Osteochondritis Dissecans of the Knee

Osteochondritis dissecans (OCD) is a localized disorder of subchondral bone and the overlying articular cartilage characterized by softening of the articular cartilage, early articular cartilage separation, partial detachment of the articular lesion, and separation with loose body formation. Clinical signs and symptoms of OCD of the knee, the most commonly affected joint, include aching and activity-related pain localized to the anterior aspect of the knee. Diagnostic imaging studies, such as plain radiographs, magnetic resonance imaging, magnetic resonance arthrography and technetium bone scans, should be performed when appropriate to characterize the lesion in terms of size and location, and to determine whether it is stable, unstable, or a full-thickness defect with or without loose bodies. Treatment options depend on various factors, including the skeletal maturity of the patient and the severity of the OCD lesion. At our institution, we consider a 3-phase nonoperative management protocol (brief periods of immobilization, rehabilitation, gradual return to activity) for patients with wide-open physes. We reserve operative treatment for those patients with detached or unstable lesions, those approaching skeletal maturity, and those who have failed conservative treatment. Regardless of the surgical technique employed, it is important to realize that the successful treatment of OCD depends on a timely diagnosis.