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A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

  • Symposium: Osteochondritis Dissecans
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Osteochondritis dissecans (OCD) was first described to provide an explanation for the nontraumatic development of loose bodies within a joint. Despite many reports on the subject, there remains no clear understanding of the etiology, natural history, or treatment.

Questions/purposes

This review was undertaken to delineate (1) the etiology of OCD; (2) the presentation and locations; (3) the most appropriate imaging modalities; and (4) the most effective treatment strategies.

Methods

We reviewed the English literature using a database compiled from a Medline search for “osteochondritis dissecans”. We identified 1716 publications, 1246 of which were in English. After exclusions, we reviewed 748 articles and of these cited 85. The observations of each study were then synthesized into this report.

Results

There appears to be no consensus concerning the etiology of OCD lesions. The presentations and locations are variable, but the knee, ankle, and elbow are most commonly involved. Although plain film assessment is important in OCD, there appears to be a trend toward the use of MRI, but the preferred sequences are in evolution. We found no consensus on the treatment of these lesions, related in part to the lack of agreement of methods for assessing outcomes.

Conclusions

Despite more than a century of study, we have made little advancement in our understanding of OCD. A study group has been formed to address this issue and actively seeks to answer these unknown issues regarding OCD.

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References

  1. Aichroth P. Osteochondritis dissecans of the knee. A clinical survey. J Bone Joint Surg Br. 1971;53:440–447.

    PubMed  CAS  Google Scholar 

  2. Barrie HJ. Hypertrophy and laminar calcification of cartilage in loose bodies as probable evidence of an ossification abnormality. J Pathol. 1980;132:161–168.

    Article  PubMed  CAS  Google Scholar 

  3. Barrie HJ. Hypothesis—a diagram of the form and origin of loose bodies in osteochondritis dissecans. J Rheumatol. 1984;11:512–513.

    PubMed  CAS  Google Scholar 

  4. Bedi A, Feeley BT, Williams RJ 3rd. Management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010;92:994–1009.

    Article  PubMed  Google Scholar 

  5. Bradley J, Dandy DJ. Osteochondritis dissecans and other lesions of the femoral condyles. J Bone Joint Surg Br. 1989;71:518–522.

    PubMed  CAS  Google Scholar 

  6. Bradley J, Dandy DJ. Results of drilling osteochondritis dissecans before skeletal maturity. J Bone Joint Surg Br. 1989;71:642–644.

    PubMed  CAS  Google Scholar 

  7. Bruns J, Rayf M, Steinhagen J. Longitudinal long-term results of surgical treatment in patients with osteochondritis dissecans of the femoral condyles. Knee Surg Sports Traumatol Arthrosc. 2008;16:436–441.

    Article  PubMed  Google Scholar 

  8. Cahill B. Treatment of juvenile osteochondritis dissecans and osteochondritis dissecans of the knee. Clin Sports Med. 1985;4:367–384.

    PubMed  CAS  Google Scholar 

  9. Cahill BR. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg. 1995;3:237–247.

    PubMed  Google Scholar 

  10. Cahill BR, Ahten SM. The three critical components in the conservative treatment of juvenile osteochondritis dissecans (JOCD). Physician, parent, and child. Clin Sports Med. 2001;20:287–298, vi.

    Article  PubMed  CAS  Google Scholar 

  11. Cahill BR, Phillips MR, Navarro R. The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy. A prospective study. Am J Sports Med. 1989;17:601–605; discussion 605–606.

    Article  PubMed  CAS  Google Scholar 

  12. Chambers HG, Shea KG, Carey JL. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg. 2011;19:307–309.

    PubMed  Google Scholar 

  13. Chiroff RT, Cooke CP 3rd. Osteochondritis dissecans: a histologic and microradiographic analysis of surgically excised lesions. J Trauma. 1975;15:689–696.

    Article  PubMed  CAS  Google Scholar 

  14. Crawford DC, Safran MR. Osteochondritis dissecans of the knee. J Am Acad Orthop Surg. 2006;14:90–100.

    PubMed  Google Scholar 

  15. De Smet AA, Fisher DR, Graf BK, Lange RH. Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. AJR Am J Roentgenol. 1990;155:549–553.

