Osteochondritis dissecans of the knee in adolescents: How to treat them?

Abstract

Background: Osteochondritis dissecans is an acquired condition of the joint that affects the articular surface and the subchondral bone. The juvenile form of osteochondritis dissecans presents in those aged 5-16 years with open growth plates. The causes of osteochondritis dissecans are unknown.

Methods: The goals of treatment are to promote healing of the subchondral bone and prevent chondral collapse, subsequent fracture, osteochondral defect formation, and early joint degeneration. Treatment modality is influenced on clinical symptoms, skeletal maturity, as well as the size, stability, and location of the lesion. This article will review the treatment strategies of juvenile form of osteochondritis dissecans of medial femoral condyle and of atypical regions, such as lateral femoral condyle, patellofemoral joint, and tibial plateau.

Level of evidence: level III.

Keywords: Juvenile osteochondritis dissecans; knee; pediatric.

Figure 1.

Authors’ preferred treatment algorithm for JOCD of the knee.

Figure 2.

(a) Inicial OCD lesion of the medial femoral condyle and (b) 10 months after conservative treatment with complete healed X-ray lesion site.

Figure 3.

(a) Transarticular drilling with arthroscopic support and (b) retroarticular drilling with arthroscopic and fluoroscopic support.

Figure 4.

(a) Retroarticular drilling in a 12-year-old patient with medial femoral condyle OCD lesion and a Lysholm of 37, (b) 5 months post-operative already with no funcional impairment and Lysholm of 100, and (c) 15 months post-operative with a complete healed X-ray lesion mantaining a Lysholm of 100.

Figure 5.

(a) Metalic implants and (b) absorbable implants.

Figure 6.

Autologous matrix-induced chondrogenesis (AMIC) on an internal femoral condyle.

Figure 7.

Mosaic osteochondral transplantation on an internal femoral condyle.

Figure 8.

Thirteen-year-old female patient, an amateur handball player consulted knee pain in the lateral region for months. On examination, she had pain in the posterior region of the knee, multiple episodes of effusions. In the radiological study, we can observe a lesion in the lateral femoral condyle (a–c). The MRI of the knee showed signs of instability (d–f).

Figure 9.

During the surgery, a crater-type lesion was observed with the detached fragment, a loose body was found (a), after preparing the surface, the fragment was fixed with poly L-lactic acid (PLLA) headless screws (b, c). Six months after the intervention, the patient presented clinical and radiological signs of healing (d–f).

Figure 10.

Thirteen-year-old female patient, an amateur basketball player consulted anterior knee pain for months. On examination, she had pain in the patellofemoral joint and block episodes. In the radiological study, we can observe a lesion in the medial facet of the patella (a–c). The MRI of the knee showed signs of instability (d–e).

Figure 11.

During surgery, a “trap door” lesion was observed. The lesion was fixed with poly L-lactic acid (PLLA) headless screws. Six months after the intervention, the patient presented clinical and radiological signs of healing (a, b).