Osteochondritis Dissecans of the Knee: Pathophysiology and Treatment

Osteochondritis dissecans (OCD) involves injury to the subchondral bone, which can progress to involve the overlying articular cartilage. Despite being a known clinical entity for more than 120 years, there is no consensus as to the etiology. Furthermore, there is a paucity of high level literature on this topic and not one paper on the natural history of OCD. Patients with OCD of the knee often present with nonspecific knee pain worse with activity.Magnetic Resonance Imaging (MRI) is the imaging modality of choice to help guide treatment decisions. Treatment for OCD lesions is dictated by many factors; however physeal status, lesion stability, and lesion size are the most important to consider when contemplating surgery. This chapter discusses common surgical treatment options for OCD including retro- and transarticular drilling, stabilization of the lesions with metallic and/or bioabsorbable screws, microfracture, osteochondral autograft transfer system (OATS), autologous chondrocyte implantation (ACI), and newer cartilage treatment techniques. Return-to-play guidelines after different surgical options for OCD are also discussed. While considerable progress has been made in the treatment of this condition, current treatment options lack uniform success, and future research is required.