An update on osteochondritis dissecans of the knee

Abstract

Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis. Knee MRI is indicated in young, active patients who have knee pain and/or effusion, to make an early diagnosis and decide about treatment, according essentially to the MRI stability signs. The choice of treatment should be also tailored, based on the patient’s skeletal maturity, as well as the size and location of the lesion. Conservative treatment with restricting sports activities is the first line treatment and often sufficient to ensure healing in patients with open physes. Surgical treatment depends on the persistence of symptoms after 6 months of conservative treatment and/or based on the development of signs of instability of the lesion. Stable lesions with intact articular cartilage may be treated by drilling of the subchondral bone aiming to stimulate vascular ingrowth and subchondral bone healing. Every attempt should be made to retain the osteochondral fragment when possible. Instable lesions should be fixed or “replaced” with salvage procedures to prevent the onset of early osteoarthritis in this young population. Furthers studies are needed to improve the knowledge and optimizing non-operative and surgical treatment and to develop noninvasive diagnostic tools to predict with more accuracy the fragment’s stability.

Conventional Radiography Assessment of the Pediatric Knee: Pearls and Pitfalls

“…The presence of a contralateral lesion is possible (reported as ∼ 15%), 35 even if the patient is asymptomatic. Performing bilateral radiographs is controversial.…”

High rates of return to sport following management of osteochondritis dissecans of the femoral trochlea: A systematic review

“…The knee is the most common joint affected, and over 70% of cases are localized to the medial femoral condyle [4]. Historically, the femoral trochlea was thought to be a rare location for OCD lesions, contributing to less than 1% of OCD cases of the knee [4].…”

“…The knee is the most common joint affected, and over 70% of cases are localized to the medial femoral condyle [4]. Historically, the femoral trochlea was thought to be a rare location for OCD lesions, contributing to less than 1% of OCD cases of the knee [4]. However, more recently the Research in Osteochondritis Dissecans of the Knee (ROCK) group published a multi‐center prospective cohort study consisting of 1004 patients, reporting that OCD was located on the trochlea in 9.5% of knees [5].…”

A Comparative Analysis of Osteochondritis Dissecans and Avascular Necrosis: A Comprehensive Review

“…Among these disorders, osteochondritis dissecans (OCD) and avascular necrosis (AVN) stand out as two distinct but sometimes closely related conditions that can severely impact the quality of patients’ lives. Both conditions affect the integrity of bone and cartilage, often leading to pain, limited mobility, and long-term dysfunction [ 6 , 7 , 8 , 9 , 10 ]. De Smet [ 11 ] highlighted three key similarities between OCD and AVN.…”

“…OCD, characterized by the detachment of cartilage and bone fragments within a joint, has long been a subject of clinical interest and debate. While it predominantly affects younger individuals, often athletes, and is believed to be linked to mechanical stress and repetitive trauma, its precise etiology and optimal management strategies remain topics of active research [ 8 , 9 ]. On the other hand, AVN, which most often occurs in the middle-aged and elderly, marked by the death of bone tissue due to compromised blood supply, is frequently associated with various factors, such as corticosteroid use, alcohol abuse, and traumatic injuries.…”