Osteochondritis dissecans of the knee

Abstract

Osteochondritis dissecans (OCD) of the knee is a common cause of knee pain and dysfunction among skeletally immature and young adult patients. OCD is increasingly frequently seen in pediatric, adolescent and young adult athletes. If it is not recognized and treated appropriately, it can lead to secondary osteoarthritis with pain and functional limitation. Stable lesions in skeletally immature patients should initially be managed non-operatively. Unstable juvenile lesions and stable juvenile lesions that fail to heal with non-operative treatment require a surgical treatment. By contrast, adult OCD of the knee rarely responds to conservative measures because of limited healing potential. Operative treatment depends on the lesion stage, and there exist several surgical options.

Keywords: cartilage; knee; osteochonditis dissecans; osteochondral.

Fig. 1

ICRS classification of OCD lesions. A: Type I: stable lesion with a continuous but softened area covered by intact articular cartilage. B: Type II: lesion with partial articular cartilage discontinuity, stable when probed. C: Type III: lesion with complete articular cartilage discontinuity, but no dislocation (“dead in situ”). D: Type IV: empty defect, or defect with a dislocated fragment or loose fragment within the bed.

Fig. 2

Lateral radiograph (A), sagittal MRI (B) and axial MRI (C) of osteochondritis dissecans lesion of the trochlea (arrow). The lesion is clearly demarcated from underlying subcondral bone with apparent anterior separation of articular surface. D: Lateral radiograph showing a loose body (arrow).

Fig. 3

Excision of a chronic loose body.

Fig. 4

Surgical view: osteoconchondral scaffold implantation at the medial femoral condyle.