Osteochondritis Dissecans
Osteochondritis dissecans (OCD) is a condition where a segment of bone just under the joint cartilage loses blood supply and can potentially separate from the surrounding bone, most often affecting the knee, but also seen in the ankle and elbow. A medical evaluation with imaging stages the lesion, since treatment differs significantly between growing adolescents (whose bones can sometimes heal the lesion on their own) and adults.
Common Symptoms
- Activity-related joint pain, often vague or poorly localized at first
- Swelling after activity
- A catching, locking, or giving-way sensation if a fragment has become unstable
- Reduced range of motion in more advanced cases
Why It Happens
A segment of subchondral bone (just beneath the joint cartilage) loses adequate blood supply, which can be related to repetitive joint stress, minor trauma, or, in growing adolescents, is thought to relate to the growth process itself in a still-maturing joint.
Why It Can Become Persistent
Once a lesion has formed, ongoing joint loading with daily activity can prevent healing or, in some cases, cause a fragment to become unstable, which is why staging and monitoring matter for treatment planning.
Who Commonly Gets It
OCD most commonly affects active adolescents and young adults, particularly those involved in running and jumping sports, though it can occur in older adults too.
How It Is Usually Diagnosed
Diagnosis involves X-ray and MRI, which stages the lesion (stable vs. unstable, and whether the overlying cartilage is intact) — a central factor in deciding between conservative treatment and surgery.
Traditional Treatment Options
- Activity modification and protected weight-bearing: For stable lesions, particularly in adolescents with open growth plates, allowing time for potential natural healing.
- Physical therapy: Maintaining strength and motion during the healing period.
- Drilling or microfracture procedures: Surgical techniques to stimulate healing for lesions that don't heal with conservative care.
- Fragment fixation or cartilage restoration surgery: Reserved for unstable lesions or those that fail conservative treatment.
Why Someone Might Start Looking for Another Option
Because surgery for OCD carries real recovery demands, there's clinical interest in non-invasive options that might support healing of stable lesions, including shockwave therapy.
Where Shockwave Therapy May Fit
A case series of 40 patients (a mix of knee and ankle lesions, all adults) treated with a single high-energy shockwave session found resting pain resolved in essentially all patients, with MRI showing complete healing in 40% and partial improvement in 30% at 1 year — though about 1 in 10 patients showed no improvement, and knee lesions responded better than ankle lesions. We also found a case report of a 14-year-old athlete with bilateral knee OCD, originally slated for surgery, who instead achieved complete healing with shockwave therapy. It's worth knowing that no OCD treatment — conservative or surgical — has strong, Level-1 randomized evidence behind it; this is a genuinely difficult-to-study condition, and shockwave therapy's evidence base, while real, reflects that broader limitation.
How Shockwave Treatment Works for This Area
Shockwave therapy would only be considered for appropriately staged, stable lesions after evaluation and imaging, generally as an alternative to surgical drilling in select cases rather than for unstable lesions, which typically need surgery.
What the Treatment Feels Like
Most patients describe a firm tapping or pressure sensation around the affected joint; your provider will discuss what to expect.
What Happens During Your First Visit
Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.
New Patient Offer
New Patient Exam + First Treatment — $99
First treatment provided when clinically appropriate following your examination.
Who May Not Be Appropriate
- Unstable lesions or those with a loose fragment, which typically need surgical evaluation
- Anyone who has not yet had imaging to stage the lesion
- Active infection, open wounds, or certain bone conditions at the treatment site
- Growing children and adolescents should be evaluated by a pediatric orthopedic specialist, given the unique considerations of a still-maturing skeleton
This list is not exhaustive. Your provider will screen for contraindications during your evaluation.
Frequently Asked Questions
No — even the best case series found about 1 in 10 patients saw no improvement, and no OCD treatment has strong randomized evidence behind it. It's a reasonable option to discuss for appropriately staged, stable lesions, not a guaranteed fix.
Growing adolescents are a distinct population where lesions can sometimes heal on their own with activity modification, and treatment decisions should be guided by a pediatric orthopedic specialist rather than assumed from adult-focused research.
What Research Says
Selected sources relevant to osteochondritis dissecans. See the full Research Center for our complete source registry and methodology.
International Journal of Surgery · 2015 · Thiele, Thiele, Gerdesmeyer
This case series of 40 patients (29 knees, 11 ankles) with osteochondritis dissecans found resting pain resolved in every patient after a single high-energy shockwave session, swelling dropped substantially, and MRI at 1 year showed complete recovery in 40% and partial defect regression in another 30%.
Limitations: No control group — no Level-1 evidence exists for any osteochondritis dissecans treatment — about 10% of patients showed no improvement at all, knee outcomes were better than ankle outcomes, and there's no follow-up data beyond 12 months.
Musculoskeletal Surgery · 2009 · Moretti, Notarnicola, Moretti, Giordano, Patella
This case report describes a 14-year-old volleyball player with bilateral knee osteochondritis dissecans who was slated for surgery but instead achieved complete healing with shockwave therapy; the authors suggest it as a pre-surgical conservative option.
Limitations: A single case with no control group — this can't be generalized to predict outcomes for other patients.
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First treatment provided when clinically appropriate following your examination.