Materiały źródłowe

• #1 Osteochondritis dissecans – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/diagnosis-treatment/drc-20375891

  Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and relieve pain, as well as reduce the risk of osteoarthritis. No single treatment works for everybody. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. […] Initially, your doctor will likely recommend conservative measures, which might include: […] Resting your joint. Avoid activities that stress your joint, such as jumping and running if your knee is affected. You might need to use crutches for a time, especially if pain causes you to limp. Your doctor might also suggest wearing a splint, cast or brace to immobilize the joint for a few weeks. […] Physical therapy. Most often, this therapy includes stretching, range-of-motion exercises and strengthening exercises for the muscles that support the involved joint. Physical therapy is commonly recommended after surgery, as well.

• #2 Management of osteochondritis dissecans (OCD) – UpToDate

  https://www.uptodate.com/contents/management-of-osteochondritis-dissecans-ocd

  Management of osteochondritis dissecans (OCD) […] 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 loose bodies usually need surgery.

• #3 Management of osteochondritis dissecans (OCD) – UpToDate

  https://www.uptodate.com/contents/management-of-osteochondritis-dissecans-ocd

  Management of osteochondritis dissecans (OCD) […] 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 loose bodies usually need surgery.

• #4 Osteochondritis Dissecans – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteochondritis-dissecans/

  Osteochondritis dissecans (OCD) is a condition that develops in joints in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. […] In many cases, OCD lesions in children and young teens will heal on their own, especially when the body still has a great deal of growing to do. Resting and avoiding vigorous sports until symptoms go away will often relieve pain and swelling. […] If symptoms do not ease after a reasonable amount of time, the doctor may recommend the use of crutches, or immobilizing (splinting or casting) the affected arm, leg, or other joint for a short period of time. […] Your child’s doctor may recommend surgery if nonsurgical treatment fails to relieve pain and swelling, the lesion is showing signs of being wobbly or detached from the surrounding bone and cartilage, the lesion is very large (greater than 1 centimeter in diameter), or the lesion is in a teen who is nearing the end of growth and has a lower chance of healing with nonsurgical treatment.

• #5 Osteochondritis dissecans – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/diagnosis-treatment/drc-20375891

  Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and relieve pain, as well as reduce the risk of osteoarthritis. No single treatment works for everybody. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. […] Initially, your doctor will likely recommend conservative measures, which might include: […] Resting your joint. Avoid activities that stress your joint, such as jumping and running if your knee is affected. You might need to use crutches for a time, especially if pain causes you to limp. Your doctor might also suggest wearing a splint, cast or brace to immobilize the joint for a few weeks. […] Physical therapy. Most often, this therapy includes stretching, range-of-motion exercises and strengthening exercises for the muscles that support the involved joint. Physical therapy is commonly recommended after surgery, as well.

• #6 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  In skeletally immature patients, who complain of knee pain and in whom the imaging findings document a stable lesion, conservative treatment continued for 3-6 months is the first-choice therapeutic strategy. […] The proposed non-surgical therapeutic options are represented by: physical activity restriction, physio kinesitherapy and muscle strengthening exercises, load restriction (partial with crutches or total with wheelchair), immobilization (with brace or plaster) and instrumental physical therapies, particularly in patients nearing the end of growth (eg. iontophoresis, shock waves and pulsed electromagnetic fields – PEMFs). […] Among the various conservative treatments proposed, the restriction or suspension of physical activity (in particular activities involving pivoting, jumping and repetitive impacts) seems to be of primary importance.

• #7 Osteochondritis Dissecans (OCD)

  https://www.nationwidechildrens.org/conditions/osteochondritis-dissecans-ocd

  Initial treatment involves an examination in the office. The Orthopedic or Sports Medicine provider will perform full range of motion of the joint, checking for any popping or clicking sounds, or any feeling of the joint catching. For both the knee and elbow, the provider will palpate over areas of the joint to check for pain over specific sites. […] A stable lesion can often be treated with rest, decreased activity, and close follow-up. For example: For a knee OCD lesion, your child may be placed on crutches for up to 6 weeks. For an elbow OCD, your child may be placed into a sling for up to 6 weeks. For an ankle OCD lesion, your child may be placed in a boot or cast for up to 6 weeks. […] Without early treatment, the lesion can become unstable or completely detached. This will need surgery to repair.

• #8 Osteochondritis Dissecans of the Knee – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538194/

  Treating osteochondritis dissecans of the knee includes conservative and surgical approaches, with the choice depending on the patient’s age as well as the severity and location of the disease. […] Clinicians consider nonoperative treatment for all juvenile patients without a displaced fragment or stage I to III disease, which includes: cessation of participation in sports, immobilization of the knee with a cast, splint, or hinged brace for 4 to 6 weeks, initiation of physical therapy by the patient after immobilization and when healing is evident radiographically, and utilization of nonsteroidal anti-inflammatory medications by the patient as necessary to manage pain and edema. […] Studies estimate that 50% to 75% of affected patients will heal without fragmentation. Nonoperative therapy is also a viable option for adults with stage I or II disease, but the healing rate with nonoperative measures is 50% or less.

• #9 Osteochondritis Dissecans (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/osteochondritis-dissecans.html

  Osteochondritis dissecans treatment includes: Rest. At first, this usually means complete rest and no weight bearing at all. Then, light daily life activities and weight bearing, as tolerated, can be introduced slowly. A cast, splint, or brace might be worn to keep the joint still. […] Avoiding any motion that causes pain. […] Taking time off from sports and other intense activities. […] Physical therapy (PT) to help with flexibility and strength. […] Surgery may be recommended: if there is no improvement after rest and PT […] if a piece of the bone breaks away completely […] to fix a problem that is causing osteochondritis dissecans (such as bow legs or knock knees). […] For pain, kids can: Put ice or a cold pack on the area every 12 hours for 15 minutes at a time. Put a thin towel between the ice and the skin to protect it from the cold.

• #10 Osteochondritis dissecans – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/diagnosis-treatment/drc-20375891

  Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and relieve pain, as well as reduce the risk of osteoarthritis. No single treatment works for everybody. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. […] Initially, your doctor will likely recommend conservative measures, which might include: […] Resting your joint. Avoid activities that stress your joint, such as jumping and running if your knee is affected. You might need to use crutches for a time, especially if pain causes you to limp. Your doctor might also suggest wearing a splint, cast or brace to immobilize the joint for a few weeks. […] Physical therapy. Most often, this therapy includes stretching, range-of-motion exercises and strengthening exercises for the muscles that support the involved joint. Physical therapy is commonly recommended after surgery, as well.

• #11 Guide | Physical Therapy Guide to Osteochondritis Dissecans | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-osteochondritis-dissecans

  Osteochondritis dissecans, or OCD, is a condition that involves damage within a joint. This condition makes the cartilage unstable and at risk for detaching from the bone. […] Surgery is sometimes required, and proper OCD management often takes many health care providers, including a physical therapist. If found early, a physical therapist can treat OCD without surgery. They also help people recover after any needed surgery. […] Your physical therapist will design a treatment program specific to your condition and goals. Your treatment plan may include: Activity guidance. If untreated, OCD may get worse over time. Working as part of your medical team, your physical therapist will help prescribe activities and exercises. […] Your physical therapist may recommend decreasing the weight you put on your leg if you have an OCD lesion in your ankle or knee. This may include using a bike or swimming instead of running.

