Osteochondritis Dissecans of the Knee: Experiences at The Children’s Hospital of Philadelphia and a Review of Literature

Osteochondritis dissecans is a condition primarily found in the knee, elbow, and ankle, which affects subchondral bone and potentially the overlying articular cartilage. Although the etiology is not certain, possible causative factors include repetitive microtrauma, ischemia, genetic and endocrine factors, and anomalies of ossification. The etiology, presentation, and management is age-dependent, as osteochondral lesions have a much greater potential to heal when those affected are skeletally immature. The first line of treatment is to remove stress from the involved area by immobilization and activity modification. However, if nonoperative measures are unsuccessful or if loose bodies are present, then surgical approaches may be used, some of which include: fixation with pins or screws, subchondral drilling, abrasion or drilling arthroplasty, and autologous chondrocyte implantation. This article discusses the etiology, clinical findings, diagnostic imaging, treatment options, rehabilitation, and considerations for future management based on current literature and our experiences at the Children’s Hospital of Philadelphia.