OCD Injuries in the Paediatric and Adult Population

Osteochondritis dissecans (OCD) is a focal pathological lesion involving the subchondral bone. It most commonly involves the knee and can result in significant damage to the overlying articular cartilage, leading to loose bodies, accelerated joint degeneration and pain. It is classically categorised into juvenile and adult forms, with many juvenile patients having favourable outcomes with nonoperative management, whereas adult patients predominantly require operative treatments. There are multiple proposed theories regarding the aetiology of the disease; however, there is no agreed-on cause. Imaging studies, specifically magnetic resonance imaging (MRI), play an important role in diagnosing and characterising OCD lesions. In addition to a patient’s skeletal maturity, characteristics including the lesion size, location and stability are among the most important prognostic factors used to guide treatment decisions. OCD lesions that require operative management can be treated by reparative or restorative techniques. Reparative techniques are generally first attempted and include drilling, loose body excision and internal fixation. Restorative treatments are reserved for patients with lesions that have failed reparative attempts or are deemed not amenable to repair. These operative treatments include microfracture, osteochondral autograft transplantation, osteochondral allograft and autologous chondrocyte implantation techniques. Ultimately the majority of patients have favourable outcomes with these treatment strategies; however, further comparative studies are essential for establishing ideal guidelines for the appropriate management of this complex pathological condition of the knee.