What is the recommended treatment for osteochondritis?

Treatment of Osteochondritis Dissecans

For osteochondritis dissecans (OCD), treatment depends entirely on skeletal maturity and lesion stability: juvenile patients with stable lesions should receive conservative management with activity restriction and physical therapy, while unstable or displaced fragments require surgical intervention regardless of age. 1, 2, 3

Critical Distinction: OCD is NOT Osteoarthritis

Osteochondritis dissecans is a subchondral bone condition with secondary cartilage involvement affecting young, active populations—fundamentally different from osteoarthritis 1, 2. The treatment algorithms for osteoarthritis (provided in several evidence sources) do not apply to OCD and should be disregarded for this condition.

Treatment Algorithm Based on Lesion Characteristics

Stage I Lesions (Stable, Intact Cartilage)

Conservative management is the appropriate first-line treatment for stable lesions, particularly in skeletally immature patients with open growth plates. 2, 3

• Activity restriction with varying degrees of immobilization until healing occurs is the cornerstone of conservative therapy 2
• Physical therapy management should address lesion characteristics, location, skeletal maturity, and presenting impairments with systematic, evidence-based progression to protect healing tissue 4
• MRI findings that justify conservative therapy include intact cartilage, contrast enhancement of the lesion, and absent cystic defects 3
• Juvenile OCD patients with open physes and low-grade lesions achieve good results with conservative therapy, with spontaneous healing expected unless fragment instability develops 2

Stage II Lesions (Unstable or Displaced Fragments)

Surgical intervention is required when cartilage defects are present, fragments show incomplete separation, fluid surrounds an undetached fragment, or fragments are dislodged. 3

• Arthroscopy with possible intervention is necessary for Stage II lesions identified on MRI 3
• When cartilage remains intact, retrograde drilling procedures are the favorable surgical approach 2
• When cartilage is damaged, multiple surgical techniques are available including drilling, microfracturing (which produce reparative cartilage), or reconstruction with osteochondral grafts and cell-based procedures like chondrocyte transplantation 2
• Procedures that reconstruct both bone and cartilage tend toward better results, with improved long-term outcomes when comorbidities are treated 2

Role of MRI in Treatment Planning

MRI should replace diagnostic arthroscopy as it noninvasively separates non-surgical from surgical lesions. 3

• MRI is becoming the method of choice for staging OCD lesions, as therapy is determined by lesion stage 3
• MRI can identify intact cartilage, contrast enhancement patterns, and cystic defects that guide conservative versus surgical management 3

Common Pitfalls to Avoid

• Do not confuse OCD with osteochondral fractures or epiphyseal ossification disturbances—age distribution, localization, and radiologic presentation distinguish these conditions 3
• Do not apply osteoarthritis treatment protocols (NSAIDs, acetaminophen, weight loss) to OCD patients, as the pathophysiology and patient populations are entirely different 1, 2
• Do not proceed directly to arthroscopy for diagnostic purposes when MRI can provide the same staging information noninvasively 3
• Recognize that mechanical and traumatic factors are etiologically dominant in OCD, though predisposition may contribute in some patients 3

Prognosis

• Severe grades of osteoarthrosis following OCD treatment are rare 2
• Many OCD lesions are asymptomatic, but advanced lesions cause pain, swelling, and mechanical symptoms requiring intervention 1