7. How to treat osteochondritis dissecans of the knee?
The treatment of osteochondritis dissecans of the knee is very varied depending upon the age of the patient, if there are other problems present in the knee, and the patient’s overall alignment.
In younger patients where the OCD lesion may be symptomatic, but is not detached, and there are open growth plates, a trial of physical therapy with activity modification, and the use of an unloader brace may be indicated. Following a program like this for several months with a follow-up set of x-rays and probably an MRI scan may indicate if the OCD lesion is healing. We have found this to be successful approximately 50-60% of the time, so it is a viable option in patients with open growth plates who do not have a detached lesion.
For those patients who have a detached lesion of the OCD, or it is completely displaced, surgery is indicated. In general, trying to preserve one’s own cartilage is better than trying a cartilage resurfacing technique. However, it is entirely dependent upon whether the OCD lesion is very fragmented or if there is a solid piece of bone present. If one does have a solid piece of bone present, it may be indicated to try a surgery to reattach the OCD lesion. We feel that making a small incision to clean out the base of the lesion, drill through the sclerotic bone at the base, and then placing a bone graft and pinning the OCD lesion may be indicated in many of these cases. For those patients who have a very fragmented OCD lesion, which has a low chance of healing with a pinning, or where the piece is completely dislodged and is macerated and not able to be put back, then one may have to look at replacing the whole bone and cartilage unit. In our hands, the use of a fresh osteoarticular allograft is indicated in these circumstances. We have found them to be highly successful for the majority of patients. In these circumstances, a complete workup is necessary to look at a patient’s alignment to determine if an osteotomy may be indicated and to verify that the meniscus cushion on the side of the proposed fresh allograft is adequate. In addition, one should ensure that all ligaments of the knee are stable to have the best outcomes with the use of a fresh allograft to treat an OCD lesion.