Osteochondritis Dissecans

Etiology
Clinical Findings
Diagnosis
Treatment
For complete discussion of equine osteochondrosis, see Osteochondrosis .
In osteochondritis dissecans (OCD), a focal area of the immature articular cartilage is
retained, and the matrix in the basal area of this region becomes chondromalacic and
acellular. The immature articular cartilage separates from the underlying trabecular
bone. The chondral fracture extends horizontally and vertically until a flap is formed.
Synovial fluid gains entrance to the underlying medullary space, and subchondral cysts
may form (usually only in larger animals). The flap of immature articular cartilage may
break away completely (joint mice) or may reattach by endochondral ossification to
the underlying bone, especially in pigs, and result in a wrinkled articular surface. The
latter occurs only if the joint is rested or protected, which permits reestablishment of the
circulation necessary for endochondral ossification. If the flap is torn free by joint
motion, it may be ground into smaller pieces during locomotion and disappear, while the
larger plaques may become attached to the synovial membrane, become vascularized,
and ossify. The resultant articular defect, in time, fills with fibrocartilage.

Etiology:
The exact cause is unknown but is assumed to be multifactorial. Factors include genetic
predisposition, fast growth, high caloric intake, low copper and high zinc levels, and
endocrine factors.

Clinical Findings:
The most common sites of OCD, which usually is seen in young animals, are the
femoropatellar joint, tibiotarsal (tarsocrural) joint, fetlock (metacarpophalangeal and
metatarsophalangeal) joints, and the shoulder.
Animals with OCD of the shoulder usually present when <1 yr old with severe forelimb
lameness and possibly some muscular atrophy. Animals with osteochondrosis in the
other joints usually present with synovial effusion and varying degrees of lameness.
Diagnosis is confirmed with radiographs.

Diagnosis:
The history, age, breed, sex, and clinical signs provide useful information; however,

radiographs are required to substantiate the diagnosis.

Treatment:
The treatment of OCD depends on the location and degree of involvement.
Femoropatellar joint lesions are associated with the lateral trochlear ridge of the femur,
medial trochlear ridge of the femur, or distal patella. They are amenable to arthroscopic
surgery, which is recommended in all cases except early lesions characterized by
flattening (without fragmentation) <2 cm long on the lateral trochlear ridge. In the
tarsocrural joint, OCD lesions are seen in decreasing frequency on the intermediate
(sagittal) ridge of the tibia, lateral trochlear ridge of the talus, medial malleolus of the
tibia, and medial trochlear ridge of the talus. All lesions are amenable to arthroscopic
surgery, and the prognosis is usually good. Surgery is recommended when synovial
effusion is present. Lesions without fragmentation in the metacarpophalangeal or
metatarsophalangeal joints can be treated conservatively, and most affected animals
recover well. If a fragment is present, arthroscopic surgery is recommended. In the
shoulder, surgery is always recommended, but the prognosis is less favorable than in the
other joints.