The juvenile and adult forms of OCD have different symptoms and modes of treatment [14]. In the juvenile form, the primary complaints include non-specific pain, mild effusion, atrophy of the quadriceps muscle, external rotation of tibia while walking [14] and episodes of ‘catching’ or locking of the knee [4].

The adult form of presentation is the knee ‘giving way’ after an episode of significant trauma [14]. In both juvenile and adult forms, when the medial condyle of the knee if involved, the primary complaint is pain and difficulty in extending the leg [14]. The pain is poorly localized and characteristically worsens with weight bearing [4].

On examination, the patient is found to have crepitus [2], joint effusions [2], and joint line tenderness [10]. Patients with knee involvement usually walk with external tibial rotation and a positive Wilson’s sign is seen [1]. This sign can be elicited by flexion of knee to 90 ninety degree and then extending slowly, looking for any painful response from the patient [3].

• Pain

  Examination shows reproduction of pain with internal rotation of the tibia during extension of the knee, and relief of pain with tibial external rotation. A radiograph and MRI is shown in Figures A and B. [orthobullets.com]

  A child with OCD classically presents with nonspecific pain, which is often worse with activity. [columbiaortho.org]

  Resting and avoiding vigorous sports until symptoms resolve will often relieve pain and swelling. [orthoinfo.aaos.org]

  Osteochondritis dissecans is a rare cause of painful knees in children. Only 10 cases of lateral tibial condyle involvement have been reported in the literature. [ncbi.nlm.nih.gov]

• Swelling

  Resting and avoiding vigorous sports until symptoms resolve will often relieve pain and swelling. [orthoinfo.aaos.org]

  Painful swelling and locking may persist. In addition, some OCD lesions present as unstable and these require surgical fixation. [columbiaortho.org]

  He also says that knee swelling typically appears after he plays basketball. On physical exam, there is mild swelling on the left knee. [step1.medbullets.com]

  […] may see their primary care provider at first with complaints of pain and swelling. [nationwidechildrens.org]

• Falling

  While OCD can occur suddenly with a specific traumatic event (such as a fall), it usually develops over time due to repetitive stress on the joint. [childrensortho.com]

  This piece may stay in place or fall into the joint space, making the joint unstable. Children usually present with pain, which is often poorly localized and associated with activity. [jitbalakumar.com.au]

  These fragments may be localized, or may detach and fall into the joint space causing pain and joint instability. Osteochondritis dissecans occurs can occur in any of the joints including your elbows, ankles, shoulders and hips. [sydneyorthopaedic.com.au]

  She intends to enroll at Stanford University in the fall, and continue competing internationally with the goal of qualifying for the 2012 Olympics in London. [intlgymnast.com]

• Collapse

  OCD belongs to a group of disorders, the so-called osteochondroses, affecting the joints of the skeleton producing fragmentation, collapse, sclerosis as well as re-ossification and reconstitution of the articular surface. [ncbi.nlm.nih.gov]

  MR images are at higher risk of collapse (34). [pubs.rsna.org]

  Here, loss of structural support can lead to collapse and fragmentation of the overlying joint surface, resulting in a painful arthritic joint ( FIG 5 ). [musculoskeletalkey.com]

  OCD happens when the repetitive trauma results in a blood supply injury to the capitellum and the bone either fails to develop from the cartilage a child was born with, or the maturing bone dies and therefore softens and collapses. [rchsd.org]

• Short Stature

  Other characteristic features of familial osteochondritis dissecans include short stature and development of a joint disorder called osteoarthritis at an early age. [medlineplus.gov]

  In the case presented in this report, the patient and his father both had the phenotypic form of a short stature, with multiple OCDs. [hindawi.com]

  No short stature or any other syndromic features were present. None of the syndromic features associated with ACAN or COL9A2 mutations or any other known syndromes were present in this case. This case suggests a possible unknown genetic anomaly. [ncbi.nlm.nih.gov]

• Knee Pain

  pain for 2 months. [orthobullets.com]

  Prompt recognition of osteochondritis dissecans is important, as this entity is a treatable cause of knee pain. [ncbi.nlm.nih.gov]

  Patella Fracture Jumpers Knee Patellofemoral Pain Syndrome PCL Tear [physioroom.com]

• Joint Effusion

  Signs In most cases, there is a full range of movement in the joint without signs of ligamentous instability. Joint effusion is often present, particularly if there has been trauma. [patient.info]

  Joint effusion is present. View larger version (213K) Fig. 6A. — 13-year-old boy with osteochondritis dissecans of anterome-dial right femoral condyle. [doi.org]

