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Osteochondritis dissecans of the knee

83 citationsUpdated Sep 2026
Illustration: knee

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Osteochondritis dissecans (OCD) of the knee presents with distinct management pathways based on patient age and lesion stability. Juvenile lesions with an intact articular surface possess the potential to heal through nonoperative treatment, specifically via the cessation of repetitive impact loading [1]. In contrast, adult OCD lesions typically require surgical intervention due to inherent instability [1]. While multiple arthroscopic classification systems exist, no single system has achieved universal acceptance [7]. Consequently, treatment indications must be individualized based on lesion size, location, patient age, and activity level [19]. The overall evidence supports the selected use of various surgical procedures for unstable OCD, emphasizing the need to match specific techniques to individual lesion characteristics [63]. However, no definitive conclusion has been reached regarding a single best current surgical technique for articular cartilage and osteochondral lesions [37].

Surgical options range from joint-preserving procedures to grafting techniques. Arthroscopic transarticular and retroarticular drilling are advocated for juvenile patients with stable lesions who have failed initial nonoperative management [4, 9]. For unstable lesions, particularly after epiphyseal closure, cylindrical osteochondral autograft transplantation (OAT) is an excellent treatment option [17]. OAT has demonstrated good clinical results at a mean follow-up of 11 years [21] and provides durable outcomes for middle-aged patients with focal, chronic non-traumatic lesions [14]. Simple excision of fragments is associated with unacceptably high rates of fair and poor outcomes in young patients [3]. Autologous Chondrocyte Implantation (ACI) offers durable outcomes, with 71% survivorship at 10 years and improved function in 75% of patients with symptomatic defects [11]. Matrix-assisted variants, including MACT and MACI, represent suitable options for local defects, showing significantly improved results at 10 years [20] and favorable short-term outcomes in pediatric populations [26].

Allografts and other techniques provide alternatives for larger or complex defects. Osteochondral allograft transplantation is effective for knee OCD, yielding significant improvements in pain and function with high patient satisfaction [13], and remains an excellent treatment with durable long-term outcomes [16]. The OsPlug technique shows significant functional improvement for up to 5 years in high-grade OCD or osteochondral defects [5]. A minced cartilage procedure offers good patient-reported midterm results with low complication rates, serving as a viable single-stage alternative for medium to large lesions [161]. Caution is advised regarding decellularized osteochondral allograft plugs due to a high short-term failure rate observed in one study [31]. Additionally, tissue-engineered cartilage implantation is considered questionable as a salvage procedure for young patients affected by knee osteoarthritis [64].

Anatomy & Pathophysiology

Definition and Classification

Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage [10]. OCD and juvenile osteochondritis dissecans (JOCD) are distinct entities that require different management [2]. JOCD occurs in patients with an open epiphyseal plate (physis) [2]. Once established, OCD has a significantly poorer prognosis than JOCD and rarely heals or unites without operative intervention [2]. The overlap between JOCD and OCD occurs when the lesion does not heal before closure of the physis of the distal femur [2]. According to the status of the growth plate, OCD is classified in juvenile (JOCD) and adult (AOCD) [130]. AOCD rarely heals without operative intervention [130].

Etiology and Pathogenesis

Mechanical factors play a major role in the pathophysiology of OCD [10]. Both JOCD and OCD result from stress fractures of the subchondral bone [2]. Histologic findings in JOCD suggest a failure of ossification secondary to ischemia of the developing cartilage in the epiphysis [57]. Histologic changes in detected JOCD lesions are identical to osteochondrosis seen in animals and represented failure of epiphyseal cartilage canal blood supply with ischemic chondronecrosis [22]. Multiple single-nucleotide polymorphisms may be associated with a genetic basis for OCD [22]. Vitamin D3 deficiency was associated with high-grade OCD lesions in a review of mostly an adult population [22]. The cause of OCD has been perplexing for more than 130 years, with hypotheses including trauma, genetics, inflammatory causes, and vascular abnormalities [55]. No single hypothesis has gained consensus agreement in the orthopedic community regarding the cause of OCD [55]. Repetitive microtrauma plays at least some role in the cause of the development of an OCD lesion [55]. Biological factors (genetic causes, deficit of ossification centers, endocrine disorders) and mechanical factors (tibial spine impingement, discoid meniscus, biomechanical alterations, injuries, overuse) act synergically in the pathogenetic progression of OCD [130]. These factors cause subchondral bone ischemia or fracture, which determines the onset of OCD [130].

