Does your child love to play sports? Or is he or she at the age where he or she can run around and play? Does he or she sometimes say things like, "Mommy, my knee hurts," or "I can't bend my elbow?" Most of the time, we just forget about it, thinking it's just a minor bruise. But if this kind of joint pain persists, it could be caused by a condition we haven't heard of much about, Osteochondritis Dissecans, or OCD for short. Although the name may sound a bit complicated, there's nothing to be afraid of. Let's talk about it simply.
What is Osteochondritis Dissecans (OCD)?
Simply put, Osteochondritis Dissecans (OCD) is a condition that affects our joints, or synovial joints. It is most common in children, adolescents, and young adults.
You know, a joint is where two bones in our body meet. In OCD, the blood supply to the end of one of these bones at a joint is cut off. Just as a branch of a tree dries out and becomes weak when it doesn't get water, when it doesn't get blood, that part of the bone also softens and becomes weak.
Over time, this weakened piece of bone dies and separates from the main bone. Sometimes, along with this piece of bone, a piece of cartilage (the smooth tissue that covers the ends of bones) that surrounds it also comes off. A small wound-like mark (lesion) is left where the bone and cartilage have come off.
Now what happens to this little piece of bone that has come loose? Sometimes it can stay where it came loose. Or, it can float around inside the joint. When this happens, the joint becomes unstable, and it can start to hurt. Surprisingly, this condition can take months, even years, to develop, so you may not notice any symptoms in the early stages.
OCD most commonly affects the following joints:
- Knees (most commonly seen in the knees)
- Elbows
- Ankle
- Shoulders
- Hip bones
However, this condition is most commonly seen in the knee, on the lower, inner side of the thigh bone (femur). In medical terms, it is called the ``medial femoral condyle''.
There are two main types of OCD.
Doctors divide OCD into two main types, and it's important to know the difference between the two.
| OCD type | Description |
|---|---|
| Sporadic Osteochondritis Dissecans | This is the most common type. It occurs in only one joint. It is usually difficult to find a specific cause for this. That is, it is a condition that occurs randomly. |
| Familial Osteochondritis Dissecans | This is very rare. As the name suggests, this is a genetic condition that is passed down from generation to generation. It can be passed down from parent to child. A person with this type can have multiple joints affected throughout their life. They also tend to be short and have an increased risk of developing osteoarthritis (wearing out of joints) at an earlier age than normal. |
What are the symptoms of OCD?
As I said before, there may be no symptoms in the early stages. Especially if the broken bone remains in one place without moving around, you may not feel any pain.
However, if symptoms do appear, you may experience things like:
- Joint pain: This is the main symptom.
- Weakness: The joint feels lifeless.
- Swelling: The joint appears swollen.
- Stiffness: A feeling of being unable to bend or straighten the joint easily.
- Limited mobility: The inability to fully move the joint normally.
- Hearing a 'click' sound: Hearing a 'click' sound when moving the joint.
- Feeling like the joint is unstable: The joint feels like it is 'jumping' out of control, or like it has no strength.
Often, these symptoms worsen as the loose bone fragment moves to other areas within the joint and becomes stuck. Also, this pain and other symptoms may increase when you play sports, exercise, or do work that puts weight on the joint.
What are the causes of OCD?
Doctors are still researching sporadic OCD. No single cause has been found. However, because the condition is common among athletes, experts believe that repeated stress on a joint is a major cause.
Imagine a cricketer bowling continuously and getting little impacts on his elbow. Or a basketball player jumping continuously and getting little impacts on his knee. While it may not be a big injury at once, these little impacts can accumulate over time and damage the joint. We call these microtraumas . These microtraumas can be caused by activities like running, jumping, and throwing something.
Familial OCD is caused by a genetic mutation. Specifically, it is caused by a mutation in the gene called `ACAN`. This `ACAN` gene instructs our body to produce a protein called `aggrecan`, which is used to build cartilage. Due to the genetic mutation, this `aggrecan` protein builds cartilage poorly or irregularly. That is why this condition occurs.
Who is most at risk of developing this condition?
Although anyone can develop OCD, some people are at higher risk.
- People between the ages of 10 and 20: This age group is most affected.
- Males: This condition is more common in boys than in girls.
- Athletes: Those who engage in various sports, especially those who play sports that put a lot of pressure on the joints, are at higher risk.