  […] pain, joint effusions, locking of joint Sites Usually at lateral aspect of medial femoral condyle near intercondylar notch; also ankle and elbow joints Radiology description Well demarcated defect in articular surface of joint Treatment Reattachment [pathologyoutlines.com]

• Elbow Pain

  Postoperatively, elbow pain was absent in 6, mild in 2, and moderate in 2 patients. The mean range of elbow motion changed from 136º to 139° (p=0.80). [ncbi.nlm.nih.gov]

• Joint Swelling

  Symptoms can include: Joint pain, which usually gets worse with increased activity Joint swelling Clicking and popping sensations in the joint Symptoms may start after a small injury that seemed to get better on its own. [stanfordchildrens.org]

  Swelling and tenderness. The skin around your joint might be swollen and tender. Joint popping or locking. Your joint might pop or stick in one position if a loose fragment gets caught between bones during movement. Joint weakness. [mayoclinic.org]

  This lesion, or area of damaged bone, can be: stable unstable, or completely detached An unstable or detached lesion may become loose in the joint. A loose piece of bone in the joint can cause pain, swelling, and issues with range of motion. [nationwidechildrens.org]

  Additional Studies If a patient's findings include the following: joint swelling, diminished thigh girth, or a positive Wilson's Test, then additional study is indicated. Usually radiographic study is the next in line to try and solve the problem. [pinnacle-ortho.com]

  Common signs and symptoms of OCD include: Soreness of the joint Swelling of the joint that can sometimes come and go Pain when the joint is used, but children sometimes have trouble identifying where the pain is Stiffness of the joint when it’s not being [saintlukeshealthsystem.org]

• Osteochondral Loose Body

  In contrast, surgical options have traditionally included drilling of the site of the defect, removing the loose body, fixing the loose body to the site of separation, and placing osteochondral grafts. [emedicine.medscape.com]

  Hypothesis—a diagram of the form and origin of loose bodies in osteochondritis dissecans. J Rheumatol. 1984;11:512-3. [PubMed] [Google Scholar] 33. [ncbi.nlm.nih.gov]

• Confusion

  We still confuse the second and third categories but osteochondritis dissecans has been identified as an ossification defect. [ncbi.nlm.nih.gov]

  Osteochondritis dissecans has been confused with other abnormalities of the joint surface, and therefore the orthopaedic literature must be read with care. [doi.org]

  It does have its risks, including memory loss, disorientation and sort of confusion. There is also a change in the activity of the heart but it's rarely significant. [medical-dictionary.thefreedictionary.com]

  Patients under age 7 may have anatomic variants of normal ossification centers that should not be confused as OCD lesions. Determining skeletal maturity will assist in prognosis and treatment. MRI recommended for staging and treatment guidance. [posna.org]

• Irritability

  In cases where fragments of cartilage are loose in the joint, surgery is necessary to either reattach the fragments or remove them to limit the irritation they can cause. [actionsportphysio.com]

  Symptoms of OCD are pain, swelling and joint weakness, which are often irritated by sports or physical activity. In more advanced cases, the patient may notice that the joint catches, locks or pops. [childrensmercy.org]

  The entire knee is irritated because of the loose pieces, and it responds by producing extra synovial fluid in the knee joint [9]. Stiffness and feeling of instability [11][13]. [physio-pedia.com]

  This complication, called a joint mouse, can result in a "pebble-in-the-shoe" feeling of irritation for the dog, as well as intermittent or persistent lameness. [web.archive.org]

  Inject a mild irritant or proliferant at the site of the pain or injury to stimulate healing to the specific area. [journalofprolotherapy.com]

As with most joint disorders, OCD is a radiologic diagnosis [10]. In patients with knee symptoms, X-rays with anteroposterior, lateral, sunrise or Merchant, and tunnel views are recommended [9]. If anteroposterior view alone is performed then there are greater chances of missing a lesion on the posterior aspect of the medial femoral condyle [1]. Once a lesion has been noticed, it is preferable that the contralateral knee must also be examined [10].

Once the lesion has been identified on X-ray, MRI must be carried out to stage the lesion for stability, as it is the most accurate method for staging lesions [12] [13] [9], studies have shown that MRI has a 97 percent sensitivity for detecting unstable lesions [12]. The presence of high signal changes on T2 images indicates the presence of fluid between the fragment and underlying bone [10]. MRI is also a strong indication if there is accompanying pathology involving the menisci, anterior cruciate ligament or articular cartilage [9]. If the plain radiographs are negative then other causes should be considered and OD can be ruled out safely [10].

