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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Orthopedics

Standard of Care Treatment for OCD

At a Glance

Treatment for Osteochondritis Dissecans (OCD) depends on patient age and lesion stability. Growing children with stable lesions often heal with 3 to 6 months of strict immobilization and crutches. Adults or patients with loose, unstable fragments typically require surgery to restore the joint.

Choosing the right treatment for Osteochondritis Dissecans (OCD) is a careful process that depends on two main factors: skeletal maturity (whether growth plates are still open) and the stability of the lesion [1][2]. The goal of treatment is to encourage the bone to heal and to keep the smooth joint surface intact to prevent long-term damage [3].

Juvenile OCD: The Non-Operative Trial

For most growing children with Juvenile OCD (JOCD) and a “stable” lesion, the first step is almost always a strict period of non-operative management [4].

  • More Than Just “Rest”: Stopping high-impact sports is not enough. Conservative management often requires strict immobilization (using a cast or a brace) and offloading the joint by using crutches to be non-weight bearing [4][2].
  • Duration: A typical trial of non-operative management lasts between 3 to 6 months [4][5].
  • Success Rate: This approach is successful in about 57% of cases overall, but success rates are highly dependent on strict adherence to the rest protocols [6].
  • Optimization: Many orthopedic surgeons now also recommend testing and supplementing Vitamin D levels during this phase to optimize the body’s biological environment for bone healing [7].

Adult OCD (AOCD): The Treatment Roadmap

Adult patients (with closed growth plates) have a very different roadmap. Because adult bone has lower healing potential, a long non-operative rest period is often unsuccessful. For AOCD, surgeons typically skip the 6-month rest trial and move more directly to surgical options, even for stable lesions, to prevent the cartilage from collapsing and detaching [4][8].

When Surgery is Indicated

Surgery is recommended if the lesion is “unstable” (loose or detached), if a stable JOCD lesion fails to show healing after 6 months of strict rest, or if the patient is an adult (AOCD) [9][4].

For Stable, Non-Healing Lesions

If the bone isn’t healing, surgeons may use “drilling” to jumpstart the process. This creates tiny channels that allow new blood vessels to reach the area [4].

  • Retroarticular (Retrograde) Drilling: The surgeon drills from the back or side of the bone to reach the lesion. This is often preferred because it leaves the healthy joint cartilage completely untouched [4][10].
  • Transarticular (Antegrade) Drilling: The surgeon drills directly through the joint surface. While effective, it does involve making small holes in the healthy cartilage [4][11].

For Unstable or Detached Fragments

If the piece of bone is loose but still “viable” (healthy enough to heal), the surgeon will perform fragment fixation.

  • Fixation: The fragment is put back in place and secured with small pins, screws, or “darts” [12]. This is the preferred method whenever possible because it preserves the patient’s own native cartilage [13].
  • Grafting (OATS/OCA): If the fragment is too damaged or has already died, it may be replaced with a graft. OATS uses a small “plug” of bone and cartilage from a less-used part of the patient’s own joint, while OCA uses a graft from a donor [14][15].

A Note on Fragment Excision

In the past, surgeons sometimes simply removed the loose fragment (excision) and left a hole in the joint. Modern research shows this is generally avoided today [16]. Removing the fragment without repairing or replacing the cartilage significantly increases the risk of developing early osteoarthritis and potentially needing a joint replacement much earlier in life [16][9]. Modern “standard of care” focuses on restoration—either fixing the original piece or replacing it with a graft—to keep the joint surface smooth and functional [3].

Common questions in this guide

How is Juvenile OCD treated differently than Adult OCD?
Juvenile OCD in growing children often responds well to strict rest and immobilization. In contrast, adult bone has lower healing potential, so adult OCD usually requires surgery rather than a long resting period.
What does non-operative treatment for OCD involve?
Conservative treatment for OCD is more than just stopping high-impact sports. It typically requires strict immobilization using a cast or brace and using crutches to keep all weight off the joint for three to six months.
When is surgery needed for osteochondritis dissecans?
Surgery is recommended if the bone fragment becomes loose or detached, if the patient is an adult, or if a child's stable lesion does not show signs of healing after six months of strict rest.
What is retroarticular drilling for OCD?
Retroarticular drilling is a surgical technique where small channels are drilled into the bone from the back or side. This stimulates new blood flow to help the bone heal without making holes in the healthy joint cartilage.
Why do surgeons avoid simply removing the loose bone fragment?
Removing the loose bone fragment leaves a hole in the joint's surface. Leaving this hole without repairing or replacing the cartilage significantly increases the risk of developing early osteoarthritis later in life.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is the lesion considered 'stable' or 'unstable' based on the latest MRI and physical exam?
  2. 2.If we choose non-operative management, will it require bracing, casting, or crutches (non-weight bearing), and for how long?
  3. 3.Would you recommend a Vitamin D test to ensure the body has the right building blocks for bone healing?
  4. 4.If surgery is needed for a stable but non-healing lesion, do you recommend retroarticular or transarticular drilling?
  5. 5.Is the fragment healthy enough for fixation (pins/screws), or are we looking at a graft (OATS/OCA)?
  6. 6.If we were to just remove the fragment, what is the specific risk of developing early osteoarthritis?