• #12 Osteochondritis dissecans: 5 natural treatment options

  https://www.medicalnewstoday.com/articles/osteochondritis-dissecans-natural-treatment

  The first line of nonsurgical treatment for osteochondritis dissecans should be to rest the affected area and stop activities that could worsen the condition. […] A doctor or physical therapist may recommend immobilizing the affected area. […] Immobilizing the area or limiting how much it can move can be effective as a nonsurgical treatment or in combination with surgery. […] A person should work with a physical therapist to determine which exercises are safe and beneficial for osteochondritis dissecans treatment. […] A physical therapist may use manual therapy to gently manipulate and stretch joints and muscles to help restore motion, strength, and functionality to the joint. […] A person may be able to relieve pain and inflammation with over-the-counter medication, such as nonsteroidal anti-inflammatory drugs.

• #13 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  In skeletally immature patients, who complain of knee pain and in whom the imaging findings document a stable lesion, conservative treatment continued for 3-6 months is the first-choice therapeutic strategy. […] The proposed non-surgical therapeutic options are represented by: physical activity restriction, physio kinesitherapy and muscle strengthening exercises, load restriction (partial with crutches or total with wheelchair), immobilization (with brace or plaster) and instrumental physical therapies, particularly in patients nearing the end of growth (eg. iontophoresis, shock waves and pulsed electromagnetic fields – PEMFs). […] Among the various conservative treatments proposed, the restriction or suspension of physical activity (in particular activities involving pivoting, jumping and repetitive impacts) seems to be of primary importance.

• #14 Osteochondritis Dissecans of the Knee – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538194/

  Treating osteochondritis dissecans of the knee includes conservative and surgical approaches, with the choice depending on the patient’s age as well as the severity and location of the disease. […] Clinicians consider nonoperative treatment for all juvenile patients without a displaced fragment or stage I to III disease, which includes: cessation of participation in sports, immobilization of the knee with a cast, splint, or hinged brace for 4 to 6 weeks, initiation of physical therapy by the patient after immobilization and when healing is evident radiographically, and utilization of nonsteroidal anti-inflammatory medications by the patient as necessary to manage pain and edema. […] Studies estimate that 50% to 75% of affected patients will heal without fragmentation. Nonoperative therapy is also a viable option for adults with stage I or II disease, but the healing rate with nonoperative measures is 50% or less.

• #15

  https://www.orthobullets.com/knee-and-sports/3028/osteochondritis-dissecans

  Osteochondritis Dissecans is a pathologic lesion affecting articular cartilage and subchondral bone with variable clinical patterns. […] Treatment may be nonoperative with restricted weight bearing in children with open physis. Surgical treatment may be indicated in older patients (closed physis), lesions that are unstable and patients who have failed conservative management. […] Nonoperative: restricted weight bearing and bracing; indications: stable lesions in children with open physes, asymptomatic lesions in adults; outcomes: 50-75% will heal without fragmentation. […] Operative: diagnostic arthroscopy; indications: impending physeal closure, clinical signs of instability, expanding lesions on plain films, failed non-operative management. […] subchondral drilling with K-wire or drill; indications: stable lesion seen on arthroscopy; outcomes: leads to formation of fibrocartilagenous tissue, improved outcomes in skeletally immature patients. […] fixation of unstable lesion; indications: acute, unstable lesion seen on arthroscopy or MRI 2cm in size; outcomes: 85% healing rates in juvenile OCD. […] chondral resurfacing; indications: large lesions, 2cm x 2cm. […] knee arthroplasty; indications: patients 60 years.

• #16 Osteochondritis Dissecans: Knee Joint Cartilage Pain | HSS

  https://www.hss.edu/condition-list_osteochondritis-dissecans-knee.asp

  In stable lesions, knee arthroscopy is utilized to assess the OCD and then make multiple holes in the lesion using a drill. This generates blood flow which provides stem cells required for healing the OCD. […] Approximately 50% of children with OCD will recover with nonoperative treatment but it often takes six months to a year for significant healing to occur.

• #17 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Conservative treatment with restricting sports activities is the first line treatment and often sufficient to ensure healing in patients with open physes. […] Surgical treatment depends on the persistence of symptoms after 6 months of conservative treatment and/or based on the development of signs of instability of the lesion.

• #18 Osteochondritis Dissecans of the Knee – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538194/

  Experts recommend surgery for treating osteochondritis dissecans of the knee if conservative measures are not suitable or prove ineffective after 3 to 6 months. […] If arthroscopy shows an unstable osteochondritis dissecans lesion or MRI shows a lesion larger than 2 cm, the lesion should be repaired by fixation. […] Chondral resurfacing is a consideration for lesions larger than 4 cm, which can be accomplished using various techniques. […] Although osteochondral allografts are a viable option, they are expensive. […] Osteochondritis dissecans can lead to lifelong pain and mechanical symptoms for both juvenile and adult patients.

• #19 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Persistent pain after 6 months and/or the development of signs of instability requires surgical treatment. […] Surgical treatment is indicated after 6 months of conservative treatment with persistence or worsening of pain in the absence of signs of radiographic healing or in the event of signs of instability of the lesion on MRI. […] There are several surgical techniques to be used depending on the type of injury: symptomatic and stable OCD lesion are managed by drilling. […] Unstable OCD lesion are managed by fixation of the fragment. […] While, when the fragment has detached, salvage procedures are used. […] Symptomatic stable OCD lesions, in which conservative treatment has not led to healing, are generally treated with arthroscopic assisted perforation of the subchondral bone with the aim of promoting healing at the subchondral cartilage-bone interface by promoting blood supply.

• #20 Osteochondritis Dissecans | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/o/osteochondritis-dissecans

  A doctor may suggest surgery for osteochondritis dissecans if: […] Non-surgical treatment hasnt relieved symptoms. […] The osteochondritis dissecans stage is more advanced. […] The patient is age 13 or older. […] Most surgeries are outpatient procedures. This means children go home the same day. The surgeon may do one of the following: […] Perform an arthroscopic surgery, where they drill into the affected area. This surgery can help get more blood flow to the area and promote healing. […] Secure the loose bone in place with pins and screws. […] Use a bone graft to replace the damaged area. New bone or cartilage for the graft may come from the patients body or another source, such as a cadaver. […] During recovery from osteochondritis dissecans surgery, most children are on crutches for at least six weeks. They also complete two to four months of physical therapy to rebuild strength in their joint.

• #21 Osteochondritis Dissecans – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteochondritis-dissecans/

  Osteochondritis dissecans (OCD) is a condition that develops in joints in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. […] In many cases, OCD lesions in children and young teens will heal on their own, especially when the body still has a great deal of growing to do. Resting and avoiding vigorous sports until symptoms go away will often relieve pain and swelling. […] If symptoms do not ease after a reasonable amount of time, the doctor may recommend the use of crutches, or immobilizing (splinting or casting) the affected arm, leg, or other joint for a short period of time. […] Your child’s doctor may recommend surgery if nonsurgical treatment fails to relieve pain and swelling, the lesion is showing signs of being wobbly or detached from the surrounding bone and cartilage, the lesion is very large (greater than 1 centimeter in diameter), or the lesion is in a teen who is nearing the end of growth and has a lower chance of healing with nonsurgical treatment.

