in partnership with
Jean-Marie Philippeau (orthopedic surgeon and traumatologist)
Osteochondritis is a relatively rare painful joint disorder that primarily affects growing children. The joints most commonly affected by osteochondritis are the hip and knee, but all of them can be affected. Update with Dr. Jean-Marie Philippeau, orthopedic surgeon and traumatologist at the Santé Atlantique clinic in Saint-Herblain (Loire-Atlantique).
What is osteochondritis?
Osteochondritis is a bone disease characterized by the separation of a fragment of bone from the cartilage on the surface of a joint. Total or partial, osteochondritis occurs gradually, spontaneously and without trauma, says Dr. Philippeau. Osteochondritis can affect all joints, but the most common are:
- Osteochondritis of the hip : also called Legg-Calvé-Perthes disease Where Juvenile idiopathic aseptic osteonecrosisrather it affects small children between the ages of 3 and 10, and especially young people;
- Knee osteochondritis Often called dissection, it often occurs during the growth phase in children, adolescents and young adults, and affects boys and girls alike;
- osteochondritis of the elbowWhere Panner’s diseaseit tends to appear before the age of 10.
What are the causes of osteochondritis?
“The pathophysiology of osteochondritis is unclearsays Doctor Philippeau. Often labeled as a growth disorder, osteochondritis is likely due to a disturbance in the vascularity of the bone tissue associated with a problem of overpressure on the joints in question..
What are the symptoms of osteochondritis?
The first and main symptom of osteochondritis is pain in the affected joint; worsens with movement and in particular the practice of a sport that stresses this joint.
Other symptoms testify to osteochondritis, such as swelling of the joint, stiffness linked to a reduction in its mobility that can go as far as stopping and leading to lameness when it affects the hip or knee.
The diagnosis of osteochondritis can be made by the attending physician, a sports doctor, a rheumatologist or an orthopedic surgeon. It is based both on a clinical examination during which the doctor strives to eliminate other potential causes of pain (such as traumatic pathology, ossification abnormalities, or patellar syndrome) and on imaging tests, explains Dr. Phillipeau. “An x-ray will allow you to suspect or see the fragment of bone that has detached from the joint. If the x-ray confirms the suspicion of osteochondritis, it is completed by carrying out an examination of the cartilage, an MRI or a CT scan, in order to determine the degree of instability of the lesion and to verify if factors of vitality of the bone fragment persist. Ideally, for an even more precise diagnosis, we will prescribe an arthro-MRI, which is an MRI preceded by the injection of a contrast medium into the joint.
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Although quite rare, spontaneous healing is possible: this is more the case in osteochondritis of the hip (Legg-Calvé-Perthes disease) or elbow (Panner’s disease) than in osteochondritis of the knee. Treatment of the latter depends on the degree of instability of the lesion:
- If the cartilage is “closed” and the fragment is stable, simple careful monitoring accompanied by “discharge” is required. The young patient must suspend any sporting activity for several months and be careful not to lean on the sore knee, even at the cost of using crutches or, if necessary, even a wheelchair. “No pharmacological treatment is indicated in the treatment of osteochondritis “emphasizes Dr. Philippeau;
- The use of surgery is recommended in the later stages. “Bone fragments that are unstable but still in place can be reattached to the bone surface from which they detached. Before that, we light up their surface and take a bone and cartilage core to bring back the bone cells and promote healing., details the specialist. “If fixation and healing are not possible, the fragment blocking the joint is removed and the bone and cartilage are reformed by the patient’s own stem cells or tissue, which is grafted at the wound. However, this type of surgery is quite rare and depends on the size and depth of the lesion.
Any surgery for osteochondritis is performed on an outpatient basis (the patient goes to the hospital in the morning and leaves the same evening), under arthroscopy. “He will need to be immobilized for about 1 month and will be able to resume physical activity after about 1 year, provided that the control artroscan confirms good bone and cartilage healing. After one or two years, a new operation, arthroscopically, will have to be performed to remove the fixation material..