Osteochondritis dissecans and loose bodies

Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.

Osteochondritis dissecans of the Elbow (OCD) is the fragmentation and separation of a portion of the cartilage of the joint. This usually presents during adolescence. Symptoms are pain aggravated by motion, limited motion, clicking, and swelling.

Osteochondritis dissecans occurs most often in children and adolescents. It can cause symptoms either after an injury to a joint or after several months of activity, especially high-impact activity such as jumping and running, that affect the joint. The condition occurs most commonly in the knee and occurs in elbows, ankles and other joints.

It may be caused by injury, but not always. A history of significant trauma can be elicited in approximately 50% of patients. Males are more commonly affected with a ratio of 3:1. The osteochondral fragment may remain in situ, or be slightly displaced or become loose within the joint cavity. If the fragment remains attached to the underlying bone, healing can occur. If completely detached, complete healing does not occur. The loose cartilage body may increase in size and cause locking and clicking of the joint. In some cases, the fragment may become absorbed. Treatment of this lesion depends on the status of the fragment.

Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen.

The most common joints affected by osteochondritis dissecans are the knee, ankle and elbow, although it can also occur in other joints. The condition typically affects just one joint, however, some children can develop OCD in several joints.

In many cases of OCD in children, the affected bone and cartilage heal on their own, especially if a child is still growing. In grown children and young adults, OCD can have more severe effects. The OCD lesions have a greater chance of separating from the surrounding bone and cartilage and can even detach and float around inside the joint. In these cases, surgery may be necessary.

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. If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. For young children whose bones are still developing, the injury might heal by itself.

• X-rays. These imaging tests provide detailed pictures of dense structures, like bone. An x-ray of the affected joint is essential for an initial OCD diagnosis, and to evaluate the size and location of the OCD lesion.
• Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, an MRI can provide detailed images of both hard and soft tissues, including the bone and cartilage. If X-rays appear normal, but you still have symptoms, your doctor might order an MRI.
• Computerised tomography (CT) scan. This technique combines X-ray images taken from different angles to produce cross-sectional images of internal structures. CT scans allow your doctor to see bone in great detail, which can help pinpoint the location of loose fragments within the joint.

Prevention

Adolescents participating in organised sports might benefit from education on the risks to their joints associated with overuse. Learning the proper mechanics and techniques of their sport, using the proper protective gear, and participating in strength training and stability training exercises can help reduce the chance of injury.