Orthopedics Hip & Knee Osteochondritis Dissecans of the Knee By Jonathan Cluett, MD twitter linkedin Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Learn about our editorial process Jonathan Cluett, MD Medically reviewed by a board-certified physician Updated on February 11, 2020 Print Osteochondritis dissecans, often called OCD for short, is a condition that causes loosening of cartilage and its supporting bone. OCD most often occurs in the knee joint, although it can also occur in other joints including the ankle and the elbow. The cause of OCD is not well understood. What happens in patients with OCD is the blood flow to the bone around a joint surface becomes abnormal. Many researchers have speculated as to the reason for this disruption of blood flow, and it is thought to be related to repetitive stress or even traumatic injury to the bone. As the blood flow to the bone is diminished, the attached cartilage can separate away from the bone. Witthaya Prasongsin / Getty Images How OCD Affects Joint Cartilage Normal joint cartilage is important for having a joint that bends smoothly and without pain. When the cartilage is damaged, a number of problems can occur. In a normal knee joint, a layer of cartilage that is several millimeters thick evenly coats the bone surfaces. The normal cartilage is smooth and slippery and firmly attached to the underlying bone. Patients who have OCD develop abnormal blood flow to the bone that surrounds the joint. The lack of normal blood flow damages the bone that supports the layer of cartilage. This can cause the bone to fragment and the cartilage to separate from its normally firm attachment. The OCD lesion ('lesion' is the cartilage and any bone attached to the cartilage fragment) can loosen and break off from the joint surface. More severe symptoms can occur when there is a fragment of cartilage floating around the joint. Symptoms of OCD of the Knee Symptoms of OCD include: Joint painKnee swellingKnee lockingInstability of the joint Treatment of OCD of the Knee There are a number of factors that must be considered when determining the best treatment for OCD. Considerations Patient Age: The most important prognostic factor is the age of the patient. Patients who have open growth plates (children and adolescents) have a much better prognosis to heal an OCD with both surgical and non-surgical treatments.Size and Location: Larger fragments and fragments in more critical parts of the joint are generally treated more aggressively with surgical options.Degree of Fragmentation/Detachment: OCD fragments are classified as either being stable or unstable, depending on the likelihood of the fragment separating from the bone. Unstable fragments that are more susceptible to this separation are most often surgically repaired. Stable fragments are more likely to heal with less-invasive treatment. Non-Surgical Treatment Depending on the combination of factors, your orthopedic surgeon can make a recommendation for treatment. When an OCD fragment is likely to heal, non-surgical treatment can be effective. While your doctor may recommend ice, anti-inflammatory medications, and other symptom treatments, the critical part of non-surgical treatment is resting the joint to allow for healing. This means limiting activity and may mean using crutches to limit weight on the joint. Surgical Treatment The goal of surgical treatment is to end up with a stable cartilage surface of the joint. If it is thought the fragment can heal, your doctor will most likely try to repair the OCD lesion, usually by using screws or pins to hold the fragment in place. Modern screws and pins are made of bioabsorbable material (rather than metal) so that they will not cause future problems to the joint cartilage. If the likelihood of healing is low, the loose cartilage will be removed from the knee, and treatment will be focused on stimulating new cartilage growth in the void on the joint surface. Methods of Stimulating New Cartilage Growth There are a number of ways to try to stimulate new cartilage growth, and each has pros and cons: Microfracture: A microfracture surgery is performed to stimulate blood flow to the area of damage, which can allow cartilage healing. This treatment is seldom used for juvenile OCD because it does not hold up over time.OATS/Cartilage Transfer: Cartilage transfer procedures move cartilage and bone from areas of the joint that don't need the cartilage to the area of damage.Autologous Chondrocyte Implantation (ACI): ACI is a procedure that grows cartilage cells in a lab, and then inserts the newly grown cartilage into the are of damage. Was this page helpful? Thanks for your feedback! Dealing with joint pain can cause major disruptions to your day. Sign up and learn how to better take care of your body. Click below and just hit send! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Chambers HG, et al. Diagnosis and Treatment of Osteochondritis Dissecans. J Am Acad Orthop Surg. May 2011 vol. 19 no. 5 297-306. Milewski M, Shea K, Nepple J. Research in Osteochondritis Dissecans of the Knee: 2016 Update. The Journal of Knee Surgery. 2016;29(07):533-538. doi:10.1055/s-0036-1586723 Sanders TL, Pareek A, Johnson NR, et al. Nonoperative Management of Osteochondritis Dissecans of the Knee: Progression to Osteoarthritis and Arthroplasty at Mean 13-Year Follow-up. Orthop J Sports Med. 2017;5(7):2325967117704644. doi:10.1177/2325967117704644 Herring MJ, Knudsen ML, Macalena JA. Open Reduction, Bone Grafting, and Internal Fixation of Osteochondritis Dissecans Lesion of the Knee. JBJS Essent Surg Tech. 2019;9(3):e23. doi:10.2106/JBJS.ST.18.00035 Winthrop Z, Pinkowsky G, Hennrikus W. Surgical treatment for osteochondritis dessicans of the knee. 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