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L'osteochondrosisalso known as osteochondritisIt consists of a lesion of bone and cartilage usually in the joint area, which can also lead, in some cases, to its fragmentation and the creation of a free osteocartilaginous body.  

It is a skeletal disorder with a necrotic-degenerative characteristic that affects the cartilaginous growth nuclei of the bony epiphyses and apophyses and the cartilages, especially during the growth period [1]. It is therefore a much more frequent pathology in adolescents than in adults, although it can also be found frequently in sportsmen, who are more prone to repeated trauma.

Let's find out more together what this is all about!

Osteochondrosis: diagnosis

As we said, the pathology manifests itself more in subjects between the ages of 10 and 20, with a greater frequency in males or, more generally, in young sportsmen. One can therefore more generally speak of juvenile osteochondrosis [2].

It mainly affects cartilaginous joints and can occur in various areas of the body, which we will analyse in more detail below. Osteochondritis is diagnosed through a clinical examination and instrumental tests.

In theexamination clinical we can find again:

• pain;
• swelling (called hydrarth);
• limitations of joint mobility.

 The instrumental examinations referred to instead are:

• X-ray: can reveal a lesion in the bone, even determining the presence of a fragment. However, it cannot determine its stability and exact size. [7]
• Magnetic resonance imaging: this is the most reliable examination and allows a more careful and accurate assessment of the clinical picture. [2] [7]
• CT scan: of lesser use than MRI due to high radiation exposure, but still extremely reliable. [7]

Now let's analyse the areas most likely to be affected!

Vertebral osteochondrosis

Osteochondrosis can occur at various vertebral levels. Recent studies have shown that cervical osteochondritis and lumbar osteochondritis occur more frequently in adults than in adolescents and that they are closely related to work activities.

In subjects with sedentary jobs, osteochondrosis occurs more frequently at the cervical level, while in subjects with manual jobs osteochondrosis occurs more frequently at the lumbar level.

Due to the close proximity between the vertebrae and spinal cord, osteochondritis at these levels could also lead to peripheral neurological problems [3].

The most frequent symptom of intervertebral osteochondrosis is pain.

Juvenile vertebral osteochondrosis

Also known as Scheuermann's disease, the most frequent location of juvenile vertebral osteochondrosis in adolescents is dorsal.

Generally painless, it manifests as a progressive curving of the back, with accentuation of the physiological kyphosis.

Hip osteochondrosis

Osteochondritis, at the level of the hip, is called Perthes' disease. The degeneration affects the proximal epiphysis of the femur.

It manifests itself between the ages of 3 and 12 years and affects more males. The most frequent symptoms are pain, which can often also radiate to the knee, limitation in movements such as internal rotation and hip abduction, muscle atrophy, dysmetria in the lower limbs and changes in gait. [5]

Age at the time of diagnosis is the most reliable prognostic criterion: in patients under 5 years of age, the prognosis is good; if, on the other hand, the patient is older than 10 years at the time of diagnosis of osteochondrosis, bone deformities may be more likely to occur, with early evolution towards arthritic phenomena of the hip. [1]

Osteochondrosis knee

Osteochondrosis at this level manifests itself more at the level of the medial condyle of the femur [4], as well as at the level of the tibia (in this case we speak of Osgood-Schlatter disease).

It manifests itself with local swelling, pain on palpation and during movement.

In these cases, fragmentation of a bone segment also often occurs.  

Osteochondrosis ankle and foot

Very frequently, the bone that is most affected in the ankle by osteochondritis is the talus. Its injury is often associated with repeated trauma to the foot, as can often occur in sportsmen.

Pain occurs with loading and may be associated with joint limitations, swelling, and sensations of locking. [6]

In the foot, the 2nd and 3rd metatarsals, the navicular bone or the calcaneus may often be involved. In the latter case, pain is usually located in the calcaneal area and often occurs after and/or during activity. [1]

If it is the navicular bone, located on the inside of the foot, that is affected by osteochondritis, we speak of Kohler's disease, which usually affects children between 3 and 5 years of age. The foot is swollen and painful, but usually resolves spontaneously within two years.

Osteochondrosis dissecans

When the cracks that are created in the bone extend from the area of injury to the articular cartilage, a fragment of cartilage or/and bone can be created. In this particular case, we speak of osteochondritis dissecans.

The osteocartilaginous fragment clearly demarcates from the surrounding tissue until it detaches and falls free into the joint. [1]

The pain, in this case, is very present and is accompanied by recurring hydrates and muscular hypotrophy. With the detachment of the fragment, real episodes of 'blockage' of the joint can occur with inability to flex and extend the leg.

This situation can occur at any site affected by osteochondrosis and its presence greatly complicates prognosis and treatment, so surgery for removal may also be necessary.

Osteochondrosis: causes

Various hypotheses are presented in the various studies, but there is still no certainty as to why osteochondritis occurs.

