Juvenile osteochondritis dissecans (JOCD)
Juvenile osteochondritis dissecans (JOCD) is a disorder which occurs in young people whose growth plates haven't closed yet. A joint is where two bones come together. Normal hard bone is covered with a softer form of bone called cartilage at the joint surface. With JOCD, there is a loosening of a piece of bone and the cartilage that covers it. Sometimes these pieces can come loose and float around inside the joint. This condition can occur at many different joints including the knee, elbow, and ankle. JOCD usually occurs in active children and young adolescents. Most children with JOCD do very well in the long-term. However, JOCD can lead to early arthritis.
How it occurs
No one knows exactly why JOCD occurs. We know that is more likely to occur in young people who are very active. The condition is likely due, in part, to multiple minor injuries or trauma to the affected area.
Signs and symptoms
Your child may complain of pain that gets worse with activity and improves with rest. He or she may also complain that the joint “locks” or “gets stuck” from time to time. Sometimes the affected joint can become swollen. Your child may be unable to fully bend or straighten his knee.
Diagnosis
Your doctor will carefully examine the affected joint. X-rays may show small pieces of bone which have separated. An MRI (magnetic resonance imaging test) may also be necessary for further evaluation.
Treatment
Treatment depends on many factors. Most children with JOCD are treated conservatively at first, with a long period of rest from physical activities. Your physician will often recommend bracing or casting during this rest period. The length of time away from activities depends on your child's symptoms and how the follow up x-rays look. If a large part of the joint is affected, if pieces of bone and cartilage have come loose, or the problem is not getting better with rest, your physician may recommend surgery.
Returning to sports and activities
Unfortunately, JOCD often requires a long period of rest from sports to allow for healing. The time until return-to-sports is different for each child. Your physician will provide you with guidelines about gradual return to activities after treatment.