Osteochondritis Dissecans of the Knee

Abstract

Osteochondritis dissecans (OCD) is a common pathological condition of the knee currently recognized as an acquired, usually idiopathic, focal lesion of the subchondral bone. With disease progression, the overlying articular cartilage may develop softening, edema, early separation from the surrounding cartilage, partial detachment, or complete osteochondral separation with loose body formation. Despite a long-standing awareness of this condition, the pathogenesis and ideal management of OCD remains poorly understood. OCD of the knee requires a timely diagnosis to prevent compromise of the articular cartilage and to maximize the opportunity to perform a restorative procedure. Children and adolescents are more commonly affected by OCD lesions, better known as juvenile OCD. In juvenile, stable forms of OCD, the majority of patients can achieve a good outcome with non-operative management. Indications for surgical treatment are based on lesion stability, physeal closure, and clinical symptoms. Reconstitution of the articular surface, improved vascularity, rigid fixation, and early motion are primary tenets for osteochondral fragment preservation. If the fragment cannot be preserved, then cartilage restoration techniques may be attempted, including marrow stimulation, autologous chondrocyte implantation, and osteochondral autograft or fresh allograft transplantation, depending on the lesion size and individual patient’s demands. The overall goal for the treatment of adult OCD lesions is to relieve pain, restore function, and prevent development of secondary osteoarthritis.