Knee

Osteochondritis Dissecans (OCD) of the Knee

Osteochondritis dissecans (OCD) of the knee is a condition in which a segment of bone and its overlying articular cartilage loses its blood supply, potentially separating from the parent bone as a loose fragment within the joint. It most often affects active adolescents and young adults and, if not treated appropriately, can lead to early onset osteoarthritis. At Maryland Orthopedic Specialists, our sports medicine surgeons distinguish between juvenile and adult OCD, assess lesion stability with advanced MRI imaging, and recommend individualized treatment to give the knee the best chance of long-term health.

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What is osteochondritis dissecans (ocd) of the knee?

The exact etiology of OCD remains debated, with repetitive microtrauma, subchondral ischemia, and genetic factors all implicated. The condition preferentially affects the medial femoral condyle in approximately 75–85% of cases, particularly the classic posterolateral aspect of the medial condyle. The lateral femoral condyle, trochlea, and patella may also be affected.

The exact etiology of OCD remains debated, with repetitive microtrauma, subchondral ischemia, and genetic factors all implicated. The condition preferentially affects the medial femoral condyle in approximately 75–85% of cases, particularly the classic posterolateral aspect of the medial condyle. The lateral femoral condyle, trochlea, and patella may also be affected.

Two clinically distinct populations:

Skeletal maturity: Juvenile OCD — Open physes; Adult OCD — Closed physes
Age: Juvenile OCD — < 12–15 years; Adult OCD — > 15–18 years
Healing potential: Juvenile OCD — High (80–90% with conservative treatment); Adult OCD — Lower; higher surgical rate
Prognosis: Juvenile OCD — Generally favorable; Adult OCD — More variable

ICRS OCD Classification (MRI-based stability):

Grade I: Signal change in subchondral bone; cartilage intact
Grade II: Cartilage breach; fragment not detached (stable)
Grade III: Fragment partially detached (unstable)
Grade IV: Fragment fully detached; loose body in joint

The distinction between stable (Grade I–II) and unstable (Grade III–IV) is the most important factor driving treatment decisions.

Treatment options

Non-Operative Management

Juvenile OCD with an open physis and a stable lesion (MRI Grade I to II) has an 80 to 90 percent healing rate with conservative management, because the open growth plate retains robust biological capacity for revascularization and remodeling. Treatment centers on activity restriction — avoiding high-impact loading, running, and jumping — combined with non-weight-bearing or restricted weight-bearing for 6 to 12 weeks in symptomatic cases. Progress is monitored with serial X-ray and MRI at 3 to 6 months, and return to full activity is permitted only after radiographic healing is confirmed, typically within 3 to 6 months. Immobilization with a cylinder cast or brace is reserved for patients who cannot adhere to activity restrictions. Adults with MRI-stable, symptomatic OCD lesions may be offered a 3 to 6 month trial of conservative management, but the healing rate is substantially lower than in juveniles — below 50 percent for larger lesions — and a lower threshold for proceeding to surgery is appropriate in this population.

Surgical Procedure

OCD Fixation — Osteochondritis Dissecans of the Knee

Internal fixation of a partially or fully detached osteochondral fragment in a young patient with OCD, using headless compression screws or bioabsorbable implants to restore the articular surface and allow the fragment to heal.

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Microfracture (Cartilage Repair)

Marrow stimulation technique that penetrates the subchondral bone to recruit stem cells and form a fibrocartilage repair patch in a focal cartilage defect. Best suited for small defects in patients who have not had prior cartilage procedures.

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OATS — Osteochondral Autograft Transfer

Transfer of one or more osteochondral plugs from a low-weight-bearing area of the patient's own knee to fill a focal cartilage defect with living hyaline cartilage and intact subchondral bone — a durable single-stage restoration.

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Frequently Asked Questions

My child has OCD — do they need surgery?

Most children with juvenile OCD and open growth plates do not need immediate surgery. Stable lesions in skeletally immature patients have an excellent healing rate with activity restriction. However, if symptoms persist after 3–6 months of conservative management, or if the MRI shows unstable features, surgery is appropriate and produces excellent results.

What happens if an OCD fragment detaches?

A detached fragment becomes a loose body in the joint, causing locking, catching, and accelerated cartilage damage on the opposing joint surface. Fragment removal, fixation if tissue quality allows, or cartilage restoration is required.

Is OCD of the knee related to osteochondritis dissecans of the elbow?

They are the same pathological entity affecting different joints. Patients with bilateral knee OCD or both knee and elbow OCD may have a familial or systemic predisposition and should be evaluated accordingly.

Can I prevent OCD?

There is no proven prevention strategy, but minimizing repetitive joint loading during growth spurts, maintaining appropriate training volumes, and early medical evaluation of persistent joint pain in young athletes represent prudent practice.

How long will my child need to avoid sports if treated non-surgically for OCD?

Juvenile OCD with an open growth plate has significant healing potential with non-surgical treatment, but recovery requires patience — typically three to six months of activity restriction, unloading (sometimes with crutches), and avoidance of impact sports. Healing is confirmed with serial MRI showing lesion consolidation and resolution of surrounding bone edema before sport is resumed. Returning to high-impact activity too soon is the most common reason for treatment failure and lesion progression. Your MOS surgeon will design a structured monitoring plan and provide clear criteria for when it is safe to return to sport.