Osteochondritis Dissecans

Disease/Disorder

Definition

Osteochondritis Dissecans (OCD) is characterized by alteration of subchondral bone, with the risk of instability and secondary damage to overlying articular cartilage. Unchecked cartilage damage can lead to early osteoarthritis.¹ There are juvenile and adult forms of this condition; the juvenile form occurs in children or adolescents with open growth plates (skeletally immature). While the vast majority of OCD occurs in the knee, the article herein also discusses OCD in the elbow and the ankle.

Etiology and pathophysiology

In 1888, König first described OCD and at the time suggested inflammation as the cause of these lesions.¹ The exact pathophysiology is unknown; however, a separation of the epiphyseal cartilage with subsequent damage to subchondral bone is thought to be one of the underlying mechanisms for OCD. Proposed causes include localized avascular necrosis, ossification center deficit, chronic microtrauma or acute trauma, joint malalignment (genu varum/valgum), and genetic predisposition, among other causes.¹ Other considerations include systemic vasculopathies, inflammation, endocrine or metabolic factors, and degenerative joint disease. The most accepted cause of osteochondritis dissecans is repetitive trauma.¹ Another explanation is involvement of the endochondral epiphyseal growth plate, which can be injured either acutely or repetitively over time. While the uninjured region of the endochondral epiphyseal growth plate continues to ossify, the injured region, either temporarily or permanently, ceases ossification, leading to development of OCD.¹

OCD affects younger adolescents aged 12-16 years at a higher rate around 11 per 100,000.¹ It is more common among males and African American race^1,2. Juvenile OCDs are significantly more common in the knee, followed by the elbow and ankle while adult OCD is more common in the ankle followed by the knee.¹ The most common location for juvenile OCD of the knee is the lateral portion of the medial femoral condyle (60-70%) followed by the lateral femoral condyle (15-20%).³ Multiple missense ACAN gene variants with autosomal dominant inheritance, affect the C-type lectin repeat of aggrecan (15q gene) and cause a rare form of hereditary osteochondritis dissecans. ACAN missense gene variants often demonstrate short stature and early osteoarthritis.¹

Knee OCD: Recent studies have shown that Vitamin D deficiency was associated with knee osteochondritis dissecans lesions among the young adult population.⁴ Moderate increase in BMI is associated with more severe lesions: subchondral edema, anteromedial condylar lesions of the knee.¹ Discoid menisci and axial malalignment have been shown to be a risk factor for lateral femoral condyle OCD.⁵ The highest incidence of juvenile knee OCD is among basketball, soccer, baseball catchers, and American football players especially, male basketball and female soccer players.^1,5

Elbow OCD: BMI more than 40 is associated with increased risk of elbow and talar OCD.¹ Overhead throwing athletes, as seen in baseball pitchers, softball pitchers, cheerleaders, cricket bowlers, cheerleaders, female gymnastics are also at risk.¹

Talar OCD: Posteromedial talar dome lesions are often the result of vascular disease and chronic ankle instability lesions, anterolateral talar dome is associated with acute trauma and lateral ankle ligament injury.^1,5

Disease progression including natural history, disease phases or stages, disease trajectory (clinical features and presentation over time)

The disease course is characterized by lesion location and stability. Stable lesions with open physeal lesions of the knee, elbow and talus respond to conservative management (physical therapy, protected weightbearing) and monitoring with repeat X rays. Repeat X ray monitoring will determine whether surgical referral is needed.

On the other hand, unstable lesions with or without loose bodies in the joint require orthopedic intervention followed by therapy. Untreated small lesions could progress and eventually require surgical intervention.⁵

Most radiographic classifications are used to describe the location of the lesion or healing progress but their use in assessing lesion stability and severity is still considered to be limited.¹ Arthroscopy (International Cartilage Repair Society’s (ICRS) arthroscopic classification) is the gold standard when evaluating stability of OCD lesions, however, MRI is the first line evaluation to guide patient management due to its non-invasive nature and its ability to detect the earliest stages of the disease.^1,5

Essentials of Assessment

History

History should include a standard assessment of pain and all its associated qualities such as location, intensity, characteristics, quality, duration, mechanism of onset, exacerbating and relieving factors, and associated symptoms and joint instability. Patients often present with activity-related pain that is nonspecific and poorly localized. The duration of pain can be ongoing and mild for several months before sudden worsening, prompting patient presentation to a provider. Lastly, inquiry of personal and family history of rheumatological conditions, surgical history, prior injury, current activity level and of all previous and ongoing sports participation should be considered.

