Management of osteochondritis dissecans (OCD)
- Albert C Hergenroeder, MD
Albert C Hergenroeder, MD
- Section Editor — Pediatric Sports Medicine; Adolescent Sports Medicine
- Professor & Chief of Pediatrics, Adolescent Medicine and Sports Medicine
- Baylor College of Medicine
- Brian S Harvey, DO
Brian S Harvey, DO
- Pediatrics and Sports Medicine
- Salina Pediatric Care
- Salina Regional Health Center
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Osteochondritis dissecans (OCD) refers to osteonecrosis of subchondral bone and most often occurs in the knee, elbow, or ankle of school-age and adolescent children where it causes pain. Plain radiographs are frequently diagnostic. Sports medicine and orthopedic specialists usually determine the staging and stability of OCD lesions by magnetic resonance imaging. Initial treatment of stable lesions typically consists of rest, nonsteroidal antiinflammatory drugs, avoidance of high intensity activities, and physical therapy. Patients who are skeletally immature frequently do well with nonoperative therapy. Patients who have large lesions or develop intraarticular foreign bodies usually need surgery.
This topic will discuss the management of OCD. The clinical manifestations and diagnosis of OCD and other causes of knee, elbow, or ankle pain in the young athlete are discussed separately:
- Petrie PW. Aetiology of osteochondritis dissecans. Failure to establish a familial background. J Bone Joint Surg Br 1977; 59:366.
- DeLee JC, Drez Jr D, Miller MD. DeLee & Drez's Orthopaedic Sports Medicine Principles and Practice, 2nd ed, Elsevier Science, Philadelphia 2003.
- BERNDT AL, HARTY M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 1959; 41-A:988.
- Dipaola JD, Nelson DW, Colville MR. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 1991; 7:101.
- Guhl JF. Arthroscopic treatment of osteochondritis dissecans. Clin Orthop Relat Res 1982; :65.
- Robertson W, Kelly BT, Green DW. Osteochondritis dissecans of the knee in children. Curr Opin Pediatr 2003; 15:38.
- Edmonds EW, Polousky J. A review of knowledge in osteochondritis dissecans: 123 years of minimal evolution from König to the ROCK study group. Clin Orthop Relat Res 2013; 471:1118.
- Wall EJ, Vourazeris J, Myer GD, et al. The healing potential of stable juvenile osteochondritis dissecans knee lesions. J Bone Joint Surg Am 2008; 90:2655.
- Chambers HG, Shea KG, Carey JL. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg 2011; 19:307.
- Takahara M, Mura N, Sasaki J, et al. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am 2007; 89:1205.
- Polousky JD. Juvenile osteochondritis dissecans. Sports Med Arthrosc 2011; 19:56.
- Perumal V, Wall E, Babekir N. Juvenile osteochondritis dissecans of the talus. J Pediatr Orthop 2007; 27:821.
- Tol JL, Struijs PA, Bossuyt PM, et al. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 2000; 21:119.
- Krause M, Hapfelmeier A, Möller M, et al. Healing predictors of stable juvenile osteochondritis dissecans knee lesions after 6 and 12 months of nonoperative treatment. Am J Sports Med 2013; 41:2384.
- Kocher MS, Tucker R, Ganley TJ, Flynn JM. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 2006; 34:1181.
- Weiss JM, Nikizad H, Shea KG, et al. The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents. Orthop J Sports Med 2016; 4:2325967116635515.
- De Smet AA, Ilahi OA, Graf BK. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol 1996; 25:159.
- Ruch DS, Cory JW, Poehling GG. The arthroscopic management of osteochondritis dissecans of the adolescent elbow. Arthroscopy 1998; 14:797.
- Gudas R, Simonaityte R, Cekanauskas E, Tamosiūnas R. A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop 2009; 29:741.
- Edmonds EW, Albright J, Bastrom T, Chambers HG. Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee. J Pediatr Orthop 2010; 30:870.
- Tabaddor RR, Banffy MB, Andersen JS, et al. Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop 2010; 30:14.
- Steinhagen J, Bruns J, Deuretzbacher G, et al. Treatment of osteochondritis dissecans of the femoral condyle with autologous bone grafts and matrix-supported autologous chondrocytes. Int Orthop 2010; 34:819.
- Matsuura T, Kashiwaguchi S, Iwase T, et al. Conservative treatment for osteochondrosis of the humeral capitellum. Am J Sports Med 2008; 36:868.
- Mihara K, Suzuki K, Makiuchi D, et al. Surgical treatment for osteochondritis dissecans of the humeral capitellum. J Shoulder Elbow Surg 2010; 19:31.
- Takahara M, Ogino T, Fukushima S, et al. Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. Am J Sports Med 1999; 27:728.
- Takahara M, Ogino T, Sasaki I, et al. Long term outcome of osteochondritis dissecans of the humeral capitellum. Clin Orthop Relat Res 1999; :108.