Although it can also occur in other joints Osteochondritis dissecans happens to knee, ankle or elbow joints. (1)
Osteochondritis dissecans is the commonest explanation for a loose body within the joint space in adolescents and should cause considerable debility. (2)
How To Diagnose Osteochondritis Dissecans?
Osteochondritis dissecans is a condition that does not have clear etiology and also presentation occurs in the young age group in most of the cases. To diagnose the case of osteochondritis dissecans, it is very important to look for the various causes using history taking. It is a very important step in diagnosing any disease because it not only gives the idea of possible etiology but also can quantify the damage based on symptoms in most of the cases. Sometimes it can occur that symptoms and history of the patient are blurring the severity of the disease but on an all, it is very much important. It could help in establishing the causative factor for osteochondritis dissecans.
For the absolute diagnosis of this condition, there is usually no blood test required because it is a local condition instead of a systemic disease. There is not much of a blood-related abnormality associated with this condition, although the doctor may suggest blood tests to get the baseline reports. The radiological investigation is very much of diagnostic importance in the case of osteochondritis dissecans.
The initial investigation is done based on the site of symptoms and is usually an x-ray. It has a very low specificity but a fairly high sensitivity which means it cannot always demarcate the condition. Many times, an x-ray is not an ideal investigation because it cannot reveal the problem with the ligaments and other non-bony structures of the joint.
To get a detailed picture of the condition, there may be other radiological investigations needed like computed tomography and magnetic resonance imaging. CT scan is a very effective method to see the bony pathologies as well as the smallest of the segments that can be seen. It is very helpful to see sclerotic parts of the bone and underlying translucency also (1).
Magnetic resonance imaging is very good with the cartilaginous and ligamentous structures. It is also helpful in ruling out infective pathologies of the bones like osteomyelitis, bone marrow edema, etc. MRI can also diagnose a case of osteonecrosis and differentiate it from osteochondritis dissecans.
What Is The Best Medicine For Osteochondritis Dissecans?
For the treatment of this condition, a conservative approach is a very good method. In this, there is the avoidance of the medical or surgical treatment and only the bed rest and immobilization are practiced. But if there is a need for medical treatment such as in the cases of severe pain, redness around the joint, etc. then only symptomatic treatment is given. Nonsteroidal anti-inflammatory drugs are the most commonly used painkillers for pain relief but sometimes Cox 2 inhibitors can also be given. To reduce the inflammatory response in very few cases, anti-inflammatory and anti-histamine drugs can be combined. For strengthening the bones and rooting out the calcium deficiency, calcium and multivitamin drugs can also be prescribed.
Diagnosis of a case of osteochondritis dissecans is not that difficult except if there is no fragment in the joint space. If the case presents with only a subchondral fracture then it is very difficult to judge based on an x-ray. There may be further radiological investigation required to see the joint carefully. An MRI of the affected joint is almost diagnostic for the condition. It can be repeated after a certain period to see the progression or regression of the disease. The age group associated with this condition is on the younger side so there may not be any need for surgical treatment.
Only the symptomatic relief is given at the time of presentation and immobilization and bed rest are the best form of treatment for this condition. Surgical treatment may be needed in adult cases or when the severity of the condition has increased.