• #22 Osteochondritis dissecans – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/diagnosis-treatment/drc-20375891

  If you have a loose fragment in your joint, if the affected area is still present after your bones have stopped growing, or if conservative treatments don’t help after four to six months, you might need surgery. The type of surgery will depend on the size and stage of the injury and how mature your bones are.

• #23 Osteochondritis Dissecans | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/o/osteochondritis-dissecans

  A doctor may suggest surgery for osteochondritis dissecans if: […] Non-surgical treatment hasnt relieved symptoms. […] The osteochondritis dissecans stage is more advanced. […] The patient is age 13 or older. […] Most surgeries are outpatient procedures. This means children go home the same day. The surgeon may do one of the following: […] Perform an arthroscopic surgery, where they drill into the affected area. This surgery can help get more blood flow to the area and promote healing. […] Secure the loose bone in place with pins and screws. […] Use a bone graft to replace the damaged area. New bone or cartilage for the graft may come from the patients body or another source, such as a cadaver. […] During recovery from osteochondritis dissecans surgery, most children are on crutches for at least six weeks. They also complete two to four months of physical therapy to rebuild strength in their joint.

• #24 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Persistent pain after 6 months and/or the development of signs of instability requires surgical treatment. […] Surgical treatment is indicated after 6 months of conservative treatment with persistence or worsening of pain in the absence of signs of radiographic healing or in the event of signs of instability of the lesion on MRI. […] There are several surgical techniques to be used depending on the type of injury: symptomatic and stable OCD lesion are managed by drilling. […] Unstable OCD lesion are managed by fixation of the fragment. […] While, when the fragment has detached, salvage procedures are used. […] Symptomatic stable OCD lesions, in which conservative treatment has not led to healing, are generally treated with arthroscopic assisted perforation of the subchondral bone with the aim of promoting healing at the subchondral cartilage-bone interface by promoting blood supply.

• #25 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Two drilling techniques have been described: trans-articular or antegrade drilling and retro-articular or retrograde drilling. […] Trans-articular or antegrade drilling is performed during knee arthroscopy; several holes (5 to 10 depending on the lesions size) are drilled orthogonal to the articular cartilage of the OCD lesion with a 1.2-1.4 mm Kirschner wire until reaching the sub-chondral bone (approximately 20 mm deep). […] In retro-articular or retrograde drilling, holes are drilled in the subchondral epiphyseal bone under fluoroscopic guidance, from the outside to the inside of the knee, without entering the joint cavity and without violating the articular cartilage, while also sparing the metaphyseal growth plate of patients with cartilage metaphyseal still open. […] Outcomes of OCD drilling are favorable in most cases with high rates of healing and low complication rates.

• #26 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Two drilling techniques have been described: trans-articular or antegrade drilling and retro-articular or retrograde drilling. […] Trans-articular or antegrade drilling is performed during knee arthroscopy; several holes (5 to 10 depending on the lesions size) are drilled orthogonal to the articular cartilage of the OCD lesion with a 1.2-1.4 mm Kirschner wire until reaching the sub-chondral bone (approximately 20 mm deep). […] In retro-articular or retrograde drilling, holes are drilled in the subchondral epiphyseal bone under fluoroscopic guidance, from the outside to the inside of the knee, without entering the joint cavity and without violating the articular cartilage, while also sparing the metaphyseal growth plate of patients with cartilage metaphyseal still open. […] Outcomes of OCD drilling are favorable in most cases with high rates of healing and low complication rates.

• #27 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Unstable OCD lesions are generally treated with the fixation of the osteochondral fragment, with the main goal of preventing detachment or repositioning the detached fragment in the injury site to ensure joint congruity. […] A variety of techniques have been described for fixation of unstable OCD lesions or detached fragments, such as fixation with resorbable implants (screws, anchors, arrows, pins) or metal implants (screws or pins), in combination with fibrin glue. […] Regardless of the surgical technique (arthroscopic or open) or the type of fixation used, a fundamental step is represented by the preparation of the receiving subchondral bed, through an accurate cruentation for the removal of the fibrotic tissue and drilling to create vascular channels to maximize revascularization and increase the cure rate.

• #28 Surgical Treatment Options for Osteochondritis Dissecans of the Knee

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3445128/

  Patient age, skeletal maturity (physeal maturity), lesion appearance (size, location, and stability), and clinical symptoms influence surgical decisions. With initial nonoperative treatment, stable OCD lesions in young patients have a favorable prognosis. The goal of conservative treatment is to obtain lesion healing before physeal closure. […] Operative treatment is indicated for young patients with detached or unstable lesions or for those approaching physeal closure whose lesions have been unresponsive to nonoperative management. […] The goal of reparative procedures is to restore the integrity of the native subchondral interface and preserve the overlying articular cartilage. […] Higher-grade OCD lesions with articular cartilage flaps and loose bodies (grades 3 and 4, respectively) may cause the knee to catch or lock, and they are generally not amenable to conservative treatment, such as observation and activity modification. Reattachment of partially detached lesions and loose bodies is appropriate for large fragments containing sufficient subchondral bone, to provide union and support of the fixation system.

• #29 Osteochondritis Dissecans (OCD) | Boston Children’s Hspital

  https://www.childrenshospital.org/conditions/osteochondritis-dissecans

  Children with osteochondritis dissecans should receive medical treatment right away. Without treatment, a loosened fragment of bone and cartilage may drift into the joint, causing it to slip, pop or lock. If this happens, the joint can get “stuck,” until it’s moved manually or otherwise manipulated. […] Your child may not need surgery if the loose piece of bone has not detached. They will need to take a break from high-impact sports while they heal. Their physician may recommend rest, ice, compression, and elevation (RICE), combined with non-steroidal anti-inflammatory medications for pain. […] Your child may need surgery if the OCD lesion is unstable, if a fragment of bone or cartilage has broken off into the joint, or if the injured area does not heal after a course of rest. […] Your child’s doctor will select a surgical technique based on the type of osteochondritis dissecans, your child’s age, and other factors. Surgical procedures to repair osteochondritis dissecans of the knee or elbow include: drilling small holes in the underlying bone to stimulate healing, removing or securing loose fragments of bone, and a procedure called osteochondral autologous transplantation surgery (OATS).

• #30 Osteochondritis Dissecans – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteochondritis-dissecans/

  There are different surgical techniques for treating OCD, depending on the individual case: drilling into the lesion to create pathways for new blood vessels to nourish the affected area, holding the lesion in place with internal fixation (such as pins and screws), or replacing the damaged area with a new piece of bone and cartilage (called a graft). […] In general, crutches are required for about 6 weeks after surgical treatment, followed by a 2- to 4-month course of physical therapy to regain strength and motion in the affected joint. […] A gradual return to sports may be possible after about 4 to 5 months, though this depends on which procedure was performed and the healing time.

• #31 Surgical Treatment Options for Osteochondritis Dissecans of the Knee

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3445128/

  Restorative procedures attempt to replace damaged cartilage with hyaline or hyaline-like tissue. […] Microfracture is indicated in patients with a localized cartilage defect (less than 2 to 3 cm2). […] The indications and optimal patient population for transplanting osteochondral tissue from a nonweightbearing region of the knee to restore a damaged articular surface remain narrow. […] Larger OCD lesions ( 2 cm2) may be treated with osteochondral allograft transplantation, which provides subjective improvement in 75% to 85% of patients and has the longest follow-up in the literature. […] The goal of autologous chondrocyte implantation is to produce a repair tissue that resembles type II hyaline cartilage, thus restoring the durability and natural function of the knee joint.

