Management of osteochondritis dissecans

Abstract

Osteochondritis dissecans (OCD) is an acquired condition affecting subchondral bone that manifests as a pathologic spectrum including softening of the overlying articular cartilage with an intact articular surface, early articular cartilage separation, partial detachment of an articular lesion, and osteochondral separation with loose bodies. The etiology of OCD remains speculative; however. repetitive microtrauma is a common association. Nonoperative initial management is indicated for stable lesions in skeletally immature patients given the potential for healing with normal subsequent function and radiographs. Nonoperative treatment options range from watchful waiting and activity modification to nonweightbearing and immobilization with trials lasting from 6 to 18 months. Operative treatment is indicated for detached or unstable lesions, adult OCD lesions or juvenile patients approaching epiphyseal closure, and failure of nonoperative management. Surgical options depend on the involved pathology and include drilling, curettage, bone grafting, internal fixation, open or arthroscopic reduction of a loose fragment with internal fixation, fragment removal, autologous or allogeneic osteochondral grafting, and autologous chondrocyte implantation. This chapter is an overview of the etiology, clinical presentation, diagnostic studies, nonoperative treatment, and operative treatment of OCD of the knee. © 2007 Humana Press Inc.