Brief Outline of Osteochondritis Dissecans
Osteochondritis dissecans (loose bodies in the joint) occurs when a fragment of bone adjacent to the articular surface of a joint is deprived of its blood supply, leading to avascular necrosis. This causes the cartilage to become brittle and a piece, or pieces, may found in several joints, this condition is most commonly assiciated with the knee and is particularly prevalent in males aged 10-20 years.
Anatomy and physiology
The bones are covered by cartilage at their ends. This cartilage protects the bones from excessive wear. If the blood supply to this area is lost due to a prior injury or other condition, the cartilage becomes hard and brittle. Impact or repetitive wear may cause it to break. If the broken pieces stay attached to the bone, there is generally no problem. When they release into the joint, the feeling of instability and a “clicking” or locking in the joint may be noticed. This causes premature wear in the joint.
Cause of Injury
Loss of blood supply to the end of the bone and attached cartilage. Impact to the joint causing a tearing or breaking of the cartilage at the bone end. Repetitive friction leading to the cartilage becoming brittle and breaking away.
Signs and symptoms
Aching, diffuse pain, and swelling, especially during activity. Stiffness with rest. Clicking, or weakness in the joint. Momentary locking if the bony fragment has displaced and id free floating within the joint.
Complications if left unattended
If left unattended, the loose bodies will continue to cause damage to the inner surface of the joint and could eventually lead to degenerative osteoarthritis. The loose bodies could also lead to tearing or “grooving” of other cartilage in the joint.
Treatment
- Rest
- Immobilisation
- Anti-inflammatory medication
- Seek medical attention
Rehabilitation and prevention
Strengthening the muscles surrounding the affected joint will help support it better during activity. Limiting the amount of time spent doing repetitive movement with the joint may also be required. Treatment of minor injuries to the joint may also help stop the chance of the blood supply being cut off. Limit activities that cause pain and gradually work back into a full schedule.
Long-term prognosis
If the broken cartilage does not release from the bone, it may repair itself. However, if it becomes lodged in the joint and the body does not dissolve it, surgery may be required. In younger athletes, a complete recovery and return to activity may be expected. In older athletes, the development of degenerative osteoarthritis is usually a by-product of this condition.
Osteochondritis Dissecans Knee Specialist
