Introduction

Osteochondritis dissecans (OCD) is a rare condition that affects the joints, mainly the knees, elbows, and ankles. It involves the detachment of a fragment of bone and cartilage from the joint surface, leading to pain, swelling, and limited joint mobility.  Understanding the causes and symptoms of OCD is essential for timely diagnosis and appropriate management of the condition.

The causes of OCD are not fully understood, but various factors can trigger OCD, including both traumatic and non-traumatic ones. Traumatic causes may include repetitive stress or injury to the affected joint, while non-traumatic causes may involve genetic predisposition or disruption of blood supply to the joint structures.

In addition to understanding its causes, recognising the symptoms of OCD is crucial for early detection and intervention. Common symptoms of OCD include joint pain, swelling, and a locking or catching sensation during movement. These symptoms can significantly impact an individual's quality of life and may worsen over time if left untreated.

In the following article, we will examine the details of osteochondritis dissecans, including its causes and symptoms, as well as exploring the various risk factors, diagnostic approaches, and treatment options. This article aims to empower the audience with the knowledge they need to recognise the signs and seek appropriate medical attention for optimal management of the condition.^1,2

Causes of osteochondritis dissecans

Various factors can trigger OCD, but mainly, we can classify them into two forms:

• Traumatic causes: these usually occur due to external factors, such as physical activities
• Non-traumatic causes: these may be developed by enteropathic conditions, for example, genetic reasons

Traumatic causes

Traumatic causes of OCD involve repetitive stress or injury to the affected joint, leading to damage to the bone and cartilage (soft tissue) structures. Activities that involve repetitive impact or strain on the joints, such as running, jumping, or weightlifting, can increase the risk of developing OCD.  Overhead activities, such as football, basketball, and gymnastics, and those involving direct blow or fall movements, are more likely to cause acute trauma to the joint, which increases the risk of developing OCD. ^1,3

Non-traumatic causes

Whilst trauma is the most common cause of OCD, there is a potential role of genetics and vascular factors in the development of OCD.

Genetic factors and familial history

Genetic predisposition to OCD is thought to be a contributing factor. Familial history of OCD or other joint-related disorders may increase an individual's risk of developing the condition. Although the specific genes involved in OCD susceptibility are not fully understood, ongoing research aims to interpret the genetic mechanisms underlying the condition.⁴

Blood supply disruption to the affected bone and cartilage

Disruption of blood supply from cartilage canal vessels to the affected bone and cartilage can impair their ability to receive essential nutrients and oxygen, leading to tissue damage and the development of OCD lesions. Ischemia has been recognised as a common factor of OCD.⁵

Symptoms of osteochondritis dissecans

Some of the early symptoms of OCD include:^1,2

• Joint pain: this may appear as persistent or intermittent discomfort in the affected joint
• Swelling and tenderness: swelling and tenderness around the affected joint are frequently observed in individuals with OCD, indicating underlying joint pathology
• Locking or catching sensation: individuals may experience a feeling of the joint "locking" or "catching" during certain motions, such as bending or straightening the joint

If you experience persistent joint pain, swelling, or other concerning symptoms, it is important to consult with a healthcare professional for evaluation and treatment

Risk factors for osteochondritis dissecans

Several factors contribute to the risk of developing OCD, ranging from demographic characteristics to lifestyle factors and genetic risks.

Age and gender

OCD most commonly affects adolescents and young adults, with peak incidence occurring during periods of rapid skeletal growth and development. While OCD can occur at any age, it is more prevalent in individuals between the ages of 10 and 15 years. Additionally, there is a higher prevalence of OCD in people assigned male at birth (AMAB) compared to those assigned female at birth (AFAB). However, the exact reasons for this gender disparity are not fully understood.^6,7

Sports participation

Participation in overhead or repetitive stress sports is a significant risk factor for OCD development. Physical activities that involve repetitive loading or impact on the joints, such as running and jumping, can increase the risk of joint trauma and subsequent development of OCD lesions. Athletes, including those in football, basketball, gymnastics, and American football, are frequently exposed to high levels of joint stress and impact forces.⁶

Genetic factors

As discussed previously, genetic factors also play a role in the development of OCD. If several members of your family have a history of bone disorders, then it may be worth consulting with your GP or healthcare professionals to undergo early screening. 