Anatomical Location and Demographics

The classic location of OCD of the knee is on the lateral aspect of the medial femoral condyle [55]. OCD lesions are classically located on the medial femoral condyle, though they may occur in the lateral condyle or the trochlea [57]. The lateral femoral condyle and patella were affected less often than the medial femoral condyle, and the tibial plateau very rarely [10]. Medial femoral condyle OCD lesions occur up to six times as often as lesions of the lateral femoral condyle [129]. Both medial and lateral condyle lesions occur in weight-bearing regions of the condyle [129]. Medial condyle lesions occur primarily in the non-meniscal portion of the knee joint [129]. Lateral condyle lesions occur more often in the central or lateral area of the lateral femoral condyle and are strongly associated with the presence of a discoid lateral meniscus [129]. OCD of the knee is usually unilateral [57]. OCD has a prevalence of 15 to 29/100,000 among the general population [130]. OCD mostly affects young patients, with a male-to-female ratio of 5:3, mainly between 10 and 20 years old [130]. In a large epidemiologic study of OCD lesions in adults, the most common location for lesions was the ankle rather than the knee [22]. Men had a higher incidence of OCD lesions than women and were more likely to have a lateral femoral condyle lesion [22].

Risk Factors and Associated Conditions

Patients with OCD had larger tibial spines, whereas intercondylar height was not statistically different from that in the control group [22]. Playing either basketball or soccer was statistically significant for the presence of a trochlear OCD lesion, suggesting repetitive patellofemoral loading may play a role in disease pathogenesis [22]. Baseball/softball catchers presented at an earlier age and had more posterior femoral condylar involvement compared with noncatchers [22]. 14.5% of patients with symptomatic discoid lateral meniscus also had a lateral femoral condyle OCD lesion [22]. Males, younger patients (age 5 to 11 years), and type C meniscal shifts seen on MRI were risk factors for lateral condyle OCD [22]. Axial alignment may be a cofactor in OCD of the femoral condyles, evoking higher loading of the affected than of the unaffected knee compartment [108]. Coronal knee malalignment may be a cause of mechanical stress in OCD lesions [129]. Rotational malalignment of the tibia was found disproportionately in patients with OCD lesions of the knee [129]. Age seems to be a risk factor for instability, with older children more likely to have unstable lesions [57].

Clinical Presentation and Imaging

OCD may present clinically with symptoms related to the integrity of the articular cartilage [48]. Early signs associated with intact cartilage may be related to a softening phenomenon and alteration in the mechanical properties of cartilage [48]. Later stages can present with signs of articular cartilage separation, cartilage flaps, loose bodies, inflammatory synovitis, persistent or intermittent joint effusion, and secondary joint degeneration [48]. MRI is a highly sensitive method for detection of osteochondritis dissecans and can aid in determining if a lesion is stable or unstable [57]. Several recent studies comparing MRI with arthroscopic findings have reported less specificity and sensitivity than previously thought with MRI, noting that MRI alone should not be used to determine lesion stability [57]. The presence of an underlying high-signal intensity line between the lesion and underlying bone, a cystic area, or a focal articular defect indicates instability and may help in preoperative planning [57]. MRI findings seem to be different for anomalous ossification centers and osteochondritis dissecans [57]. Osteochondritis dissecans of the knee in children should not be confused with anomalous ossification centers [57]. Comparison radiographs of the affected and unaffected knees are advised to distinguish OCD from anomalous ossification centers [57]. MRI findings do correlate with clinical outcomes after cartilage repair surgery in the knee, although the specific parameters that correlate best vary by the type of procedure performed [41].

Classification

Entity Distinction: Osteochondritis dissecans (OCD) and juvenile osteochondritis dissecans (JOCD) are distinct entities that require different management [2]. The principal clinical distinguishing factor is that JOCD occurs in patients with an open epiphyseal plate (physis) [2]. OCD is defined as a focal, idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage, which may result in premature osteoarthritis [23]. As a disorder of subchondral bone, it secondarily affects the overlying articular cartilage [32]. In end-stage disease, separation of a fragment of articular cartilage, complete with a layer of its subchondral bone, occurs [32].

Defect Typology: OCD is one of several types of osteochondral defect, which can be divided into focal and degenerative lesions [32]. Focal defects are well delineated and include OCD, traumatic chondral and osteochondral fractures, and osteonecrosis [32]. Degenerative defects are typically poorly demarcated [32]. Differentiation between these types of defect is based on a combination of history, clinical examination, and imaging [32].

ROCK Study Group: The Research in OsteoChondritis of the Knee (ROCK) study group developed a classification system for arthroscopic evaluation of OCD of the knee that includes 6 arthroscopic categories: 3 immobile types and 3 mobile types [120]. No single arthroscopic classification system includes mutually exclusive categories that capture all of the salient features of stability, chondral fissuring, and fragment detachment [120].

MRI Classification: A novel MRI classification system provides a foundation for the subsequent establishment of an operative treatment algorithm for knee OCD [111].

Other Considerations: The reliability of assessing healing on plain radiographs has not been well-established for knee osteochondritis dissecans [118]. Articular cartilage lesions can be reliably classified among surgeons at different sites [148].

