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Osteochondritis

  • Overview

    We advise kids not to specialize in just one sport. Multi-sport athletes tend not to get as many OCD injuries and other kinds of overuse injuries. As for practicing, we advise kids and coaches to alternate exercises and vary drills.

    --Yi-Meng Yen, MD, PhD, orthopedic surgeon, Boston Children's Hospital

    More and more kids are playing organized sports, and they’re specializing in one sport at an early age. While exercise and athletics are hugely beneficial for children and adolescents, there’s an element of risk that offsets some of the benefits: Overuse injuries like osteochondritis dissecans (OCD) are on the rise.

    If your child or teen has been diagnosed with OCD, we know that he’s experiencing discomfort, as well as some disappointment at the disruption of his sports training. At Children’s Hospital Boston, we’ll approach your child’s treatment with sensitivity and support. We want to get him back to his normal activities—and back into his game—safely.

    About osteochondritis (OCD)

    • OCD and other overuse injuries are sports-related microtraumas (small injuries) that result from repetitively using the same parts of the body.
      • OCD can have other causes, too, such as trauma, a genetic predisposition, rapid growth and bone formation anomalies.
    • OCD is a joint disorder in which a loose piece of bone and cartilage separates from the end of the bone because of a loss of blood supply.
    • In kids and teens, OCD injury most often affects the knee (high-impact landings) and elbow (pitching, throwing).
    • OCD can affect both boys and girls, but is most common in boys 10 to 20 years old.
    • Signs and symptoms of OCD injury include:
      • a “popping” sensation
      • soreness, tenderness at the joint line
      • swelling or stiffness
      • difficulty straightening the joint fully
      • feeling like the joint is locking, “catching” or “giving way”
      • collection of fluid (“water on the knee”)
    • Treatment in kids is usually non-surgical, but surgery can be necessary in serious cases.
    • If untreated, OCD can lead to early osteoarthritis—chronic joint inflammation causing pain and damage to the joint.
    • The risk of OCD can often be reduced with:
      • proper conditioning and training (especially cross-training)
      • sport-appropriate equipment and protective gear
      • adequate rest between exercise sessions
         

    The detailed information on the following pages will help you gain a better understanding of OCD and other overuse injuries and a clearer picture of how to help your child recover from one.
     

    Boston Children's Hospital approach to osteochondritis dissecans and overuse injuries

    At Children's, our doctors are committed to repairing your child's joint with the least invasive option possible. The team in Boston Children’s Orthopedic Center has treated thousands of children, adolescents, adults and professional athletes with injuries ranging from the minor to the highly complex. We can provide your child with expert diagnosis, treatment and care—as well as the benefits of our advanced clinical and scientific research.

    Our orthopedic experts have cared for many generations of young athletes and we are the health care choice of professional athletes and world-renowned dancers. We are the official orthopedic caregivers for the internationally famous Boston Marathon and the Boston Ballet.

    We provide comprehensive assessment, treatment and follow-up care to children, adolescents and young adults who have sports-related orthopedic injuries. Our skilled orthopedists and sports medicine experts work with physical therapy staff to develop long-term treatment and activity plans. Our team has also developed innovative evaluation programs and effective injury prevention programs and strategies.

    Our orthopedic team includes 24 orthopedic surgeons, 10 primary care sports medicine specialists, two podiatrists, a nutritionist, a sports psychologist, eight physician assistants, 14 nurses and four certified athletic trainers. Besides our busy Boston practice, Children's physicians see hundreds of patients every week at our locations in Lexington, Weymouth, Peabody and Waltham. Our surgeons perform an average of 5,000 surgical procedures each year.

    We’re known for our science-driven approach—we’re home to the most extensive research enterprise located in a pediatric hospital in the world. As part of our research efforts, we’re working to create a way to help jump-start the knee into healing itself.

    Osteochondritis dissecans: Reviewed by Yi-Meng Yen, MD, PhD
    © Boston Children's Hospital, 2011

    Boston Children's Performs for the Boston Ballet

    Our Division of Sports Medicine provides comprehensive medical care for dancers in the Boston Ballet, which has more than 50 full-time, top-trained performers. In addition, through a unique partnership with the Division of Sports Medicine, students from Boston Ballet’s summer dance program—one of the premier ballet training programs in the nation—receive physical therapy from Children’s specialists with expertise in dance-specific injuries.