Although the nomenclature implies the presence of an underlying inflammatory process (osteochondritis) there is little evidence to confirm this. Therefore, to date, the most commonly used term is osteochondrosis. [7]

Among the most accredited hypotheses, we certainly find that vascular. It is hypothesised that there may be a process of hypovascularisation and subsequently necrosis (cell death) at the level of bone and/or cartilage, whereby the tissues no longer receive the necessary nourishment resulting in a deficit of the bone growth centre. [7]

 This hypothesis relates to and may be the basis for a more mechanics according to which repeated trauma or microtrauma, as can occur in sportsmen and women, can cause bone and cartilage damage resulting in osteochondrosis. [7]

Many studies are also investigating the presence of factors genetic o endocrinesuch as vitamin D deficiency, especially in cases of juvenile osteochondrosis. [8]

Osteochondrosis: symptoms

As previously mentioned, the most frequent way in which osteochondritis manifests itself is through pain, swelling and limitation of movement, which will obviously vary depending on the district affected. If left untreated, over time it could lead to the onset of early arthritic processes.

Involvement of the lower limb may cause alterations in walking.

If the affected person is a sportsman, the sporting activity practised may be difficult to perform.

Osteochondrosis: treatment

In spite of all that has been said so far, don't worry, osteochondrosis usually tends to regress spontaneously, especially in adolescence!

Obviously, each clinical case must be evaluated individually and it is good practice to intervene in order to be able to reduce symptoms or avoid complications in the most severe cases.

Let us now take a look at the various treatments possible in cases of osteochondritis.

In stable lesions, it is preferable to proceed with treatment conservativeThis usually consists of a reduction in the load and, consequently, in the case of sportsmen and women, a reduction in the intensity and frequency with which the activity is carried out. This is accompanied by a correct physiotherapeutic intervention which, depending on the district affected, will ensure a gradual re-exposure to the load and activities, trying to encourage normal vascularisation, thus reducing pain. [9] To this, one can add the use of anti-inflammatories or analgesics for the management of pain symptoms. [6]

In cases where osteochondritis has caused the presence of a bone fragment, a approach surgicalwhich involves its removal or fixation, depending on the age and staging of the osteochondrosis.

Conclusion

Osteochondrosis is a complex pathology that, although it can regress spontaneously, requires specialist orthopaedic and physiotherapeutic evaluation in every case.

Each case will have to be assessed individually and appropriate treatment formulated for a normal return to activities.

A specialised team will certainly be able to help you!

Bibliography

1. Morlacchi, C., Mancini, A., (2006). Orthopaedic Clinic: Manual - Atlas
2. Grimm, N. L., Weiss, J. M., Kessler, J. I., & Aoki, S. K. (2014). Osteochondritis dissecans of the knee: Pathoanatomy, epidemiology, and diagnosis. Clinics in Sports Medicine, 33(2), 181-188. https://doi.org/10.1016/j.csm.2013.11.006
3. Motina, A. N., Astaschenko, Y. A., Masaleva, I. O., & Tretyakova, E. E. (2020). [The social hygienic characteristics of patients with osteochondrosis of spine]. Problemy Sotsial'noi Gigieny, Zdravookhraneniia I Istorii Meditsiny, 28(3), 396–399. https://doi.org/10.32687/0869-866X-2020-28-3-396-399
4. Bauer, K. L. (2018). Osteochondral Injuries of the Knee in Paediatric Patients. The Journal of Knee Surgery, 31(5), 382-391. https://doi.org/10.1055/s-0038-1625956
5. Mills, S., & Burroughs, K. E. (2022). Legg Calve Perthes Disease. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK513230/
6. Badekas, T., Takvorian, M., & Souras, N. (2013). Treatment principles for osteochondral lesions in foot and ankle. International Orthopaedics, 37(9), 1697-1706. https://doi.org/10.1007/s00264-013-2076-1
7. Chau, M. M., Klimstra, M. A., Wise, K. L., Ellermann, J. M., Tóth, F., Carlson, C. S., Nelson, B. J., & Tompkins, M. A. (2021). Osteochondritis Dissecans. The Journal of bone and joint surgery. American volume, 103(12), 1132-1151. https://doi.org/10.2106/JBJS.20.01399
8. Maier, G. S., Lazovic, D., Maus, U., Roth, K. E., Horas, K., & Seeger, J. B. (2019). Vitamin D Deficiency: The Missing Etiological Factor in the Development of Juvenile Osteochondrosis Dissecans? Journal of Paediatric Orthopedics, 39(1), 51-54. https://doi.org/10.1097/BPO.0000000000000921
9. Bobunov, D. N., Ovasapyan, E. D., Matveeva, D. V., Iordanishvili, A. K., Senyukov, A. V., & Shagalin, D. V. (2022). [Physical rehabilitation for osteochondrosis of the cervical and thoracic spine in elderly and senile people (Stage 2).]. Advances in Gerontology = Uspekhi Gerontologii, 35(1), 126-133

Dr Raffaella Loporchio.

Physiotherapist graduated from the University of Foggia with top marks. I am currently attending the Master of Advanced Studies in neuromusculoskeletal physiotherapy at SUPSI University in Switzerland and am continuing my training with various refresher courses in the musculoskeletal field.
I deal with disorders of the musculoskeletal system and re-education and reintegration into activity in professional athletes.
I am currently self-employed at my practice in Bari.