From the Guidelines
Surgical treatment for osteochondritis dissecans (OCD) lesions is typically indicated when the lesion is unstable, detached, or has failed conservative management, and the primary goal is to restore joint congruity, prevent further articular damage, and reduce the risk of early osteoarthritis. The choice of surgical technique depends on lesion size, location, stability, and patient factors, and may include arthroscopic drilling, fixation using bioabsorbable pins, screws, or headless compression screws, or cartilage restoration procedures such as microfracture, osteochondral autograft transfer (OATS), or autologous chondrocyte implantation (ACI) 1.
Surgical Approaches
- Arthroscopic drilling for stable lesions with intact cartilage creates channels for revascularization and healing
- Fixation using bioabsorbable pins, screws, or headless compression screws is performed to reattach the fragment to the underlying bone for unstable or detached fragments
- Cartilage restoration procedures such as microfracture, OATS, or ACI are used to restore the articular surface if the fragment is not salvageable
Postoperative Management
- Patients typically require protected weight-bearing for 6-8 weeks, followed by progressive rehabilitation focusing on range of motion and strengthening exercises 1
- Postoperative physical therapy is recommended to address impairments such as loss of motion, strength deficits, altered movement patterns, and postoperative effusion 1
Considerations
- The work group recommends that symptomatic, skeletally mature patients with salvageable unstable or displaced OCD lesions be offered the option of surgery, as the risks of not performing surgery, including irreversible osteoarthritis, outweigh the risks of surgery 1
- The choice to proceed with surgery is part of a shared decision-making process between the patient, family, and physician, and informed consent is necessary to ensure that patients are aware of the potential risks and benefits of surgery 1
From the Research
Surgical Treatment for OCD Lesions
- OCD lesions are generally categorized as juvenile or adult, with many juvenile lesions healing with conservative care and most symptomatic adult lesions requiring surgical intervention 2
- Surgical options for OCD lesions include debridement, drilling, microfracture, reduction and fixation, autograft osteochondral transplantation, autologous chondrocyte implantation, and allograft osteochondreal transplantation 2
- Arthroscopic debridement of grade 3 or 4 OCD lesions of the capitellum can provide satisfactory long-term improvement in patient-reported outcomes, with 96% of patients reporting improvement and 80% returning to their sports of interest 3
- The treatment of OCD lesions depends on various factors, including the patient's age and skeletal maturity, as well as the size, location, and stability of the lesion 4
Specific Surgical Procedures
- Debridement and osteochondral autograft transfer are two common surgical procedures for treating OCD lesions, with both resulting in good short- and midterm outcomes 5
- Larger defects involving more than 50% of the articular surface or involving the lateral margin of the capitellum may have worse outcomes after debridement and may be better treated with fragment fixation or osteochondral autograft transfer 5
- Arthroscopic debridement of OCD lesions can result in high rates of overall survivorship free of revision surgery, with 90% of patients surviving 5 years and 88% surviving 10 years without revision surgery 3
Comparison of Surgical Procedures
- There is a lack of high-level evidence to determine the superiority of debridement or osteochondral autograft transfer for the treatment of OCD lesions 5
- A prospective longitudinal multicenter study is needed to establish optimal treatment for unstable OCD lesions 5
- Lesion procedures, such as stereotactic radiosurgery and MR-guided high intensity focused ultrasound, are being utilized for the treatment of OCD, but more research is needed to determine their safety and efficacy 6