Stages I and II involve lesions which are stable and stages III and IV show unstable lesions which have infringed upon the cartilage [10]. It is imperative to distinguish between stage II and stage III in order to plan the surgery [13]. If the MRI shows unstable lesions of stage III or IV, the arthroscopy should be performed to evaluate the extent of involvement of the cartilage [10]. Other radiographic modalities such as computed tomography, arthrography and nuclear bone scans have also been used to evaluate stability and prognosis, however they have their limitations [6].

Staging of the lesions is absolutely necessary before deciding the mode of treatment. While stable lesions are managed conservatively, unstable lesions are an indication for surgery [10], followed by post-operative physical therapy [9].

Juvenile OCD must be treated before epiphyseal closure in order to ensure full recovery [10]. In cases of the adult form, the therapy aims to preserve function of the joint and prevent onset of degenerative osteoarthritis [3].

Conservative management includes observation. It also requires the patients to avoid competitive sports for a minimum of six to eight weeks [10]. The aim of this type of therapy is to enable the patient to be symptom free [1]. Physical therapy including stretching, conditioning and quadriceps strengthening are also helpful [10].

If symptoms do not resolve with conservative measures, then the development of a loose body must be suspected and arthroscopic evaluation must be carried out [1].

According to recent trends, in cases where surgical intervention is required, there are five main surgical techniques which have yielded favorable results, these include osteochondral autologous transplantation, autologous chondrocyte implantation with bone graft, biomimetic nanostructured osteochondral scaffold implantation, bone-cartilage paste graft, "one-step" bone-marrow-derived cell transplantation technique [8].

The overall prognosis is good as patients usually recover. However, factors favoring a poorer prognosis include large size of the lesion and occurrence on a weight bearing area. Prognosis also worsens with increased age and physis closure [10].

Girls ages 11 years and less and boys aged 13 years and less have remarkable chances of resolution, whereas those affected over the age of 20 years have worse outcomes [1]. Stage III and IV lesions which are unstable and occurring in patients with a closed physis, have a particularly poor prognosis [10].

Although most cases of OCD are said to be of unknown nature [3], certain etiologies responsible for OCD include environmental [10], hereditary, recent or recurrent episodes of trauma, abnormalities of epiphyseal ossification, endocrine abnormalities and avascular necrosis factors [14].

The current incidence of OCD is approximately 15 to 30 cases per 100,000 persons [1] [5]. Although the conventional population affected by OCD includes young males between ages 10 and 20 years [10], the recent trend shows that it is increasingly affecting women [2] and children [1]. The sites most affected include the femoral condyles, talar dome and capitellum of humerus [6]. The knee is involved in 75 percent of the cases [3], specifically the non-weight bearing medial femoral condyle [7].

The mechanism of injury which is common to all etiologies is constant and recurrent shear and compression forces affecting the joint [10]. Majority of the patients with a classical picture OCD have a history of repeated incidents of micro-trauma rather than a single incident of trauma [1]. The fact that OCD is often bilateral and affects non-weight bearing areas, make it more likely that causes other than trauma are responsible for the insult [10].

Mechanisms thought to be involved in cutting off the blood supply to the joint include ischemia due to vascular spasm, emboli of fat and thrombosis or infection [1] [3]. Children are more susceptible to mild trauma during growth spurts because of the increased porosity bones and open epiphyseal plates during this period [11]. Certain abnormal ossification centers, common in rapidly growing children, are said to be responsible for starting the disease process [1].

There is no guideline for the prevention of OCD.

Osteochondritis dissecans (OCD) is a disease affecting the joints, in which the bone and some of the adjacent cartilage undergo necrosis as a result of loss of blood supply. The affected area is a focal of segment of bone undergoing necrosis [10]; the resultant necrosis of the cartilage is due to resorption of bone and the loss of supporting structure of the cartilage [2]. As a result, there is an outgrowth of bone into the empty space [10].

OCD can be classified in to two basic types: The juvenile form, occurring before epiphyseal closure, and the adult form, occurring after epiphysis closure [3].

Osteochondritis dissecans (OCD) is a disease of the joints in which a part of bone of cartilage (or both) loses blood supply and dies. This may be consequent to an injury or due to overuse as occurs in certain types of activities such as competitive sports.
The onset of the disease may be painless or may cause a sudden or gradual onset of symptoms. Sometimes, OCD is diagnosed ‘accidentally’ when as X-ray is being performed for some other reason.

The presenting symptoms can include pain, swelling, sensation of grinding within the joint, decreased range of movement or complete locking of the joint. Younger patients have a better prognosis as their growth plates have not fused as yet, whereas older patients have poorer outcomes. The prognosis also depends on the type and stage of the lesion with stages I and II having favorable outcomes and stages III and IV having more serious sequelae.

Treatment again depends on the staging of the disease; the first two stages can be managed with simple bed rest and physiotherapy and stages III and IV require surgical intervention.

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