Osteochondritis dissecans (OCD)
Treatment & Care
Often, parents initially provide at-home aid for their child’s injury before a doctor diagnoses osteochondritis dissecans (OCD). This home care usually follows the “R.I.C.E.” steps (rest, ice, compression and elevation), as well as medications to help control pain and swelling:
- rest: Make sure your child doesn’t exert in any way that involves the injured knee; he can use crutches or a cane, if it helps.
- ice: Wrap a towel around ice cubes, or use a bag of frozen vegetables, to ice the area at two-hour intervals, for 20 minutes each time.
- compression: Wrap a bandage or soft brace (from the drugstore) around his injury.
- elevation: Your child should remain seated or reclining, with his leg elevated, as often as possible before and after seeing the doctor.
At Children’s Orthopedic Center we are proud to offer patients comprehensive care—including evaluation, diagnosis, consultation, non-surgical therapies, surgery and follow-up care.
Initial treatment follows the basic “R.I.C.E.” formula above, combined with non-steroidal anti-inflammatory medications for pain. Patients temporarily stop any running or impact sports activity. If the loose piece is stable (not detached), this conservative treatment may be all that’s needed. Blood vessels sometimes can feed the outer edges of the injured bone, giving the piece the potential to heal on its own.
If your child’s OCD doesn’t heal on its own and the joint becomes painful, stiff or locked, he may need surgery.
Depending upon the type of OCD, your child’s age and other factors, the doctor may recommend surgery to:
- make small drill holes into the underlying bone to stimulate healing or
remove a loose piece, or secure it in place using a screw (which may need to be removed with a second surgery six weeks after the first surgery, or which may be able to be left in place)
A child may still have an increased risk of premature arthritis (pain, inflammation, degeneration of the joint) in the joint following osteochondritis dissecans, even if surgery has been performed.
Care before surgery
If your child is to have arthroscopic surgery to treat his osteochondritis dissecans, he may need a complete physical with his pediatrician before surgery to assess his health and rule out any conditions that could interfere with his surgery.
Before surgery, tell your child’s doctor about any medications that he’s taking. You’ll be informed which medications he should stop taking before surgery. Typically, this includes aspirin and anti-inflammatory medications, which should be stopped 10 days before surgery.
Your doctor may also order tests—such as blood samples or an echocardiogram—to help prepare for your child’s procedure.
Care after surgery
After surgery, you and your child will be given written instructions, pictures of his surgery, a prescription for physical therapy and a copy of our rehabilitation guidelines. After surgery, a cast or brace will immobilize your child’s joint for a period of time that your child’s doctor will determine.
Care during healing
Your child will need to complete a course of rehabilitation exercises before gradually resuming his activity or sport. He’ll meet with the physical therapist, who will recommend exercises, advise in wound care and how much weight he should place on the repaired joint. Throughout the rehab period, your Children’s team will be available to answer questions, address your concerns and offer help.
A child has a great chance of returning to his usual activity level after treatment for osteochondritis dissecans, although he may not be able to keep playing high-impact sports.
After your child’s joint has healed, and after his strength and stability have returned through physical therapy, he should be able to return to sports and activities—usually within six months. In fact, it’s important for him to stay involved in some form of orthopedic fitness to ensure continued physical health and well-being.
But your child’s doctor may recommend lifestyle changes for him if he has joint changes, such as arthritis or instability, that couldn’t be corrected (even with surgery).
Your child’s doctor will give you guidance about how long your child should rest his joint in order for it to heal. He’ll need to avoid any activities that cause discomfort, and he may need to avoid impact sports for three to six months. Your doctor may suggest stretching exercises or swimming instead.
Coping and support
At Children’s Hospital Boston, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child’s—and your own—hospital experience as pleasant as possible. Our Center for Families staff will give you all the information you need regarding:
- getting to Children’s
- navigating the hospital experience
resources that are available for your family
In particular, we understand that you may have a lot of questions when your child is diagnosed with osteochondritis dissecans. Will this affect my child long term? When can he return to his sports and activities? Children’s can connect you with extensive resources to help you and your family through this stressful time, including:
patient education: From the first doctor’s appointment to treatment and recovery, our staff will be on hand to walk you through your child’s treatment and help answer questions you may have—Will he need surgery? How long will his recovery take? Will he need home exercises and physical therapy? We’ll help you coordinate and continue the care and support your child received while at Children’s.
parent-to-parent: Want to talk with someone whose child has been treated for osteochondritis dissecans? We can often put you in touch with other families who’ve been through the same process that you and your child are facing, and who will share their experience at Children’s.
faith-based support: If you’re in need of spiritual support, we’ll connect you with the Children’s chaplaincy. Our program includes nearly a dozen clergy— representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your Children’s experience.
- social work: Our clinical social workers have helped many families in your situation. Your Children’s social worker can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to dealing with a child’s injury, changing family dynamics and financial issues.
We care for professional athletes and dancers
The Division of Sports Medicine has cared for thousands of young athletes and is the health care choice of world-renowned dancers and professional athletes. We are the orthopedic caregivers for the Boston Ballet and the Boston Marathon.
A long line of orthopedic firsts
With a long history of excellence and innovation and a team of clinicians and researchers at the forefront of orthopedic research and care, Children’s is home to many treatment breakthroughs:
- advanced techniques and microsurgery care for complex fractures and soft tissue injuries to the hand and upper extremity
- one of the first pediatric sports medicine clinics in the nation
- a hip program that has performed more than 7,000 periacetabular osteotomies
- advances in our spinal program, such as video-assisted thorascopic surgery
We are also: