How is Osteochondritis Dissecans of the knee treated for pediatric patients?
The treatment of OCD depends on two factors – the skeletal maturity of the patient and the stability of the lesion. Both of these require imaging to adequately assess.
Stable lesions in skeletally immature athletes can be treated successfully without surgery if you catch it early enough. Non-surgical management requires activity modification, cessation of both organized sports and free play and use of unloading braces. Typically, it will take a stable OCD lesion 3-4 months to heal with this approach. If caught early enough, this strategy has an established track record of success – however some do not heal and require surgery.
Surgical management is reserved for the following scenarios:
- Failure of non-surgical management in a stable lesion
- Unstable lesions at any age
- Stable or unstable lesions in kids who are skeletally mature or reaching maturity
- In some cases, surgery will be discussed for high risk stable lesions in skeletally immature athletes. Specifically, chronic lesions and/or large or atypical lesions maybe candidates for more aggressive management.
- Depending on the characteristics of the lesion there are several surgical options available.
They range from:
Drilling: For stable lesions that require surgery (failed non-op and high risk), holes may be drilled into the lesion to encourage bleeding and healing. This technique is very low risk, minimally invasive and works by creating pathways for new blood vessels to nourish the affected area.
Internal fixation: Unfortunately, unstable lesions require stability and drilling alone is not successful in this context. In this scenario, a small incision is made and the base of the lesion is drilled and scar tissue is removed and the OCD fragment is fixed typically with metal screws. This technique is very successful but often requires a second surgery for hardware removal.
Debridement: In some cases, the OCD fragment is not viable or salvageable or it has failed previous fixation. In these cases, the fragment can be removed. Amazingly, kids have such robust healing responses that they can regenerate cartilage in this area without the need for a graft.
Osteochondral Allograft (OCA): In some cases, a graft is required to reconstruct the cartilage/bone unit that is injured. The most successful technique for this is an Osteochondral Allograft. This is an established procedure with decades of success and can be a very long lasting and durable repair when needed.
Cartilage repair is one of the most challenging and nuanced repairs performed by orthopedic surgeons. Dr. Vidal has extensive experience in the management of these injuries and in complex reconstructions.