Osteochondritis Dissecans

Ovid: 5-Minute Sports Medicine Consult, The

Osteochondritis Dissecans
Susan Park
  • Osteochondritis dissecans (OCD) is an acquired defect in the articular cartilage and subchondral bone.
  • It is classified into juvenile and adult forms, depending on growth plate status.
  • It often affects the femoral condyles (most common: posterolateral portion of medial condyle), talar dome, and humeral capitellum but can occur in all large joints.
  • Incidence estimated to be 15–30/100,000 persons
  • Predominant gender: Male > Female (5:3).
  • Occurs most commonly in ages 10–20 yrs but can occur from 5–50 yrs of age
Risk Factors
  • Repetitive microtrauma or overuse
  • Familial predisposition
  • Endocrine abnormalities
  • Anomalies of ossification
  • Impaired blood supply
  • OCD in 1 joint is risk factor for contralateral involvement; 20–30% of patients with OCD of the knee have bilateral involvement.
  • Sports involving jumping, pivoting, cutting movements
  • Throwing sports and gymnastics are specific risk factors for OCD of the elbow.
General Prevention
  • Learning proper mechanics of sports/activities
  • Strength and stability training
  • Repeated microtrauma may lead to microfractures, which may cause some focal ischemia and may result in alteration of growth.
  • May lead to cartilage separation and fragmentation
MRI staging classification:
  • Stage I: Subchondral lesion of low signal intensity (subchondral compression fracture); stable
  • Stage II: Hypointense rim on images indicating demarcation but not separation of lesion (osteochondral fragment attached by osseous bridge); stable
  • Stage III: High signal intensity and underlying cystic changes indicative of instability (detached nondisplaced fragment); unstable
  • Stage IV: Partial or complete dislocation of osteochondral fragment into the joint space (displaced fragment, loose body); unstable
  • Insidious onset of symptoms
  • Preceding injury to joint surface seen in <50% of patients
  • Stiffness after periods of rest
  • If symptoms in knee, may have pain going up and down stairs or hills
Physical Exam
  • Signs and symptoms:
    • Vague joint pain, aching
    • Locking
    • Restricted range of motion (ROM)
    • Sense of giving way or weakening
    • Pain with activity or weight bearing
  • Physical examination:
    • Effusion and/or crepitus may be present.
    • Decreased or painful ROM
    • Poorly localized joint-line tenderness
    • Point of maximal tenderness
    • Mild antalgic gait
    • Ipsilateral quad atrophy if symptom in knee
Diagnostic Tests & Interpretation
  • X-ray is standard for diagnosis. For knee, obtain anteroposterior (AP), lateral, and tunnel views.
  • Bone scan occasionally is useful for diagnosis if onset is acute and x-rays are negative; may help to predict healing if physis is open.
  • US is unreliable.
  • CT scan can be used.
  • MRI is “gold standard” for staging after diagnosis; also good for assessment of loose body; may help to predict prognosis of nonoperative management.
Differential Diagnosis
  • Knee:
    • Meniscal or ligamentous injury
    • Tendinitis
    • Patellofemoral pain syndrome
    • Osteoarthritis
    • Posttraumatic osteochondral defect
    • Spontaneous osteonecrosis of the knee
    • Crystal-induced arthropathies
  • Elbow:
    • Panner's disease
    • Ligament sprains
    • Fractures
    • Posttraumatic asteochondral defect, “loose body”
  • Ankle:
    • DJD
    • Ligament sprains
    • Fractures
    • Arthropathies
    • Posttraumatic osteochondral defect, “loose body”


Ongoing Care
Follow-Up Recommendations
Orthopedic referral is indicated for all patients with unstable OCD and for those who fail conservative treatment.
Additional Reading
Bohndorf K. Osteochondritis dissecans: a review and new MRI classification. Eur Radiol. 1998;8:103–112.
Ganley TJ, Flynn JM. Osteochondritis dessicans of knee. The pediatric and adolescent knee. 2006;273–293.
Hixon AL, Gibbs LM. Osteochondritis dissecans: a diagnosis not to miss. Am Fam Physician. 2000;61:151–156, 158.
Kocher MS, Tucker R, Ganley TJ, et al. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med. 2006;34:1181–1191.
Stäbler A, Glaser C, Reiser M. Musculoskeletal MR: knee. Eur Radiol. 2000;10:230–241.
Tol JL, Struijs PA, Bossuyt PM, et al. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int. 2000;21:119–126.
732.7 Osteochondritis dissecans

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