Clinical Presentation

Osteochondritis dissecans (OCD) of the knee is most commonly diagnosed during adolescence and classically affects skeletally immature patients who are keen on sport [10] [32]. The condition also occurs in adults, for whom the prognosis is worse than in juveniles [32]. While the knee is the most commonly affected joint in OCD [32], juvenile OCD (JOCD) occurs more often in boys that actively participate in sports [58]. JOCD is generally considered to be a painful condition [58].

Patients with OCD of the knee usually present with symptoms such as knee pain, swelling, locking, decreased range of motion, and giving way [58]. These symptoms are nonspecific and often poorly localized, making early diagnosis complex [58]. Consequently, JOCD is usually discovered when it is already in a progressed stage because the beginning stages are often asymptomatic [58]. The time to diagnosis for JOCD is prolonged because of the vague nature of symptoms [58]. Patients with osteochondritis dissecans may be asymptomatic or present with pain and mechanical symptoms [32].

On examination, patients with osteochondritis dissecans of the knee present with a lateral rotation gait [25]. Medial rotation of the tibia in flexion produces typical pain over the medial femoral condyle in patients with osteochondritis dissecans [25]. The degree of lesion instability in osteochondritis dissecans can be assessed by magnetic resonance imaging [10].

Investigations

Plain radiography: Plain radiographs serve as the appropriate initial imaging study for most knee conditions, allowing for the assessment of osteochondral injury [53]. On radiography, osteochondral defects present as subchondral radiolucency, most commonly located in the medial femoral condyle [53]. While radiographic evaluations are essential for diagnosing osteochondritis dissecans (OCD) lesions of the knee, important aspects of the lesion may be better visualized with magnetic resonance imaging (MRI) [98].

MRI: MRI is the most useful study for differentiating osteonecrosis from other conditions such as osteochondritis dissecans, transient osteoporosis, bone bruises, or occult fractures [102]. The degree of lesion instability in OCD can be assessed by MRI [10], and assessment of the potential instability of an OCD lesion is key to early treatment [98]. MRI may identify the degree of articular cartilage injury, including chondrosis and full-thickness cartilage loss, as well as the presence of associated bone marrow edema and location [53]. Magnetic resonance imaging parameters of a healed osteochondral fragment and patients with satisfactory functional results correspond with arthroscopic evidence of fragment stability [70]. MRI findings correlate with clinical outcomes after cartilage repair surgery in the knee, although the specific parameters that correlate best vary by the type of procedure performed [41]. However, MRI criteria for OCD instability in the pediatric knee do not always correlate with the necessity for surgical intervention [171].

Clinical Examination: Physical examination along with radiographic or advanced imaging findings must be used concomitantly to determine the source of each patient’s symptoms and to determine appropriate surgical intervention when nonsurgical measures have failed [52]. Assessment of the joint must combine physical examination along with radiographic (including full-length alignment views) and MRI findings [103].

Other Considerations: Imaging of the subchondral bone needs to fit into the concept of the functional cartilage–subchondral bone unit, and image evaluation methods need to be refined for adequate and reproducible analysis [172]. Satisfactory clinical outcomes and new cartilage formation, as observed by MRI, are achieved with AMIC at mid-term follow-up for ICRS grade 3–4 in small-to-medium-sized patellar defects in patients under 52 years of age [174].

Treatment

Non-Operative

Conservative management is the initial standard of care for juvenile osteochondritis dissecans (OCD), with approximately 50% of cases healing to provide a normal knee in adult life [2]. In patients with open physes, nonoperative treatment should always be considered [57]. When the radiographic diagnosis is made early in a patient with open physes, healing can often be achieved simply by restricting sports activities [10]. OCD of the knee in children with open physes usually heals when treated with cast immobilization or protected weight bearing [57]. Up to 12 months of conservative treatment might be successful if cyst-like lesions are less than 1.3 mm in length as seen on an MRI [57]. The management of patellofemoral cartilage lesions is controversial and should begin with a comprehensive nonsurgical treatment plan [27].

Operative

Indications: Once established, adult OCD has a significantly poorer prognosis than juvenile OCD and rarely heals or unites without operative intervention [2]. Specific indications for operative treatment in children include prolonged pain without evidence of healing during a 6-month period, an unhealed lesion in which symptoms persist after physeal closure, a sclerotic lesion in the crater (unstable lesion), and a troublesome loose body [57]. In skeletally mature individuals, surgery is necessary to evaluate the lesion and implement treatment [57]. When the lesion remains unstable and the pain persists despite a period of rest, surgery is indicated [10].

Surgical Approach / Technique: The treatment of juvenile and adult OCD, whether nonoperative or operative, should be based on the principles of fracture treatment [2]. Surgical correction of either juvenile or adult OCD is unlikely to succeed unless the joint surface is perfectly restored [2]. Arthroscopic exploration is always the first step in surgical management [10]. Whether the lesion is drilled, excised, curetted, replaced and pinned, or bone grafted depends on the size, stability, and weight-bearing nature of the lesion, which can be determined only at surgery [57]. The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics [63].