• #32 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  If there is a resultant bone void, bone grafting from the proximal tibia or iliac crest is performed. […] Generally, when the fragment has a discrete layer of subchondral bone, the choice of the fixation falls on metal screws because they guarantee good compression. […] Resorbable fixation devices, composed in polyglycolic acid (PGA) or polylactic acid (PLA), do not require removal, but in some cases resorption of the resorbable material may cause reactive synovitis associated with cystic lesions resulting in failure of synthesis. […] The success rate has been reported between 91.7% and 100% with articular cartilage regeneration. […] In some cases, fixation of the OCD lesion is not possible due to excessive fragmentation, incongruity of the donor site or cartilage wear. […] In these scenarios (rare in pediatric patients), the fragment is removed and the salvage techniques are used: microfractures (MFX), autologous osteochondral transplants (OATS), fresh osteochondral allografts or autologous chondrocyte transplantation with ACI, MACI or AMIC techniques.

• #33 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Microfracture drilling has been recommended for OCD lesions 2 cm2, but it should be remembered that treatment with microfracture alone does not restore joint congruency and also in most OCD lesions this may not be possible as the subchondral bone is often absent. […] For larger lesions, fresh osteochondral allograft transplantation procedures may be used. […] Autologous chondrocyte implantation (ACI) or matrix-induced autologous chondrocyte implantation (MACI) has the same issue of not restoring congruity, although the bony defect can be dealt with using bone grafting. […] Several authors demonstrate favorable outcomes following ACI in patients with OCD of the knee. […] […] […] Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis.

• #34 Treatment of knee osteochondritis dissecans with autologous tendon transplantation: Clinical and radiological results

  https://www.wjgnet.com/2218-5836/full/v12/i11/867.htm

  Treatment of knee osteochondritis dissecans with autologous tendon transplantation: Clinical and radiological results. […] The autologous tendon transplantation is a single-step, safe, simple, cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes, particularly in patients with less than 4 cm2 lesion. […] The purpose of this study is to retrospectively evaluate the clinical and radiological results of autologous tendon transplantation using the peroneus longus tendon in patients with ICRS grade 3 or 4 defects. […] The main aim in the treatment of osteochondral defect is to restore joint integrity by creating a tissue that is the same or similar to the biomechanical properties of the articular cartilage. […] The results of this technique we have described show that we have achieved this.

• #35 Treatment of knee osteochondritis dissecans with autologous tendon transplantation: Clinical and radiological results

  https://www.wjgnet.com/2218-5836/full/v12/i11/867.htm

  The most important finding of the present study is that all of the patients treated with autologous tendon transplantation had excellent and good clinical and radiological outcomes with minimum 2 years follow-up. […] All parameters of the KOOS score improved significantly (P < 0.001). [...] Patients with less than 4 cm2 lesion had statistically significantly better overall KOOS (P < 0.01) than patients whose more than 4 cm2 lesion. [...] This technique allows to avoid many of the disadvantages of other techniques. Important advantages; It is done in one step, it is an autograft, it does not require additional cost and it is easy to apply. [...] The autologous tendon transplantation is a single-step, safe, simple, cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes, particularly in patients with less than 4 cm2 lesion.

• #36 Osteochondritis Dissecans – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteochondritis-dissecans/

  There are different surgical techniques for treating OCD, depending on the individual case: drilling into the lesion to create pathways for new blood vessels to nourish the affected area, holding the lesion in place with internal fixation (such as pins and screws), or replacing the damaged area with a new piece of bone and cartilage (called a graft). […] In general, crutches are required for about 6 weeks after surgical treatment, followed by a 2- to 4-month course of physical therapy to regain strength and motion in the affected joint. […] A gradual return to sports may be possible after about 4 to 5 months, though this depends on which procedure was performed and the healing time.

• #37 Osteochondritis Dissecans (OCD): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21073-osteochondritis-dissecans

  Your provider will suggest treatments that help your joint heal and restore blood flow to your affected bone. The most common OCD treatments include: […] Your provider might suggest surgery if you’ve tried other treatments and still have severe symptoms after a few months. […] The term natural doesn’t have a set medical definition. Most people can manage osteochondritis dissecans symptoms with conservative or at-home treatments. […] Kids and teens with osteochondritis dissecans are more likely to heal with only rest and time. […] Most people need a few months to heal. Your provider will tell you which kinds of physical activities are safe to do while you’re recovering. […] Recovering from osteochondritis dissecans surgery usually takes around two months. You’ll need physical therapy for a few months after that to regain your strength and range of motion.

• #38 Osteochondritis Dissecans (OCD)

  https://www.nationwidechildrens.org/conditions/osteochondritis-dissecans-ocd

  After surgery, your child will be on crutches or in a sling for up to 6 weeks. For a while, your child will not be able to bear weight on the affected limb. They will be out of sports and activities for several months to give the lesion time to heal. X-rays are often taken at 3 months after surgery to evaluate healing.

• #39 Osteochondritis Dissecans | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/o/osteochondritis-dissecans

  A doctor may suggest surgery for osteochondritis dissecans if: […] Non-surgical treatment hasnt relieved symptoms. […] The osteochondritis dissecans stage is more advanced. […] The patient is age 13 or older. […] Most surgeries are outpatient procedures. This means children go home the same day. The surgeon may do one of the following: […] Perform an arthroscopic surgery, where they drill into the affected area. This surgery can help get more blood flow to the area and promote healing. […] Secure the loose bone in place with pins and screws. […] Use a bone graft to replace the damaged area. New bone or cartilage for the graft may come from the patients body or another source, such as a cadaver. […] During recovery from osteochondritis dissecans surgery, most children are on crutches for at least six weeks. They also complete two to four months of physical therapy to rebuild strength in their joint.

• #40 Osteochondritis Dissecans – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteochondritis-dissecans/

  There are different surgical techniques for treating OCD, depending on the individual case: drilling into the lesion to create pathways for new blood vessels to nourish the affected area, holding the lesion in place with internal fixation (such as pins and screws), or replacing the damaged area with a new piece of bone and cartilage (called a graft). […] In general, crutches are required for about 6 weeks after surgical treatment, followed by a 2- to 4-month course of physical therapy to regain strength and motion in the affected joint. […] A gradual return to sports may be possible after about 4 to 5 months, though this depends on which procedure was performed and the healing time.

• #41 Non-surgical treatments for Osteochondritis dissecans –

  https://caringmedical.com/prolotherapy-news/osteochondritis-dissecans/

  Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. […] Having obtained positive results, we believe that PRP injections are a safe, simple, and minimally invasive treatment option for juvenile OCD which doesn’t respond to conservative therapy before a surgical approach. […] The researchers found that “this technique allows articular surface restoration with viable physiologic osteochondral tissue with a high clinical efficacy and imaging results.

