Osteochondritis Dissecans | Diagnosis & Treatment

How is osteochondritis dissecans diagnosed?

To diagnose osteochondritis dissecans, a orthopedic specialist will take a medical history and perform a physical exam on your child. The doctor will check for pain along the affected joint line.

For osteochondritis dissecans of the knee, the doctor will conduct what’s called the Wilson Test, in which your child’s knee is bent at a 90-degree angle, then turned inward so that the shinbone rotates toward the opposite leg. Your child will extend the affected leg to the point of pain. If your child has osteochondritis dissecans, he or she will reach that point at about 30 degrees of flexion. If rotating your child’s foot back into its normal position facing forward alleviates the pain, then he or she has osteochondritis dissecans.

To diagnose osteochondritis dissecans of the elbow, ankle or another joint, your child’s doctor will perform similar specialized manipulations.

What are the tests for osteochondritis dissecans?

Various tests may be used to confirm the osteochondritis dissecans diagnosis.

  • X-rays: Typically, multiple x-ray views are taken to confirm and assess the extent of the injury. X-rays may also be taken of the same joint on the other limb as a basis for comparison.
  • MRI (magnetic resonance imaging): An MRI can show whether the loose piece is still in place or has moved into the joint space.
  • Arthroscopy: Rarely needed to help assess osteochondritis dissecans, arthroscopy is a minimally-invasive outpatient procedure that inserts a small camera into the joint for the doctor to inspect.

How is osteochondritis dissecans treated?

Initial treatment follows the basic “R.I.C.E.” steps (rest, ice, compression and elevation), combined with non-steroidal anti-inflammatory medications for pain. Patients will need to temporarily stop running or playing impact sports.

If the loose piece is stable (not detached), this conservative treatment may be all that's needed. Blood vessels sometimes can feed the outer edges of the injured bone, allowing the piece to heal on its own.

Surgical repair

If your child's osteochondritis dissecans doesn't heal on its own, and the joint becomes painful, stiff or locked, surgery may be needed. Depending on the type of osteochondritis dissecans, your child's age and other factors, the doctor may recommend a surgery to:

  • make small drill holes into the underlying bone to stimulate healing
  • remove a loose piece or secure it in place using a screw (which may need to be removed with a second surgery six weeks later, or which may be left in place)

After surgery, your child will need to wear a cast or brace to immobilize the joint for a period of time that your child's doctor will determine. Your child may still have an increased risk of premature arthritis (pain, inflammation and degeneration of the joint) in the joint, even if he or she has surgery.

What is the long-term outlook for osteochondritis dissecans?

Your child will need to complete a course of physical therapy before gradually resuming activity or sports. After the joint has healed and regained strength and stability, your child should be able to return to sports and activities — usually within six months.

It's important for your child to stay involved in some form of fitness to ensure continued physical health and well-being. The doctor may recommend lifestyle changes if there are joint changes, such as arthritis or instability, that couldn’t be corrected.