Knee OCD: History of swelling and presence of mechanical symptoms suggestive of loose joint bodies, such as locking, catching, popping, or buckling should be elicited.¹

Capitellum OCD: History of posterior or lateral elbow pain relieved with rest should be elicited. Associated mechanical symptoms could include clicking and locking throughout the range of motion.¹ Swelling may be present.

Talar OCD: History of vague anterior ankle pain relieved with rest. Mechanical symptoms including clicking and locking may be less common compared to the other joints due to the talus being covered by the tibial plafond during range of motion.¹

Physical examination

The examination of the patient should include inspection of the overall alignment of the affected joint, palpation, range of motion, and provocative examination³. Evaluation should be completed on both sides as up to 1/3 of cases have been found to be present bilaterally with non-specific symptomatologyasymptomatic.^1,5 The patient may have an antalgic gait if the lesion is in the lower extremity and may exhibit avoidance of the injured side. Additionally, there may be pain over the peri-articular regions and chronic or intermittent effusion of the joint.

Knee OCD: Range of motion (ROM) is often preserved in knee. Tenderness to the medial femoral condyle may be noted. Patients may have pain with flexion, extension, and rotation of the knee and joint effusion. The characteristics of knee OCD are not typically uniform, and exam findings are typically non-specific.³

Elbow OCD: Tenderness on the radial elbow is noted. ROM may be decreased in elbow lesions. Diagnosis of OCD in the elbow is supported by a positive radio capitellar compression test or “grip and grind test,” which is demonstrated by pain with axial compression force during active pronation and supination of the elbow in extension. Data on the validity of this provocative maneuver is limited.⁵

Talus OCD: Pain during active ROM, ligamentous laxity from prior lateral ankle sprain, and joint effusion may be present.Diagnosis is supported by tenderness to palpation of the ankle with extreme dorsiflexion of the ankle, a provocative maneuver that exposes the talar dome to the examiner’s hand. Data on the validity of this provocative maneuver is limited.⁵

Functional assessment

Numerous generalized scales that have been validated and used in OCD research to collect uniform data on outcome measures. The most common ones are listed below^3,5,6,7

• International Knee Documentation Committee and Subjective Knee Evaluation (IKDC): Provides a functional score based on subjective assessment of 3 categories: symptoms, sports activity tolerance, and knee function.
• Lysholm Knee Score
• PEDI-IKDC Questionnaire: Pediatric version of IKDC
• Knee Injury and Osteoarthritis Outcome Score (KOOS): Evaluates short-term and long-term symptoms and function in subjects with knee injury and osteoarthritis
• Tegner score
• Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score: Specifically evaluated in capitellar OCD patients
• Osteochondral Lesions of Ankle (OCLA-G): Developed as first patient-reported and injury-specific outcome scale to measure impact of osteochondral lesions in ankle
• Knee, Elbow, Ankle OCD: Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS): An eight-item scale that measures level of physical activity and fitness.

Laboratory studies

There are no laboratory findings associated with OCD.

Imaging

The diagnosis of OCD is made radiographically. Plain radiographs are often the first choice of investigation and may demonstrate subtle lucency, fragmentation, and loose bodies in the intra-articular space.