Implant Selection: Drilling: Drilling of the lesion produces excellent outcomes if the lesion is stable [10]. Extra-articular, intraepiphyseal drilling is a viable treatment option when conservative treatment fails for stable OCD lesions involving the femoral condyles [105]. This technique has yielded good clinical outcomes with high healing rates and relatively early return to sports [105].

Fixation: Unstable OCD lesions require fixation and, in some cases, bone grafting [10]. Internal fixation of unstable OCD of the knee has been performed in both skeletally immature and mature patients [34]. Displaced osteochondral fragments can sometimes be replaced and secured with small recessed screws or absorbable pins [117].

Osteochondral Autografts (OAT): The cylindrical osteochondral graft method appears to be an excellent treatment option for patients with unstable OCD lesions seen after closure of the epiphyseal cartilage on the growth plate [17]. Middle-aged patients with focal, chronic non-traumatic osteochondral lesions of the knee also profit from osteochondral autograft transplantation at a short follow-up [14]. Osteochondral autograft transplantation surgery for treating patients with cartilage defects of the knee had good clinical results after a mean follow-up of 11 years [21]. The primary indication for mosaic osteochondral transplantation is deep, small defects on the medial femoral condyle [121]. Osteochondral autograft transfer can be used to address medium-sized lesions (2–3 cm²) that include subchondral bone loss [117]. Lateral trochlea and medial trochlea are acceptable harvest locations for osteochondral autograft transfer [117]. Complications of osteochondral autograft transfer include donor site morbidity [117].

Osteochondral Allografts (OCA): Osteochondral allografting was successfully employed to treat complex knee chondral and osteochondral pathology in patients less than 18 years of age, yielding improved function, decreased pain, and high satisfaction [134]. Osteochondral allograft remains an excellent treatment for osteochondral lesions with durable outcomes at long-term follow-up [16]. No other effective treatment exists, at the moment, for large osteochondral lesions [45]. Osteochondral allograft transplant utilizes cadaveric donor plugs and can be used for larger lesions (≥4cm²), especially with bone loss [117]. Main concerns with osteochondral allografts include the small risk of disease transmission and chondrocyte viability, which has improved with graft preservation techniques [117]. Osteochondral allografts are ideally used within 14 to 28 days of donor death [117]. A decellularized osteochondral allograft plugs implant should be used with caution in the treatment of osteochondral lesions of the knee due to a high short-term failure rate observed in one study [31].

Chondrocyte Implantation (ACI/MACI): Autologous chondrocyte implantation provided durable outcomes with a survivorship of 71% at 10 years and improved function in 75% of patients with symptomatic cartilage defects of the knee at a minimum of 10 years after surgery [11]. Treatment of articular cartilage defects of the knee with autologous chondrocyte implantation in physically active young individuals can return nearly two-thirds of individuals to daily activity with decreased pain and improved function [12]. Autologous chondrocyte implantation is appropriate in the management of carefully selected adolescents with symptomatic chondral and osteochondral defects [18]. Matrix-induced autologous chondrocyte transplantation represents a suitable option in the treatment of local cartilage defects in the knee, with significantly improved results on 3 outcome measures after 10 years [20]. Matrix-assisted autologous chondrocyte implantation treatment for knee osteochondral defects in pediatric populations demonstrated favorable outcomes at short term follow up (6 months to 2 years) [26]. Cartilage repair in adolescent knees using autologous chondrocyte implantation provides success across different clinical outcomes measures [132]. Autologous chondrocyte implantation is an effective treatment for full thickness chondral defects of the knee, providing an improvement of clinical outcomes [142]. Treatment of articular cartilage defects of the knee joint leads to satisfactory results concerning everyday activities [49]. Autologous chondrocyte implantation is a two-stage process, including biopsy of patient’s articular cartilage followed by ex vivo expansion, with subsequent implantation into the defect [117]. Autologous chondrocyte implantation allows for creation of type II collagen–rich hyaline-like cartilage, with minimal type I collagen, fibrocartilage, present [117]. Autologous chondrocyte implantation is indicated for medium-sized to larger chondral lesions without bony defects [117]. Complications related to autologous chondrocyte implantation include chondrocyte overgrowth and periosteal flap hypertrophy, along with the morbidity of the second surgical procedure [117]. Patellar dysplasia should not be seen as a contraindication for cell-based cartilage repair procedures [144].

Other Techniques: Impaction bone grafting and autologous matrix-induced chondrogenesis is a safe and reliable option for treating deep, knee osteochondral lesions, providing a statistically significant and clinically important improvement in patient-reported outcomes [141]. Marrow-stimulating techniques include microfracture, drilling, and abrasion arthroplasty [117]. Marrow-stimulating techniques involve perforation of the subchondral bone after removal of the “tidemark” cartilage, with eventual clot formation and fibrocartilaginous repair tissue [117]. Marrow-stimulating techniques result in type I collagen with inferior wear characteristics [117]. Good clinical results in small defects (<2 to 3 cm²) are obtained in 60% to 80% of patients treated with marrow-stimulating techniques [117]. Débridement and chondroplasty are currently recommended for symptomatic articular cartilage lesions [117]. Particulated juvenile cartilage allograft remains investigational [117].

