Management and Outcomes of Osteochondritis Dissecans of the Knee in the Pediatric and Adolescent Population.

Abstract

Purpose of review: Osteochondritis dissecans (OCD) of the knee is a complex condition in pediatric and adolescent patients, and management relies heavily on lesion characteristics including size, stability, and fragmentation. The purpose of this review is to inform readers of the current understanding, treatment options, and outcomes of the disorder in pediatric and adolescent patients.

Recent findings: While management of OCD of the knee is tailored highly to patient- and lesion-specific factors, broad management pathways are dictated first by lesion stability, and further by salvageability of unstable lesions. Lesion appearance on MRI and arthroscopy are critical in informing appropriate management. Stable lesions, especially in skeletally immature patients, should undergo 3-6 months of nonoperative management, with an initial 4-6 week period of nonweightbearing and avoidance of high impact or repetitive stress for a minimum of 3 months. Patients with stable lesions who fail nonoperative treatment are candidates for retro- or trans-articular drilling of the lesion to promote healing. Unstable lesions may be amenable to salvage approaches including arthroscopic or open fixation with metallic screws, bioabsorbable implants, autograft, and suture bridge constructs. When not salvageable, osteochondral autograft transfer, osteochondral allograft transplantation, or autologous chondrocyte implantation is recommended and pursued depending on lesion size and subchondral involvement. All techniques have good potential for success in healing, patient reported outcomes, and return to activity when applied in the appropriate circumstances. Significant heterogeneity exists in management and outcomes of OCD of the knee, largely attributed to the varying presentation and treatment modalities. Management pathway should be patient-specific, however there is a paucity of robust comparative trials within specific populations.