    Orthopedic Center
    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • In-Depth

    If your child or teen has an osteochondritis dissecans injury (OCD), it may comfort you to know that Boston Children's Hospital Orthopedic Center has a tremendous amount of experience treating this injury, developing therapies for healing it and conducting research that leads to the most innovative care possible.

    An important first step in understanding what lies ahead is familiarizing yourself with the basics about OCD.
     

    What is osteochondritis dissecans?

    In osteochondritis dissecans, a loose piece of bone and cartilage separates from the end of the bone because of a loss of blood supply. The loose piece may stay in place or fall into the joint space, making the joint unstable. This causes pain and a sense that the joint is “catching” or “giving way.” These loose pieces are sometimes called “joint mice.” Osteochondritis dissecans usually affects the knees and elbows, but can affect any joint.
     

    How does OCD occur?

    Young athletes involved in high-impact sports can sustain an OCD injury from repetitive motions that stress the joint. Typical sports that can put teen athletes at risk for OCD of the knee are football, basketball, gymnastics, soccer and lacrosse. Sports that can increase the risk of OCD of the elbow are squash, tennis, baseball and weight-lifting.
     

    What are the signs and symptoms of OCD?

    When a child or teen sustains an OCD injury, he might experience a “popping” sensation. Most people can still walk on an injured knee, and many athletes keep playing.

    When symptoms of inflammation set in, the knee or elbow feels painful and tight. Your child may experience:

    • soreness, tenderness at the joint line
    • swelling or stiffness
    • difficulty straightening the joint fully
    • feeling like the joint is locking, “catching” or “giving way”
    • collection of fluid (“water on the knee”)
       

    The signs and symptoms of OCD can resemble those of other joint injuries. So it’s important that your child see his doctor for a diagnosis.
     

    How is osteochondritis dissecans diagnosed?

    Your child’s doctor will begin to diagnose an OCD injury with a physical exam. The orthopedic surgeon may order further diagnostic studies, including:


    If the loose piece is unstable, your child may need surgery to remove or secure it. If the loose piece is stable, he may be able to be treated non-surgically.
     

    Will my child be OK?

    The good news is 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).
     

    How is osteochondritis dissecans treated?

    Initial treatment follows the basic “R.I.C.E.” formula: rest, ice, compression and elevation, combined with non-steroidal anti-inflammatory medications for pain. The child usually needs to stop any running or impact sports activity until he’s treated and recovers.

    If the loose piece is stable, 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 surgical repair. (For details on surgery, see Treatment & Care.)
                                                                                               

    What should I do if I think my child has OCD?

    If you think your child has osteochondritis dissecans, see his doctor right away. Without treatment, a loosened fragment of bone and cartilage may drift into the knee joint, causing it to slip, pop or lock; if this happens, the knee can get “stuck,” often at a 45-degree angle, until it’s moved manually or otherwise manipulated.
     

    Why are there more osteochondritis dissecans and other overuse injuries in kids these days?

    Youth and teen participation in organized sports (many of which have repetitive drills) has grown to about 35 to 40 million kids across the United States. Not surprisingly, the incidence of sports injuries is also growing. Statistics suggest that 30 to 60 percent of student athletes will have an overuse injury at some point in time. In one doctor’s orthopedic practiceat Children’s, for example, at least half of the young patients have an overuse injury.
     

    Aren’t organized sports supposed to be good for kids?

    Organized sports are very important and help kids—not just in terms of physical health, but also in academics and social situations—and they’re good for children’s overall development and growth. The downside is that “overuse syndrome,” where the kids repeat the same drill over and over, causes overuse injuries.
     

    Can OCD be prevented?