Other Considerations: Surgical management of complex knee pathologies often requires concomitant procedures for the success of any single procedure [39]. Cartilage restoration procedures combined with optimization of background factors such as patellofemoral alignment and congruity are essential to achieve success [65]. Diffuse chondral damage is a relative contraindication to cartilage restoration procedures [117]. Age, lesion size, patient’s desired activity level, alignment, meniscal integrity, and ligamentous stability must all be taken into consideration in selection of the appropriate treatment option for articular cartilage injury [117]. Concomitant osteotomies to correct malalignment should be considered in the management of focal cartilaginous lesions of the knee [117]. Condylar lesions undergoing cartilage restoration techniques demonstrate superior outcomes compared with patellofemoral lesions [117]. Improved clinical outcomes following microfracture, osteochondral autograft transfer, or autologous chondrocyte implantation are seen in well-selected patients [117]. Variable long-term results following microfracture are seen in high-demand patients [117]. Current best available research suggests that for smaller lesions, microfracture, osteochondral autograft transfer, and autologous chondrocyte implantation have similar recovery periods and functional results [117]. There is no indication for a combined cartilage treatment and knee osteotomy in osteoarthritic joints in routine clinical practice until new evidence proves otherwise [143].

Complications

Progression to Osteoarthritis

Osteochondritis dissecans of the knee can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis [10]. In adults, osteochondritis dissecans is often followed by the early onset of degenerative arthritis [2]. The 20-year cumulative risk of knee arthroplasty after a focal cartilage lesion in the knee was 19% [72]. Probable but inconclusive risk factors for osteoarthritis following osteochondritis dissecans were the age of the patients and the size of the osteochondritis dissecans [8].

Surgical Complications and Outcomes

Isolated excision of weight-bearing OCD lesions led to poorer clinical and radiographic results than other surgical techniques [35]. Surgical correction of osteochondritis dissecans is unlikely to succeed unless the joint surface is perfectly restored [2]. A high short-term failure rate was observed with decellularized osteochondral allograft plugs for the treatment of knee cartilage lesions [31]. One of every 4 patients may experience a secondary failure after undergoing a revision cartilage procedure [75]. In the short term, combining patellofemoral arthroplasty and autogenous osteochondral femoral condylar transplantation does not substantially alter the rehabilitation, increase the morbidity, or compromise the outcome of patellofemoral arthroplasty [154].

Recovery

Non-Operative Recovery: Juvenile osteochondritis dissecans carries a significantly better prognosis than adult osteochondritis dissecans [2].

Operative Recovery: Arthroscopic Procedures: Arthroscopic transarticular drilling is indicated for juvenile osteochondritis dissecans of the medial femoral condyle with an intact articular surface following failure of initial nonoperative management [4]. This procedure is associated with low morbidity and improvements in both functional and radiographic outcomes [4]. Long-term outcomes for osteochondral lesions of the knee treated with abrasion chondroplasty and loose body removal have been encouraging [66].

Operative Recovery: Cartilage Restoration (ACI/MACI): Autologous chondrocyte implantation provides durable outcomes, with a survivorship of 71% at 10 years [11]. At a minimum of 10 years after surgery, this technique improved function in 75% of patients with symptomatic cartilage defects of the knee [11]. Treatment of articular cartilage defects of the knee joint leads to satisfactory results concerning everyday activities [49]. Matrix-induced autologous chondrocyte implantation for knee osteochondral defects in pediatric populations demonstrated favorable outcomes at short-term follow-up (6 months to 2 years) [26]. Autologous chondrocyte implantation is effective in filling full-thickness chondral defects of the knee, with improvements noted in 86% of patients at 6-year follow-up [163]. In patients with discrete articular cartilage lesions of the knee and a history of failed microfracture, autologous chondrocyte implantation may render favorable clinical outcomes comparable to primary autologous chondrocyte implantation [15].

Operative Recovery: Osteochondral Grafting (Autograft/Allograft): When osteochondral plugs were obtained from healthy knees, 34 patients (85%) were asymptomatic at follow-up [46]. Follow-up of femoral condyle osteochondral allografting demonstrated durable improvement in pain and function, with graft survivorship of 82% at 10 years [60]. Clinical and functional outcomes were similar in patients who underwent osteochondral allograft transplantation or autologous chondrocyte implantation/matrix-induced autologous chondrocyte implantation for patellofemoral articular cartilage defects at a mean follow-up of 5 years [68]. A shorter time to return to sports was observed in knees with medial lesions compared with lateral lesions after internal fixation using osteochondral autologous transplantation for osteochondritis dissecans of the knee [176]. At 36 months after surgery, the clinical outcome is good with excellent Lysholm and IKDC scores for osteochondral grafting in a young adult with anterior cruciate ligament deficit [178]. Autologous bone grafting in combination with autologous chondrocyte implantation yields good clinical outcomes at mid- to long-term follow-up with favourable histological results for osteochondral defects of the knee [47].

