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.


It is unknown exactly what disrupts the blood supply and the resulting OCD. Doctors think it probably involves repetitive trauma or stresses to the bone over time.

The reduced blood flow to the end of the affected bone might result from repetitive trauma — small, multiple episodes of minor, unrecognised injury that damage the bone. There might be a genetic component making some people more inclined to develop the disorder.

Risk factors

Osteochondritis dissecans occurs most commonly in children and adolescents between the ages of 10 and 20 who are highly active in sports.


Depending on the joint that’s affected, signs and symptoms of osteochondritis dissecans might include:

  • Pain. This most common symptom of osteochondritis dissecans might be triggered by physical activity — walking upstairs, climbing a hill or playing sports.
  • Swelling and tenderness. The skin around your joint might be swollen and tender.
  • Joint popping or locking. Your joint might pop or stick in one position if a loose fragment gets caught between bones during movement.
  • Joint weakness. You might feel your joint is “giving way” or weakening.
  • Decreased range of motion. You might be unable to straighten the affected limb completely.

Doctor Examination

After discussing your child’s symptoms and medical history, Prof Imam will examine the affected joint.

During the physical exam, Prof Imam will press on the affected elbow, checking for areas of swelling or tenderness. In some cases, we might be able to feel a loose fragment inside the joint. Prof Imam will also check other structures around the joint, such as the ligaments.

Prof Imam will also ask you to move your joint in different directions to see whether it can move smoothly through its normal range of motion.

Other tests which may help your doctor confirm a diagnosis include:

  • 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.


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.


Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint, relieve pain, and reduce the risk of osteoarthritis.

No single treatment works for everybody. In children whose bones are still growing, the bone defect may heal with a period of rest and protection.


Observation and Activity Changes

In most cases, OCD lesions in children and young teens will heal on their own, especially when the body still has a great deal of growing to do. Resting and avoiding vigorous sports until symptoms resolve will often relieve pain and swelling.

Initially, Prof Imam or a team member will likely recommend conservative measures, which might include:

  • Resting your joint. If your knee is affected, avoid activities that stress your joints, such as jumping and running. You might need to use crutches for a time, especially if pain causes you to limp. Inital treatment for OCD of the elbow would be stopping sports for some time. Your doctor might also suggest wearing a splint, cast or brace to immobilise the joint for a few weeks.
  • Physiotherapy. This therapy often includes stretching, range-of-motion exercises and strengthening exercises for the muscles that support the involved joint. Physical therapy is commonly recommended after surgery, as well.


If you have a loose fragment in your joint, if the affected area is still present after your bones have stopped growing, or if conservative treatments don’t help after four to six months, you might need surgery. The type of surgery will depend on the size and stage of the injury and how mature your bones are.

Your doctor may recommend surgery if:

  • Nonsurgical treatment fails to relieve pain and swelling
  • The lesion is separated or detached from the surrounding bone and cartilage, moving around within the joint
  • The lesion is very large (greater than 1 centimeter in diameter), especially in older teens

Different surgical techniques for treating OCD depend upon the individual case.

  • Drilling into the lesion to create pathways for new blood vessels to nourish the affected area. This will encourage healing of the surrounding bone.
  • Holding the lesion in place with internal fixation (such as pins and screws).
  • Replacing the damaged area with a new piece of bone and cartilage (called a graft). This can help regenerate healthy bone and cartilage in the area damaged by OCD.

Preparing for your appointment

You might first consult with your GP, who might refer you to Prof Imam.

What you can do

  • Write down your symptoms and when they began.
  • List key medical information, including other conditions you have and the names of medications, vitamins or supplements you take.
  • Note recent accidents or injuries that might have damaged your back.
  • Take a family member or friend along, if possible. Someone who accompanies you can help you remember what your doctor tells you.
  • Write down questions to ask your doctor to make the most of your appointment time.

Loose Bodies

During repetitive overhead and lifting sports and occupations, the elbow experiences tremendous stress. This may lead to the formation of small loose fragments of cartilage or bone (loose bodies) or elbow joint spurs. This is more common in heavy manual workers and weightlifting athletes.
The loose bodies can cause pain, clicking or locking of your elbow. Your elbow may get ‘stuck’ and then click free (unlock). This is often painful. Sometimes you may feel something moving around inside your elbow joint and be aware of the loose body.
If stiffness and early morning discomfort is associated with this, then arthritis might be present. 

Painkillers and physiotherapy are often helpful, but if the symptoms are severe and debilitating, removal of the loose bodies by arthroscopy or open surgery is indicated. Arthroscopic removal is becoming the treatment of choice nowadays.

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