Osteochronditis dissecans aka ocd is a condition in which the bone that supports the cartilage inside a joint undergoes softening. Osteochondritis dissecans ocd is the end result of the aseptic separation of an osteochondral fragment with the gradual fragmentation of the articular surface. Osteochondritis dissecans is an acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilage involvement and instability. Osteonecrosis on is a disease caused by ischemic death of the bony and marrow tissues jones 1994. Age distribution and localization combined with the radiologic and surgical presentation distinguishes. Osteochondritis dissecans most commonly affects children who are very active in sports.
Juvenile osteochondritis dissecans od of the talus is a rare disease, affecting subchondral bone and, secondarily, articular cartilage in a skeletal immature population, usually sited in the. Osteochondritis dissecans of the knee radiology reference article. Osteochondritis dissecans of the knee sciencedirect. Patients present with a vague, poorly localized aching pain typically of several months duration. Osteochondritis dissecans of the capitellum is similar to osteochondritis dissecans in other joints, such as the knee. Although osteochondritis dissecans occurs mostly in the knee, chapters also discuss osteochondritis dissecans in the elbow and talus. To discuss the case of a patient with osteochondritis dissecans, a common disorder primarily affecting children and adolescent patients that involves the medial femoral condyle, and to examine its radiologic appearance. If left untreated, this softening can lead to damage of the cartilage in the joint. Osteochondritis dissecans symptoms and causes mayo clinic.
Its most common in children and teens who are active in sports. Usually the person affected can remember having injured the joint. Osteochondritis dissecans of medial femoral condyleovoid fragment of bone is separated from surface of condyle but does not yet lie freely within the joint. A radiology case report journal of manipulative and physiological therapeutics, vol. Without treatment, a loosened fragment of bone and cartilage may drift into the joint, causing it to slip, pop or lock. Describing ocd together with osteochondral fractures and epiphyseal ossification disturbances and considering these three conditions as one entity has caused much confusion. Osteochondritis dissecans ocd of the knee is an acquired, reversible, idiopathic condition of the subchondral bone. It can cause symptoms either after an injury to a joint or after several months of activity, especially highimpact activity such as jumping and running, that affects the joint. The research in osteochondritis of the knee rock group developed a novel classification. Jul 30, 2015 an osteochondritis dissecans lesion in the knee is a condition that is caused by a reduction of blood flow to the end of a bone within the knee joint. This specific type of lesion was recognized, described as an entity, and named long before the disease was sufficiently well defined to permit selection. How to read an mri of an osteochondritis dissecans lesion. Osteochondritis dissecans ocd or od is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone may happen.
Treatment of osteochondritis dissecans is jointspecific. However, in the adult patient with a stable lesion, nonoperative treatment should be the first line of management. Osteochondritis dissecans ocd is a disorder of the joint that may cause progressive changes in the subchondral bone and associated articular cartilage, including softening, swelling, early separation, partial detachment, or complete osteochondral separation with a loose body. Mri can further characterize the lesions stability. Apr 28, 2017 juvenile versus adult osteochondritis dissecans of the knee. Osteochondritis dissecans is a similar disorder in which a piece of joint cartilage and of underlying bone breaks off and lodges in the joint cavity. Text and images used with permission of the holder. The incidence of surgery in osteochondritis dissecans in. A 25yearold man with knee pain sought treatment at a chiropractic clinic. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. However, affected people may experience pain, weakness andor decreased range of motion in the affected joint if the cartilage and. Osteochondritis dissecans ocd of the knee is an idiopathic, focal, subchondralbone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis.
How to read knee mri of osteochondritis dissecans lesion. Osteochondritis dissecans is an idiopathic disease which affects the. Osteochondritis dissecansocd of the elbow is a condition that occurs in children and adolescents who participate in sports that place a large amount of stress on the elbow joint. Depending on findings, the procedure will be as follows. Osteochondritis dissecans of the elbow physiopedia. Over time, if left untreated, this can lead to damage to the overlying cartilage of the joint. In this case, you can see disruption of the bone and some cysts forming near the ocd lesion. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint. Age distribution and localization combined with the radiologic and surgical presentation. Osteochondritis dissecans are typically located mainly on the femoral condyle, with reported but less common cases of patella involvement. The patient had a 2year history of left knee pain that was exacerbated. It involves localized avascular necrosis of subchondral bone and subsequent loss of structural support for the adjacent articular cartilage.
