Osteochondritis Dissecans

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In osteochondritis dissecans, a small piece of bone in a joint softens and dies. It may separate from the bone underneath and come loose inside the joint.

Osteochondritis dissecans (pronounced oss-tee-o-kon-DRY-tiss DISS-uh-kanz) is a small area of dying bone under the in a . The bone softens and dies because it is not getting enough blood.

The cartilage covering the bone may become damaged too. If it does, a piece of bone can come loose inside the joint and float around.

This condition is more common in teens than in younger children. It can happen in any joint. But most often it affects knees, elbows, hips and ankles.

What causes osteochondritis dissecans?

Often, it is not clear what has caused the problem. In some cases, it may happen when repeated positions or motions put too much stress on a joint over time ().

Osteochondritis Dissecans Care at Seattle Children's

Our specialists treat osteochondritis dissecans in children, teens and young adults up to age 21.

What are the symptoms of osteochondritis dissecans?

Children, teens and young adults with osteochondritis dissecans may:

Have pain when they move the affected joint
Have pain when they put weight on their leg if the hip, knee or ankle is affected
Hear a "clinking" or “clunking” sound in their joint when they move it
Feel their joint catch or give way
Feel that something is moving around inside the affected joint
Feel the joint is swollen or stiff

How is osteochondritis dissecans diagnosed?

Pain in the affected area

When you come to our clinic, we ask about any pain:

How bad is it?
When did it begin?
How does it affect activities?

Imaging

After asking about symptoms, the doctor will examine the joint. We may take an . This helps us see if the joint surface appears rough or if a piece of bone seems to be separating.

We may ask for an . This lets us look at the cartilage on the surface of the joint and check for fluid between the bone and cartilage, which can slow healing.

These imaging tests can help the doctors and your family decide on the best treatment.

How is osteochondritis dissecans treated?

Treatment for osteochondritis dissecans depends on if the dying area of bone (lesion) is still in place (stable) or if it has come loose or looks likely to come loose (unstable).

If the lesion is stable, the doctor may recommend nonsurgical treatment. If it’s unstable, surgery may help to repair and heal the area.

Activity changes

Changes in activity may decrease stress on the affected joint, and this may be enough to help the bone heal. The doctor will explain which activities to avoid (like repeated motions or motions that forcefully impact the joint) and for how long. They can also suggest other ways to stay active during this time.

Casting

If it might be difficult for a child to change their activities and rest the affected joint, doctors sometimes recommend using a cast to keep the joint still, giving the bone a chance a heal.

Physical therapy

We offer physical therapy programs to keep the muscles strong while protecting the joints. Our therapists teach exercises to help keep young people strong while they are healing.

Often, it takes 6 to 18 months to heal. During that time, we offer rehabilitation services in our on-site sports gym.

Unloader bracing

For osteochondritis dissecans in the knee, we may provide a nonsurgical therapy called “unloader bracing.” This treatment involves wearing a brace to push the knee into a position that puts less stress on the lesion. We work with bracing experts to get the right brace for each person’s needs.

Surgery

When surgery is needed, we often do procedures that use special tools called arthroscopes. These tools let doctors get to the joint without opening it up. Instead, they get to it through very small cuts (incisions).

In arthroscopic surgery (PDF), the doctor inserts a tiny camera through 1 of the incisions. The camera is attached to a video monitor, like a television. The doctor uses the monitor to see inside the joint.

Compared to open surgery, arthroscopy means your child may:

Recover faster
Have fewer problems after surgery
Have less pain and stiffness during recovery

For osteochondritis dissecans, we do surgeries to:

Promote healing of stable lesions by drilling tiny holes in the bone to improve blood flow
Screw or pin an unstable lesion in place so it doesn’t come loose and can heal
Remove bone and cartilage that came loose and then transplant bone or cartilage in its place

Why choose Seattle Children’s for osteochondritis dissecans treatment?

Seattle Children’s Orthopedics and Sports Medicine specialists treat osteochondritis dissecans in children, teens and young adults up to age 21.

The experts you need are here
- At Seattle Children’s, your care team includes experienced , pediatric , , , nurses, certified , registered and a rehabilitation medicine doctor.
- To restore health and function, we often use nonsurgical methods, like activity changes, physical therapy (PT) and bracing. We have the largest team of physical therapists in the Pacific Northwest who specialize in the care of children, teens and young adults.
- For those who need surgery, our orthopedic surgeons are leaders in their field. They have additional training and expertise in sports medicine, the subspecialty that treats osteochondritis dissecans.
Care through young adulthood
- Our experts have the knowledge, training and skills to treat children who are still growing through young adults in their early 20s. We have special training in the physical, emotional and social needs of young people of all ages.
- We tailor treatment to each person’s specific problem and consider their age and development. Young people with osteochondritis dissecans may need different care than adults do. When treating conditions like this in a growing child, doctors must take into account the  near the end of each long bone.
- Growing children have a better chance of healing from osteochondritis dissecans without surgery than those who have finished growing. We are extremely careful to monitor a child’s growth to make sure that they have the best chance of healing.
- We have the largest group of pediatric radiologists in the Northwest. For imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images.
Our approach to surgery improves life for our patients
- We offer several surgical options for children, teens and young adults who need more than activity changes, physical therapy and bracing, and we are careful to choose the option that best matches each patient’s condition.
- We recommend surgery only when we believe it will provide the best outcomes. First, we look at each patient as a whole person. The team will take many factors into account. These include how serious the condition is, its health effects, if the body is still growing and what results you can expect from treatment.
- Seattle Children’s surgeons are experienced in minimally invasive surgery, such as arthroscopic surgery (PDF), for young people.
Support for the best recovery
- Your team at Seattle Children’s does more than plan and provide care. We also make sure you and your family understand the condition and treatment options. We support you in making choices that are right for you.
- Our physical therapy programs are designed to strengthen the muscles and protect the joints during healing.
- To help patients return to play quickly and safely, we do more than treat the current problem. We focus on preventing future injuries.
- For your convenience, our doctors see patients at several locations  around Washington. Seattle Children’s Sports Physical Therapy is available at our hospital campus and Odessa Brown Children’s Clinic Othello in Seattle as well as in Bellevue, Everett and Federal Way to make ongoing rehab easier for you.
- Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Center and Guest Services are here to help.
Research to improve care
- Our team members partner with experts at other children’s hospitals on multicenter studies. Together, they work to understand more about the best ways to treat bone and joint problems in young people.
- We track results of our patients so we can improve care and provide families with accurate information about our success rates, the risk of complications and the chance that patients will return to their previous level of activity. To help with this effort, we may ask you or your child or teen to fill out questionnaires about their function after treatment.
- Orthopedics and sports medicine care is about more than just the joints, muscles and bones. For example, we know that physical health and mental health can affect each other. We have done research on topics like depression symptoms in those with an ACL (knee ligament) injury so we can better address all of our patients’ needs.
- Learn more about current orthopedics research at Seattle Children’s.