Osteochondritis Dissecans of the Knee
Osteochondritis dissecans (OCD) is a relatively common cause of knee pain and dysfunction in children and adolescents. OCD is an acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamnination and sequestration with or without articular cartilage involvement and instability. 11,15,26,31,37,52,65 Etiology of OCD remains speculative. 11,15,26,52 Knee OCD classifications are based on anatomic location, surgical appearance, scintigraphic findings, and chronological age. 11,12,15,26,29,52 OCD is subcategorized into juvenile and adult forms depending on distal femoral physis maturity. The majority of cases of adult OCD are thought to be due to persistence of an unresolved juvenile OCD lesion although de novo adult OCD lesions have been described. 11 Juvenile OCD has a better prognosis than adult OCD. 13,27,29,59,63 Adult OCD and juvenile OCD lesions which do not heal have potential for later sequelae. 42,62
Juvenile OCD management is controversial. Nonoperative initial management is indicated for stable lesions in skeletally immature patients. 11,13,14,26 Operative treatment is indicated for detached or unstable lesions, a patient approaching epiphyseal closure, and failure of nonoperative management. 11
We will review etiology, clinical presentation, diagnostic evaluation, nonoperative, and operative treatments and outcomes of knee OCD.