Questions For You

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References

References (16)
  1. 1

    Physeal fusion status and lesion size are more important than patient age for healing of juvenile osteochodritis dessicans lesions of the distal femur.

    Brimmo O, Boeyer ME, Hoernschemeyer DG, et al.

    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2023; (31(7)):2936-2943 doi:10.1007/s00167-022-07284-w.

    PMID: 36538059
  2. 2

    Update in diagnosis, treatment, and prevention of osteochondritis dissecans of the capitellum.

    van den Bekerom MP, de Klerk HH, van Riet R

    Shoulder & elbow 2024; (16(1 Suppl)):24-34 doi:10.1177/17585732231190011.

    PMID: 38425733
  3. 3

    Pediatric Knee Osteochondritis Dissecans Lesions.

    Cruz AI, Shea KG, Ganley TJ

    The Orthopedic clinics of North America 2016; (47(4)):763-75.

    PMID: 27637663
  4. 4

    Osteochondritis Dissecans in the Skeletally Immature Knee.

    Shea KG, Richmond CG, Ganley TJ

    Instructional course lectures 2018; (67()):403-412.

    PMID: 31411428
  5. 5

    Physician preferences in diagnostics and treatment of juvenile osteochondritis dissecans are diverse across the knee, ankle and elbow: an ESSKA survey.

    Kemmeren LAM, van Bergen CJA, Reijman M, Piscaer TM

    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2023; (31(11)):5228-5237 doi:10.1007/s00167-023-07563-0.

    PMID: 37787862
  6. 6

    Nonoperative treatment of stable juvenile osteochondritis dissecans of the knee: effectiveness of unloader bracing.

    Tepolt FA, Kalish LA, Heyworth BE, Kocher MS

    Journal of pediatric orthopedics. Part B 2020; (29(1)):81-89 doi:10.1097/BPB.0000000000000617.

    PMID: 31774736
  7. 7

    Management of the Failed OCD.

    Perkins CA, Willimon SC

    Current reviews in musculoskeletal medicine 2020; (13(2)):173-179 doi:10.1007/s12178-020-09611-5.

    PMID: 32147780
  8. 8

    Conservative treatment for stable osteochondritis dissecans of the elbow before epiphyseal closure: effectiveness of elbow immobilization for healing.

    Takahara M, Uno T, Maruyama M, et al.

    Journal of shoulder and elbow surgery 2022; (31(6)):1231-1241 doi:10.1016/j.jse.2022.01.148.

    PMID: 35247573
  9. 9

    Osteochondritis dissecans of the knee.

    Accadbled F, Vial J, Sales de Gauzy J

    Orthopaedics & traumatology, surgery & research : OTSR 2018; (104(1S)):S97-S105 doi:10.1016/j.otsr.2017.02.016.

    PMID: 29197636
  10. 10

    Outcomes of Osteochondral Autograft Transplantation in Pediatric Patients With Osteochondritis Dissecans of the Capitellum.

    Ayzenberg M, Clippinger B, Slate EL, et al.

    The Journal of hand surgery 2021; (46(11)):1028.e1-1028.e15 doi:10.1016/j.jhsa.2021.02.024.

    PMID: 33902975
  11. 11

    What's New in Osteochondritis Dissecans of the Knee, Elbow, and Ankle.

    Meadows MC, Wilson PL, Wall EJ, et al.

    Instructional course lectures 2021; (70()):433-452.

    PMID: 33438926
  12. 12

    Internal Fixation of Osteochondritis Dissecans Lesions in the Patellofemoral Joint.

    Nuelle CW, Farr J

    The journal of knee surgery 2018; (31(3)):206-211 doi:10.1055/s-0037-1607199.

    PMID: 28977816
  13. 13

    Arthroscopic Fixation of Knee Femoral Condyle Osteochondritis Dissecans Fragment With Bone Marrow Aspirate Concentrate.

    Massey PA, McClary KN, McBride HD, et al.

    Arthroscopy techniques 2021; (10(10)):e2357-e2363 doi:10.1016/j.eats.2021.07.013.

    PMID: 34754745
  14. 14

    Editorial Commentary: Knee Focal Cartilage Defect Treatment Must Be Individualized.

    Moezzi D

    Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2016; (32(10)):2131-2132 doi:10.1016/j.arthro.2016.07.014.

    PMID: 27697187
  15. 15

    Treatment of unstable knee osteochondritis dissecans in the young adult: results and limitations of surgical strategies-The advantages of allografts to address an osteochondral challenge.

    Filardo G, Andriolo L, Soler F, et al.

    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2019; (27(6)):1726-1738 doi:10.1007/s00167-018-5316-5.

    PMID: 30523367
  16. 16

    High Rate of Osteoarthritis After Osteochondritis Dissecans Fragment Excision Compared With Surgical Restoration at a Mean 16-Year Follow-up.

    Sanders TL, Pareek A, Obey MR, et al.

    The American journal of sports medicine 2017; (45(8)):1799-1805 doi:10.1177/0363546517699846.

    PMID: 28419816

This page provides general educational information about Osteochondritis Dissecans (OCD) treatment options. It is not medical advice; always consult your orthopedic surgeon about your specific diagnosis and treatment plan.

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