    Osteochondritis dissecans is not strictly a preventable injury, since sports such as football, basketball, gymnastics, soccer, tennis and baseball do put athletes at some risk. But young athletes can reduce their risk by:

    • maintaining general health and fitness: sport-specific conditioning, diet, exercise, sleep
    • learning/using proper sport-specific movements (form) and techniques
    • wearing/using proper sport-specific gear
    • risk awareness: learning which moves cause risks
    • hamstring/leg strengthening (especially for girls)
       

    How can parents and coaches help kids avoid OCD and other overuse injuries?

    Parents and coaches have a great deal of influence—for better or for worse. They should stress moderation in training and should restrain the zeal with which they push youth and teens.

    Coaches themselves should use proper training techniques and should avoid too many repetitive drills, since these are the main causes of overuse injuries. Coaches should also teach proper running mechanics and other sports-motion techniques.

    Physical education departments should make sure that the surfaces of tracks and fields are in good shape, and that proper equipment, footwear and protective gear are used for each sport.

    Our orthopedic specialists advise:

    • warming up and stretching before practice
    • resting at least one day a week
    • cross-training/alternating sports: Multi-sport athletes tend to get fewer overuse injuries than those who specialize in just one sport.
    • alternating exercises during practice: An athlete less likely to experience an injury—and over the long term, his muscle memory actually improves—if he varies practice drills.
       

    Are there other guidelines and resources for injury prevention and safer training?

    The American Academy of Orthopaedic Surgeons (AAOS) has issued comprehensive guidelines for helping to prevent sports injuries. Below is an excerpt from the current AAOS recommendations:

    • Use proper equipment.
       
    • Warm up.
      • Warm up to prepare to exercise, even before stretching.
      • Run in place for a few minutes.
      • Breathe slowly and deeply, or gently rehearse the motions of the exercise to follow.
         
    • Stretch. Stretch slowly to the point of muscle tension.
      • Hold each stretch for 10 to 20 seconds, then slowly release.
      • Inhale before each stretch, exhale on release.
      • Do each stretch only once.
      • Never bounce on a fully stretched muscle.
    • Drink water.
      • Drink enough water to prevent dehydration, heat exhaustion and heat stroke.
      • Drink 16 ounces (one pint) of water 15 minutes before exercising and another 16 ounces after cool-down.
      • Drink water every 20 minutes or so while exercising.
    • Cool down.
      • Cool down for twice as long as warm-up.
      • Slow down motion and lessen intensity for at least 10 minutes before stopping completely.
    • Rest.
      • Schedule regular days off from exercise, and rest when tired.
      • Fatigue, soreness and pain are good reasons to not exercise.
         

    Who at Children’s will be caring for my child?

    Members of our orthopedic  team will provide expert care and support for your child. Our team includes 10 primary care sports medicine specialists, 24 orthopedic surgeons, two podiatrists, a nutritionist, a sports psychologist, eight physician assistants, 14 nurses nurse and four certified athletic trainers.


    What is the Orthopedic Center at Boston Children’s doing to encourage injury prevention and safer training?

    With Boston Children’s goal of dramatically reducing overuse injuries in young athletes, members of our team often travel to local and regional schools, youth groups and sports clubs to teach leg strengthening and other techniques. We also conduct frequent safe training programs and clinics for coaches. Call 617-355-3501 for details.
     

    FAQ

    Q: Who gets osteochondritis dissecans?
    A:
    Anyone can get OCD, but it mostly affects boys and young men 10 to 20 years old. It’s now also being diagnosed more often in girls, as they become more active in organized sports. OCD usually affects athletes, especially gymnasts and baseball players. The adult form occurs in mature bone, and the juvenile form occurs in growing bone.
     

    Q: If my child gets OCD, does he need to stop sports activities?
    A:
    If your child is treated non-surgically, he should avoid activities that cause discomfort and may need to avoid impact sports for three to six months. His doctor may suggest stretching exercises or swimming instead during this time.
     

    Q: What are the signs and symptoms of OCD?
    A:

    • a “popping” sensation in the joint
    • soreness, tenderness at the joint line
    • swelling or stiffness
    • difficulty straightening the joint fully
    • feeling like the joint is locking, “catching” or “giving way”
    • collection of fluid (“water on the knee”)
       

    The signs and symptoms of OCD can resemble those of other joint injuries. So it’s important that your child see his doctor for a diagnosis.
     

