In the realm of children’s orthopaedics, there are few enigmatic pathologic processes that challenge us more than osteochondritis dissecans (OCD). After assembling the collaborative efforts and research of thought leaders regarding OCD, it is our pleasure to present a symposium that we hope contains the best current evidence and can present a guide to what we now know about this condition. However, the manuscripts contained within this symposium do not cure our lack of understanding; rather, they highlight the dearth of this understanding, while concurrently pointing toward some new avenues of management.Fig. 1: Dr. Eric W. Edmonds is shown.Many of the authors who contributed to this symposium are members of an international study group dedicated to Research in OsteoChondritis dissecans of the Knee (ROCK) [4]. These publications are partly the individual efforts of some of those individuals, but the work of this group was motivated by the recent evidence-based Clinical Practice Guideline of the American Academy of Orthopaedic Surgeons on OCD of the knee [1, 2, 5]. This guideline highlighted the lack of literature regarding OCD and influenced the development of the ROCK study group. Our objective was to highlight a need for better understanding and to be thought-provoking in terms of future research avenues related to OCD. We hope to have succeeded in this regard.Fig. 2: Dr. Kevin G. Shea is shown.Starting with a translation (from the original German) of König’s 1887 article [3] that coined the term “osteochondritis dissecans” (see Classic in this symposium, DOI 10.1007/s11999-013-2824-y), we hope to sweep the reader into a conversation with the world’s experts on OCD through their current research. The symposium begins with a concise review of current knowledge within the medical literature of OCD to bridge the gap of knowledge between König from the last century and the latest concepts about pathology and efforts of the ROCK group. Our authors cover all aspects of diagnosis, from the histopathology of OCD to assessment of radiographic parameters and how those relate to pathologic findings in OCD of the elbow capitellum. After this, we offer an evaluation of current treatment modalities, as well as a few papers evaluating potential future management approaches. In the hopes of highlighting the unique nature of OCD and the clear need for future collaborative research on the subject, we thought it best to leave you with a simple case study that emphasizes the complexity of this pathologic process and the numerous treatment strategies available. The purpose of this symposium was to highlight what we do and do not understand in regard to OCD and its histology, natural history, outcomes, and treatment. Should reading about the limits of what we know kindle a desire in you to conduct more research on the topic, we would like to leave you with a working definition of OCD (developed by members of the ROCK group, January 2013) that hitherto has been unpublished and that might help you in your work: Osteochondritis dissecans is a focal, idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis.
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Edmonds et al. (2013) studied this question.