Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. The separated fragments are sometimes called “joint mice”. These fragments may be localized, or may detach and fall into the joint space causing pain and joint instability.
Osteochondritis dissecans can occur in any of the joints including your knees, elbows, ankles, shoulders and hips.
Osteochondritis dissecans is more common among boys and young men between 10 and 20 years who actively take part in sports. Athletes participating in sports such as gymnastics and baseball may develop osteochondritis dissecans involving the elbow.
The exact cause for osteochondritis dissecans remains unknown and certain factors such as trauma, fractures, sprains, or injury to the joint are considered to increase the risk of developing the condition. Osteochondritis dissecans may be caused by restricted blood supply to the end of the affected bone that usually occurs in conjunction with repetitive trauma. Following the injury or trauma, the bones in the area may be deprived of blood flow leading to necrosis and finally the bone fragment may break off. This may initiate the healing process however by this time, articular cartilage will be compressed, flattened, and a subchondral cyst will be developed. All these changes in addition to increased joint pressure cause failure of healing of the joint.
Patients with osteochondritis dissecans usually have joint pain, swelling, stiffness, and decreased range of motion. Pain usually increases after activity.
Dr. Mansour will probably order an X-ray of both joints to see the abnormality in the joint space and to compare them. You may also have a CT or MRI scan that is useful in determining the location of loose fragments within the joint.
Your physician may recommend various treatments depending on the reports of diagnostic scans, age, severity, stability of the cartilage and other factors. Goals of treatment are to relieve the symptoms and stop or impede the progression of degeneration of the joint. Conservative treatment approaches such as wait & watch approach, pain medications, and immobilization for 1-2 weeks are recommended if the condition is diagnosed at early stages and if the severity is mild. However surgery is required if the condition is diagnosed at advanced stage or if the condition is severe.
Surgical correction of osteochondritis dissecans can be done using by open technique or arthroscopic techniques. Some of the surgical procedures include drilling, bone grafting, open reduction internal fixation, osteochondral grafting, or autologous chondrocyte implantation (ACI).