This protocol targets skeletally immature patients — those with open physes — who have osteochondritis dissecans (OCD) of the knee with an unstable or displaced lesion and are symptomatic, presenting with knee pain, swelling, locking, catching, popping, giving way, tenderness, effusion, loss of motion, or crepitus.
Skeletally immature patients with open physes who exhibit continued or progressing symptoms and signs of OCD lesion loosening — typically detectable on MRI — are unlikely to heal without intervention. Conservative management is generally insufficient in this specific sub-population when the lesion is unstable or displaced.
Symptomatic skeletally immature patients with unstable or displaced OCD lesions may be offered surgery involving internal fixation of the OCD lesion. The choice of fixation method depends on lesion stage and characteristics. The complete surgical algorithm and selection criteria are detailed in the full protocol.
Healing of the OCD lesion with radiographic evidence of reossification, and resolution of knee symptoms.
Symptomatic skeletally immature patients with unstable or displaced OCD lesions be offered the option of surgery.
Children who are skeletally immature (i.e., those with open physes) who exhibit continued or progressing symptoms and signs of loosening (usually detected by MRI) are unlikely to heal without treatment.
The methods of fixation varied based on the stage of the lesion and included the use of pitch screws (n = 11), bioabsorbable tacks (n = 10), partially threaded cannulated screws (n = 3), and bioabsorbable pins (n = 3).
Another potential benefit is that these patients will be relieved of their existing symptoms.
The authors reported no statically significant differences in the healing rate by lesion location, type of fixation, and patients with prior surgery.
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