Surgical management of osteochondritis dissecans of the knee

Abstract

Osteochondritis dissecans of the knee primarily affects subchondral bone, with a secondary effect on the overlying articular cartilage. This process can lead to pain, effusions, and loose body formation. While stable juvenile lesions often respond well to nonoperative management, unstable juvenile lesions, as well as symptomatic adult lesions, often require operative intervention. Short-term goals focus on symptomatic relief, while long-term expectations include the hope of preventing early-onset arthritis. Surgical options include debridement, loose body removal, microfracture, arthroscopic reduction and internal fixation, subchondral drilling, osteochondral autograft or allograft transplantation, and autologous chondrocyte implantation. Newer single-stage cell-based procedures have also been developed, utilizing mesenchymal stem cells and matrix augmentation. Proper treatment requires evaluation of both lesional (size, depth, stability) and patient (age, athletic level) characteristics.

Osteochondritis Dissecans of the Knee in Children and Adolescents: Our Experience with Transchondral Drilling

“…These techniques are reserved for unsalvageble lesions such as those with extensive comminution, fragmentation or with chronic complete detachent of the chondral lesion. Newer surgical treatments, including single-stage cell-based procedures, use mesenchymal stem cells and matrix augmentation (8).…”

Knee pain in an athletic young man

“…Displacement of a previously stable fragment of subchondral bone can occur, causing an increase in severity of symptoms. Other presentations, which may relate to the presence and location of any displaced intra-articular fragments, include bony tenderness, joint effusion, and joint locking 12…”

Surgical treatment for osteochondritis dessicans of the knee

“…Surgical techniques for OCD of the knee can be classified as palliative, reparative, and restorative/reconstructive [18]. Palliative techniques including loose body removal or debridement of the defect aim to relieve mechanical symptoms without restoring the articular surface.…”