On most commonly affects the femoral head, but it can also affect other epiphyseal areas including the. This softening is caused by an interruption in the blood flow to that portion of the bone. Osteochondritis dissecans ocd most commonly affects the knee. Osteochondritis dissecans ocd is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. It is an acquired pathological condition in which the subchondral bone becomes avascular, thus destabilizing the chondral coverage. This can result in localised necrosis and fragmentation of bone and cartilage. Cartilage t2 mapping of stable medial femoral condyle lesions. It is difficult to determine the true incidence and prevalence of this disorder because many of the lesions are asymptomatic and may be found incidentally on a radiograph obtained for other purposes.
Osteochondritis dissecans ocd of the knee is a relatively common cause of pain and functional limitation among children and young adults. Diagnosis and treatment of osteochondritis dissecans case. Knee osteochondritis dissecans statpearls ncbi bookshelf. Stage 2 osteochondritis dissecans with double line sign on t2weighted images. Osteochondritis dissecans ocd is a common but poorly understood source of. See osteochondritis dissecans article for a general discussion. Unstable lesion or failure of conservative management. Osteochondritis dissecans genetic and rare diseases. The condition occurs most commonly in the knee, but also occurs in elbows, ankles and other joints. Osteochondritis dissecans osteochronditis dissecans aka ocd is a condition in which the bone that supports the cartilage inside a joint undergoes softening. Cardiac radiology genitourinary radiology learning radiology.
An osteochondral fragment may be present in situ, incompletely. Completed osteochondritis dissecans stabilization with 2 herbert screws. Osteochondritis dissecans approach bmj best practice. This softening is caused by an interruption in the blood flow to that portion of bone. Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans. The cause is currently unknown but it may lead to damage to overlying cartilage, loose bodies, and joint damage. Osteochondritis osteochondrosis dissecans ocd is a common condition in children, adolescents, and young adults. Although the symptoms of ocd can be vague, plain radiographs can make the diagnoses. After an x ray and mri osteochondritis dissecans was diagnosed a biopsy may be taken, so cartilage cells may be grown in a. Other articles where osteochondritis dissecans is discussed. Stem cell therapy stroke victims dec 22, 2014 one of the great hopes for stem cell regeneration therapy is the potential to grow healthy. Osteochondritis dissecans ocd of the knee is a somewhat rare cause of knee dysfunction and pain that has been recognized for over one hundred years, but the etiology is still poorly understood. Symptoms include pain and joint locking or catching. Pathology location the condition occurs bilaterally in 25% of cases, and has a characteristic distribution 2,4,6.
Schoolaged children and adolescents are most commonly affected. Weiss jm, nikizad h, shea kg, gyurdzhyan s, jacobs jc, cannamela pc, et al. With the vague clinical symptoms and signs of ocd, imaging plays a vital role in making the diagnosis and helping with the prognosis of ocd lesions. Osteochondritis dissecans definition of osteochondritis. Feb 07, 2018 juvenile versus adult osteochondritis dissecans of the knee. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with. Osteochondritis dissecans is a joint condition that occurs when a piece of cartilage and the thin layer of bone beneath it, separates from the end of the bone. Jun 10, 2016 osteochondritis dissecans ocd is a pathological process affecting the subchondral bone most often in the knee joint of children and adolescents with open growth plates juvenile ocd and young adults with closed growth plates adult ocd. Learn about the symptoms and treatment of this joint.
Case of the week 220 on awardwinning, noncommercial radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases. Osteochondritis dissecans located on the medial tibial. Osteochondritis dissecans ocd is a term for osteochondral fracture. Imaging of osteochondritis dissecans musculoskeletal key. The majority of adult osteochondritis dissecans lesions necessitate surgical intervention. Osteochondritis dissecans ocd of the elbow is a condition that occurs in children and adolescents who participate in sports that place a large amount of stress on the elbow joint.
The site contains over 200 powerpoint lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. Od occurs as a result of overuse or trauma, and 75% of cases affect the knee. Diagnosis and treatment of osteochondritis dissecans case study. The diagnosis may be made in childhood or adulthood. Osteochondritis dissecans od is a focal aseptic necrosis of subchondral bone in which a bonecartilage fragment detaches and becomes displaced in the joint space. Osteochondritis dissecans ocd or od is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. Noerdlinger osteochondritis dissecans ocd develops when the blood supply to an area of subchondral bone is interrupt ed.
