Osteochondritis: what are the symptoms and how to treat it?
What is osteochondritis?
Osteochrondritis is an abnormality in the growth of bones and cartilage – the latter is a flexible tissue that acts as a “shock absorber” between the bone and the joint. ” In the event of osteochondritis, there is an interruption of the vascularization of the nuclei of ossification, where bone growth takes place, explains Dr. Alexandre di Iorio, orthopedic surgeon. This poor vascularization leads to a loss of contact between the bone and the cartilage: gradually, the cartilage is detached from the bone. ”
Osteochrondritis is a disease most commonly seen in “growing” children and adolescents. It can develop in many places on the body – the most common locations are:
- l’osteochondritis of the hip (also called “Legg-Calvé-Perthes disease” or “juvenile idiopathic aseptic osteonecrosis”). This pathology affects an average of four boys for a girl between the age of 3 and 10 years. It occurs when the head of the femur (the thigh bone that connects the pelvis to the knee) is no longer vascularized.
- l’osteochondritis of the knee (also called “osteochondritis of the femoral condyle”). Rare after the age of 25, osteochondritis of the knee is characterized by the progressive separation (then the rupture) of a fragment of cartilage and bone compared to the rest of the joint.
- l’osteochondritis of the elbow (also called “Panner’s disease”). Rather, it occurs before the age of 10, in children who play throwing sports (baseball, for example) and / or gymnastics on the floor.
What are the causes of osteochondritis? To date, unfortunately, no cause has been identified for osteochondritis. It is probably not a genetic disease or an infectious disease.
What are the symptoms of osteochondritis?
Osteochondritis is a painful disease: the pain is localized in the affected joint, and it worsens during movement, especially during sports activity – it is called mechanical pain. Thus, in case of Panner’s disease (osteochondritis of the elbow), epicondylar pain (in the elbow) is observed.
Other symptoms can be added to this mechanical pain:
- Swelling (edema) and redness (erythema),
- A reduction in the mobility of the joint: the patient has difficulty in flexing the knee, the elbow … We can even observe a joint blockage,
- Lameness in case of osteochondritis of the hip or knee.
How is osteochondritis diagnosed? The diagnosis of osteochondritis can be made by the general practitioner, the sports doctor, the orthopedic surgeon or even by the rheumatologist. It is based first of all on a clinical examination, then on additional medical imaging examinations: these are mainly x-rays, possibly supplemented by an MRI examination and / or a scanner.
Osteochondritis: what are the treatments?
To know. Certain osteochondrites have the particularity of healing spontaneously: this is particularly the case of osteochondritis of the hip (Legg-Calvé-Perthes disease) or osteochondritis of the elbow (Panner’s disease). For osteochondritis of the knee, there are 4 stages of severity which involve different treatment strategies:
- At stages 1 and 2, a “landfill” is enough: in short, the child / adolescent is asked not to lean on the affected leg – this may require the use of crutches or even a wheelchair. Sports rest is prescribed for several months. Pain is relieved with anti-inflammatory therapy (NSAIDs). Physiotherapy and / or osteopathy sessions can also be effective for rapid and complete healing.
- At stage 3, the articular fragment begins to separate from the joint: using a surgical operation (performed arthroscopically, that is to say under ultrasound of the joint cavity), it will be a matter of fixing it to using screws or micro-perforations.
- At stage 4, the articular fragment is freed in the joint: here again, the surgical operation is essential and consists in removing the cartilage which has detached – again under arthroscopy.
Thanks to Dr. Alexandre di Iorio, orthopedic surgeon at the Montagard Surgical Center in Avignon (ELSAN group).
Calot Institute – Hopale Foundation
Department of orthopedics and traumatology (Vaud University Hospital Center – CHUV)