Treatment of OCD Lesions in the Knee: PRP vs Steroids
Neither PRP nor corticosteroid injections are recommended or supported by evidence for the treatment of osteochondritis dissecans (OCD) lesions of the knee. The American Academy of Orthopaedic Surgeons (AAOS) guidelines do not address either injection therapy as a treatment option for OCD, and the standard of care remains activity modification, protected weight-bearing for stable lesions, or surgical intervention for unstable/failed conservative management 1.
Why These Injections Are Not Appropriate for OCD
Fundamental Difference from Osteoarthritis
- OCD is a structural osteochondral lesion, not a degenerative joint disease 2, 3
- The pathology involves disruption of subchondral bone blood supply with potential fragment separation, requiring mechanical healing or surgical fixation 2, 3
- Both PRP and corticosteroids target inflammatory conditions like osteoarthritis, which is mechanistically different from OCD 4, 5
Lack of Evidence for Either Treatment
- The AAOS systematic review found no studies evaluating injection therapies (PRP or corticosteroids) for OCD lesions 1
- One small case series (6 patients) suggested PRP might help healing after surgical fixation of ICRS type III lesions, but this was used as an adjunct to surgery, not as primary treatment 6
- Major orthopedic guidelines (ACR/AF, AAOS) recommend against PRP even for knee osteoarthritis due to lack of standardization and inconsistent evidence 5
Evidence-Based Treatment Algorithm for OCD
For Skeletally Immature Patients with Stable Lesions
- Activity modification with protected weight-bearing for 3-6 months 2, 3
- Serial imaging (radiographs and/or MRI) to monitor healing 1
- If failed conservative treatment after ≥3 months: consider arthroscopic drilling 1, 2, 3
For Unstable or Displaced Lesions (Any Age)
- Surgical intervention is recommended 1, 2, 3
- Salvageable fragments: fixation with screws or bioabsorbable pins 2, 3
- Unsalvageable fragments: cartilage repair techniques including bone marrow stimulation, osteochondral autograft transfer (OATS), or autologous chondrocyte implantation (ACI) 1, 2, 3
For Skeletally Mature Patients
- Lower healing potential compared to immature patients 2, 3
- Symptomatic patients with salvageable unstable lesions should be offered surgery 1
- Treatment choice depends on fragment viability and size 3
Critical Pitfalls to Avoid
Do not treat OCD like osteoarthritis. The use of injections appropriate for degenerative joint disease (whether PRP or corticosteroids) is not supported for this structural osteochondral pathology 1, 2, 3.
Do not delay appropriate surgical referral. Patients with mechanical symptoms (locking, catching), unstable lesions on MRI, or failed conservative management require orthopedic surgical evaluation 2, 3.
Recognize the risk of progression to early osteoarthritis. OCD patients who remain symptomatic despite treatment have significant risk of developing severe osteoarthritis at a young age, making preservation of native cartilage the priority 1.