Operative Recovery: Other Techniques and Complications: Based on the high short-term failure rate observed in a study, a decellularized OC allograft plugs implant should be used with caution in the treatment of OC lesions of the knee [31]. At short, medium, and long term (minimum 15 years), mosaicplasty results in a better, clinically relevant outcome than microfracture in articular cartilage defects (2-5 cm2) of the distal femur of the knee in patients aged 18 to 50 years [169]. The clinical outcome in patients with multiple cartilage defects is inferior to that of patients with a single defect after microfracture treatment [177].

Long-Term Prognosis and Risk Factors: Probable but inconclusive risk factors for osteoarthritis following osteochondritis dissecans of the knees were the age of the patients and the size of the osteochondritis dissecans [8]. Injury origin, sex, symptom duration, lesion size, lesion site, age, and previous surgery might determine the final outcome and can be used as a sort of clinical profiling to guide the surgeon in the choice of this procedure and in giving realistic expectations to patients requiring cartilage treatment [175].

Key Evidence

  • [L5] Juvenile osteochondritis dissecans lesions with an intact articular surface have a potential to heal with nonoperative treatment through cessation of repetitive impact loading, whereas adult lesions typically require surgical intervention due to instability. [1] (10.1177/0363546506290127)
  • [L4] [2] (10.5435/00124635-199507000-00006)
  • [L4] Simple excision of an osteochondritis dissecans fragment results in an unacceptably high percentage of fair and poor outcomes at intermediate followup in young patients. [3] (10.1097/01.blo.0000128216.10732.d8)
  • [L4] Given the low morbidity of drilling and the associated improvement in functional and radiographic outcomes, the authors advocate arthroscopic transarticular drilling for patients with juvenile osteochondritis dissecans of the medial femoral condyle with an intact articular surface who have had failure of initial nonoperative management. [4] (10.1177/03635465010290050701)
  • [L4] The OsPlug technique shows significant improvement of functional outcome for up to 5 years in patients with high-grade osteochondritis dissecans or osteochondral defect. [5] (10.1177/0363546516631739)
  • [L4] Harvesting osteochondral grafts did not exert adverse effects on donor knee function in young athletes at 2 years after undergoing osteochondral autograft transplantation for capitellar osteochondritis dissecans. [6] (10.1177/0363546510388386)
  • [L4] Multiple systems have been described for classifying osteochondritis dissecans lesions of the knee during arthroscopy, but no single system has been universally accepted. [7] (10.1016/j.csm.2013.11.005)
  • [L1] Probable but inconclusive risk factors were the age of the patients and the size of the osteochondritis dissecans. [8] (10.1007/s00167-020-06365-y)
  • [L4] We advocate retroarticular drilling for patients with stable juvenile osteochondritis dissecans of the knee whose initial nonoperative treatment has failed. [9] (10.1016/j.arthro.2008.09.008)
  • [Paper] [10] (10.1016/j.otsr.2017.02.016)
  • [L4] ACI provided durable outcomes with a survivorship of 71% at 10 years and improved function in 75% of patients with symptomatic cartilage defects of the knee at a minimum of 10 years after surgery. [11] (10.1007/s11999-013-3146-9)
  • [L4] Treatment of articular cartilage defects of the knee with ACI in physically active young individuals can return nearly two-thirds of individuals to daily activity with decreased pain and improved function. [12] (10.1177/2325967117706057)
  • [L4] Osteochondral allograft transplantation was an effective treatment for osteochondritis dissecans of the knee, with significant improvement in pain and function scores and high patient satisfaction. [13] (10.1177/2325967114s00001)
  • [L4] Middle-aged patients with focal, chronic non-traumatic osteochondral lesions of the knee also profit from OAT at a short follow-up. [14] (10.1016/j.otsr.2016.06.004)
  • [L3] In patients with discrete articular cartilage lesions of the knee and history of failed microfracture, ACI may render favorable clinical outcomes comparable to primary ACI. [15] (10.1177/2325967116s00125)
  • [L5] OCA remains an excellent treatment for osteochondral lesions with durable outcomes at long-term follow-up, though larger cohorts are needed to better identify predictors of success and correct for confounders. [16] (10.1016/j.arthro.2025.05.020)
  • [L4] The method appears to be an excellent treatment option for patients with unstable osteochondritis dissecans lesions seen after closure of the epiphyseal cartilage on the growth plate. [17] (10.1177/03635465020300032301)
  • [L4] The authors believe that ACI is appropriate in the management of carefully selected adolescents with symptomatic chondral and osteochondral defects. [18] (10.1177/0363546511404202)