Knee OCD: For the knee, the anteroposterior, lateral, Rosenberg/tunnel or notch view and sunrise views should be obtained.¹

Elbow OCD: For the elbow, the extension anterior-posterior, 45-degree flexion anterior-posterior, radial head and lateral views are recommended.¹

Ankle OCD: For the ankle, oblique, mortise, horizontal beam lateral view, heel rise view, and plantarflexed views including with the ankle in 15-degree of internal rotation is suggested to better visualize the superolateral corner of the talus without fibular overlap. Stress X rays with talar tilt can be useful in the setting of ankle sprains.¹

While standard radiographs are useful in diagnosing OCD and have utility in monitoring healing of the lesion, MRI is the best imaging modality for OCD due to its ability to assess the interface between the subchondral bone and its surrounding cartilage. This allows the clinician to stage the lesion and assess for instability, which is the key factor in determining management and prognosis. MRI should be obtained if the patient is symptomatic with negative radiographs which may be the case in the earliest stages. Arthroscopy is considered the gold standard for determining lesion stability.¹

Disease stages are described on plain radiographs¹ as follows

• Stage 1: Small fragment of compression/flattening of subchondral bone, nondisplaced.
• Stage 2: Partially detached osteochondral fragment.
• Stage 3: Completely detached osteochondral fragment that remains within the underlying crater bed, nondisplaced.
• Stage 4: Completely detached and displaced osteochondral fragment, known as a loose body.
• Stage 5: Subchondral cyst

Disease stages for OCD are described arthroscopically as follows¹

• Stage 1: Stable lesions with continuous but softened area covered by in-tact cartilage
• Stage 2: Lesions with partial discontinuity that are stable when probed
• Stage 3: Lesions with a complete discontinuity that are not yet dislocated.
• Stage 4: Empty defects and defects with a dislocated fragment or loose fragment within the bed

MRI Staging of Joints with Osteochondritis Dissecans¹

• Stage 1: Injury limited to articular cartilage demonstrated as thickening of articular cartilage and subchondral edema.
• Stage 2: Injury of articular cartilage with subchondral fracture, no detachment. In addition to changes seen in previous criteria, low-signal rim can be seen behind fragment.
• Stage 3: Detached, non-displaced fragment visualized. On MRI, high-signal changes can be seen between fragment and underlying subchondral bone.
• Stage 4: Osteochondral fragment displaced.

Imaging findings for lesion instability for both adults and juveniles on MRI are characterized as follows

• High-signal-intensity surrounding the lesion,
• Focal defect in the articular cartilage,
• Fracture of the articular cartilage, and
• Presence of subchondral cysts.

However, most lesions with a high T2 signal in the base healed in younger, skeletally immature patients.

For juvenile OCD, having all 4 of these criteria was noted to have 100% sensitivity for instability.

With the addition of the following secondary criteria, the specificity was also 100%¹

• Multiple breaks in the subchondral bone plate,
• Outer rim of low T2 signal intensity, and
• Rim of fluid signal intensity.

Musculoskeletal ultrasound can provide further screening and diagnostic value for OCD of the capitellum and knee but is operator dependent.^1,5

Early predictions of outcomes

Those with stable lesions are predicted to heal more quickly and with less aggressive measures than those with unstable lesions. In addition, patients with open physis have better outcomes than patients with closed physis. Furthermore, patients with BMI greater than 25 have poorer outcomes.¹ Physical activity in the form of overhead throwing sports could predispose children to have elbow OCD lesions.¹ The presence of Vitamin D deficiency is one of the multiple etiological factors in juvenile OCD and could impede healing.⁴

Outcomes in different types of OCD

Knee OCD: Males had similar outcomes compared to females. Age, lesion size and large cystic lesions could be predictors of outcomes.^1,2

Elbow OCD: Arthroscopic debridement without microfracture and osteochondral autograft (costal or knee) transfer achieved a good healing response for capitellar OCD including the professional athletic population.⁵

Ankle OCD: Lower BMI and younger age (10-14 years) correlated with better outcomes for talar OCD among children.^1,8 Central-medial tibial plafond OCD responded favorably to microfracture of lesions < 150 sq.mm.⁸

Environmental

Special consideration of the child’s non-weight bearing status and available school accommodations should be explored. Additionally, the child’s home environment should be assessed, including the need to climb stairs or hills to reach home.

Social role and social support system

Social history should be obtained from the patient about the types of sports played (if any), level of competition, and hours of activity per week, all of which should be considered when deciding return to play.