    Article  PubMed  Google Scholar 

  16. De Smet AA, Ilahi OA, Graf BK. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol. 1996;25:159–163.

    Article  PubMed  Google Scholar 

  17. Edmonds EW, Albright J, Bastrom T, Chambers HG. Outcomes of extra-articular, intra-epiphyseal drilling for osteochondritis dissecans of the knee. J Pediatr Orthop. 2010;30:870–878.

    Article  PubMed  Google Scholar 

  18. Emmerson BC, Gortz S, Jamali AA, Chung C, Amiel D, Bugbee WD. Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med. 2007;35:907–914.

    Article  PubMed  Google Scholar 

  19. Fairbanks H. Osteo-chondritis dissecans. Br J Surg. 1933;21:67–82.

    Article  Google Scholar 

  20. Fonseca F, Balaco I. Fixation with autogenous osteochondral grafts for the treatment of osteochondritis dissecans (stages III and IV). Int Orthop. 2009;33:139–144.

    Article  PubMed  Google Scholar 

  21. Freifberg AH, Woolley PG. Osteochondritis dissecans: concerning its nature and relation to formation of joint mice. J Bone Joint Surg Am. 1910; s2–s8: 477–494.

    Google Scholar 

  22. Friederichs MG, Greis PE, Burks RT. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. Arthroscopy. 2001;17:542–545.

    Article  PubMed  CAS  Google Scholar 

  23. Garrett JC. Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults. Clin Orthop Relat Res. 1994;303:33–37.

    PubMed  Google Scholar 

  24. Gebarski K, Hernandez RJ. Stage-I osteochondritis dissecans versus normal variants of ossification in the knee in children. Pediatr Radiol. 2005;35:880–886.

    Article  PubMed  Google Scholar 

  25. Ghazavi MT, Pritzker KP, Davis AM, Gross AE. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br. 1997;79:1008–1013.

    Article  PubMed  CAS  Google Scholar 

  26. Glancy GL. Juvenile osteochondritis dissecans. Am J Knee Surg. 1999;12:120–124.

    PubMed  CAS  Google Scholar 

  27. Gomoll AH, Flik KR, Hayden JK, Cole BJ, Bush-Joseph CA, Bach BR Jr. Internal fixation of unstable Cahill Type-2C osteochondritis dissecans lesions of the knee in adolescent patients. Orthopedics. 2007;30:487–490.

    PubMed  Google Scholar 

  28. Green WT, Banks HH. Osteochondritis dissecans in children. J Bone Joint Surg Am. 1953;35:26–47; passim.

    PubMed  Google Scholar 

  29. Gudas R, Simonaityte R, Cekanauskas E, Tamosiunas R. A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop. 2009;29:741–748.

    Article  PubMed  Google Scholar 

  30. Guhl JF. Arthroscopic treatment of osteochondritis dissecans. Clin Orthop Relat Res. 1982;167:65–74.

    PubMed  Google Scholar 

  31. Hefti F, Beguiristain J, Krauspe R, Moller-Madsen B, Riccio V, Tschauner C, Wetzel R, Zeller R. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B. 1999;8:231–245.

    PubMed  CAS  Google Scholar 

  32. Hughston JC, Hergenroeder PT, Courtenay BG. Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am. 1984;66:1340–1348.

    PubMed  CAS  Google Scholar 

  33. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Association between mechanical axis of the leg and osteochondritis dissecans of the knee: radiographic study on 103 knees. Am J Sports Med. 2010;38:1425–1428.

    Article  PubMed  Google Scholar 

  34. Johnson LL, Uitvlugt G, Austin MD, Detrisac DA, Johnson C. Osteochondritis dissecans of the knee: arthroscopic compression screw fixation. Arthroscopy. 1990;6:179–189.

    Article  PubMed  CAS  Google Scholar 

  35. Jurgensen I, Bachmann G, Schleicher I, Haas H. Arthroscopic versus conservative treatment of osteochondritis dissecans of the knee: value of magnetic resonance imaging in therapy planning and follow-up. Arthroscopy. 2002;18:378–386.