  • [L5] Knee focal cartilage treatment depends on many variables including lesion size, location, age, and patient activity level, and indications must be individualized based on these factors. [19] (10.1016/j.arthro.2016.07.014)
  • [L4] The significantly improved results on 3 outcome measures after 10 years suggest that MACT represents a suitable option in the treatment of local cartilage defects in the knee. [20] (10.1177/0363546514548160)
  • [L4] OAT surgery for treating patients with cartilage defects of the knee had good clinical results after a mean follow-up of 11 years. [21] (10.1007/s00167-018-4995-2)
  • [L4] Patients with osteochondritis dissecans of the knee present with a lateral rotation gait, and medial rotation of the tibia in flexion produces typical pain over the medial femoral condyle. [25] (10.2106/00004623-196749030-00006)
  • [L4] MACI treatment for knee osteochondral defects in pediatric populations demonstrated favorable outcomes at short term follow up (6 months to 2 years). [26] (10.1177/2325967126s00108)
  • [L5] The management of patellofemoral cartilage lesions is controversial and should begin with a comprehensive nonsurgical treatment plan. [27] (10.5435/jaaos-d-16-00009)
  • [L4] No adverse effects of osteochondral graft harvest on donor knee function were found after mosaicplasty for capitellar osteochondritis dissecans in young athletes. [30] (10.1177/0363546507306465)
  • [L4] Based on the high short-term failure rate observed in this study, the authors advise that a decellularized OC allograft plugs implant should be used with caution in the treatment of OC lesions of the knee, as similar outcomes have not been noted with other cartilage restoration techniques. [31] (10.1016/j.arthro.2017.07.018)
  • [L5] [32] (10.1302/0301-620x.98b6.36816)
  • [L3] [34] (10.1177/03635465231164410)
  • [L4] [35] (10.1007/s00167-012-1917-6)
  • [L4] No definitive conclusion could be made in respect to the best current surgical technique for articular cartilage and osteochondral lesions. [37] (10.1016/j.arthro.2016.01.055)
  • [L5] Surgical management of complex knee pathologies often requires concomitant procedures for the success of any single procedure, and orthopaedic surgeons must understand joint preservation techniques including biologic and reconstructive approaches in young, high-demand patients. [39] (10.5435/jaaos-d-17-00087)
  • [L1] MRI findings do correlate with clinical outcomes after cartilage repair surgery in the knee, although the specific parameters that correlate best vary by the type of procedure performed. [41] (10.1177/0363546513485931)
  • [L4] No other effective treatment exists, at the moment, for large osteochondral lesions. [45] (10.1016/j.arthro.2014.11.025)
  • [L4] When osteochondral plugs were obtained from healthy knees, 34 patients (85%) were asymptomatic at follow-up. [46] (10.1177/2325967117732525)
  • [L4] The current literature suggests that ABCI yields good clinical outcomes at mid- to long-term follow-up with favourable histological results for osteochondral defects of the knee. [47] (10.1002/ksa.12342)
  • [L5] [48] (10.5435/00124635-200602000-00004)
  • [L4] Treatment of articular cartilage defects of the knee joint leads to satisfactory results concerning everyday activities. [49] (10.1177/0363546515614578)
  • [L5] [55] (10.1016/j.csm.2014.01.002)
  • [L3] [58] (10.1016/j.jisako.2026.101102)
  • [L4] Followup of femoral condyle osteochondral allografting demonstrated durable improvement in pain and function, with graft survivorship of 82% at 10 years. [60] (10.1007/s11999-012-2556-4)
  • [L5] The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics. [63] (10.1007/s00167-018-5316-5)
  • [L4] Tissue-engineered cartilage implantation is questionable for this indication as a salvage procedure for young patients affected by knee osteoarthritis. [64] (10.1177/0363546512463675)
  • [L5] Cartilage restoration procedures combined with optimization of background factors such as patellofemoral alignment and congruity are essential to achieve success. [65] (10.1055/s-0035-1549018)
  • [L4] The long-term outcomes of these subjects who were treated for osteochondral lesions of the knee with abrasion chondroplasty and loose body removal were encouraging. [66] (10.1016/j.arthro.2013.03.060)
  • [L3] Clinical and functional outcomes were similar in patients who underwent OCA or ACI/MACI for patellofemoral articular cartilage defects at a mean follow-up of 5 years. [68] (10.1016/j.arthro.2024.05.018)
  • [L4] This study suggests that magnetic resonance imaging parameters of a healed osteochondral fragment and patients with satisfactory functional results correspond with arthroscopic evidence of fragment stability. [70] (10.1177/0363546505274717)
  • [L4] The 20-year cumulative risk of knee arthroplasty after a focal cartilage lesion in the knee was 19%. [72] (10.2106/jbjs.22.01174)
  • [L4] One of every 4 patients may experience a secondary failure after undergoing a revision cartilage procedure. [75] (10.1177/03635465241260271)
  • [Paper] [105] (10.1016/j.eats.2013.02.012)
  • [L4] This evokes higher loading of the affected than of the unaffected knee compartment, and therefore, axial alignment may be a cofactor in OCD of the femoral condyles. [108] (10.1177/0363546509359070)
