Osteochondritis dissecans (OCD) is where a portion of subchondral bone and articular cartilage undergoes separation from the underlying bone. This leaves a bone fragment that can be stable or unstable. It can lead to premature Osteoarthritis
OCD is a rare cause of joint pain. In adults, men are more commonly affected than women, and the ankle is most commonly affected. In children OCD most commonly affects the knee, followed by the elbow and ankle.
Pain is felt in the knee, elbow, or ankle either following a specific injury or following repetitive injury. Patients report that pain is worse with exercise. In more severe disease, especially in the presence of a loose body, there may be mechanical symptoms such as catching or locking. The pain may gradually get worse over several months. In OCD of the talus there may be ongoing pain after an ankle inversion injury.
On examination there is tenderness over the relevant location - medial femoral condyle, anterolateral elbow, medial or lateral talar dome
Plain films will usually show evidence of OCD. The typical findings are a subchondral bony fragment that is surrounded by an area of crescent-shaped radiolucency. If plain films are normal and suspicion remains then MRI may be indicated. MRI can also help to grade the lesion and help with management planning.
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