    Article  PubMed  Google Scholar 

  36. Kijowski R, Blankenbaker DG, Shinki K, Fine JP, Graf BK, De Smet AA. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology. 2008;248:571–578.

    Article  PubMed  Google Scholar 

  37. Kivisto R, Pasanen L, Leppilahti J, Jalovaara P. Arthroscopic repair of osteochondritis dissecans of the femoral condyles with metal staple fixation: a report of 28 cases. Knee Surg Sports Traumatol Arthrosc. 2002;10:305–309.

    PubMed  CAS  Google Scholar 

  38. Kobayashi T, Fujikawa K, Oohashi M. Surgical fixation of massive osteochondritis dissecans lesion using cylindrical osteochondral plugs. Arthroscopy. 2004;20:981–986.

    PubMed  Google Scholar 

  39. Kocher MS, Micheli LJ, Yaniv M, Zurakowski D, Ames A, Adrignolo AA. Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med. 2001;29:562–566.

    PubMed  CAS  Google Scholar 

  40. Kocher MS, Tucker R, Ganley TJ, Flynn JM. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med. 2006;34:1181–1191.

    Article  PubMed  Google Scholar 

  41. Konig F. Ueber freie korper in den gelenken. Dtsch Z Chir. 1887;27:90–109.

    Article  Google Scholar 

  42. Kouzelis A, Plessas S, Papadopoulos AX, Gliatis I, Lambiris E. Herbert screw fixation and reverse guided drillings, for treatment of types III and IV osteochondritis dissecans. Knee Surg Sports Traumatol Arthrosc. 2006;14:70–75.

    Article  PubMed  Google Scholar 

  43. Kozlowski K, Middleton R. Familial osteochondritis dissecans: a dysplasia of articular cartilage? Skeletal Radiol. 1985;13:207–210.

    Article  PubMed  CAS  Google Scholar 

  44. Larsen MW, Pietrzak WS, DeLee JC. Fixation of osteochondritis dissecans lesions using poly(L-lactic acid)/poly(glycolic acid) copolymer bioabsorbable screws. Am J Sports Med. 2005;33:68–76.

    Article  PubMed  Google Scholar 

  45. Lebolt JR, Wall EJ. Retroarticular drilling and bone grafting of juvenile osteochondritis dissecans of the knee. Arthroscopy. 2007;23:794.e1–e4.

    Google Scholar 

  46. Lee CK, Mercurio C. Operative treatment of osteochondritis dissecans in situ by retrograde drilling and cancellous bone graft: a preliminary report. Clin Orthop Relat Res. 1981;158:129–136.

    PubMed  Google Scholar 

  47. Linden B. The incidence of osteochondritis dissecans in the condyles of the femur. Acta Orthop Scand. 1976;47:664–667.

    Article  PubMed  CAS  Google Scholar 

  48. Linden B. Osteochondritis dissecans of the femoral condyles: a long-term follow-up study. J Bone Joint Surg Am. 1977;59:769–776.

    PubMed  CAS  Google Scholar 

  49. Lindholm TS, Osterman K. Treatment of juvenile osteochondritis dissecans in the knee. Acta Orthop Belg. 1979;45:633–640.

    PubMed  CAS  Google Scholar 

  50. Litchman HM, McCullough RW, Gandsman EJ, Schatz SL. Computerized blood flow analysis for decision making in the treatment of osteochondritis dissecans. J Pediatr Orthop. 1988;8:208–212.

    PubMed  CAS  Google Scholar 

  51. Mackie IG, Pemberton DJ, Maheson M. Arthroscopic use of the Herbert screw in osteochondritis dissecans. J Bone Joint Surg Br. 1990;72:1076.

    PubMed  CAS  Google Scholar 

  52. Makino A, Muscolo DL, Puigdevall M, Costa-Paz M, Ayerza M. Arthroscopic fixation of osteochondritis dissecans of the knee: clinical, magnetic resonance imaging, and arthroscopic follow-up. Am J Sports Med. 2005;33:1499–1504.

