AANA Lab Course 913 - Advanced Knee Course-OCD Treatment_ Take Home Pearls to Guide your Treatment Faculty Lecture

OCD Treatment_ Take Home Pearls to Guide your Treatment Faculty Lecture_ Steven E. Rokito, MD

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This presentation by Dr. Steven E. Rokito provides a comprehensive overview of Osteochondritis Dissecans (OCD) lesions, primarily affecting the knee. OCD involves separation of a fragment of subchondral bone and overlying cartilage from underlying bone, most commonly seen in the lateral portion of the medial femoral condyle (85% of cases). It is relatively rare, with 15-21 cases per 100,000 knees, typically affecting males aged 10-15 years, and bilateral lesions occur in 15-30% of patients.<br /><br />The exact cause of OCD is unclear and multifactorial, possibly involving trauma, ischemia, or genetic factors. Clinically, juvenile-onset OCD (with open growth plates) responds well to conservative treatment, showing healing rates of 50-91%, whereas adult-onset often represents unresolved lesions that lead to joint degeneration.<br /><br />Diagnosis involves physical exam—pain, swelling, mechanical symptoms—and imaging with X-rays and MRI to determine lesion size, location, and stability. MRI staging ranges from simple cartilage injury (Stage 1) to loose bodies in the joint (Stage 4). Arthroscopic classification parallels those findings, guiding treatment.<br /><br />Treatment depends on lesion stability, size, and skeletal maturity. Stable juvenile lesions are managed conservatively or with drilling if nonoperative care fails. Unstable or detached lesions require surgical intervention: debridement, bone grafting, and fixation. Larger lesions (>2 cm) not amenable to fixation may need restorative procedures like osteochondral allografts or autologous chondrocyte implantation (ACI).<br /><br />Osteochondral allografting is effective for large, deep lesions after failed treatments, showing good medium-term outcomes (75-91% good/excellent results). Postoperative rehabilitation includes protected weight bearing, progressive strengthening, and functional training.<br /><br />In summary, early identification and characterization of OCD lesions with imaging and arthroscopy are critical. Juvenile stable lesions should initially undergo conservative management, while unstable or larger lesions often require surgical repair or restorative techniques to optimize outcomes.

Keywords

Osteochondritis Dissecans

OCD lesions

knee

medial femoral condyle

juvenile-onset OCD

adult-onset OCD

MRI staging

arthroscopic classification

osteochondral allografting

autologous chondrocyte implantation