Contemporary Treatment of Adult and Juvenile Osteochondritis Dissecans of the Knee: A Treatment Algorithm

Introduction Osteochondritis dissecans (OCD) of the knee is an idiopathic disease process leading to a spectrum of osteochondral defects ranging from softening to fragmentation and loose body formation. Although an expanding body of literature exists on OCD treatment outcomes, a widely accepted, standardized treatment algorithm remains lacking. Objectives and Methods This narrative review integrates contemporary evidence with clinical interpretation to present a treatment algorithm for knee OCD supplemented by real-world case examples. The proposed algorithm uses a structured approach considering physeal status, lesion stability, and patient-specific factors to provide a reproducible approach to treatment. Results and Conclusions Initial treatment for juvenile OCD involves conservative therapy and activity modification. For most juvenile OCD patients, conservative therapy confers symptom resolution with high rates of healing and low rates of subsequent OA. Treatment-refractory OCD converges upon a primary treatment pathway involving several treatment options including debridement, drilling, and fragment fixation. OCD lesions refractory to primary repair follow a secondary treatment pathway involving palliative (marrow stimulation), regenerative (autologous chondrocyte implantation), or restorative (osteochondral autograft or allograft) therapies. Secondary treatment pathways confer early return to sport and favorable clinical outcomes despite prior OCD treatment. Future research is needed to determine the roles for treatment augmentation with orthobiologics, multiphasic scaffolds, and implementation of artificial intelligence in diagnosing and treating OCD lesions.