Osteochondritis Dissecans (OCD) can occur in any joint in the human body, but the knee is the most commonly affected joint. OCD in the knee is a significant health issue that primarily affects young and active individuals. It involves damage to the cartilage and the underlying subchondral bone, causing pain, swelling, and limited mobility.
This condition is often associated with disruptions in blood flow during embryological development, leading to long-term knee problems.
Thanks to advanced imaging techniques like MRI and modern treatment strategies, early diagnosis and effective management of OCD are now possible. This article explores the causes, symptoms, classification, and current treatment approaches for OCD in detail.
What is Osteochondritis Dissecans?
In OCD, blood flow to a portion of the subchondral bone (the bone beneath the cartilage surface) in the knee is disrupted, often due to genetic factors. This disruption results in the death of the cartilage and underlying bone.
As the condition progresses, the dead cartilage and bone may detach and fall into the joint space, forming a loose body or "joint mouse." This can lead to mechanical symptoms such as locking or catching in the knee.
What Causes Osteochondritis Dissecans?
OCD develops during embryological development when blood flow to a specific area of the subchondral bone in the knee becomes disrupted.
Symptoms may not appear until the patient reaches their 20s.
By their 20s or 30s, individuals with OCD may begin to experience symptoms such as knee pain and swelling.
Classification of Osteochondritis Dissecans
Type 1: Bone-cartilage lesion causing depression in the joint surface.
Type 2: Bone-cartilage fragment that remains in place and is not fully detached.
Type 3: Bone-cartilage fragment that remains in place but is completely detached.
Type 4: Fully detached bone-cartilage fragment that falls into the joint space, creating a loose body and leaving a void in the joint surface.
What Are the Symptoms of Osteochondritis
Dissecans (OCD)?
Knee Pain: The most common symptom, which tends to worsen over time.
Swelling: The knee joint may swell and become tender.
Limited Mobility: Difficulty in straightening or bending the knee.
Knee Locking: If the cartilage and subchondral bone fragment detaches, it can become a loose body in the joint, sometimes causing locking by getting stuck between the bones.
How is Osteochondritis Dissecans Diagnosed?
OCD is diagnosed through a detailed physical examination followed by imaging techniques such as X-rays and MRI.
How is Osteochondritis Dissecans Treated?
Treatment for OCD is individualized and varies from patient to patient.
Non-Surgical Treatment of Osteochondritis Dissecans
If the patient’s growth plates are still open and the cartilage-bone fragment is not fully detached (as seen on MRI), Op. Dr. Utku Erdem Özer employs the following first-line treatment protocol:
Rest
Use of crutches (non-weight-bearing)
Strengthening exercises
Range-of-motion exercises to maintain joint flexibility
PRP or PRGF injections
When is Surgery Necessary for Osteochondritis Dissecans?
Surgery is required in cases where the cartilage-bone fragment is completely detached or displaced, corresponding to Type 3 and Type 4 OCD.
Surgery may also be planned for Type 1 and Type 2 OCD if non-surgical treatments fail.
What Types of Surgeries Are Performed for Osteochondritis Dissecans?
Arthroscopic Debridement:
Used for smaller lesions causing mechanical issues such as catching or locking, or for removing a loose body. Additional cartilage repair surgery may be performed based on the lesion size.
Cartilage-Bone Fragment Fixation with Screws:
If the fragment is viable, it can be reattached to its original position using headless metal screws or biodegradable screws.
Metal screws need to be removed 3–6 months post-surgery.
Mosaicplasty:
If the fragment cannot be reattached and the OCD lesion is smaller than 4 cm², mosaicplasty is performed. Healthy cartilage plugs from non-weight-bearing areas are transplanted to the damaged site.
Autologous Chondrocyte Implantation (ACI):
For lesions larger than 4 cm² where reattachment is not possible, ACI is performed. This involves culturing cartilage cells from the patient and implanting them in the damaged area.
Postoperative Recovery for Osteochondritis Dissecans
Recovery depends on the type of surgery performed but generally involves:
6 weeks of using crutches with no weight-bearing on the operated leg.
Wearing an adjustable knee brace.
Early initiation of range-of-motion and isometric exercises to prevent stiffness and muscle loss.
Conclusion
Osteochondritis Dissecans (OCD) is a serious condition that causes knee pain, swelling, and limited mobility, particularly in young adults. Early diagnosis and appropriate treatment are essential to prevent permanent damage and long-term complications.
Modern medicine offers a variety of treatment options, including rest, physical therapy, medical injections, and, when necessary, surgical interventions. With individualized treatment plans based on the type and severity of the condition, most patients can recover and return to their normal activities.
Op. Dr. Utku Erdem Özer specializes in diagnosing and treating Osteochondritis Dissecans (OCD) with precision and care. If you’re dealing with OCD symptoms or need expert advice, don’t hesitate to contact Op. Dr. Utku Erdem Özer: Whatsapp Contact.