    Article  PubMed  Google Scholar 

  53. Michael JW, Wurth A, Eysel P, Konig DP. Long-term results after operative treatment of osteochondritis dissecans of the knee joint-30 year results. Int Orthop. 2008;32:217–221.

    Article  PubMed  CAS  Google Scholar 

  54. Milgram JW. Radiological and pathological manifestations of osteochondritis dissecans of the distal femur. A study of 50 cases. Radiology. 1978;126:305–311.

    PubMed  CAS  Google Scholar 

  55. Miniaci A, Tytherleigh-Strong G. Fixation of unstable osteochondritis dissecans lesions of the knee using arthroscopic autogenous osteochondral grafting (mosaicplasty). Arthroscopy. 2007;23:845–851.

    Article  PubMed  Google Scholar 

  56. Mitsuoka T, Shino K, Hamada M, Horibe S. Osteochondritis dissecans of the lateral femoral condyle of the knee joint. Arthroscopy. 1999;15:20–26.

    Article  PubMed  CAS  Google Scholar 

  57. Miura K, Ishibashi Y, Tsuda E, Sato H, Toh S. Results of arthroscopic fixation of osteochondritis dissecans lesion of the knee with cylindrical autogenous osteochondral plugs. Am J Sports Med. 2007;35:216–222.

    Article  PubMed  Google Scholar 

  58. Mubarak SJ, Carroll NC. Familial osteochondritis dissecans of the knee. Clin Orthop Relat Res. 1979;140:131–136.

    PubMed  Google Scholar 

  59. Mubarak SJ, Carroll NC. Juvenile osteochondritis dissecans of the knee: etiology. Clin Orthop Relat Res. 1981;157:200–211.

    PubMed  Google Scholar 

  60. Murray JR, Chitnavis J, Dixon P, Hogan NA, Parker G, Parish EN, Cross MJ. Osteochondritis dissecans of the knee; long-term clinical outcome following arthroscopic débridement. Knee. 2007;14:94–98.

    Article  PubMed  CAS  Google Scholar 

  61. Nakagawa T, Kurosawa H, Ikeda H, Nozawa M, Kawakami A. Internal fixation for osteochondritis dissecans of the knee. Knee Surg Sports Traumatol Arthrosc. 2005;13:317–322.

    Article  PubMed  Google Scholar 

  62. Nawata K, Teshima R, Morio Y, Hagino H. Anomalies of ossification in the posterolateral femoral condyle: assessment by MRI. Pediatr Radiol. 1999;29:781–784.

    Article  PubMed  CAS  Google Scholar 

  63. O’Connor MA, Palaniappan M, Khan N, Bruce CE. Osteochondritis dissecans of the knee in children. A comparison of MRI and arthroscopic findings. J Bone Joint Surg Br. 2002;84:258–262.

    Article  PubMed  Google Scholar 

  64. Paget J. On the production of some of the loose bodies in joints. St Bartholomew’s Hospital Reports. 1870;6:1–4.

    Google Scholar 

  65. Paletta GA Jr, Bednarz PA, Stanitski CL, Sandman GA, Stanitski DF, Kottamasu S. The prognostic value of quantitative bone scan in knee osteochondritis dissecans. A preliminary experience. Am J Sports Med. 1998;26:7–14.

    PubMed  Google Scholar 

  66. Peterson L, Minas T, Brittberg M, Lindahl A. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am. 2003;85(Suppl 2):17–24.

    PubMed  Google Scholar 

  67. Petrie PW. Aetiology of osteochondritis dissecans. Failure to establish a familial background. J Bone Joint Surg Br. 1977;59:366–367.

    PubMed  CAS  Google Scholar 

  68. Phillips HO, Grubb SA. Familial multiple osteochondritis dissecans. Report of a kindred. J Bone Joint Surg Am. 1985;67:155–156.

    PubMed  CAS  Google Scholar 

  69. Ribbing S. Studies on hereditary, multiple epiphyseal disorder. Acta Radiol. 1937;34:1–107.

    Google Scholar 

  70. Schenck RC Jr, Goodnight JM. Osteochondritis dissecans. J Bone Joint Surg Am. 1996;78:439–456.

    PubMed  Google Scholar 

  71. Slawski DP. High tibial osteotomy in the treatment of adult osteochondritis dissecans. Clin Orthop Relat Res. 1997;341:155–161.