Insights into the epiphyseal cartilage origin and subsequent. It is often associated with intraarticular loose bodies. The next sequence in how to read an mri of an osteochondritis dissecans lesion is the sagittal view. In this case report, we reported a rare case of osteochondritis dissecans located on the medial tibial plateau. Osteochondritis dissecans of the talus radiology case. Learn about the symptoms and treatment of this joint condition. The exact cause and natural history remain elusive in the literature. Osteochondritis dissecans ocd in children and adults is a relatively rare condition of the distal aspect of the femur. Without spontaneous healing, the bone and adjacent cartilage fragments separate and become loose bodies. Stone, md cpmc grand rounds 22009 stone research foundation. Osteochondritis dissecans occurs most often in children and adolescents.
Osteochondritis dissecans boston childrens hospital. Experts on osteochondritis dissecans explain the best methods for clinical evaluation and diagnosis, as well as surgical treatment options for skeletally immature and skeletally mature patients. The forces needed to cause ocd are produced primarily in athletes participating in baseball and gymnastics. The patient will usually deny mechanical symptoms including catching or locking. Osteochondritis dissecans symptoms, diagnosis and treatment. Osteochondritis dissecans ocd is a poorly characterized process that involves a fragmentation of articular cartilage andor subchondral bone resulting in focal devitalization that can result in debilitating pain, inflammation, and degeneration. Clinical guidelines for ocd osteochondritis dissecans. If this happens, the joint can get stuck, often at a 45degree angle, until its moved manually or otherwise manipulated. Osteochondritis dissecans doctors and departments mayo. Osteochondritis dissecans is a painful joint problem.
The incidence of surgery in osteochondritis dissecans in children and adolescents. Osteochondritis dissecans knee histology studies have. It results in significant pain and swelling in the affected joint, depriving it of its normal range of function. Osteochondritis dissecans is a long recognized yet poorly understood condition. Common entities include acute traumatic osteochondral injuries, subchondral insufficiency fracture, socalled spontaneous osteonecrosis of the. Juvenile versus adult osteochondritis dissecans of the knee. Chapter 82 covers osteochondritis dissecans ocd, and includes information on definition, demographics, clinical features, anatomy, imaging modalities and features, imaging algorithm, applied physics, differential diagnoses and pitfalls, and a bulleted summary of key points. Osteochondritis of left humeral head with secondary deformation of bone. Avascular necrosis is a term applied to ischemic necrosis involving the epiphyseal region, while on of the metadiaphysis is referred to as bone infarction sweet and madewell 1995. Osteochondritis dissecans childrens hospital colorado. The condition happens most often in the knees, but your child can also have. Osteochondritis dissecans doctors and departments mayo clinic.
Well demarcated defect in articular surface of joint case reports. In this view we can see the meniscus and the ocd lesion. Osteochondritis dissecans ocd and osteonecrosis are two of the many types of pathology that may. Osteochondritis dissecans ocd is a condition in which the bone that supports the cartilage of a joint softens. Ocd usually causes pain and swelling of the affected joint which catches and locks during movement. Osteochondritis dissecans is a fracturing or cracking of the articular cartilage, the material lining the end of a bone, and the subchondral bone underneath it. An osteochondritis dissecans lesion in the knee is a condition that is caused by a reduction of blood flow to the end of a bone within the knee joint. Stem cell treatment osteochondritis dissecans stem cell. Stone, md cpmc grand rounds 22009 stone research foundation 2. If the piece of cartilage and bone remain close to where they detached, they may not cause any symptoms. Ocd of the elbow is most commonly seen in the sporting adolescent population ages 1214 in particular throwing sports or upper limb dominant sports such as baseball or hockey.
Feb 24, 2012 osteochondritis dissecans is a long recognized yet poorly understood condition. Nov 04, 2015 osteochondritis dissecans ocd of the knee is a relatively common cause of pain and functional limitation among children and young adults. Osteochondritis dissecans radiology reference article. Children with osteochondritis dissecans should be seen by a doctor right away. A 26yearold han chinese woman presented with a lesion on her left medial tibial plateau. Compared with the knee, however, osteochondritis of the capitellum is much less common. Osteochondritis dissecans knowledge for medical students. Jan 31, 2014 osteochondritis osteochondrosis dissecans ocd is a common condition in children, adolescents, and young adults. Osteochondritis dissecans ocd is defined as an inflammatory pathology of bone and cartilage. The scope of this guideline is specifically limited to osteochondritis dissecans of the knee.
Red arrows point to osteochondral defect and bone edema on t1 and stir mri images of the knee in same patient as above. Osteochondritis dissecans repair musculoskeletal key. Osteochondritis dissecans knee pediatric orthopaedic. The loose piece may stay in place or fall into the joint space, making the joint unstable. Osteochondritis dissecans is a joint disorder in which a loose piece of bone and cartilage separates from the end of the bone because of a loss of blood supply.