Osteochondritis dissecans (OCD)

At Children’s Hospital Boston, we know that the first step to treating your child is forming an accurate, timely diagnosis.

The exam

To diagnose osteochondritis dissecans (OCD), your child’s orthopedic specialist will take a medical history and perform a physical exam on your child. The doctor will check for pain along the affected joint line.

The Wilson Test. For OCD of the knee, your doctor will conduct what’s called the Wilson Test, in which your child’s knee is bent at a 90-degree angle, then turned inward so that the shinbone rotates toward the opposite leg. Your child will extend the affected leg to the point of pain. If osteochondritis dissecans is present, he’ll reach that point at about 30 degrees of flexion. If rotating your child’s foot back into its normal position facing forward alleviates the pain, then the test for osteochondritis dissecans is positive.

To determine OCD of the elbow, ankle or another joint, your child’s doctor will perform similar specialized manipulations.
 

The tests

To confirm the diagnosis with detailed images of the injury, the doctor may also use:

• x-rays:Typically, multiple x-ray views are taken to confirm and assess the extent of the injury; x-rays may also be taken of the same joint on the other limb as a basis for comparison.
   
• MRI (magnetic resonance imaging): MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. An MRI can show whether the loose piece is still in place or whether it has moved into the joint space.
   
• arthroscopy: Rarely needed to help assess OCD, arthroscopy is a minimally invasive outpatient procedure that inserts a small camera into the joint for the doctor to inspect.
   

If the loose piece is stable, your child may be able to be treated non-surgically. If the loose piece is unstable, he may need surgery to remove or secure the piece.

Our Orthopedic Clinical Effectiveness Research Center (CERC)

The Orthopedic Clinical Effectiveness Research Center (CERC) was established by Children’s Orthopedic Center to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and is playing an instrumental role in establishing, for the first time, evidence-based standards of care for pediatric orthopedic patients throughout the world.