    Article  PubMed  Google Scholar 

  72. Slough JA, Noto AM, Schmidt TL. Tibial cortical bone peg fixation in osteochondritis dissecans of the knee. Clin Orthop Relat Res. 1991;267:122–127.

    PubMed  Google Scholar 

  73. Smith DS, Sharp DC, Resendes M. MRI of healing osteochondritis dissecans fragment with absorbable pins. J Comput Assist Tomogr. 1994;18:832–833.

    Article  PubMed  CAS  Google Scholar 

  74. Stanitski CL, Bee J. Juvenile osteochondritis dissecans of the lateral femoral condyle after lateral discoid meniscal surgery. Am J Sports Med. 2004;32:797–801.

    Article  PubMed  Google Scholar 

  75. Steinhagen J, Bruns J, Deuretzbacher G, Ruether W, Fuerst M, Niggemeyer O. Treatment of osteochondritis dissecans of the femoral condyle with autologous bone grafts and matrix-supported autologous chondrocytes. Int Orthop. 2010;34:819–825.

    Article  PubMed  Google Scholar 

  76. Tabaddor RR, Banffy MB, Andersen JS, McFeely E, Ogunwole O, Micheli LJ, Kocher MS. Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop. 2010;30:14–20.

    Article  PubMed  Google Scholar 

  77. Thomson NL. Osteochondritis dissecans and osteochondral fragments managed by Herbert compression screw fixation. Clin Orthop Relat Res. 1987;224:71–78.

    PubMed  Google Scholar 

  78. Uozumi H, Sugita T, Aizawa T, Takahashi A, Ohnuma M, Itoi E. Histologic findings and possible causes of osteochondritis dissecans of the knee. Am J Sports Med. 2009;37:2003–2008.

    Article  PubMed  Google Scholar 

  79. Wall E, Von Stein D. Juvenile osteochondritis dissecans. Orthop Clin North Am. 2003;34:341–353.

    Article  PubMed  Google Scholar 

  80. Wall EJ, Vourazeris J, Myer GD, Emery KH, Divine JG, Nick TG, Hewett TE. The healing potential of stable juvenile osteochondritis dissecans knee lesions. J Bone Joint Surg Am. 2008;90:2655–2664.

    Article  PubMed  Google Scholar 

  81. Wilson JN. A diagnostic sign in osteochondritis dissecans of the knee. J Bone Joint Surg Am. 1967;49:477–480.

    PubMed  CAS  Google Scholar 

  82. Woods K, Harris I. Osteochondritis dissecans of the talus in identical twins. J Bone Joint Surg Br. 1995;77:331.

    PubMed  CAS  Google Scholar 

  83. Wright RW, McLean M, Matava MJ, Shively RA. Osteochondritis dissecans of the knee: long-term results of excision of the fragment. Clin Orthop Relat Res. 2004;424:239–243.

    Article  PubMed  Google Scholar 

  84. Yonetani Y, Nakamura N, Natsuume T, Shiozaki Y, Tanaka Y, Horibe S. Histological evaluation of juvenile osteochondritis dissecans of the knee: a case series. Knee Surg Sports Traumatol Arthrosc. 2010;18:723–730.

    Article  PubMed  Google Scholar 

  85. Yoshida S, Ikata T, Takai H, Kashiwaguchi S, Katoh S, Takeda Y. Osteochondritis dissecans of the femoral condyle in the growth stage. Clin Orthop Relat Res. 1998;346:162–170.

    Article  PubMed  Google Scholar 

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  1. Rady Children’s Hospital and Health Center, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Eric W. Edmonds MD

  2. Rocky Mountain Hospital for Children, Denver, CO, USA

    John Polousky MD

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Correspondence to Eric W. Edmonds MD.

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Edmonds, E.W., Polousky, J. A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group. Clin Orthop Relat Res 471, 1118–1126 (2013). https://doi.org/10.1007/s11999-012-2290-y

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