• #42 Osteochondritis Dissecans (OCD) Non-Surgical Treatment Chicago – Jorge Chahla, MD

  https://www.jorgechahlamd.com/cartilage-conditions/osteochondritis-dissecans-ocd-non-surgical-treatment-chicago/

  The goal of an intra-articular injection is to manage pain and inflammation of the knee. […] Early-stage osteochondritis dissecans may heal with non-surgical treatment, including activity modification, bracing, and physical therapy to promote bone and cartilage healing. […] Regenerative treatments, such as PRP or stem cell therapy, may also help enhance recovery. […] Dr. Jorge Chahla offers conservative treatment options for OCD, aiming to restore joint function without surgery whenever possible.

• #43 Osteochondritis dissecans – Diagnosis and treatment – PremiQaMed by Mavie

  https://www.premiqamed.com/en/medical-treatment-austria/medical-focus-areas/orthopedics/osteochondritis-dissecans-treatment

  The aim of the treatment is to restore the normal function of the joint, eliminate pain and minimize the risk of osteoarthritis. […] In some cases, conservative therapy is sufficient, i.e. resting the joint, physical therapy or taking anti-inflammatory drugs. […] In advanced cases, surgery may be necessary to repair or remove the affected cartilage or bone parts. […] The treatment of OCD has evolved in recent years and some innovative approaches have been introduced. […] One such treatment method is the use of a bone screw, the so-called „Shark Screw”. […] This treatment is purely arthroscopic, i.e. minimally invasive. […] In addition to using the bone screw, growth factors are used to promote healing and the growth of new cartilage cells. […] The benefit of this method is that it allows targeted repair of the damaged joint area while supporting the body’s natural healing processes. […] Most patients achieve a good recovery and restoration of the normal joint function after this procedure. […] However, not every patient with OCD is suitable for this specific treatment. […] Careful aftercare is important to support recovery.

• #44 Surgical Treatment Options for Osteochondritis Dissecans of the Knee

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3445128/

  Patient age, skeletal maturity (physeal maturity), lesion appearance (size, location, and stability), and clinical symptoms influence surgical decisions. With initial nonoperative treatment, stable OCD lesions in young patients have a favorable prognosis. The goal of conservative treatment is to obtain lesion healing before physeal closure. […] Operative treatment is indicated for young patients with detached or unstable lesions or for those approaching physeal closure whose lesions have been unresponsive to nonoperative management. […] The goal of reparative procedures is to restore the integrity of the native subchondral interface and preserve the overlying articular cartilage. […] Higher-grade OCD lesions with articular cartilage flaps and loose bodies (grades 3 and 4, respectively) may cause the knee to catch or lock, and they are generally not amenable to conservative treatment, such as observation and activity modification. Reattachment of partially detached lesions and loose bodies is appropriate for large fragments containing sufficient subchondral bone, to provide union and support of the fixation system.

• #45 Knee Osteochondritis Dissecans Treatment – Sports Medicine Review

  https://www.sportsmedreview.com/blog/osteochondritis-dissecans-knee-treatment/

  Management of osteochondritis dissecans of the knee remains a controversial topic. Treatment decisions are influenced on clinical symptoms, skeletal maturity and characteristics of the lesion (size, location and stability). Skeletal maturity and lesion stability are generally considered the most important information for clinical decision-making. […] Depending on these factors, nonoperative or operative treatment may be appropriate. Nonoperative treatment is well accepted for patients with open physes, stable lesions, or minimal symptoms. Duration is typically a minimum of 3 to 6 months followed by gradual return to activity. […] Immediate cessation of athletics and impact activities is usually recommended if nonoperative management is pursued. Some providers prefer protected weight-bearing for minimizing compression across the lesion, while others have reported success with unloader bracing protecting the lesion.

• #46 Osteochondritis Dissecans (OCD): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21073-osteochondritis-dissecans

  Your provider will suggest treatments that help your joint heal and restore blood flow to your affected bone. The most common OCD treatments include: […] Your provider might suggest surgery if you’ve tried other treatments and still have severe symptoms after a few months. […] The term natural doesn’t have a set medical definition. Most people can manage osteochondritis dissecans symptoms with conservative or at-home treatments. […] Kids and teens with osteochondritis dissecans are more likely to heal with only rest and time. […] Most people need a few months to heal. Your provider will tell you which kinds of physical activities are safe to do while you’re recovering. […] Recovering from osteochondritis dissecans surgery usually takes around two months. You’ll need physical therapy for a few months after that to regain your strength and range of motion.

• #47 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  OCD treatment has two main objectives: 1) to promote the healing of the subchondral bone and the overlying articular cartilage; 2) ensure joint congruity and to prevent the onset of early osteoarthritis. […] Conservative treatment, is the first line choice of management of JOCD of the knee, although there is no strong recommendation in the more recent AAOS guideline. […] Treatment depends on stability of the lesion, age of the patient and symptoms. […] Conservative or nonsurgical, treatment has high rates of success in skeletally immature patients and should be the primary approach for stable JOCD of the knee. […] Non-operative treatment options include: immobilization (casting, bracing, splinting, unloader brace), limited weight-bearing and activity restriction. […] When the diagnosis is incidental in an asymptomatic patient, it is sufficient to periodically check the patient until radiographic healing is achieved.

• #48 Surgical Treatment Options for Osteochondritis Dissecans of the Knee

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3445128/

  Restorative procedures attempt to replace damaged cartilage with hyaline or hyaline-like tissue. […] Microfracture is indicated in patients with a localized cartilage defect (less than 2 to 3 cm2). […] The indications and optimal patient population for transplanting osteochondral tissue from a nonweightbearing region of the knee to restore a damaged articular surface remain narrow. […] Larger OCD lesions ( 2 cm2) may be treated with osteochondral allograft transplantation, which provides subjective improvement in 75% to 85% of patients and has the longest follow-up in the literature. […] The goal of autologous chondrocyte implantation is to produce a repair tissue that resembles type II hyaline cartilage, thus restoring the durability and natural function of the knee joint.

• #49 Osteochondritis Dissecans of the Elbow: A Review of Presentation, Diagnosis, Treatment and Complications | AOAO

  https://aoao.org/2024/08/22/osteochondritis-dissecans-of-the-elbow-a-review-of-presentation-diagnosis-treatment-and-complications/

  Osteochondritis dissecans (OCD) is a relatively rare disorder affecting subchondral bone and overlying cartilage. […] Early diagnosis, often with CT and MRI, is critical for proper staging and subsequent treatment, which generally ranges from conservative management for stable lesions to surgical intervention for unstable lesions. […] Non-operative management is generally the first-line treatment and has been shown to be more successful in those with open physis, small or stable lesions, short durations of symptoms, and compliance with activity limitations. […] For stable lesions, treatment begins with rest from the sport/activity. […] Elbow rest for at least six months is the general recommendation for non-operative treatment. […] Non-steroidal anti-inflammatory drugs (NSAIDs) have been reported as beneficial for early symptom management.

• #50 Osteochondritis Dissecans of the Knee – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538194/

  Experts recommend surgery for treating osteochondritis dissecans of the knee if conservative measures are not suitable or prove ineffective after 3 to 6 months. […] If arthroscopy shows an unstable osteochondritis dissecans lesion or MRI shows a lesion larger than 2 cm, the lesion should be repaired by fixation. […] Chondral resurfacing is a consideration for lesions larger than 4 cm, which can be accomplished using various techniques. […] Although osteochondral allografts are a viable option, they are expensive. […] Osteochondritis dissecans can lead to lifelong pain and mechanical symptoms for both juvenile and adult patients.

