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Osteochondrosis Dissecans

Information about Osteochondrosis Dissecans (OCD) and its management

This is a developmental disorder which is more commonly seen in large and giant breed dogs such as Rottweilers, Mastiffs and Labradors. Whilst any joint can be affected, we find it most often in the shoulder, stifle and hock joints.

​OCD occurs due to a disturbance in the blood supply to the cartilage bed​ of the joint surface during growth resulting in separation​ of a flap of cartilage from the underlying subchondral bone, ​which may become detached. It has been shown that rapid growth, nutrition ​and hormonal imbalances can increase the probability of development of an OCD lesion.

Diagnosis

OCD is usually diagnosed in juvenile patients often under a year of age. As the lesion can occur anywhere within the joint, severity of signs can be variable but typical ​presenting signs include lameness, stiff gait with joint swelling and pain on palpation.

Initially a clinical examination is performed which will localise the joint(s) affected. Radiographs are then taken under sedation or general anaesthesia of the affected and healthy contra-lateral (if applicable) joint. OCD lesions are usually seen on radiographs as an abnormal area of flattening​ of the joint surface with subchondral sclerosis. You may also see a ‘joint mouse’ if ​a calcified flap has detached completely. Occasionally CT may also be required.

Treatment

Typically the first approach would be arthroscopy, the OCD lesion excised and the subchondral bone debrided. On occasion the lesion is too large to remove arthroscopically and an arthrotomy is required.

​In large lesions resurfacing techniques can be considered. The two options available are Osteochondral Autograft Transplant ​System (OAT​S) ​ and Synacart, a synthetic plug to restore the integrity of the joint surface.

OATS uses a donor plug of cartilage and bone harvested from a non weight bearing portion of the joint that is transferred to the defect left by removal of the OCD lesion. Both of these systems have pros and cons, and their use will be discussed during the initial consultation.

Prognosis

​While removal of the OCD flap will lead to short term clinical improvement, in the long term degenerative joint disease will occur leading to osteoarthritis. Of the commonly affected joints, shoulder OCD has the best outlook, and return to full exercise is common. Unfortunately the outlook is not so good for stifle and hock OCD, with chronic joint problems likely. ​In these cases, maintenance of a lean body weight, exercise moderation and judicious use of supplements and anti inflammatory medications may be required to get the best results. In cases where these measures do not give an adequate quality of life, salvage procedures such as Total Knee Replacement or arthrodesis can be considered.