Diagnosis of osteochondritis dissecans

Diagnosing OCD involves a combination of clinical evaluation and imaging studies to assess joint function and identify potential risk factors.

Clinical evaluation

This initial step in diagnosing OCD typically involves a thorough physical examination by a healthcare professional. During the examination, the healthcare provider will assess the affected joint for signs of swelling, tenderness, and restricted range of motion.¹

Imaging

Imaging studies play a crucial role in confirming the diagnosis of OCD and assessing the lesion status of joint involvement. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are commonly used to visualise the bone and cartilage structures of the affected joint and detect characteristic abnormalities, such as lesion sizes, articular cartilage and ligament (soft tissues), and joint space narrowing. MRI is beneficial for evaluating the stability and integrity of OCD lesions and guiding treatment decisions.⁴

Treatment options for osteochondritis dissecans

Healthcare professionals will recommend treatment options based on the severity of symptoms and the individual’s specific conditions. 

Non-surgical treatment

Non-surgical treatment approaches are typically recommended as initial management strategies for mild to moderate cases of OCD, such as activity modification, immobilisation and non-weight-bearing. ⁶

Surgical treatment

Surgical intervention may be necessary for severe or refractory cases of OCD that do not respond to non-surgical treatment approaches. Arthroscopic surgery is a minimally invasive surgical technique used to treat OCD by removing loose fragments of bone and cartilage from the affected joint.²

Complications

As with any medical condition, OCD can be associated with potential complications that may affect the long-term care for affected people. It is important to be aware of these complications and to implement appropriate management strategies to minimise their impact.

Potential complications

• Joint instability and recurrent symptoms: People with unstable joints may be at increased risk of further injury or progression of joint damage if left untreated. Which can lead to recurrent symptoms such as:¹
  • Pain
  • Swelling
  • Reduced range of motion
  • Impairing joint function
  • Mobility
• Development of osteoarthritis in the affected joint: People with a history of OCD may be at higher risk of developing osteoarthritis due to ongoing joint damage and instability

Summary

In summary, OCD is a condition that affects the joints, particularly in adolescents and young adults, prevalent between the ages of 10 and 15 years. This condition is associated with symptoms, including joint pain, swelling, and sensations of locking during movement. Understanding the causes, symptoms, and risk factors associated with OCD is crucial for timely diagnosis and appropriate management. The causes of OCD can be both traumatic and non-traumatic, including repetitive stress or injury to the joint, genetic predisposition, and disruption of blood supply to the affected bone and cartilage. Certain factors, such as sports participation and family history, can increase the risk of developing OCD. Clinical evaluation and imaging studies are commonly used for OCD diagnosis. The treatment options vary depending on the severity of symptoms and extent of joint damage. Non-surgical treatments are often recommended initially. However, surgical interventions such as arthroscopic surgery may be necessary for severe cases. Additionally, individuals with OCD may experience complications such as joint instability and the development of osteoarthritis in the affected joint over time.

FAQs

Is osteochondritis dissecans curable?

Osteochondritis dissecans can be managed and treated, but it may not always be curable. Treatment options include non-surgical approaches such as rest, activity modification, and physical therapy, as well as surgical interventions in more severe cases.

What causes osteochondritis dissecans?

Osteochondritis dissecans can be caused by traumatic factors such as overhead activities, as well as non-traumatic factors, including genetics and cartilage canal vascular disorders.

How is osteochondritis dissecans diagnosed?

Osteochondritis dissecans is diagnosed through a combination of clinical examination, imaging such as CT and MRI scans. Symptoms such as joint pain, stiffness, and swelling are also taken into consideration during diagnosis.