Osteochondrosis is seen by clinicians working within paediatric and musculoskeletal clinics.
What is it?
Osteochondrosis can affect the growth plates in children in the upper or lower limbs or the spine.
Degeneration or necrosis of the growth area of the bone can result from abnormal growth, injury or overuse of the developing growth plate. This can happen due to genetics, repetitive trauma, vascular abnormalities, abnormal mechanical forces or hormone imbalances.
Boys are more likely to be affected than girls because they are more likely to have an accident or an overuse injuries. It’s more common in children aged 2–18 or until skeletal maturity occurs.
Diagnosis
X-ray imaging can show the affected bone fragmentation, flattening of articular surfaces and sclerosis depending on the stage of the disease.
Symptoms
Painful swellings, inflammation, tenderness, limping, difficulty walking, playing sports or exercising, foot pain and referred knee pain can sometimes be seen in Perthe’s disease.
Osteochondrosis in the lower limbs
Perthe’s disease is avascular necrosis of the femoral epiphysis, primarily seen in children aged 4-8 years old. Possible reasons include birth problems such as low weight, abnormal presentation, number of previous children, family history and lower socio-economic status. Treatment is to maintain a good femoroacetabular contact and round femoral head – but the condition may lead to hip-replacements in later life.
Osteochondritis Dissecans – not a true osteochondrosis, more of an inflammation of the bone and overlying articular cartilage which causes joint catching and locking. It affects the lateral femoral condyle of the knee and the dome of the talus and may not respond to conventional treatments without surgery.
Osgood Schlatter’s disease affects the Tibial tuberosity where the patella tendon inserts. A repetitive micro-trauma on the tibial tuberosity gives anterior knee pain. It affects children aged 10-14 years with a higher incidence in sporty or athletic children. The pain is exacerbated by jumping and direct pressure when kneeling. Treatment is to modify activity, give NSAIDs, plus stretching and strengthening exercises to improve flexibility of the hamstrings, quadriceps, gastrocnemius and soleus.
Sidings-Larson Johansson’s disease affects the patella on the proximal edge where the Patella tendon inserts into the inferior pole. This also gives anterior knee pain and can be misdiagnosed or confused with Osgood Schlatter’s disease. Seen in children aged 10-14 years and children with cerebral palsy. Treatment requires activity modification and exercises to increase flexibility.
Sever’s disease causes tenderness and swelling to be seen where the Achilles tendon inserts into the apophysis of the calcaneal. Usually seen in young athletes who run and play football and symptoms are often exacerbated at the start of a sports season, after a growth spurt and with the wearing of studded footwear like football boots. Treatment includes shoe modifications, padded heel cups, silicone gel heel, Achilles protectors, silicone heel cups and exercises to increase flexibility.
Kohler’s disease, or avascular necrosis of the navicular, affects children between 2-8 years old. There is no history of trauma and, if there is, then an orthopaedic opinion should be sought. On X-ray, the navicular appears wafer thin. Patients may benefit from a below-knee cast for 8 weeks.
Frieberg’s disease, or avascular necrosis of the second metatarsal head, affects adolescent girls more than boys. X-rays show in the early stages cystic lesions and a widening of the metatarophalagneal joint. Treatment is Metatarsal pads – silicone, poron, padded or cushioning footwear and it’s important to modify activities.
Differential Diagnosis
Several conditions mimic or have similar symptoms to Osteochondrosis. These include:
Traumatic conditions – fractures or stress fractures.
Inflammation conditions – Juvenile Rheumatoid Arthritis, Infrapatellar bursitis, Achilles tendonitis or plantar fasciitis.
Infections – osteomyelitis or septic arthritis
Medical conditions – Sickle cell anaemia, leukaemia, tumours, haemophilia or epiphyseal dysplasia.
Treatment
Conventional treatment is successful in the majority of cases but may require orthopaedic surgery or paediatric specialist input if the symptoms occur or continue post-skeletal maturity. Conditions which may need earlier intervention from an orthopaedic team include: Perthe’s disease or Kohler’s disease.