ConditionBones, joints & muscles
Osteochondritis Dissecans (OCD)
Osteochondritis dissecans (OCD) is a joint condition in which a small area of bone beneath the cartilage loses its blood supply, softens, and may crack and separate, sometimes taking cartilage with it as a loose fragment. It most often affects the knee, followed by the elbow and ankle, and is most common in active children and teenagers. Symptoms are activity-related joint pain, swelling and, if a piece comes loose, catching or locking. Young patients with stable lesions often heal with rest; unstable lesions need surgery.
Also called: OCD of the joint, OCD lesion, osteochondral lesion, juvenile osteochondritis dissecans
At a glance
- What it is
- A patch of bone under the joint cartilage that weakens and may separate.
- Where
- Knee (most common, especially the inner femoral condyle), elbow (capitellum) and ankle (talus).
- Who gets it
- Mostly active children and teenagers aged 10 to 20, more often boys.
- Symptoms
- Activity-related joint pain, swelling, stiffness, catching, locking or giving way.
- Diagnosis
- X-rays (including special views) and MRI to judge stability.
- Treatment
- Activity modification and sometimes bracing for stable lesions in young patients. Surgery for unstable or loose fragments.
When to get help
See a doctor within a day or two
- A joint that locks and cannot be straightened or bent fully
- Sudden swelling of the knee or elbow after activity, especially with a sensation of something moving inside the joint
- A child who cannot bear weight or is limping badly
- A hot, red, swollen joint with fever (to rule out infection)
Book a routine appointment
- Knee, elbow or ankle pain in an active young person that worsens with sport and lasts more than a few weeks
- Recurrent swelling, clicking or catching in a joint
- Elbow pain in a young throwing athlete or gymnast
Usually safe to manage at home
- Mild aching after sport that settles fully within a day, while arranging a checkup if it recurs
What happens in osteochondritis dissecans
Joints are lined with smooth cartilage that sits on a layer of bone (subchondral bone). In OCD, a small area of this bone loses blood supply, possibly from repetitive stress or minor trauma. The area softens and may:
- heal if the stress is removed (stable lesion)
- crack along its edge, so the fragment becomes partly detached
- break free completely, forming a loose body that floats in the joint, leaving a defect in the joint surface
Stable lesions in children whose growth plates are still open heal much more often than lesions in adults.
Where OCD occurs
| Joint | Typical location | Typical patient |
|---|---|---|
| Knee | Inner (medial) femoral condyle, less often lateral condyle or kneecap | Teens in running and jumping sports. Can be confused with Osgood-Schlatter disease |
| Elbow | Capitellum (outer elbow) | Throwers, gymnasts, racket sports, sometimes alongside medial epicondylitis |
| Ankle | Talus bone | Often after ankle sprains |
Causes and risk factors
The exact cause is unclear. Contributing factors include:
- Repetitive stress on the joint from sports, especially in young athletes who specialize early
- Minor trauma or ankle sprains. An acute injury can instead cause an osteochondral fracture
- Genetic factors: some families have multiple affected members
- Rapid growth and skeletal immaturity
- Disrupted blood supply to the bone
Symptoms
- Joint pain during or after activity, often vague and hard to pinpoint
- Swelling
- Stiffness or reduced range of motion
- Catching, clicking or locking if a fragment is loose
- Giving way or weakness
- Limping, especially in children
Elbow OCD may reduce the ability to straighten the arm fully. Ankle OCD often causes deep ankle pain that persists after a sprain.
Diagnosis
- Examination: tenderness over the lesion, swelling and range of motion. In the knee, the Wilson test (pain when rotating the shin inward while straightening the knee) may be positive.
- X-rays: including a tunnel or notch view for the knee, to show the lesion and whether growth plates are open.
- MRI: the key test for assessing size, cartilage condition and stability. Fluid behind the fragment or a cyst suggests instability.
- CT occasionally, for ankle lesions or surgical planning.
Lesions are classified by stability, which is the main factor guiding treatment.
Treatment
Non-surgical treatment
For stable lesions, especially in children with open growth plates:
- Activity modification: stopping sports and high-impact activity for typically 3 to 6 months
- Bracing, a cast or crutches in some cases to reduce load
- Physical therapy to maintain strength and motion
- Repeat imaging every few months to confirm healing
Many young patients heal fully with this approach.
Surgery
Surgery is considered for unstable lesions, loose fragments, failure of non-surgical treatment after 3 to 6 months, or lesions in adults:
- Drilling: small holes made in a stable lesion to stimulate blood flow and healing
- Fixation: reattaching a loose fragment with screws or pins
- Removing loose bodies
- Cartilage restoration for large defects: microfracture, osteochondral autograft (OATS) or allograft transplantation, or cartilage cell implantation
Recovery after surgery often takes 4 to 6 months before returning to sport.
Complications
- Loose bodies causing locking
- Persistent pain and swelling, sometimes with a coexisting meniscus tear
- Joint surface damage leading to early osteoarthritis or post-traumatic arthritis
- Reduced range of motion, particularly in the elbow
Outlook
Children and teenagers with stable lesions and open growth plates have the best outlook, with high healing rates. Adults and people with large or unstable lesions have a higher risk of long-term joint problems, but modern surgical techniques allow many to return to sport.
Frequently asked questions
What is osteochondritis dissecans?
It is a condition in which a small area of bone beneath the joint cartilage loses its blood supply, weakens and may separate, sometimes forming a loose fragment. It most often affects the knee, elbow and ankle of active young people.
What are the symptoms of osteochondritis dissecans?
Common symptoms are joint pain with activity, swelling, stiffness, and, if a fragment loosens, catching, clicking or locking of the joint. Children may limp. Symptoms often develop gradually.
Can osteochondritis dissecans heal on its own?
In children and teenagers with stable lesions and open growth plates, it often heals with 3 to 6 months of rest from sport and activity modification. Unstable lesions and those in adults are less likely to heal without surgery.
How is osteochondritis dissecans of the knee treated?
Stable lesions are treated with activity restriction, sometimes bracing or crutches, and physical therapy. Unstable or loose lesions, or those not healing, are treated surgically with drilling, fragment fixation, loose body removal or cartilage restoration.
Does osteochondritis dissecans lead to arthritis?
It can, especially if the joint surface is damaged or a fragment detaches and is not repaired. Early diagnosis and appropriate treatment reduce this risk. Young patients whose lesions heal usually do well long term.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Osteochondritis Dissecans
- American Academy of Orthopaedic Surgeons: Clinical Practice Guideline on Osteochondritis Dissecans of the Knee
- Research in OsteoChondritis of the Knee (ROCK) study group: classification resources
- MedlinePlus: Osteochondritis dissecans
- Boston Children's Hospital: Osteochondritis dissecans