Treatment algorithm for osteochondral injuries of the knee

Trauma, osteochondritis dissecans, osteonecrosis, osteochondroses, and hereditary epiphyseal abnormalities can cause osteochondral lesions in the knee joint.(25, 61, 62, 72) When an osteochondral defect persists in a weightbearing portion of the knee joint, degenerative arthritis of that compartment can result. Treatment of osteochondral injuries and osteochondritis dissecans (OCD) is quite controversial and has received recent attention in the literature.* Pathology ranges from the young child with open physes and an OCD lesion, to the middle-aged athlete with an osteochondral fracture secondary to trauma. Significant articular cartilage incongruity often causes mechanical joint dysfunction and eventual cartilage deterioration, resulting in osteoarthritis. Treatment options to restore joint congruity vary widely from nonoperative closed treatment to arthroscopic drilling, with or without fixation, to tissue rransplantation or reconstructive procedures. The purpose of this article is to give an overview of the treatment options available for osteochondral defects in the knee and to propose a treatment algorithm based on the senior author's (WGC) experience.