    Q: What should we do before we see the doctor for a diagnosis?

    A: If you suspect that your child has osteochondritis dissecans, home care before your child gets to the doctor should include “R.I.C.E.”:

    • rest: Make sure he doesn’t exert the injured area; 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 seeing the doctor.
       

    Q: What will happen if OCD goes untreated?
    A:
    Without treatment, a fragment of the bone and cartilage may loosen and drift into the joint, causing it to slip, pop or lock—the knee gets “stuck,” often at a 45-degree angle, and must be manipulated manually. Later, osteoarthritis—painful inflammation and degeneration—in the joint will also be a risk.
     

    Q: How is OCD usually diagnosed?
    A:

    • physical exam (see Wilson Test in Tests)
    • MRI (magnetic resonance imaging): a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. An MRI can show whether the loose piece is still in place or whether it has moved into the joint space.
       

    If the loose piece is unstable, your child may need surgery to remove or secure it. If the loose piece is stable, the doctor may be able to treat it non-surgically.
     

    Q: How does Children’s treat osteochondritis dissecans?
    A:

    • “R.I.C.E.”: rest, ice, compression and elevation
    • non-steroidal anti-inflammatory pain medications
    • rest from activity that may stress or twist the knee
    • if injury doesn’t heal, surgery

    (For details about surgery, see Treatment & Care.)
     

    Q: Will my child be OK?

    A: Most kids with OCD can return to sports and regular activities after a few months of rest and healing time. Your child’s doctor will give you guidance about how long the joint should be rested in order for it to heal, and whether your child can resume impact sports.

    During the healing period, it’s important to support your young athlete’s resolve to rest his joint, since he may feel disappointed and frustrated at not being able to play his sport. (For more on your encouraging your teen, see the For Teens and For Parents tabs.)

    Q: If my child has been injured playing sports, should he go back to playing?

    A: If your child’s doctor has cleared him to go back to sports, the many benefits and life lessons he’ll gain from playing greatly outweigh the risks of injury. These benefits include:

    • physical fitness
    • teamwork, competitive prowess, accomplishment
    • improved body composition—less risk of obesity
    • reduced risk of heart disease and diabetes
    • stronger immune system
    • academic fitness—kids who play sports often academically outperform kids who don’t
    • emotional and psychological fitness—improved self-esteem, self-concept, self-confidence, empowerment and perception of competence
       

    Q: What is Boston Children’s experience in orthopedics?

    A:
    At Boston Children’s Orthopedic Center, we’re known for our clinical innovations, research and leadership. Ranked among the top three in orthopedics for 2012-13 by U.S.News & World Report, we provide the most advanced diagnostics and treatments, several of which were pioneered and developed by Children’s researchers and clinicians—including platelet-rich plasma (PRP) treatment for tendon repair and physeal-sparing ACL procedures for children whose growth plates are still open.
     

    Causes

    As more and more kids play organized sports, there’s been a rise in the incidence of OCD and other overuse injuries (microtraumas to bones, tendons, ligaments or muscles) among adolescents and children, largely from repetitively using the same parts of the body.

    Typical sports that can put teen athletes at risk for OCD of the knee are football, basketball, gymnastics, soccer and lacrosse. Sports that can increase the risk of OCD of the elbow are squash, tennis, baseball and weight-lifting.
     

    Signs and symptoms

    • a “popping” sensation in the joint
    • soreness, tenderness at the joint line
    • swelling or stiffness
    • difficulty straightening the joint fully
    • feeling like the joint is locking, “catching” or “giving way”
    • collection of fluid (“water on the knee”)
       

    When to seek medical advice

    OCD usually causes enough discomfort that an injured child will seek medical or parental help. Consult your child’s doctor if:

    • your child is in pain
    • his knee, elbow or another joint is swollen
    • walking and bending his knee are difficult
       

    Questions to ask your doctor

    You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

    You probably already have some ideas and questions on your mind, but it can be easy to forget what you wanted to ask when you’re talking to your child’s doctor. It’s often helpful to jot your questions down ahead of time to make sure that all your concerns get addressed. You may also suggest that your child write down questions to ask, too.

