JK is a 14 year-old male who complains of right knee pain while playing soccer. His knee has hurt on and off for the past six months. He cannot recall any injury. His parents and coaches have noted that he limps toward the end of the game. He has not had any popping, giving out or swelling.
JK presents to our office. On physical exam, his knee is nontender and stable. X-rays show an irregularity on his femur [thighbone] that appears to be osteochondritis dissecans.
What is osteochondritis dissecans [OCD]?
OCD is a disorder of cartilage and bone that occurs in the joints of children and young adults. Cartilage is the slippery surface that allows joints to move smoothly. Cartilage is not a strong material for weightbearing. Therefore, it is very dependent on the bone underneath for support. In OCD, the bone that supports the cartilage softens and the cartilage loses its support. Over time, the unsupported cartilage can crack and even break off, leaving a defect in the joint surface.
Is OCD common?
Knee pain is very common in children and adolescents. Most knee pain is treated with exercises and stretching. Also, most knee pain is not related to cartilage damage in the knee. OCD, however, is a much less common cause of knee pain.
What causes OCD?
No one knows for sure, but OCD seems to be related to repetitive trauma, such as frequent running and jumping.
What are the symptoms of OCD?
Most patients with OCD have knee pain with strenuous activities. Often, patients have no pain at rest or lighter activities. Many parents will notice a limp that may not hurt. In later stages, patients can have swelling, clicking and popping of the affected joint.
How are trigger thumbs diagnosed?
In general, plain x-rays will make the diagnosis and should be the first imaging study performed. Treatment is based on the condition of the cartilage, which can be seen with an MRI.
How is OCD treated?
Treatments range from bracing or casting, in younger patients with stable lesions, to surgical treatments such as drilling to stimulate healing. In very bad OCD’s, which cannot be fixed, cartilage transplantation is an option.
What is the long-term outlook for my child?
If the OCD is treated early and heals, the long-term outlook is excellent. However, more severe cases that require more complicated treatment have a more guarded outlook.
JK was diagnosed with a stable OCD. He underwent our casting and bracing program. Unfortunately, after 4 months the OCD did not heal. He then underwent a simple, minimally invasive, arthroscopic drilling procedure to stimulate healing. Within 6 weeks, his OCD was no longer visible on the x-ray and his knee was pain free.
Dr. Polousky has a strong interest in cartilage disease in children and adolescents. He is a nationally recognized expert on cartilage disease in young people. He is an active member in the Research in Osteochondritis Dissecans Of the Knee [ROCK] Study group. Other member institutions include: The Children’s Hospitals of Boston, Philadelphia, and Cincinnati among others. The ROCK group is now starting a registry to study OCD over the next 20 years in order to find the most effective treatments for the disease.