• #51 Long-Term Outcome and Athletic Level following Operative Treatment for Osteochondritis Dissecans of the Knee in Pediatric and Adolescent Patients

  https://www.mdpi.com/2077-0383/12/12/4140

  Reduction and internal fixation using metal or bioabsorbable screws is the most common surgical treatment for unstable but salvageable OCD fragments in both OCDO and OCDC. […] The aim of the present study is to report long-term clinical outcomes and activity level in sports after surgical treatment for OCD of the knee regardless of the growth plate’s condition. […] The present cohort study reports a good long-term outcome with high athletic level up to 18 years following surgical treatment for OCD of the knee. […] All therapy methods examined, whether revascularizing or reconstructive, achieved good to very good results with a high athletic level on the long-term, even when performing knee-straining sports. Individual treatment options should be stage-dependent. Nevertheless, refixation of osteochondral fragments should be preferred, if possible.

• #52 Osteochondritis Dissecans of the Knee – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538194/

  Treating osteochondritis dissecans of the knee includes conservative and surgical approaches, with the choice depending on the patient’s age as well as the severity and location of the disease. […] Clinicians consider nonoperative treatment for all juvenile patients without a displaced fragment or stage I to III disease, which includes: cessation of participation in sports, immobilization of the knee with a cast, splint, or hinged brace for 4 to 6 weeks, initiation of physical therapy by the patient after immobilization and when healing is evident radiographically, and utilization of nonsteroidal anti-inflammatory medications by the patient as necessary to manage pain and edema. […] Studies estimate that 50% to 75% of affected patients will heal without fragmentation. Nonoperative therapy is also a viable option for adults with stage I or II disease, but the healing rate with nonoperative measures is 50% or less.

• #53

  https://www.orthobullets.com/knee-and-sports/3028/osteochondritis-dissecans

  Osteochondritis Dissecans is a pathologic lesion affecting articular cartilage and subchondral bone with variable clinical patterns. […] Treatment may be nonoperative with restricted weight bearing in children with open physis. Surgical treatment may be indicated in older patients (closed physis), lesions that are unstable and patients who have failed conservative management. […] Nonoperative: restricted weight bearing and bracing; indications: stable lesions in children with open physes, asymptomatic lesions in adults; outcomes: 50-75% will heal without fragmentation. […] Operative: diagnostic arthroscopy; indications: impending physeal closure, clinical signs of instability, expanding lesions on plain films, failed non-operative management. […] subchondral drilling with K-wire or drill; indications: stable lesion seen on arthroscopy; outcomes: leads to formation of fibrocartilagenous tissue, improved outcomes in skeletally immature patients. […] fixation of unstable lesion; indications: acute, unstable lesion seen on arthroscopy or MRI 2cm in size; outcomes: 85% healing rates in juvenile OCD. […] chondral resurfacing; indications: large lesions, 2cm x 2cm. […] knee arthroplasty; indications: patients 60 years.

• #54 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Unstable OCD lesions are generally treated with the fixation of the osteochondral fragment, with the main goal of preventing detachment or repositioning the detached fragment in the injury site to ensure joint congruity. […] A variety of techniques have been described for fixation of unstable OCD lesions or detached fragments, such as fixation with resorbable implants (screws, anchors, arrows, pins) or metal implants (screws or pins), in combination with fibrin glue. […] Regardless of the surgical technique (arthroscopic or open) or the type of fixation used, a fundamental step is represented by the preparation of the receiving subchondral bed, through an accurate cruentation for the removal of the fibrotic tissue and drilling to create vascular channels to maximize revascularization and increase the cure rate.

• #55 Surgical Treatment Options for Osteochondritis Dissecans of the Knee

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3445128/

  Restorative procedures attempt to replace damaged cartilage with hyaline or hyaline-like tissue. […] Microfracture is indicated in patients with a localized cartilage defect (less than 2 to 3 cm2). […] The indications and optimal patient population for transplanting osteochondral tissue from a nonweightbearing region of the knee to restore a damaged articular surface remain narrow. […] Larger OCD lesions ( 2 cm2) may be treated with osteochondral allograft transplantation, which provides subjective improvement in 75% to 85% of patients and has the longest follow-up in the literature. […] The goal of autologous chondrocyte implantation is to produce a repair tissue that resembles type II hyaline cartilage, thus restoring the durability and natural function of the knee joint.

• #56 Long-Term Outcome and Athletic Level following Operative Treatment for Osteochondritis Dissecans of the Knee in Pediatric and Adolescent Patients

  https://www.mdpi.com/2077-0383/12/12/4140

  Reduction and internal fixation using metal or bioabsorbable screws is the most common surgical treatment for unstable but salvageable OCD fragments in both OCDO and OCDC. […] The aim of the present study is to report long-term clinical outcomes and activity level in sports after surgical treatment for OCD of the knee regardless of the growth plate’s condition. […] The present cohort study reports a good long-term outcome with high athletic level up to 18 years following surgical treatment for OCD of the knee. […] All therapy methods examined, whether revascularizing or reconstructive, achieved good to very good results with a high athletic level on the long-term, even when performing knee-straining sports. Individual treatment options should be stage-dependent. Nevertheless, refixation of osteochondral fragments should be preferred, if possible.

• #57 Osteochondritis dissecans – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/symptoms-causes/syc-20375887

  Surgery might be necessary if the fragment comes loose and gets caught between the moving parts of your joint or if you have persistent pain. […] Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. […] If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. […] For young children whose bones are still developing, the injury might heal by itself. […] Osteochondritis dissecans can increase your risk of eventually developing osteoarthritis in that joint.

• #58 Osteochondritis Dissecans: Symptoms, Causes, Risk Factors, Treatment

  https://www.healthline.com/health/osteochondritis

  OCD often heals on its own, especially in children who are still growing. However, other cases might require treatment to restore joint function and reduce your risk of developing osteoarthritis. […] Sometimes, the affected joint just needs to rest. Try to avoid doing strenuous or high-impact activities for a few weeks to give your joint time to heal. Your doctor might also recommend using crutches or wearing a splint to prevent your joint from moving too much. […] If your symptoms dont improve after four to six months, you might need surgery. Your doctor will also likely recommend surgery if you have loose bone or cartilage fragments in your joints. […] There are three main approaches when it comes to surgery for OCD: […] After surgery, youll probably need to use crutches for about six weeks. Your doctor might also recommend doing physical therapy for several months to help you regain strength. You should be able to start returning to your usual activity level in about five months. […] While most people make a full recovery, having OCD can increase your risk of eventually developing osteoarthritis in the affected joint. You can reduce your risk by following up with strength and stability training, combined with periods of rest.

• #59 Osteochondritis Dissecans (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/osteochondritis-dissecans.html

  Take pain medicine as recommended by the doctor. […] Kids with osteochondritis dissecans usually need at least a few months off from sports. Kids who had surgery will need more time to heal. Returning to sports too soon can lead to long-term pain and joint problems. […] Kids should only go back to sports if they: do not have pain in the area […] do not have any trouble doing everyday activities […] have followed their doctor’s recommendations for resting the joint and PT […] have been cleared for sports by their doctor. […] Kids with osteochondritis dissecans heal best when they: Go to all follow-up doctor visits. […] Follow the recommendations for rest and PT. […] Don’t go back to sports until the doctor says it’s OK.