    Some of the questions you may want to ask include:

    • What has happened to my child’s knee (or elbow or another joint), and why?
    • Is this a serious injury? Will it do any permanent damage?
    • What tests will you perform to diagnose my child?
    • What actions might you take after you reach a diagnosis?
    • Will my child be OK if he has osteochondritis dissecans?
    • Will there be restrictions on my child’s activities? If so, for how long?
    • What should we do at home?
    • How can we help him understand that he needs to rest the injury?
       

    Who’s at risk

    At greatest risk are those young athletes whose sports involve high impact to a joint, such as:

    • football, basketball, gymnastics and basketball (knee)
    • tennis and baseball (elbow)
                                                                            

    Complications

    Complications after proper treatment for OCD are rare, but can occur and can include:

    • premature arthritis—chronic joint inflammation causing pain and joint degeneration
    • the need for further procedures
       

    If the condition goes untreated, complications such as a “locked” joint and premature arthritis can result.
     

    For teens

    Having osteochondritis dissecans as a teenager can seem especially tough. Many teens who have OCD are not only high-performing, determined athletes, but also high-performing, determined students. If you approach your healing period with that same spirit of determination, you should be back to sports and your active lifestyle within a few months, depending on how severe your injury was in the first place.

    The most important thing you can do to get back into sports is to give your knee or elbow a total rest. But even though you know the importance of resting your injury, you may still find this to be a tough time. If you feel frustrated, depressed or angry during this important time, speak to your doctor, parent or counselor—they’re all on your team, and they all want to help.

    Children’s Teen Advisory Committee

    To help teenagers take a more proactive role in their treatment and to have their needs recognized, Children’s developed the Teen Advisory Committee. The group—made up of current Children’s patients, ages 14 to 21—serves as a team of peers who can listen to other patients’ needs, ensure their voices are heard and advocate for change.
     

    For parents

    If your teen is like many young athletes who’ve sustained osteochondritis dissecans, he’s not only a high-performing, determined athlete—he’s also a high-performing, determined student. Encourage him to approach his recovery period with the same drive and spirit of determination that he applies to other areas of his life. With patience and perseverance, he’ll probably be back to sports and his active lifestyle within a few months.

    Even though you and your teen know the importance of resting his knee or elbow, you both might experience his healing period as a difficult time. Parents who identify with their children’s success can feel frustrated or depressed along with their children, so speak to your doctor or counselor if you need help.
     

    Prevention

    Our Sports Medicine specialists advise young athletes to:

    • warm up and stretch before practice
    • rest at least one day a week
    • cross-train/alternate sports: It’s usually unwise for a child or teen to specialize in just one sport. Multi-sport athletes tend to get fewer overuse injuries than those who specialize in just one sport.
    • alternate exercises during practice: An athlete less likely to experience an injury—and over the long term, his muscle memory actually improves—if he varies practice drills.
       

    Long-term outlook after surgery

    If your child has had surgery, his long-term outlook is very positive. Most patients who’ve had surgery for OCD can return to sports and regular activities without joint instability. (It is possible that your child’s doctor will recommend that he pursue sports that involve a lower level of impact.)
     

