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Knee

Osteochondritis Dissecans (OCD) of the Knee

What Is Osteochondritis Dissecans?

Osteochondritis dissecans (often called OCD) is a condition that affects both the bone and cartilage inside the knee. It occurs when a small area of bone just beneath the joint surface loses its blood supply and becomes weakened. As that bone softens, the cartilage covering it can crack or separate, creating an unstable area inside the joint. In more advanced cases, a piece of bone and cartilage can partially or completely break free, becoming a loose fragment inside the knee.

OCD most commonly involves the femoral condyles—the rounded ends of the thigh bone that form the top of the knee joint. The condition is seen most often in children, adolescents, and young adults, particularly those who are physically active. While the exact cause is not always clear, OCD is thought to be related to a combination of repetitive stress, subtle trauma, and blood-flow changes to the bone.

OCD can affect people of many ages, but it is most common in:

  • Adolescents and teenagers involved in sports such as soccer, basketball, football, and gymnastics
  • Young adults who remain very active
  • Individuals with a history of repetitive impact or twisting injuries to the knee

Doctors often distinguish between:

  • Juvenile OCD – occurs when growth plates are still open
  • Adult OCD – occurs after growth plates have closed

This distinction is important because juvenile OCD lesions have a better chance of healing without surgery, while adult OCD is more likely to require operative treatment if the lesion becomes unstable.

Symptoms can vary depending on how stable the lesion is. Early on, patients may notice only vague knee pain during or after activity. As the condition progresses, symptoms may include:

  • Swelling after sports or prolonged walking
  • A dull ache deep inside the knee
  • Stiffness or reduced range of motion
  • Catching, locking, or a sense that something is moving inside the joint
  • Episodes where the knee feels like it may “give way”

If a fragment becomes loose, mechanical symptoms such as locking and sudden sharp pain are more common.

Diagnosis begins with a careful history and physical examination. Dr. Vega will ask about activity level, prior injuries, and how symptoms have changed over time. On exam, there may be tenderness along the affected part of the knee or swelling after activity.

X-rays are often the first imaging test and can show characteristic changes in the bone. MRI is especially important because it allows Dr.Vega to:

  • Determine the size and depth of the lesion
  • Assess whether the lesion is stable or unstable
  • Evaluate the health of the overlying cartilage
  • Look for fluid behind the fragment, which suggests instability

This information helps guide treatment and determine whether the lesion can be managed conservatively or requires surgery.

In many cases—especially in younger patients with stable lesions—OCD can heal without surgery. When the growth plates are still open, the bone has a greater capacity to revascularize and remodel.

Nonsurgical care typically includes:

  • Activity modification, avoiding impact sports and jumping
  • Temporary bracing or protected weight-bearing
  • Physical therapy to maintain motion and strength while limiting stress on the lesion

Healing is monitored with follow-up imaging over several months. Many juvenile patients experience complete healing with this approach, allowing a safe return to sports once symptoms and imaging improve.

However, if pain persists, the lesion appears unstable, or a loose fragment develops, surgery may be needed to protect the joint surface.

Surgery is more commonly recommended when:

  • The lesion is unstable
  • A fragment has partially or fully detached
  • Symptoms persist despite appropriate nonsurgical care
  • The patient is skeletally mature and healing potential is lower
  • Mechanical symptoms such as locking or catching are present

The overall goal of surgery is to preserve the joint surface, restore stability to the affected area, and reduce the risk of early arthritis.

OCD is different from simple cartilage wear. Because it affects the bone and cartilage together, untreated or unstable lesions can lead to:

  • Chronic pain
  • Loose bodies in the joint
  • Progressive cartilage damage
  • Early-onset osteoarthritis

Early recognition allows treatment while the lesion is still small and stable, improving the chance of long-term knee health.

Osteochondritis dissecans of the knee is a unique condition that affects the foundation of the joint—the bone beneath the cartilage. Although it often begins with subtle symptoms, it can progress to more serious problems if not properly treated. The good news is that with early diagnosis and the right management plan, many patients—especially children and adolescents—can heal and return to full activity. Even in more advanced cases, modern treatment options offer excellent ways to protect the knee and restore function.

If you or your child is experiencing persistent knee pain, swelling, or mechanical symptoms, contact Dr. José Vega’s office in Cleveland to schedule a consultation. A thorough evaluation can help determine the cause of your symptoms and guide a personalized plan to protect your knee for the long term.

References:

  1. Andriolo L, Crawford DC, Reale D, et al. Osteochondritis Dissecans of the Knee: Etiology and Pathogenetic Mechanisms. A Systematic Review. Cartilage. 2020;11(3):273-290.
  2. Coladonato C, Perez AR, Sonnier JH, et al. Evaluating Return to Sports After Surgical Treatment of Unstable Osteochondritis Dissecans of the Knee: A Systematic Review. Orthop J Sports Med. 2024;12(8):23259671241258489.
  3. Erickson BJ, Chalmers PN, Yanke AB, Cole BJ. Surgical management of osteochondritis dissecans of the knee. Curr Rev Musculoskelet Med. 2013;6(2):102-114.
  4. Hevesi M, Sanders TL, Pareek A, et al. Osteochondritis Dissecans in the Knee of Skeletally Immature Patients: Rates of Persistent Pain, Osteoarthritis, and Arthroplasty at Mean 14-Years’ Follow-Up. Cartilage. 2020;11(3):291-299.
  5. Husen M, Van der Weiden GS, Custers RJH, et al. Internal Fixation of Unstable Osteochondritis Dissecans of the Knee: Long-term Outcomes in Skeletally Immature and Mature Patients. Am J Sports Med. 2023;51(6):1403-1413.
  6. Kocher MS, Tucker R, Ganley TJ, Flynn JM. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med. 2006;34(7):1181-1191.
  7. Nuelle CW, Rucinski K, Stannard JP, Ma R, Kfuri M, Cook JL. Comparison of Outcomes After Primary Versus Salvage Osteochondral Allograft Transplantation for Femoral Condyle Osteochondritis Dissecans Lesions. Orthop J Sports Med. 2024;12(3):23259671241232431.
  8. Pascual-Garrido C, Moran CJ, Green DW, Cole BJ. Osteochondritis dissecans of the knee in children and adolescents. Curr Opin Pediatr. 2013;25(1):46-51.
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Dr. Jose Vega

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  • Fellowship-trained sports medicine specialist
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