and lead to long-term knee problems.

We work with patients and families to help them understand their child’s condition, and what the treatment and recovery process will look like. Minor OCD can take six to 12 months to heal, while recovering from more severe OCD usually takes about a year. We support our patients from their diagnosis through years after recovery. As they heal, we also help them slowly move back into their activities and regain their strength, while avoiding the risk of reinjuring their knee.