    OCD glossary

    • arthroscope: a thin, fiberoptic scope introduced into a joint for diagnostic and treatment procedures inside the joint; can be used for diagnosis or repair
    • bone remodeling: the absorption of bone tissue and the simultaneous depositing of new bone; a bone’s continuous self-renewal, self-healing and self-realignment, partially through reorientation of the growth plate. In kids, the bone’s remodeling capability is usually very good.
    • brace or cast: a custom-made protection worn around your child’s knee or elbow while it heals after surgery for osteochondritis dissecans
    • cartilage (cartilaginous): smooth, rubbery tissue that cushion the bones at the knee, elbow or another joint, between the vertebrae and in other areas; allows the bones to move easily without pain. The younger the child, the greater the amount of cartilage in the bones. Growth plates in kids’ bones are largely cartilage.
    • The Center for Families at Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
    • diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
    • elbow: the complex joint between the upper arm bone (humerus) and the forearm bones (radius and ulna)
    • knee: the largest and most complex joint in your child’s body, joining the thigh bone and shin bone and covered by the patella. It depends on four ligaments, as well as other muscles and tendons, to function properly.
    • lateral: side
    • laxity (in the knee): looseness, instability
    • ligament: elastic band of tissue connecting bone to bone
    • medial: inside
    • microtrauma: a small injury to the body, such as microtears to muscle fibers, stress to the tendon, bruising of the bone; can occur to bone, muscle, tendon or ligament. If not allowed rest in order to heal, microtraumas can lead to overuse injuries, such as osteochondritis dissecans.
    • MRI (magnetic resonance imaging): a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. For osteochondritis dissecans, an MRI can show whether the loose piece is still in place or whether it has moved into the joint space.
    • non-surgical (non-operative) treatments: alternatives to surgery; most treatments for overuse injury are non-surgical
    • orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
    • orthopedist/orthopedic surgeon: a physician concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
    • overuse injuries: sports-related microtraumas that result from repetitively using the same parts of the body, usually by overtraining; can occur to muscle, tendon, ligament or bone
    • physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities
    • post-operative (post-op): occurring after surgery
    • premature arthritis: inflammation of a child’s (knee) joint caused by trauma to the joint, as in osteochondritis dissecans; often accompanied by pain and swelling
    • pre-operative (pre-op): occurring before surgery
    • x-ray (radiograph): common, diagnostic radiology; shows the dense structures, including bones, inside your child’s body. X-rays are fast, non-invasive and easy to take, making them particularly useful for emergency diagnoses.

    For more orthopedic terms, see our Orthopedic glossary.

  • Tests

    At Boston Children's Hospital, we know that the first step to treating your child is forming an accurate, timely diagnosis.

    The exam

    To diagnose osteochondritis dissecans (OCD), your child’s orthopedic specialist will take a medical history and perform a physical exam on your child. The doctor will check for pain along the affected joint line.

    The Wilson Test. For OCD of the knee, your doctor will conduct what’s called the Wilson Test, in which your child’s knee is bent at a 90-degree angle, then turned inward so that the shinbone rotates toward the opposite leg. Your child will extend the affected leg to the point of pain. If osteochondritis dissecans is present, he’ll reach that point at about 30 degrees of flexion. If rotating your child’s foot back into its normal position facing forward alleviates the pain, then the test for osteochondritis dissecans is positive.

    To determine OCD of the elbow, ankle or another joint, your child’s doctor will perform similar specialized manipulations.
     

    The tests

    To confirm the diagnosis with detailed images of the injury, the doctor may also use:

    • x-rays:Typically, multiple x-ray views are taken to confirm and assess the extent of the injury; x-rays may also be taken of the same joint on the other limb as a basis for comparison.
       
    • MRI (magnetic resonance imaging): MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. An MRI can show whether the loose piece is still in place or whether it has moved into the joint space.
       
    • arthroscopy: Rarely needed to help assess OCD, arthroscopy is a minimally invasive outpatient procedure that inserts a small camera into the joint for the doctor to inspect.
       

    If the loose piece is stable, your child may be able to be treated non-surgically. If the loose piece is unstable, he may need surgery to remove or secure the piece.

  • 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 Boston Children's Orthopedic Center we are proud to offer patients comprehensive care—including evaluation, diagnosis, consultation, non-surgical therapies, surgery and follow-up care.
     

    Non-operative treatment

    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.
     

    Surgical repair

    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 echocardiogramto 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 Boston Children's Hospital, 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
    • accommodations
    • 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:

    • the oldest and largest comprehensive center for the care of spina bifida
    • one of the first scoliosis clinics in the nation
    • one of the first centers in the nation to use adjuvant chemotherapy and perform limb salvage surgery for patients with osteosarcoma
  • Research & Innovation

    For more than a century, orthopedic surgeons and investigators at Children’s Hospital Boston have played a vital role in the field of musculoskeletal research—pioneering approaches and major advances in the care and treatment of joint trauma, scoliosis, polio, TB, hip dysplasias and traumas to the hand and upper extremities.

