Management of Symptomatic Osteochondritis Dissecans of the Knee

Osteochondritis dissecans (OCD) is a focal lesion of the subchondral bone that can result in fragmentation, instability, and if untreated, loose body formation with progression to early degenerative changes. Particularly in adolescent male athletes, OCD of the knee is a common source of pain, effusion, and mechanical symptoms with sporting activities. Conservative treatment of athletes with OCD of the knee can entail several months of activity modification and non-weight-bearing restrictions, with varying degrees of healing and return to activity. For unstable OCD lesions not amenable to conservative treatment, previous studies have shown excellent outcomes in patients undergoing osteochondral fixation, with hardware placement and technique being critical determinants of patient outcomes. This infographic reviews the presentation and description of different types of OCD lesions, prognostic factors, surgical indications, and considerations for determining the optimal treatment algorithm. With unstable lesions showing either a "locked door" or "trapdoor" at the time of arthroscopy, subchondral bone preparation and arthroscopic-assisted or open fixation with dual-pitch metal or bio-composite screws can be successful in 67% to 100% of cases. Nonviable or chronically displaced lesions may undergo abrasion chondroplasty, marrow stimulation, or preferably, secondary cartilage restoration.