Rehabilitation Management and Treatments

Coordination of care

Coordination of care between the physiatrist, physical therapist and orthopedic surgeon can be helpful if non-operative treatment is not successful in reducing pain complaints and/or function.

Diagnostic Tests

Knee radiographs (AP, lateral, sunrise, tunnel views) are an option in patients with mechanical symptoms and signs of effusion, tenderness, ROM limitation.¹

In known cases of OCD seen on radiographs, MRI provides information on lesion characteristics, concomitant knee pathology and healing.^1,5

Treatment Plan

Juvenile OCD (Open physes) with stable lesions: The first line rehabilitation treatment approach for knee OCD is activity restriction for a duration of 6 weeks. Other interventions that may provide some benefit include physical therapy, physical instrumental therapies such as iontophoresis and extracorporeal shock wave therapy, weightbearing with crutches, or immobilization with casting or bracing.⁵.Physical therapy can be utilized to correct any malalignment/strength deficits after restricted weight bearing with strengthening and stretching around the joint and improving abnormal movement patterns.⁵

X-rays are taken at 4-6 weeks to evaluate for healing. If healing is not noted on X-ray, gentle non-weight bearing range of motion followed by re-casting for a total of 3 months is done. After 3 months of casting, or after X-ray evidence of healing is noted, the child is provided with a brace. MRI could be considered at 3 months to evaluate the healing process. Restriction of painful and impactful activities like running and jumping sports is recommended. To keep pediatric patients active and to preserve ROM, activity modification should focus on low-impact, non-weight bearing exercises like biking; however, no specific physical therapy protocols have currently been validated for OCD.⁵

X-rays are repeated at the 6 to 8-week mark to monitor for healing. With continued healing, activity restrictions and bracing can be progressively decreased for 6 months or until pain-free. If healing is not noted, surgery referral is recommended. MRI is repeated at 6 months and if the lesion is worsening, surgery referral is warranted. Vitamin D deficiency should be treated if present.⁴

Knee OCD: Weight bearing precautions can be implemented by using assistive devices (cane, walker, crutches), casting or bracing (non-unloader brace)¹. Stable juvenile OCD lesions managed conservatively demonstrate healing rates ranging from approximately 40-88%, with favorable outcomes in younger patients aged <12 years, and those with smaller lesions in non-weight-bearing regions.⁵

Elbow OCD: Elbow immobilization may enable both an early return to sports and complete healing. A comparison treatment study found cast immobilization for 4 weeks followed by splinting for 7 weeks and activity restriction significantly accelerated healing compared to activity restriction alone, with almost all individuals achieving complete healing at approximately 6 months versus less than half individuals achieving complete healing with restriction alone.⁹

Talus OCD: Acute, nondisplaced lesions are managed with 4-6 weeks of immobilization and protected weight bearing, with greater than 50% of individuals showing symptomatic improvement by 3 months.²⁹ If symptoms persist at 3 months, surgical referral should be considered.^1,10

Surgery for stable lesions

Approximately one-third of pediatric patients with OCD progress to surgical management, with higher rates in patients of older age at diagnosis.¹ Surgery to stimulate growth, restoration, or repair can be considered in patients with stable lesions whose symptoms have failed to improve despite a course of conservative management. These restorative techniques include drilling, microfracture, and osteochondral autograft transfer surgery (OATS). Drilling of the subchondral bone is thought to stimulate growth and restoration via neovascularization and re-ossification. This procedure is often considered for stable lesions with intact articular cartilage. Microfracture involves operative fracture of the subchondral bone to promote cartilage healing via release of growth factors and stem cells from the underlying cancellous bone. OAT is a technique that replaces hyaline cartilage in the lesion by transplantation of osteochondral plugs from non-weight bearing surfaces of the femur. Salvage procedures, such as osteochondral allografts, should not be attempted as a first line procedure, but may be helpful in larger and deeper OCD lesions.