• #60 Osteochondritis Dissecans – Seattle Children’s

  https://www.seattlechildrens.org/conditions/osteochondritis-dissecans/

  We offer physical therapy programs to keep the muscles strong while protecting the joints. Our therapists teach exercises to help keep young people strong while they are healing. […] For osteochondritis dissecans in the knee, we may provide a nonsurgical therapy called unloader bracing. This treatment involves wearing a brace to push the knee into a position that puts less stress on the lesion. […] When surgery is needed, we often do procedures that use special tools called arthroscopes. These tools let doctors get to the joint without opening it up. Instead, they get to it through very small cuts (incisions). […] For osteochondritis dissecans, we do surgeries to: promote healing of stable lesions by drilling tiny holes in the bone to improve blood flow, screw or pin an unstable lesion in place so it doesnt come loose and can heal, remove bone and cartilage that came loose and then transplant bone or cartilage in its place.

• #61 Osteochondritis Dissecans (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/osteochondritis-dissecans.html

  Take pain medicine as recommended by the doctor. […] Kids with osteochondritis dissecans usually need at least a few months off from sports. Kids who had surgery will need more time to heal. Returning to sports too soon can lead to long-term pain and joint problems. […] Kids should only go back to sports if they: do not have pain in the area […] do not have any trouble doing everyday activities […] have followed their doctor’s recommendations for resting the joint and PT […] have been cleared for sports by their doctor. […] Kids with osteochondritis dissecans heal best when they: Go to all follow-up doctor visits. […] Follow the recommendations for rest and PT. […] Don’t go back to sports until the doctor says it’s OK.

• #62 Osteochondritis Dissecans – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/osteochondritis-dissecans/

  There are different surgical techniques for treating OCD, depending on the individual case: drilling into the lesion to create pathways for new blood vessels to nourish the affected area, holding the lesion in place with internal fixation (such as pins and screws), or replacing the damaged area with a new piece of bone and cartilage (called a graft). […] In general, crutches are required for about 6 weeks after surgical treatment, followed by a 2- to 4-month course of physical therapy to regain strength and motion in the affected joint. […] A gradual return to sports may be possible after about 4 to 5 months, though this depends on which procedure was performed and the healing time.

• #63 Osteochondritis Dissecans (OCD) | Boston Children’s Hspital

  https://www.childrenshospital.org/conditions/osteochondritis-dissecans

  OATS, or osteochondral autologous transplantation surgery, is a treatment option for certain OCD injuries. The procedure involves replacing injured bone and cartilage in the joint with healthy tissue taken from another part of the body, such as the side of the knee. […] After surgery, your child may need to wear a cast or brace while their joint heals. They may need to complete a course of physical therapy before gradually resuming activity or sports. […] Your child should be able to return to sports and activities after their knee, elbow, or other joint has regained strength and stability — usually around six months after surgery. If your child’s joint remains painful or unstable after surgery and a period of recovery, their doctor may recommend lifestyle changes such as switching to low-impact sports.

• #64 Treatment of Osteochondritis Dissecans of the Knee

  https://www.proactiverehab.com/Injuries-Conditions/Knee/Research-Articles/Reviewing-the-Latest-in-Treatment-of-Osteochondritis-Dissecans-of-the-Knee/a~1777/article.html

  Parents of teens with osteochondritis dissecans (OCD) and any adult who ever had OCD as a teenager will find this review of interest. […] Treatment depends on the grade of the subchondral bone. […] For grades 3 and 4, osteoarthritis will occur without surgical treatment to repair or reconstruct the cartilage. […] Conservative care has evolved over time with evidence from studies to suggest optimal ways of supporting natural healing. […] If conservative care fails, then surgery is still an option. […] In those cases, the surgeon has quite a few options to choose from. […] Autologous chondrocyte implantation (ACI) is the final treatment option discussed. […] The authors conclude by saying that treatment for OCD of the knee is most successful when the condition is caught early and treated before long-lasting damage can be done.

• #65 Osteochondritis Dissecans (OCD) | Boston Children’s Hspital

  https://www.childrenshospital.org/conditions/osteochondritis-dissecans

  Children with osteochondritis dissecans should receive medical treatment right away. Without treatment, a loosened fragment of bone and cartilage may drift into the joint, causing it to slip, pop or lock. If this happens, the joint can get “stuck,” until it’s moved manually or otherwise manipulated. […] Your child may not need surgery if the loose piece of bone has not detached. They will need to take a break from high-impact sports while they heal. Their physician may recommend rest, ice, compression, and elevation (RICE), combined with non-steroidal anti-inflammatory medications for pain. […] Your child may need surgery if the OCD lesion is unstable, if a fragment of bone or cartilage has broken off into the joint, or if the injured area does not heal after a course of rest. […] Your child’s doctor will select a surgical technique based on the type of osteochondritis dissecans, your child’s age, and other factors. Surgical procedures to repair osteochondritis dissecans of the knee or elbow include: drilling small holes in the underlying bone to stimulate healing, removing or securing loose fragments of bone, and a procedure called osteochondral autologous transplantation surgery (OATS).

• #66 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Conservative treatment with restricting sports activities is the first line treatment and often sufficient to ensure healing in patients with open physes. […] Surgical treatment depends on the persistence of symptoms after 6 months of conservative treatment and/or based on the development of signs of instability of the lesion.

• #67 Osteochondritis Dissecans (OCD) in Dogs | VCA Animal Hospitals

  https://vcahospitals.com/know-your-pet/osteochondritis-dissecans-or-ocd-in-dogs

  Surgical removal of the diseased cartilage will relieve the inflammation and pain, allow the joint surface to remodel, and minimize the development of degenerative joint disease (osteoarthritis). […] For the first 2-3 weeks postoperatively, your dog will be restricted to short leash walks only, and you will be instructed on how to perform PROM exercises. Anti-inflammatory medications (e.g., meloxicam, brand name Metacam) and joint supplements will be prescribed. After 3 weeks, the amount of controlled exercise will be increased and specific rehabilitation exercises such as swimming may be prescribed. After 6 weeks, your dog may progress to other controlled activities such as light jogging. […] The prognosis varies depending on the joint that is affected. If the shoulder joint is affected, the prognosis is good; if the elbow joint is affected, the prognosis is guarded. In all cases, the prognosis improves if surgery is performed early in the course of the disease. Weight control is important to avoid unnecessary stress and inflammation in the joint.

• #68 Osteochondritis Dissecans | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/o/osteochondritis-dissecans

  Osteochondritis dissecans is most common in growing children, ages 8-16, who are very active in sports. It often starts as a mild, aching pain that can get worse over time. […] Without treatment, osteochondritis dissecans can lead to further joint damage and early development of osteoarthritis. […] There are two main types of treatment: non-surgical treatment and surgery. […] Most patients start with non-surgical treatment for osteochondritis dissecans. The first step is to rest the joint. Children must stop playing most sports for at least two to four months. During that time, they also may use crutches, a brace or a cast to reduce pressure and protect the joint. […] Physical therapy for osteochondritis dissecans is also used as a non-surgical treatment. Its important to start a physical therapy routine quickly after an injury. Physical therapy can address pain, range of motion and strength while protecting the joint as it heals. The goal of physical therapy is to get children back to their previous activities.

