Operative Techniques: Osteochondritis Dissecans of the Pediatric Knee

Osteochondritis dissecans (OCD) of the knee is a relatively rare condition with multifactorial etiology. OCD of the knee most commonly presents in children and adolescents; therefore, timely and appropriate treatment is necessary to prevent long-term cartilage damage and osteoarthritis. The clinical presentation of OCD may vary depending on the location and stability of the lesion. Radiographic and magnetic resonance imaging (MRI) is essential to further classify the lesion and guide treatment. Depending on the lesion's characteristics, nonoperative or operative treatment may be recommended. Nonoperative treatment is recommended for stable lesions in patients with open physes. A period of activity restriction, decreased weight-bearing and immobilization may be recommended. Operative treatment is recommended for stable lesions in patients with closed physes, unstable lesions or failure of nonoperative treatment. A variety of operative techniques are utilized based on stability of the lesion and articular surface integrity. Given the varied presentation of knee OCD lesions, it is critical for clinicians to maintain a high index of suspicion in the at-risk age group. It is also necessary to maintain an in depth understanding of recommended evaluation and treatment techniques to optimize prognosis for healing and minimize long-term sequelae.