  • [L3] This simpler classification system provides a foundation for the subsequent establishment of an operative treatment algorithm for knee OCD. [111] (10.1177/2325967121s00412)
  • [L3] [118] (10.1177/0363546517698933)
  • [L3] [120] (10.1177/0363546516637175)
  • [L4] The primary indication is deep, small defects on the medial femoral condyle. [121] (10.1016/j.otsr.2011.08.005)
  • [L3] [129] (10.1007/s00167-014-3289-6)
  • [L4] [130] (10.1177/1947603518758435)
  • [L1] Cartilage repair in adolescent knees using ACI provides success across different clinical outcomes measures. [132] (10.1016/j.arthro.2016.03.007)
  • [L4] Osteochondral allografting was successfully employed to treat complex knee chondral and osteochondral pathology in patients less than 18 years of age, yielding improved function, decreased pain, and high satisfaction. [134] (10.1177/2325967113s00076)
  • [L3] BG-AMIC is a safe and reliable option for treating deep, knee osteochondral lesions, providing a statistically significant and clinically important improvement in patient-reported outcomes. [141] (10.1007/s00167-023-07626-2)
  • [L1] ACI is an effective treatment for full thickness chondral defects of the knee, providing an improvement of clinical outcomes. [142] (10.1007/s00167-010-1050-3)
  • [L4] Until new evidence proves otherwise, there is no indication for a combined cartilage treatment in routine clinical practice. [143] (10.1007/s00167-018-4871-0)
  • [L3] Patellar dysplasia should not be seen as a contraindication for cell-based cartilage repair procedures. [144] (10.1177/03635465231220028)
  • [L1] Articular cartilage lesions can be reliably classified among surgeons at different sites. [148] (10.1177/0363546505275129)
  • [L4] In the short term, combining these 2 procedures does not substantially alter the rehabilitation, increase the morbidity, or compromise the outcome of patellofemoral arthroplasty. [154] (10.1016/j.arth.2005.08.012)
  • [L4] Minced cartilage procedure for medium to large chondral- and osteochondral lesions of the knee show good patient-reported midterm results with low complications and reoperation rates and are a viable, single-stage alternative to more conventional techniques. [161] (10.1016/j.jisako.2023.03.200)
  • [L4] ACI is effective in filling full-thickness chondral defects of the knee, with improvements noted in 86% of patients at 6-year follow-up, though longer follow-ups are needed to confirm long-term effectiveness. [163] (10.1016/j.otsr.2012.04.019)
  • [L1] At short, medium, and long term (minimum 15 years), mosaicplasty results in a better, clinically relevant outcome than microfracture in articular cartilage defects (2-5 cm2) of the distal femur of the knee in patients aged 18 to 50 years. [169] (10.1177/0363546517745281)
  • [L4] MRI criteria for OCD instability in the pediatric knee do not always correlate with the necessity for surgery. [171] (10.1177/2325967117738516)
  • [L4] Imaging of the subchondral bone needs to fit into the concept of the functional cartilage–subchondral bone unit, and image evaluation methods need to be refined for adequate and reproducible analysis. [172] (10.1007/s00167-010-1053-0)
  • [L3] Satisfactory clinical outcomes and new cartilage formation, as observed by MRI, are achieved with AMIC at mid‐term follow‐up for ICRS grade 3–4 in small‐to‐medium‐sized patellar defects in patients under 52 years of age, with improvements maintained for up to 5 years. [174] (10.1002/ksa.12518)
  • [L4] Injury origin, sex, symptom duration, lesion size, lesion site, age, and previous surgery might determine the final outcome and can be used as a sort of clinical profiling to guide the surgeon in the choice of this procedure and in giving realistic expectations to patients requiring cartilage treatment. [175] (10.1177/0363546513518552)
  • [L4] A shorter time to return to sports was observed in knees with medial lesions compared with lateral lesions. [176] (10.1177/23259671241302125)
  • [L3] The clinical outcome in patients with multiple cartilage defects is inferior to that of patients with a single defect. [177] (10.1007/s00167-009-0974-y)
  • [L4] At 36 months after surgery, the clinical outcome is good with excellent Lysholm and IKDC scores. [178] (10.1016/j.arthro.2006.07.019)

See Also

References

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[4] Functional and Radiographic Outcome of Juvenile Osteochondritis Dissecans of the Knee Treated with Transarticular Arthroscopic Drilling. The American Journal of Sports Medicine. 2001. DOI: 10.1177/03635465010290050701

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[47] Autologous bone grafting in combination with autologous chondrocyte implantation yields favourable outcomes in the treatment of osteochondral defects of the knee: A systematic literature review. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12342

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1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.