Osteochondritis Dissecans and Osteochondrosis - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Osteochondritis dissecans is a condition that affects the joints of children and young adults. It occurs when a small segment of the bone separates from the surrounding region due to a lack of blood supply which results in cracking and loosening. In contrast, osteochondrosis is a group of disorders that affects the growing skeleton. This occurs due to injury, abnormal growth, and overuse of developing growth plate and ossification (bone hardening) centers.

What Is the Anatomy of the Joint?

The joint is where the ends of the bone meet, such as the knee, ankle, and shoulder joints. Healthy joints move easily because of the cartilage, which is smooth and slippery. In addition, cartilage covers and protects the bone ends where they meet to form a joint.

What Are Osteochondritis Dissecans?

It Is a condition that affects the joints. The most common occurrence of osteochondritis dissecans is the knee joint at the end of the thigh bone. It may also occur in the ankle, knee, and other joints. This condition usually involves one joint but sometimes occurs in multiple joints too. In many cases, the affected bone and cartilage heal independently, especially in growing children. Whereas in grown and young adults, the osteochondritis dissecans lesions have a greater chance of separating from the bone and cartilage and getting detached and floating around the joint space.

What Are the Causes of Osteochondritis Dissecans?

The cause is unknown. It may occur due to trauma and repetitive stress.

What Are the Symptoms of Osteochondritis Dissecans?

The symptoms of osteochondritis dissecans are:

• Pain and swelling of the joint.

• Joint catching and locking in advanced cases.

How to Diagnose Osteochondritis Dissecans?

Osteochondritis is diagnosed as follows:

• A thorough medical history.

• Physical examination.

• Other investigations include:

• X-Rays: X-rays help to diagnose initial osteochondritis dissecans lesions. They also help to evaluate the size and location of the lesion.

• Magnetic Resonance Imaging (MRI): MRI helps the physician to evaluate the extent to which the overlying cartilage is affected.

What Is the Treatment of Osteochondritis Dissecans?

The treatment of osteochondritis includes:

Observation and Changing the Activity:

• Osteochondritis dissecans in children usually heal on their own, especially when there is an active growth phase.

• Taking proper rest and avoiding vigorous sports activities will relieve pain and swelling.

Non-Surgical Treatment:

• Using crutches, splinting, or casting the affected arm, leg, or other joints for a short period.

• In general, most children feel better after two to four months of rest and non-surgical treatment.

• Once the symptoms improve, one can return to regular activity.

Surgical Treatment:

• When the non-surgical treatment fails to relieve pain and swelling.

• When the lesion is separated from the bone and cartilage.

• When the lesion is larger than one centimeter in diameter, especially in older teens.

• Drilling into the lesion creates pathways for new blood vessels that nourish the affected area. This encourages the healing of surrounding bones.

• Holding the lesion in place with the help of pins and screws.

• Replacing the damaged bone and cartilage with grafts helps in regeneration.

• Crutches are recommended for about six weeks after surgical management.

• This is followed by physical therapy for two to four months to regain strength and motion of the affected joint.

• Returning to sports may be possible after four to five months.

What Is Osteochondrosis?

It is defined as a group of disorders that affects persons with immature skeletons. It results from abnormal development, injury, and overuse of the growth plate and surrounding ossification (bone hardening area) center.

What Are the Causes of Osteochondrosis?

The causes of osteochondrosis are:

• Trauma.

• Inflammation.

• Infection.

• Abnormal growth.

• Injury.

• Overuse.

• Genetic causes.

• Vascular abnormalities.

• Hormonal imbalance.

• Dietary imbalance.

What Are the Symptoms of Osteochondrosis?

The symptoms of osteochondrosis are:

• Symptoms appear between ten to fourteen years of age.

• Boys are more commonly affected.

• Pain and disability.

• Areas of the body more commonly involved are the hip, knee, foot, elbow, and back.

• In the wrist, it causes swelling- Kienbock's disease.

• In the hip, it causes the victim to limp- Legg-calve-Perthes disease.

• In the spine, it causes bending, the convex curvature of the upper spine giving a hung back appearance- Scheyrmann's disease.

What Is the Pathophysiology of Osteochondrosis?

It is a developmental disease. It occurs in the early stages of life and is characterized by interruption of blood supply to the bone, which results in localized bony necrosis (bone death) and is followed by regrowth of bone.

How to Diagnose Osteochondrosis?

X-rays show flattening and fragmentation of bones.

What Is the Treatment of Osteochondrosis?

The treatment includes:

• Usuallyrequires no treatment and heals on its own within a few months.

• Sometimes the physician suggests taking complete rest.

• The use of a brace or cast may be helpful in some cases, which reduces the movement.

• Exercises and stretches are practiced to strengthen the joint muscles and tendons.

• Sever's disease causes heel pain and is aggravated by jumping and kneeling. They are treated with activity modification, heel cups, and calf stretches. They respond well to non-surgical management.

• Elbow pain is caused by medial epicondyle apophysitis and is exacerbated by throwing. They are treated with cessation of activity, taking proper rest, and using nonsteroidal anti-inflammatory drugs to reduce pain.

• Osgood-Schlatter disease responds well to activity modification, and nonsteroidal anti-inflammatory drugs are self-limited. In recurrent cases, physical therapy helps to reduce the symptoms.

• Surgical treatment is indicated in Scheuermann's disease to alleviate pain and improve cosmesis.

Is It Necessary to Do an Orthopedic Referral?

Individuals with osteochondrosis should be referred to an orthopedic surgeon if the non-surgical management is ineffective and for further evaluation. Individuals with mobile joint fragments should be referred to an orthopedician, as it requires joint debridement. Individuals with recent trauma, illness, and elevated inflammatory markers are referred to an orthopedician to rule out infection or any underlying fracture. Individuals with pain despite several weeks of rest and mobile joint fragments should be referred.

Conclusion:

A distinction between osteochondritis dissecans and osteochondrosis should be made, as it is confusing for physicians. Osteochondritis dissecans is an inflammatory condition of the bone and its overlying cartilage that affects joints, whereas osteochondritis is due to activity-related pain. Lesions from osteochondritis dissecans may or may not respond to non-operative management, while osteochondrosis resolves when the growth plates have closed.