What is Osteochondritis Dissecans (OCD):

OCD is a condition which occurs when an area of bone and adjacent cartilage in a joint become damaged, weak and loose.  In some cases, a piece of this damaged bone and/or cartilage may break off and float freely in the joint, impeding normal joint function. OCD can occur in a number of different joints, but is most common in the knee, elbow and ankle.

The precise cause of OCD is unknown, though various theories exist to explain it. OCD tends to occur in adolescents and young adults, and is more prevalent in males than in females.

Symptoms of OCD:

The most common symptom of OCD is pain in the joint, which may become worse following physical activity, and often gets progressively worse over time. Swelling, catching, and locking in the joint are also associated with OCD. Many people also experience a loss of range of motion and may feel the sensation of a loose body in the joint. The symptoms depend largely on the size and characteristics of the lesion. The pain and other symptoms may begin acutely following an injury, or may begin slowly and progress over time.

How is OCD diagnosed:

In order to diagnose OCD, the doctor will take a history of your physical activity background, any specific injuries sustained, and all joint symptoms and pain. The doctor will also examine your joint to determine what movements cause pain, where the pain is located, and to evaluate any loss of range of motion. This will allow the doctor to determine whether your symptoms fit the picture of OCD.

Imaging such as x-rays and MRIs are also used in the diagnosis of OCD by allowing damage to the bone and cartilage to be visualized, as well as the presence of any loose bodies within the knee. Both of these techniques provide valuable information in the diagnosis of OCD.

Treatment of OCD:

In many cases, before a surgical route is undertaken, a more conservative management path will be attempted. This could involve any of the following: rest, activity modification, bracing, immobilization, protected weight bearing, and physiotherapy and exercises to increase joint strength and range of motion. The goal is to promote the healing of the bone and cartilage and to regain normal function of the joint. Non-surgical treatment is often very successful in young patients whose bones haven’t achieved full maturity, and in those patients with small, non-detached lesions.

If symptoms persist, or in older patients with large or detached lesions, surgery may be considered. The goals of surgery are to eliminate symptoms, to prevent further damage to the bone and cartilage, and to allow the individual to return to their desired level of physical activity. The details of the particular procedure performed depend on the location, size and characteristics of the lesion, and range from minimally invasive arthroscopic surgeries, to more complex open surgeries including the possibility of bone grafting. In general, surgery is undertaken to reattach or remove a loose piece of bone or cartilage, to promote cartilage growth and bone healing, and/or to promote revascularization of the area.

Recovery and outcome:

Recovery and outcome following surgery for OCD will differ from patient to patient, and depend largely on the size and location of the lesion, and the individual’s pre- and post-surgery levels of physical activity. Recovery after surgery takes months of hard work to rehabilitate the joint in order to achieve a full range of motion and adequate strength for physical activity. It may take up to 1 year of recovery and rehab prior to returning to high intensity physical activity. Recovery should be a steady improvement in the long-run, however, there will be bumps along the way.

Following surgery, the goal is to end up with a joint that feels strong, with reduced pain, an increased range of motion, and which allows you to be physically active. Although this goal is achieved in most patients, some will find that though their joint is improved, some symptoms persist and they are unable to return to all forms of physical activity following surgery.