    Our advanced research helps answer the most pressing questions in pediatric orthopedics today—providing the children we treat with the most innovative care available.

    Boston Children's research shows that too much high-impact training can lead to stress fractures in pre-teen and teen girls
    Today’s kids are urged to participate in sports at younger and younger ages and at greater levels of intensity. While weight-bearing activity is generally thought to increase bone density, a Children's study found that for preadolescent and adolescent girls, too much high-impact activity can lead to stress fractures.

    If stress fractures are detected too late in children and adolescent athletes, they pose a risk of true fracture, deformity or growth disturbance requiring surgical treatment, say the researchers, led by Alison Field, ScD, of Children's Division of Adolescent Medicine, and Mininder S. Kocher, MD, MPH, associate director of Sports Medicine at Children's.

    Their study, published online on April 4, 2011, by the Archives of Pediatric and Adolescent Medicine, followed 6,831 girls aged 9 to 15 participating in the large national Growing Up Today study, co-founded by Field. During the seven years after enrollment, 4 percent of the girls developed a stress fracture. The most significant predictors were high-impact activities—particularly running, basketball, cheerleading and gymnastics. Read more about this study.


    Sports Medicine Research Laboratory

    Children’s Sports Medicine Research Laboratory, led by principal investigator Martha M. Murray, MD, focuses on sports medicine injuries, including those of the ACL (anterior cruciate ligament), knee meniscus and articular cartilage. Murray’s research includes studying ways to stimulate self-healing in the ACL.

    In conjunction with our collaborators, we are studying these problems on multiple levels: gene, protein, cell, tissue and organism.

    Researchers at Children’s Sports Medicine Research Laboratory

    The lab’s research includes projects in:

    • molecular orthopedics
    • platelet optimization and characterization
    • tissue engineering
    • joint imaging
    • biomechanics of injury repair
    • histology and immunohistochemistry
    • device design and development
    • injury prevention
    • outcomes research


    The Orthopedic Center conducts research into:

    • the mechanisms of sports injuries
    • the techniques of rehabilitation and treatment
    • the physiology of exercise and conditioning
       

    Ongoing research includes the study of:

    • knee injuries
    • running injuries
    • injuries to pre-adolescent children
    • the psychological impact of sports and sports injuries
    • the treatment and prevention of injuries to dancers
       

    Sports Medicine Division director Lyle J. Micheli, MD, is one of the world's leading authorities on sports care. Micheli has treated world-renowned dancers and professional athletes, and is the author of hundreds of published clinical studies and scholarly review articles and books.
     

    Innovations for tendon and ligament treatment

    Platelet-rich plasma. For tendon repair, as with tennis elbow, the Orthopedic Center is now incorporating the latest in tendon regeneration—the application of platelet-rich plasma (PRP). This treatment has been popular in Europe—and now in the United States—for stimulating tissue regeneration in difficult-to-heal areas such as tendons (including Achilles, elbow and patella) that don’t respond to physical therapy or to limits on activity.

    There are normally many healing growth factors in our platelets. The process involves isolating these growth factors in the patient’s blood platelets, and then injecting them into the affected areas under ultrasound guidance. This special procedure is performed by Children’s Pierre d'Hemecourt, MD.

    Physeal sparing. A series of innovative, age-specific reconstruction techniques for treating the ACL injuries of growing children has been developed by Children’s orthopedic surgeon and director of the Division of Sports Medicine Lyle Micheli, MD. These are classified as physeal sparing procedures—that is, they spare the child’s growth plates (physes) from disruption that would occur in traditional ACL reconstructive surgery.

    These physeal sparing treatment techniques are customized to the growing child’s age: pre-pubescent, adolescent or older adolescent. Originally developed as a temporary procedure until a child reached skeletal maturity, follow-up studies have found that five years after their surgeries, 95 percent of children who’d had physeal sparing procedures were doing so well that they didn’t need ACL reconstructive surgery, after all.

    Children speak about what it's like to be a medical research subject

    View a video of a day in the life of Children’s Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science.

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
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