Osteochondritis Dissecans

Your child will see caregivers who are part of Orthopedics and Sports Medicine, a team of pediatricians, pediatric orthopedic surgeons, nurse practitioners, physician assistants, nurses, athletic trainers, certified medical assistants, registered orthopedic technologists and sports physical therapists. We have the knowledge and experience to give your child expert care, from nonsurgical therapy, to complex surgery, to rehabilitation.

All our caregivers also have special training in the emotional and social needs of young people.

Kids are still growing well into their teens. Their bodies can be damaged in ways that an adult body can’t. At Seattle Children’s, we specialize in treating injuries to the bones and joints of children and teenagers who are still growing.

We understand that in treating any joint problem, doctors must take into account the stage of your child’s growth plates. These are the areas of growing tissue near the end of each long bone. They determine the size and shape of your child’s bones once your child is grown up.

Growing children have a better chance of healing from osteochondritis dissecans without surgery than those who have finished growing. We are extremely careful to monitor your child’s growth to make sure that they have the best chance of healing.

Seattle Children’s has the largest group of board-certified pediatric radiologists in the Northwest. We keep your child’s safety in mind at all times. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image.

We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.

When you and your child come to our clinic, we ask about pain:

• How bad is it?
• When did it begin?
• How has it affected your child’s activities?

After asking about pain, the doctor will examine your child’s joint. We may take a radiograph. This helps us see if the joint surface appears rough or if a fragment of bone seems to be separating.

We may ask your child to have an MRI (magnetic resonance imaging) scan. This lets us look at the cartilage on the surface of the joint and check for fluid between the bone and cartilage. Both can slow healing.

The doctor also may ask for a bone scan to see whether your child’s body is trying to heal the osteochondritis dissecans.

All of these imaging tests can help doctors, patients and their families decide on the best treatment.

Many growing children can heal from osteochondritis dissecans without surgery. For these children, we offer physical therapy programs designed to keep their muscles strong while protecting their joints. Our therapists teach your child exercises to help keep them strong while they are healing.

Often, it takes between 6 and 18 months for children to heal. During that time, we offer rehabilitation services in our on-site sports lab.

If your child needs more treatment, we may provide a nonsurgical therapy called “unloader bracing.” In this treatment, your child wears a brace to push the knee into a position that decreases the stresses on the osteochondritis dissecans.

Our orthotics team specializes in fitting children of all sizes and ages.

If your child needs surgery, we often begin treatment with procedures that use special tools called arthroscopes. Arthroscopes can reach the joint through very small cuts (incisions). Using arthroscopy (PDF), doctors insert a tiny camera through the incision. The camera is attached to a video monitor, like a television. The doctor uses the monitor to see inside the knee.

Then doctors punch tiny holes in the bone near the spot where the cartilage and bone have separated. As the bone heals, it forms cells that have the potential to make new cartilage (scar cartilage). These procedures are called arthroscopic drilling and microfracture operations.

Arthroscopy allows doctors to get to the joint without opening it up. This means your child may:

• Recover faster
• Have fewer problems after surgery
• Have less pain and stiffness during recovery

In more persistent cases of osteochondritis dissecans, doctors can transplant bone or cartilage to your child’s knee to help in healing. In this procedure, we either use:

• Plugs of bone topped with cartilage from your child’s knee
• Plugs from a similarly shaped knee donated to the bone bank, the Northwest Tissue Center