Management strategies for osteochondritis dissecans of the knee in the skeletally immature athlete

Osteochondritis dissecans (OCD) is a disorder resulting in focal breakdown of the subchondral bone, with potential disruption of the overlying articular cartilage. The femoral condyles of the knee are the most common locations for OCD, and the incidence of OCD appears to be increasing among active c...

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Bibliographic Details
Published in:The journal of orthopaedic and sports physical therapy 2014-09, Vol.44 (9), p.665-679
Main Authors: Eismann, Emily A, Pettit, Robert J, Wall, Eric J, Myer, Gregory D
Format: Article
Language:English
Subjects:
Adolescent
Arthroscopy
Athletic Injuries - complications
Bone Malalignment - complications
Cumulative Trauma Disorders - complications
Humans
Ischemia - complications
Knee Joint - blood supply
Knee Joint - diagnostic imaging
Knee Joint - pathology
Lower Extremity
Magnetic Resonance Imaging
Osteochondritis Dissecans - diagnosis
Osteochondritis Dissecans - etiology
Osteochondritis Dissecans - therapy
Radiography
Treatment Outcome
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Summary:Osteochondritis dissecans (OCD) is a disorder resulting in focal breakdown of the subchondral bone, with potential disruption of the overlying articular cartilage. The femoral condyles of the knee are the most common locations for OCD, and the incidence of OCD appears to be increasing among active children. Juvenile OCD (JOCD) can be distinguished from adult OCD by the presence of open growth plates. Due to a lack of evidence on its early diagnosis, optimal treatment, and long-term course of healing, JOCD presents a unique challenge for the health care team. Approximately 50% to 67% of stable JOCD lesions heal successfully with nonoperative treatment. For unstable lesions and stable lesions that fail nonoperative treatment, a variety of surgical interventions can be utilized to stimulate bony healing and address articular cartilage lesions. It is recommended that rehabilitation of JOCD be tailored to the individual patient, based on the stage and radiographic status of the lesion and the mode of surgery employed when surgically addressed. Although there is a growing body of literature on this condition, the etiology and optimal methods for treatment, rehabilitation, and evaluating outcomes remain inconclusive due to a lack of quality evidence. Therapy, level 5.
ISSN:0190-6011
1938-1344
DOI:10.2519/jospt.2014.5140