Surgery for unstable lesions

Surgical options include arthroscopic reduction and internal fixation with bioabsorbable/ metal screws, microfracture, bone grafting, and fixation with autograft osteochondral plugs or autologous cultured chondrocytes on porcine collagen membrane.¹¹

Salvageable unstable lesions or loose bodies among skeletally mature and immature population

Orthopedic surgery should be followed by post-operative rehabilitative physical therapy. Surgical approaches include drilling of intact OCD lesion (retro-articular or trans-articular), fixation with or without bone grafting, fragment excision and isolated debridement, fragment excision and marrow stimulation, OATS, osteochondral allograft transplantation, and autologous chondrocyte implantation (with or without bone grafting).

Patient & family education

Skeletally immature pediatric patients and family should be educated on the fact that many stable lesions do not require any operative treatments. Additionally, they should be educated about the fact that many patients do not have any long-term risks or complications from having a history of OCD.

Long-term risks or complications may include delayed return to sport if there is prolonged symptom duration and the patient is of older age.¹² There is evidence to suggest that those with fragmented lesions or large amounts of bone/cartilage loss are at an increased risk for degenerative changes in the joint later in life especially patients with BMI greater than 25, lesions greater than 4 sq.cm and after undergoing fragment excision.² Occasionally, transient ulnar neurapraxia and radial head enlargement (capitellar OCD) can occur.¹³ Depending on the donor-site, OAT can result in complications including pneumothorax (costal) and mechanical symptoms (knee).¹⁴

The patient may require accommodation at school for appropriate access, including assistance carrying objects such as books or traversing stairs if there is no available elevator. These accommodations should be discussed between patients and school officials and may require documentation from a provider. Knee OCD: Juvenile OCD with stable lesions managed non-operatively could mean that the kids could return to playing (track and field, weightlifting) by around 6 months.¹ In order to keep kids active and to preserve ROM, non-weight bearing exercises like biking could be encouraged.

Elbow OCD: Strict non-weightbearing precautions are recommended for gymnasts and cheerleaders (bilateral limb use), pitchers (dominant upper limb). Around 3 months, decision could be made based on MRI findings regarding surgical referral if lesion has not healed. To preserve ROM and encourage exercise, non-weight-weight bearing exercises like swimming could be encouraged.¹⁵

Ankle OCD: 3 months of non-impact activities (walking, cycling, swimming) could be encouraged while MRI could provide guidance regarding surgical referral for stable lesions. OATS surgery performed for talar OCD resulted in 80% return to sport at prior level around 6 months.¹⁶

Translation into practice: Practice “pearls”/performance improvement in practice (PIPs)/changes in clinical practice behaviors and skills

Consider X-ray imaging and immobilization of involved limb for a child presenting with knee/elbow/ankle joint pain:

• Of insidious onset or after a traumatic event
• Chronic joint-related/intra-articular pain
• Evidence of intra-articular injury (traumatic effusion)
• With or without mechanical symptoms (buckling, clicking, locking).

If X-ray is suggestive of OCD lesion, MRI is pursued to characterize and stage the lesion.

If X-ray is not suggestive of OCD and the pain is extra-articular without mechanical symptoms, consider the following other injuries which should be excluded

Knee

• Tibial tubercle apophysitis (Osgood-Schlatter)
• Patellar apophysitis (Sinding-Larsen-Johansson)

Elbow

Panner’s disease is seen among kids aged 4-12 years without loose bodies.¹⁵

Ankle

Osteochondral lesions of the talus are noted among adults aged 30-50 years and should not be mistaken for OCD lesions.

Cutting Edge/Emerging and Unique Concepts and Practice

Joints of patients having unstable OCD lesions, despite surgical treatment, have been observed over time, often to progress to early osteoarthritis. Several recent interventions have shown promise in reducing risk of progressive joint degeneration for patients with unstable OCD lesions that have failed surgical fixation. Cartilage reconstruction (including osteochondral autograft transfer, osteochondral allograft transplantation, and autologous chondrocyte implantation) or unstable fragment (OCD knee) removal have been helpful in these cases and generally provide good functional outcomes and return to sport.¹¹ Building on the growing interest in biologically driven cartilage restoration strategies for OCD, emerging strategies have included scaffold based regenerative techniques. Extracellular matrix grafting combined with bone marrow aspirate concentrate (ECM-BMAC) has shown promising results for capitellar and talar OCD in pediatric athletes, extending regenerative strategies beyond the knee.^17,18 While these findings indicate the potential of cell-based restorative methods, these studies were conducted at a single center and had 16-20 participants treated by 1-2 orthopedic surgeons. Additional studies are needed to support their use.

