Current Concepts in the Management of Juvenile Osteochondritis Dissecans of the Knee

Abstract

Osteochondritis dissecans (OCD) is a disease of subchondral bone that leads to a spectrum of pathologies, ranging from the softening of articular cartilage to the complete detachment of an osteochondral fragment, creating an intra-articular loose body. In the past 4 years, important findings have altered the management of OCD. Nonsurgical management is the preferred initial treatment for OCD. Two surgical techniques for stable lesions are transarticular antegrade and extra-articular retrograde drilling. However, although both techniques may lead to good outcomes, AAOS clinical practice guidelines do not firmly recommend either technique. Unstable lesions are often treated with arthroscopic reduction and internal fixation, microfracture, or osteochondral autologous transplantation. The internal fixation of unstable OCD lesions with a headless screw has shown good results, and in a paper published in 2010, was reported to produce excellent results with a bioabsorbable implant. A prospective, randomized trial reported in 2009, in which microfracture was compared with osteochondral autologous transplantation, found that patients who underwent osteochondral grafting had significantly better outcomes at 4 years postoperatively.

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