Few things are more upsetting for a young, competitive athlete than being sidelined from the game. They miss out on playing the sport they love, and they miss out on developing deeper team camaraderie.

For kids diagnosed with osteochondritis dissecans (OCD) in their knee or elbow, that's exactly what happens. This condition causes their cartilage and a thin layer of bone to separate from the underlying bone.

Diagnosing OCD is difficult, however. And if left untreated, it can have life-long consequences. As a result, Cincinnati Children’s Orthopaedics Sports Center is dedicated to improving detection and treatment methods. The goal is to get kids back in the game as quickly—and as healthily—as possible.

“Osteochondritis dissecans is a condition of frustration,” says Eric Wall, MD, director of orthopaedic sports medicine. “It frustrates patients because all they want is to get back to sports.”

A Rare, But Serious, Condition

Unlike sprains, strains and fractures, OCD is uncommon. It impacts fewer than 30 out of every 100,000 children, and it most often occurs in kids between ages 10 and 15. The majority—up to 60%—are regularly involved with sports that involve repetitive stress and impact on the joints, such as basketball, gymnastics or soccer.

According to experts, the frequent activity-related pivoting, vaulting and impact is likely to blame for OCD’s development.

“Kids are forming new bone all the time, but the continuous pounding can take its toll,” Wall says. “They’re young, so think of their bone as a newly planted lawn that isn’t ready to be walked on yet. These are high-intensity kids, and they keep walking on the new grass. We believe that constant stress impedes the growth of new bone under the cartilage.”

Over time, this condition leads to cartilage damage in the knee or elbow joints. Some pieces of loose bone and cartilage also may break way and float freely in the joint, causing it to pop, slip or lock. In the long term, patients can develop early onset of arthritis.

A Difficult Diagnosis

Diagnosing OCD is tricky. Vague pain is the main symptom, but the discomfort typically isn’t bad enough to pull a player from the game. Most patients don’t seek treatment for roughly 13 months, Wall says. And even when they see a doctor, proper identification is difficult.

“This is a serious condition that can be camouflaged among mild overuse syndromes, such as patellofemoral syndrome, patellar tendonitis or jumper’s knee, or Osgood-Schlatter disease,” he says. “Those are common repetitive stress conditions that kids are going to outgrow. OCD is something they don’t outgrow.”

Orthopaedists rely on X-rays and MRI scans to reveal the characteristic cartilage and bone damage needed for diagnosis. Improvements in image quality have made it easier for providers to detect these problems and initiate treatment earlier.

“If we catch OCD relatively early, the child’s bone will regrow with just simple rest,” Wall says. “But without therapy, the cartilage cracks and wears away. And then there’s a point of no return where the bone may just not heal.”

Roughly two-thirds of patients respond well to rest, physical therapy and braces. But full recovery can take up to a year. If a patient is nearing bone maturity or if their imaging scans show cracks in the cartilage, providers skip non-operative therapies and recommend surgery. Still, there’s currently little agreement or understanding around which treatment options work best for which patients.

Collaborating to Improve Treatment

Providers only diagnose approximately 5,000 new cases of OCD in the United States each year. Consequently, determining the best therapies requires multi-institutional collaboration, Wall says.

As a founding member of the 26-center Research in OsteoChondritis of the Knee (ROCK), organization, Cincinnati Children’s has been a leader in this effort. For the past decade, this group of hospitals and health systems has worked together on prospective studies that follow outcomes for about 2,000 patients based on the type of therapy they received.

ROCK researchers have created a database of patient surveys and imaging results to help determine how well patients respond to specific treatments. Orthopaedists, radiologists and physical therapists at Cincinnati Children’s all contribute to these investigations, and they plan to follow patients for 25 years. As incoming ROCK president, Wall says the ultimate intent is to gain a better understanding of OCD and build a better playbook for treating each patient.

“We’re hoping these results will lead us to quicker diagnosis and more targeted treatments,” he says. “Right now, we can completely cure around 25% of cases. Our goal is getting as close to 100% cured as possible. We want these children to have an absolutely normal X-rays or MRI at the end of treatment that reveals two knees that look alike and healthy.”