The knee and other joints achieve smooth movement due to the presence of cartilage. However, if the same operation is repeated for a long time in sports, cartilage will fall off in the joint. This condition is called osteochondritis dissecans.
Osteochondritis dissecans often develops as a part of sports disorders related to baseball and basketball. If your child complains of discomfort in the elbows or knees, it is important to take measures such as changing the position or taking a rest for a long time in consideration of long-term player life.(1)
Is Osteochondritis Dissecans Hereditary?
Experts believe that the normal growth of cartilage is hampered by a poorly organized cartilage network in developing bones, contributing to short stature. Infrequent osteochondritis dissecans are not usually resulted by genetic abnormalities and are primarily not inherited.
In rare cases, the disorder might impact more members of the same family; in such cases, the condition is caused by alterations (mutations) in the gene ACAN, which is an inherited autosomally dominant way. Treatment of this disease depends on several factors, such as the diagnosed individual’s age and symptom severity but can include rest, physical therapy, surgery, casting, or splinting.(2)
Repeated stress and trauma to the same place in a joint can lead to impaired blood flow in cartilage and bone. Then, a part of the damaged bone is necrotic, and the bone and the cartilage attached to it will come off. This is the cause of detached osteochondritis. In sports, the same parts such as the elbows and knees are frequently heavily loaded, and as a result of sports disorders, osteochondritis dissecans may be positioned.
The cartilage of growing children is fragile and is prone to developing osteochondritis dissecans. Other genetic factors are also thought to cause the disease.
Is Osteochondritis Dissecans A Chronic Condition?
Osteochondritis dissecans can be regarded as a joint disease where the lack of blood supply makes the cartilage present under the bone joints to die. This leads to breaking and loosening out of the bones and cartilages resulting in pain, discomfort, and impeding joint motion.
In many children with osteochondritis dissecans, the damaged bone and cartilage repair on without intervention, particularly in growing age. But, it is more serious in adults and children who passed the growing age.(3)
Symptoms Of Osteochondritis Dissecans
Osteochondritis dissecans commonly occurs in the elbows and knees. There is no characteristic symptom in the early stages, but when cracks or degeneration occur on the surface of the articular cartilage, they become aware of pain. The stronger the pain, the harder it is to continue the sport.
When the cartilage is completely detached, the fragments will float in the joint without a foothold. These loose pieces cause problems in bending and stretching joints and make people aware of being caught.(4)
Diagnosis Of Osteochondritis Dissecans
For osteochondritis, radiographs and ultrasound echo are performed. Image inspection can confirm that the bone is peeling off, and early detection is possible even when there are no symptoms. If detected early, it may be cured without surgery. Therefore, it is recommended to try early detection by screening.
Also, a detailed image examination such as CT or MRI may be performed if necessary. It is possible to detect in detail such as the extent of lesion expansion that cannot be confirmed by X-ray or ultrasound.
Treatment For Osteochondritis Dissecans
In the early stages of osteochondritis dissecans, the lesions may be repaired by inhibiting the movements that cause throwing, and the lesions may be completely cured. However, we may restrict exercise for a long period of 3 to 6 months, and in some cases for a year or more.
In advanced cases, surgery may be considered to avoid future disability. A specific procedure is to remove free osteochondral fragments and attach them with bioabsorbable nails to create new bone (called bone nail fixation). When it is difficult to attach free osteochondral fragments, osteochondral cut off at other sites is transplanted to form cartilage on the surface of the joint (called osteochondral column transplantation or mosaic formation).
Osteochondritis dissecans develops due to overuse of joints in childhood when bone and cartilage tissue has not yet grown. Also, if you continue to overuse, your medical condition will worsen. Therefore, by prioritizing sports, etc., osteochondritis dissecans becomes severe, and it may not be possible to recover without surgery. In the worst case, the player’s life may be lost.
Considering the player’s condition, in the long run, changing positions, and temporarily banning exercise are also important options. It is important to judge the situation flexibly so as not to overdo the joint.(5)
- Pascual-Garrido C, Southworth TM, Slabaugh MA, et al. Osteochondritis Dissecans. 2019.
- Mohr B, Taylor RG, Baldea JD. Knee Osteochondritis Dissecans. StatPearls [Internet]: StatPearls Publishing; 2019.
- Gobbi A, Whyte GP. Osteochondritis dissecans: pathoanatomy, classification, and advances in biologic surgical treatment. Bio-orthopaedics: Springer; 2017:489-501.
- Gobbi A, Espregueira-Mendes J, Karahan M, Cohen M, Whyte GP. Osteochondritis dissecans of the knee in football players. Injuries and Health Problems in Football: Springer; 2017:189-200.
- Filardo G, Andriolo L, Soler F, et al. Treatment of unstable knee osteochondritis dissecans in the young adult: results and limitations of surgical strategies—The advantages of allografts to address an osteochondral challenge. Knee Surgery, Sports Traumatology, Arthroscopy. 2019;27(6):1726-1738.
- Osteochondritis or Osteochondritis Dissecans: Causes, Symptoms, Treatment
- What is Osteochondritis Dissecans of Knee Joint and How is it Treated?