osteochondritis dissecans

Osteochondritis dissecans is a condition of athletes in which a section of joint cartilage and its underlying bone slowly separates from the underlying bone. It is most common in active 13 to 21 year olds. It most commonly affects the the medial side of the distal end of the femur (the thigh bone).

The main complaint of the patient is knee pain, either over the involved area or generalized to the whole knee. This is the only early symptom. As the disease progresses, there may be swelling, locking of the knee, or a grinding or crunching sensation. Subtle withering (atrophy) of the thigh muscles is consistently found.

What has happened? There has been death and reabsorption of the bone underlying the involved area. A small fragment gradually detaches and eventually will float free into the knee joint, causing advanced symptoms of crunching and locking.

The disease is usually thought to be caused by a combination of factors, most notably acute injury, repetitive low-grade injury from over use, or abnormalities in the way that the bone forms. Treatment can be conservative with rest, exercise modifications, and strengthening of the thigh musclulature but advanced cases may require surgery to secure the loose bone fragment in place.

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