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The current treatment of osteochondritis dissecans (OCD) and osteochondral fractures in the knee is a rapidly evolving and an increasingly relevant topic. The advancing interest in hyaline cartilage restoration and resurfacing has placed more emphasis on the preservation of native articular cartilage. More comprehensive knee reconstructive surgeries heighten the indications for stabilizing chondral fragments and OCD lesions. Several factors determine treatment approaches including symptoms, patient's age as it relates to the onset of skeletal maturity, lesion size and surface area, location, displacement, fragment dissection, and stage of the disease. Failure of nonsurgical treatment and acute traumatic osteochondral detachment with loose body symptoms are indications for surgical intervention. Procedures include debridement and lavage, marrow stimulation, and fixation techniques. New methods for metallic and bioabsorbable fixation in addition to bone grafting have been introduced. The purpose of this article is to review the current understanding of the etiology, diagnosis, classification and treatment of osteochondral lesions, and OCD of the knee, with an emphasis on newer approaches and updated surgical techniques.