- Family history: If someone in your family (parents, siblings) has OCD, you are at risk of developing it too.
What happens if it is not treated?
If OCD is not treated properly, the symptoms can worsen over time. Eventually, you may develop chronic pain or osteoarthritis . People with familial OCD are at a higher risk of developing osteoarthritis much earlier than the average age (around 50 years old). So this is not something to be taken lightly.
How do you find this, Doctor?
When you go to see a doctor, he will first ask you about your symptoms. He will ask you things like when the pain started, what time of day it is, and whether the pain comes after any activity.
Then, the affected joint is examined. The range of motion is measured and compared to the healthy joint.
Next, they may order imaging tests, such as an X-ray or MRI (Magnetic Resonance Imaging) scan, to confirm the diagnosis. If there is a suspicion of familial OCD, they may also refer you for genetic testing to confirm it.
What are the treatments for this?
There are two main goals of treating OCD. One is to help the joint heal. The other is to restore blood supply to the affected bone. Treatment options can be divided into non-surgical and surgical.
Non-surgical treatment
Often, especially for children and young people, this is the first treatment that doctors recommend.
| Treatment method | Description |
|---|---|
| Rest | This is the most important thing. The best way to heal is to stop putting any more pressure on the joint. You may need to stop playing sports, running, or jumping for a month or two. |
| Medication | Your doctor may prescribe painkillers, such as NSAIDs (nonsteroidal anti-inflammatory drugs) , to reduce swelling and pain. But remember, do not take painkillers continuously for more than 10 days without medical advice. |
| Immobilization of the joint | You may need to wear a brace, splint, or cast to keep the joint in place until it heals. If your knee or ankle is affected, you may be told to use crutches to reduce weight on it. |
| Physical Therapy | A physical therapist will help you strengthen the muscles around the joint and teach you exercises and stretches to restore movement to the joint. |
Will surgery be necessary?
If your symptoms are severe after several months of nonsurgical treatment, your doctor may recommend surgery. The surgeon may do something like this:
- A very small hole is made in the affected bone and cartilage. This stimulates the body to provide fresh blood supply to the area, which then heals faster.
- Reattaching the detached bone and cartilage fragments using pins and screws.
- Replacing damaged tissue with a bone graft from another part of your body or a graft from a compatible donor.
The type of surgery you need will depend on where the OCD is located, how severe the damage is, and how far the loose piece has come. Your surgeon will explain this to you in detail.
Will this heal on its own?
This is a good question. Because the bones of children and young adults with osteochondritis dissecans are still growing, the condition is more likely to resolve on its own with rest and time.
But, don't take risks with your child's joints just because they're painful. If your child has joint pain for more than a week, don't just wait and hope that it will get better on its own. Definitely see a doctor.
Because the sooner a doctor diagnoses this condition and begins treatment, the lower the risk of complications in the future.
How long will it take to get better? Will it affect the future?
It takes many people several months to fully recover. Your doctor will tell you what exercises and activities you can and cannot do during your recovery.
It usually takes about two months to recover from surgery. After that, you will need to undergo physical therapy for several months to regain lost strength and mobility.
As for the future of children and young people, long-term effects are much less likely to occur after proper treatment. However, to prevent future joint damage, it may be necessary to change the sport or stop certain repetitive motions. For example, a child with OCD in the elbow may be able to play cricket again after recovery, but may be advised to stop pitching.
Older adults are at higher risk of developing osteoarthritis in the affected joint and are also more likely to need surgery.
When should I see a doctor?
If you or your child has joint pain that lasts for more than a week, be sure to see a doctor.
Also, if you have a trauma that prevents you from moving a joint or if you are in severe pain, go to the nearest hospital's Emergency Department (ETU) immediately.
Take-Home Message
- Osteochondritis Dissecans (OCD) is a condition caused by a lack of blood supply to a bone in a joint. It is most common in children and young adults who play sports.
- The main symptoms are pain, swelling, and stiffness in joints such as the knees, elbows, and ankles.
- The main treatment for this is rest. It is essential to avoid putting pressure on the affected joint.
- If a child continues to complain about joint pain, don't dismiss it as "growing pains." Be sure to seek medical advice.
- With timely diagnosis and proper treatment, most children can recover completely without any long-term effects.
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