Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Apr;13(2):173-179.
doi: 10.1007/s12178-020-09611-5.

Management of the Failed OCD

Crystal A Perkins  1 , S Clifton Willimon  2
Affiliations
Review

Management of the Failed OCD

Crystal A Perkins et al. Curr Rev Musculoskelet Med. 2020 Apr.

Abstract

Purpose of the review: Osteochondritis dissecans (OCD) is a pathologic condition of subchondral bone most frequently occurring in the medial femoral condyle of the knee in children and adolescents. Salvage techniques are necessary when either nonoperative or typical operative treatments fail, or the OCD presents in an unsalvageable state. The purpose of this review is to describe the evaluation and management of failed OCDs.

Recent findings: Thorough preoperative planning is essential to the treatment of failed OCDs. Radiographs and advanced imaging such as MRI and CT allow for a detailed assessment of subchondral bone and cartilage. Long-leg alignment radiographs are critical to assess for malalignment which may increase the contact forces on the affected condyle. Malalignment can be corrected with hemiepiphysiodesis or an osteotomy depending on the skeletal maturity of the patient. Osteochondral allografts and autologous chondrocyte implantation treat the defect in both bone and cartilage or solely cartilage and have good short to moderate term outcomes, particularly as compared to the inferior outcomes of microfracture of larger OCDs. Osteochondritis dissecans of the knee that fails to heal with initial operative measures can result in a large defect of bone and cartilage in the knee of adolescents. Treatment of the bone and cartilage defect can be accomplished with either osteochondral allograft transplantation or matrix-assisted autologous chondrocyte implantation can be performed with good outcomes. Assessment and correction of lower extremity malalignment is a critical component of treatment. Durable long-term solutions are necessary for the treatment of these difficult lesions.

Keywords: Autologous chondrocyte implantation; Cartilage; Osteochondral allograft; Osteochondritis dissecans.

PubMed Disclaimer

Conflict of interest statement

Crystal A. Perkins declares that she has no conflict of interest pertaining to this chapter.

S. Clifton Willimon declares that he has no conflict of interest pertaining to this chapter.

Figures

Fig. 1
Fig. 1
15-year-old male with OCD of the lateral femoral condyle (a) initially treated with curretage, grafting, and fixation. He had incomplete healing on MRI, radiographs (b) and arthroscopy at 5 months post-op. He later underwent osteochondral allograft transplantation as a salvage surgery 6 months after his initial surgery (c)
Fig. 2
Fig. 2
AP, lateral, and notch radiographs of the right knee of a 15-year-old male with a lateral femoral condyle OCD
Fig. 3
Fig. 3
16-year-old male with unsalvageable lateral femoral condyle OCD and genu valgum treated with osteochondral allograft transplantation and distal femoral osteotomy
Fig. 4
Fig. 4
Donor hemicondyle and recipient following osteochondral allograft transplantion to the lateral femoral condyle using a “snowman” technique to interdigitate allograft dowels
See this image and copyright information in PMC

References

    1. Kessler JI, Nikizad H, Shea KG, Jacobs JC Jr, Bebchuk JD, Weiss JM. The demographics and epidemiology of osteochondritis dissecans of the knee in children and adolescents. Am J Sports Med. 2014;42(2):320–326. doi: 10.1177/0363546513510390. - DOI - PubMed
    1. Hefti F, Beguiristain J, Krauspe R, Möller-Madsen B, Riccio V, Tschauner C, Wetzel R, Zeller R. Osteochondritis dissecans: a multicenter study of the European pediatric orthopedic society. J Pediatr Orthop B. 1999;8(4):231–245. - PubMed
    1. Cahill BR, Phillips MR, Navarro R. The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy. A prospective study. Am J Sports Med. 1989;17(5):601–5. doi: 10.1177/036354658901700502. - DOI - PubMed
    1. Krause M, Hapfelmeier A, Möller M, Amling M, Bohndorf K, Meenen NM. Healing predictors of stable juvenile osteochondritis dissecans knee lesions after 6 and 12 months of nonoperative treatment. Am J Sports Med. 2013;41(10):2384–2391. doi: 10.1177/0363546513496049. - DOI - PubMed
    1. Chambers HG, Shea KG, Anderson AF, Jojo Brunelle TJ, Carey JL, Ganley TJ, et al. American Academy of Orthopaedic surgeons clinical practice guideline on: the diagnosis and treatment of osteochondritis dissecans. J Bone Joint Surg Am. 2012;94(14):1322–4. - PubMed