Gaps in Evidence-Based Knowledge

There are still several gaps in knowledge pertaining to OCD. Although factors like ischemic chondronecrosis and chronic mechanical load have recently emerged as drivers of OCD, the exact etiology remains multifactorial and not fully understood.¹ While MRI is a helpful tool in staging the injury and determining stability, there are no known imaging findings that correlate with information on prognosis or length to recovery. However, newer quantitative 3T MRI techniques, such as T2 mapping, may help differentiate healing from non-healing lesions over time.¹⁹ Additionally, apparent diffusion coefficient values from quantitative diffusion MRIs may help identify lesions at higher risk for surgical intervention.²⁰ Nonetheless, these techniques require further validation before routine clinical application. CT-SPECT and PET-scans can be used in characterizing and providing prognostic information, but its use comes with exposure to high doses of radiation. Finally, the natural history and progression for OCD lesions is still unclear despite better characterization of pathological progression. Clinicians are still not able to reliably predict which lesions will heal with conservative treatment versus require surgical intervention. Most recommend non-operative treatment in skeletally immature patients for the first 3 to 6 months in stable lesions. However, the optimal type of conservative treatment and expected duration have not yet been established.

References

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2. Ross BJ, Hermanns CA, Xu S, et al. Males and Females Exhibit Comparable Outcomes Following Treatment of Osteochondritis Dissecans Lesions of the Knee: A Systematic Review. Arthroscopy. 2022;38(10). doi:10.1016/J.ARTHRO.2022.03.015
3. Nissen CW, Albright JC, Anderson CN, et al. Descriptive Epidemiology From the Research in Osteochondritis Dissecans of the Knee (ROCK) Prospective Cohort. Am J Sports Med. 2022;50(1):118-127. doi:10.1177/03635465211057103
4. Maier GS, Lazovic D, Maus U, Roth KE, Horas K, Seeger JB. Vitamin D Deficiency: The Missing Etiological Factor in the Development of Juvenile Osteochondrosis Dissecans? J Pediatr Orthop. 2019;39(1):51-54. doi:10.1097/BPO.0000000000000921
5. Konarski W, Poboży T, Konarska K, Derczyński M, Kotela I. Understanding Osteochondritis Dissecans: A Narrative Review of the Disease Commonly Affecting Children and Adolescents. Children (Basel). 2024 Apr 22;11(4):498. doi: 10.3390/children11040498. PMID: 38671714; PMCID: PMC11049496.
6. Performance of Patient-Reported Outcomes Measurement Information System (PROMIS) scores compared with legacy metrics in evaluating outcomes after surgical treatment for osteochondritis dissecans of the humeral capitellum. Broughton, James Sam et al. Journal of Shoulder and Elbow Surgery, Volume 30, Issue 7, 1511 – 1518
7. Lohrer H, Wagner S, Wenning M, Kühle J, Schmal H, Gollhofer A. Development and validation of a questionnaire to measure the severity of pain, functional limitations, and reduction of sports ability for german-speaking patients with osteochondral lesions of the ankle (OCLA-G). BMC Musculoskelet Disord. 2023 May 1;24(1):340. doi: 10.1186/s12891-023-06445-3. PMID: 37127617; PMCID: PMC10150525.
8. Allahabadi S, Allahabadi S, Allala R, Garg K, Pandya NK, Lau BC. Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes. Orthop J Sports Med. 2021;9(4). doi:10.1177/2325967121997120
9. Takahara M, Uno T, Maruyama M, Harada M, Mitachi R, Ono H, Satake H, Takagi M. Conservative treatment for stable osteochondritis dissecans of the elbow before epiphyseal closure: effectiveness of elbow immobilization for healing. J Shoulder Elbow Surg. 2022 Jun;31(6):1231-1241. doi: 10.1016/j.jse.2022.01.148. Epub 2022 Mar 2. PMID: 35247573.