• #69 Osteochondritis Dissecans of the Elbow: A Review of Presentation, Diagnosis, Treatment and Complications | AOAO

  https://aoao.org/2024/08/22/osteochondritis-dissecans-of-the-elbow-a-review-of-presentation-diagnosis-treatment-and-complications/

  Osteochondritis dissecans (OCD) is a relatively rare disorder affecting subchondral bone and overlying cartilage. […] Early diagnosis, often with CT and MRI, is critical for proper staging and subsequent treatment, which generally ranges from conservative management for stable lesions to surgical intervention for unstable lesions. […] Non-operative management is generally the first-line treatment and has been shown to be more successful in those with open physis, small or stable lesions, short durations of symptoms, and compliance with activity limitations. […] For stable lesions, treatment begins with rest from the sport/activity. […] Elbow rest for at least six months is the general recommendation for non-operative treatment. […] Non-steroidal anti-inflammatory drugs (NSAIDs) have been reported as beneficial for early symptom management.

• #70 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  OCD treatment has two main objectives: 1) to promote the healing of the subchondral bone and the overlying articular cartilage; 2) ensure joint congruity and to prevent the onset of early osteoarthritis. […] Conservative treatment, is the first line choice of management of JOCD of the knee, although there is no strong recommendation in the more recent AAOS guideline. […] Treatment depends on stability of the lesion, age of the patient and symptoms. […] Conservative or nonsurgical, treatment has high rates of success in skeletally immature patients and should be the primary approach for stable JOCD of the knee. […] Non-operative treatment options include: immobilization (casting, bracing, splinting, unloader brace), limited weight-bearing and activity restriction. […] When the diagnosis is incidental in an asymptomatic patient, it is sufficient to periodically check the patient until radiographic healing is achieved.

• #71 Knee Osteochondritis Dissecans Treatment – Sports Medicine Review

  https://www.sportsmedreview.com/blog/osteochondritis-dissecans-knee-treatment/

  Surgery is primarily indicated for patients with unstable lesions, failed conservative treatment, or poor nomogram predictions. The technique depends on the lesion characteristics. […] Subchondral drilling is well-established for stable lesions to stimulate influx of mesenchymal cells and growth factors. […] Principles for treating unstable salvageable lesions include articular surface restoration, fracture fixation, and vascular enhancement. […] If fixation is not possible, there are multiple salvage techniques available. […] In summary, nonoperative treatment should be the first-line treatment for stable lesions. Surgical treatment for stable lesions with intact articular cartilage involves drilling the subchondral bone aiming to stimulate vascular ingrowth and subchondral bone healing. If the lesion is unstable, fixation is indicated.

• #72 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Conservative treatment with restricting sports activities is the first line treatment and often sufficient to ensure healing in patients with open physes. […] Surgical treatment depends on the persistence of symptoms after 6 months of conservative treatment and/or based on the development of signs of instability of the lesion.

• #73 An update on osteochondritis dissecans of the knee | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/38829-an-update-on-osteochondritis-dissecans-of-the-knee

  Persistent pain after 6 months and/or the development of signs of instability requires surgical treatment. […] Surgical treatment is indicated after 6 months of conservative treatment with persistence or worsening of pain in the absence of signs of radiographic healing or in the event of signs of instability of the lesion on MRI. […] There are several surgical techniques to be used depending on the type of injury: symptomatic and stable OCD lesion are managed by drilling. […] Unstable OCD lesion are managed by fixation of the fragment. […] While, when the fragment has detached, salvage procedures are used. […] Symptomatic stable OCD lesions, in which conservative treatment has not led to healing, are generally treated with arthroscopic assisted perforation of the subchondral bone with the aim of promoting healing at the subchondral cartilage-bone interface by promoting blood supply.

• #74 Long-Term Outcome and Athletic Level following Operative Treatment for Osteochondritis Dissecans of the Knee in Pediatric and Adolescent Patients

  https://www.mdpi.com/2077-0383/12/12/4140

  Reduction and internal fixation using metal or bioabsorbable screws is the most common surgical treatment for unstable but salvageable OCD fragments in both OCDO and OCDC. […] The aim of the present study is to report long-term clinical outcomes and activity level in sports after surgical treatment for OCD of the knee regardless of the growth plate’s condition. […] The present cohort study reports a good long-term outcome with high athletic level up to 18 years following surgical treatment for OCD of the knee. […] All therapy methods examined, whether revascularizing or reconstructive, achieved good to very good results with a high athletic level on the long-term, even when performing knee-straining sports. Individual treatment options should be stage-dependent. Nevertheless, refixation of osteochondral fragments should be preferred, if possible.

• #75 Surgical Treatment Options for Osteochondritis Dissecans of the Knee

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3445128/

  Restorative procedures attempt to replace damaged cartilage with hyaline or hyaline-like tissue. […] Microfracture is indicated in patients with a localized cartilage defect (less than 2 to 3 cm2). […] The indications and optimal patient population for transplanting osteochondral tissue from a nonweightbearing region of the knee to restore a damaged articular surface remain narrow. […] Larger OCD lesions ( 2 cm2) may be treated with osteochondral allograft transplantation, which provides subjective improvement in 75% to 85% of patients and has the longest follow-up in the literature. […] The goal of autologous chondrocyte implantation is to produce a repair tissue that resembles type II hyaline cartilage, thus restoring the durability and natural function of the knee joint.

• #76 Osteochondritis Dissecans | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/o/osteochondritis-dissecans

  A doctor may suggest surgery for osteochondritis dissecans if: […] Non-surgical treatment hasnt relieved symptoms. […] The osteochondritis dissecans stage is more advanced. […] The patient is age 13 or older. […] Most surgeries are outpatient procedures. This means children go home the same day. The surgeon may do one of the following: […] Perform an arthroscopic surgery, where they drill into the affected area. This surgery can help get more blood flow to the area and promote healing. […] Secure the loose bone in place with pins and screws. […] Use a bone graft to replace the damaged area. New bone or cartilage for the graft may come from the patients body or another source, such as a cadaver. […] During recovery from osteochondritis dissecans surgery, most children are on crutches for at least six weeks. They also complete two to four months of physical therapy to rebuild strength in their joint.

• #77 Osteochondritis dissecans | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/osteochondritis-dissecans

  If surgery is needed, our world-renowned orthopedic surgeons will: Secure or remove a loose piece of the bone, Stimulate new bone formation. […] Your child with OCD injuries should continue to be monitored periodically by a physician. […] If your child had surgery, he will need to see the orthopedic surgeon about one to two weeks after surgery, then again at three and six months post-surgery. After that, annual monitoring by trained clinicians is strongly encouraged to ensure any problems are spotted and treated as soon as possible.

• #78 Osteochondritis dissecans: Deciding the best candidates for nonoperative treatment | Children’s NationalSearchLink to: Accelerating advanced cardiac treatments for tiny patientsLink to: MRI and ultrasound imaging detect the spectrum of Zika’s impactScroll

  https://innovationdistrict.childrensnational.org/osteochondritis-dissecans-deciding-the-best-candidates-for-nonoperative-treatment/

  Dr. Niu notes that OCD can be a devastating injury for young athletes, interrupting their participation in sports on average for a minimum of six months and significantly longer if nonoperative treatments fail and surgery becomes necessary. Being able to shave some time off that schedule with better knowledge of which type of treatment is most likely to work, she says, can help her patients get back to doing what they love significantly faster.

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