Knee Osteochondritis Dissecans

Individuals with Knee Osteochondritis Dissecans usually present with a primary complaint of knee pain and knee dysfunction, or the condition may be discovered incidentally during x-rays for another condition. Other common symptoms include:

• Swelling and tenderness: The area around the affected joint may become swollen and tender to the touch.
• Joint popping or locking: Individuals may experience sensations of popping, locking, or giving way in the knee joint. This is due to the loose fragment interfering with joint movement.
• A sensation of the knee giving way.
• Decreased range of motion: There might be a reduction in the joint’s ability to move and function normally.

The exact cause of Osteochondritis Dissecans is not well understood, but it is believed to result from a combination of factors including:

• Lack of blood flow: Reduced blood flow to the end of the affected bone can lead to the death of bone tissue and the eventual separation of the cartilage and bone fragment.
• Genetic predisposition: There may be a genetic component that makes some individuals more susceptible to developing OCD.
• Physical activity and sports: Repetitive trauma or stress on a joint from sports or physical activity can interrupt blood flow and contribute to the development of OCD. This is particularly evident in sports that involve high-impact landings or rapid direction changes. However, it can also result from an isolated injury.
• Growth spurts: Adolescents going through periods of rapid growth may be at higher risk for OCD due to potential disturbances in bone formation.

Your UCSF Women’s Sports Medicine physician will take a thorough medical history, inquire about a history of trauma, any recent increase in activity, previous knee injury and the presence of mechanical symptoms. Studies report that about 80% of patients report pain while performing weight-bearing activities.

They will perform an orthopedic examination regarding knee alignment, muscle weakness and feel for swelling and tenderness, and test range of motion. Special orthopedic tests can reveal lesions. Plain X-rays will be ordered to locate lesions, assess growth plates and rule out other conditions. An MRI may also be ordered to aid in the diagnosis.

Treatment depends on several factors, including the age of the patient, the stage of the disease, and whether the lesion is stable. Treatment options range from non-operative measures, such as rest, activity modification, casting, NSIADS for pain and physical therapy. Conservative treatment is suitable for young patients. However, adults may require surgical intervention.

Surgery will be recommended if conservative measures are not suitable or prove to be ineffective after 3-6 months.  Surgical options may include drilling to promote revascularization, fixation of the fragment, or grafting if the lesion is unstable or has detached.