10. Powers RT, Dowd TC, Giza E. Surgical Treatment for Osteochondral Lesions of the Talus. Arthroscopy. 2021 Dec;37(12):3393-3396. doi: 10.1016/j.arthro.2021.10.002. PMID: 34863377.
11. Matthews JR, Sonnier JH, Paul RW, et al. A systematic review of cartilage procedures for unstable osteochondritis dissecans. Phys Sportsmed. Published online 2022. doi:10.1080/00913847.2022.2082262
12. Cheng C, Milewski MD, Nepple JJ, Reuman HS, Nissen CW. Predictive Role of Symptom Duration Before the Initial Clinical Presentation of Adolescents With Capitellar Osteochondritis Dissecans on Preoperative and Postoperative Measures: A Systematic Review. Orthop J Sports Med. 2019;7(2). doi:10.1177/2325967118825059
13. McLaughlin RJ, Leland DP, Bernard CD, et al. Both Debridement and Microfracture Produce Excellent Results for Osteochondritis Dissecans Lesions of the Capitellum: A Systematic Review. Arthrosc Sports Med Rehabil. 2021;3(2):e593-e603. doi:10.1016/J.ASMR.2020.10.002
14. Bexkens R, Ogink PT, Doornberg JN, et al. Donor-site morbidity after osteochondral autologous transplantation for osteochondritis dissecans of the capitellum: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2237-2246. doi:10.1007/S00167-017-4516-8
15. Eygendaal D, Bain G, Pederzini L, Poehling G. Osteochondritis dissecans of the elbow: State of the Art. Published online 2017. doi:10.1136/jisakos-2015-000008
16. Barbier O. Osteochondral lesions of the talar dome. Orthop Traumatol Surg Res. 2023 Feb;109(1S):103452. doi: 10.1016/j.otsr.2022.103452. Epub 2022 Oct 20. PMID: 36273506.
17. Bram JT, Jones RH, Cogsil T, et al. Outcomes of grafting extracellular matrix with bone marrow aspirate concentrate in pediatric and adolescent patients with capitellar osteochondritis dissecans. J Shoulder Elbow Surg. 2025;34(8):2015-2021. DOI:10.1016/j.jse.2024.12.008.
18. Bram JT, Jones RH, Beber SA, Cho D, Drakos MC, Fabricant PD. Concentrated Bone Marrow Aspirate with Extracellular Matrix Grafting for Osteochondral Lesions of the Talus in Pediatric and Adolescent Patients. Journal of the Pediatric Orthopaedic Society of North America,2026,100324,ISSN 2768-2765, https://doi.org/10.1016/j.jposna.2026.100324.
19. Kajabi AW, Zbýň Š, Johnson CP, Tompkins MA, Nelson BJ, Takahashi T, Shea KG, Marette S, Carlson CS, Ellermann JM. Longitudinal 3T MRI T2 * mapping of Juvenile osteochondritis dissecans (JOCD) lesions differentiates operative from non-operative patients-Pilot study. J Orthop Res. 2023 Jan;41(1):150-160. doi: 10.1002/jor.25343. Epub 2022 Apr 30. PMID: 35430743; PMCID: PMC9573934.
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Original Version of the Topic

Farah Hameed, MD. Osteochondritis Dissecans. 12/02/2013

Previous Revision(s) of the Topic

Thomas Chai, MD, Larry Driver, MD. Osteochondritis Dissecans. 2/12/2018

Shane Mario Andre Drakes, MD, Anusha Lekshminarayanan, MD, Michael Lew, DO, Xiao Wei Liu, MD. Osteochondritis Dissecans. 5/18/2023

Author Disclosure

Shane Mario Andre Drakes, MD
Nothing to Disclose

Anusha Lekshminarayanan, MD
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Arjun Ashok, MD
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Enrique Cruz, MD
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Marlou Abril, DO
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Michelle Cho, MD, MS
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Suriya Lisa, MD, MS
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