Anatomy & Function
Osteochondrosis dissecans describes a disease of the articular cartilage and the underlying bone that primarily affects children and adolescents between the ages of 10 and 20. A temporary reduction in blood flow results in focal damage to a bone district. In severe cases, a cartilage-bone fragment may detach, allowing it to move freely in the joint and damage the remaining articular cartilage.
The most frequent localizations are the upper ankle joint and the knee jointmore precisely on the inner side of the thigh bone. In principle, however, the disease can affect any joint, e.g. also the elbow joint. Boys are affected twice as often as girls.
Symptoms & Complaints
Signs of osteochondrosis dissecans may include:
- Load-dependent pain
- Swelling of the affected joint
- Movement restrictions
The complaints depend on the stage and localization of the disease. In the majority of cases, the symptoms are unilateral; rarely is a joint affected on both sides.
Typically, there is joint pain that increases with physical exertion and is not preceded by a trigger. Irritation of the joint may result in joint effusion, leading to visible swelling.
In the context of a joint blockage, affected persons may also suffer from movement restrictions, as the detached cartilage-bone fragment restricts certain movements in the joint. This can manifest itself, for example, in the fact that patients are no longer able to fully extend their knee.
Causes
Causes of osteochondrosis dissecans include:
- Genetic
- Overload
Osteochondrosis dissecans is caused by a reduced blood supply to bones. The exact cause of this reduced blood supply is not yet fully understood. However, it is suspected that mainly genetic factors play a role.
A known risk factor for the development of osteochondrosis dissecans is the overloading of joints, for example through excessive sport or obesity. Accordingly, children who engage in competitive sports at a young age are more frequently affected by this joint disease.
Diagnosis
Our specialist for pediatric orthopedics Priv.-Doz. Dr. Pestka will interview you and your child in detail about the symptoms. Typically, in the case of osteochondrosis dissecans, children complain of joint pain, which is particularly noticeable during physical exertion. The affected joint is then carefully inspected and its mobility examined.
An imaging procedure, usually an X-ray examination, is recommended to confirm the diagnosis and for staging. In early stages, it is possible that the X-ray image does not yet show any changes. In these cases, magnetic reson ance imaging is used.
Treatment
Early treatment of osteochondrosis dissecans is crucial to improve the chances of recovery and reduce the risk of complications. A feared complication is joint wear, so-called arthrosis, in which joint cartilage is destroyed.
The therapy depends on the respective stage, the stability of the bone-cartilage fragment and the age of the child.
Conservative therapy:
In the case of a stable joint where the cartilage-bone fragment is not expected to dislodge, a conservative therapeutic approach can be pursued.
The following conservative therapies are available:
- Protection of the affected joint
- Sports break
- Immobilization with splints
- Painkiller
- Regular controls
- Shock wave therapy (ESWT)
The decisive therapy component for improving the blood supply to the bone and accelerating healing is to relieve the affected joint and refrain from sports . This measure can be supported, for example, by the use of forearm crutches or the application of a cast for a few weeks.
Pain relievers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) can be used in the short term to reduce pain. The stability of the joint should be checked regularly by imaging.
Operation:
In advanced stages, where detachment of the cartilage-bone fragment is imminent or has even already occurred, surgical therapy should definitely be performed.
As a rule, this involves a joint endoscopy (arthroscopy). An arthroscopy is a minimally invasive surgical procedure in which a camera with a light source and a working instrument are inserted into the affected joint through several small incisions in the skin. This allows the joint to be assessed in detail and a therapeutic intervention to be performed at the same time.
If detachment of a cartilage-bone fragment has not yet occurred, the bone area around the lesion can be tapped to promote blood flow.
In the context of detached cartilage-bone fragments, the piece of bone can be fixed back in its original place using screws. If this is not possible, the fragment is removed and the existing cartilage defect is filled with the help of a cartilage transplant .
At Orthozentrum Freiburg , our pediatric orthopedist Priv.-Doz. Dr. Pestka will be happy to advise you further and answer any questions you may have.
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