AAOS guidelines on OCD Knee

• Osteochondritis dissecans is a condition of the joints that appears to affect subchondral bone primarily, with  secondary effects on articular cartilage
• Osteochondritis Dissecans of the knee has been a disorder in which proper treatment guidelines have not been established
• Several aetiologies like, family history, repetitive micro-trauma, growth disorders, and ischemia—have been proposed
• One study identified the incidence of OCD as  29 cases per 100,000 males and 18 cases per 100,000 females.

• The AAOS has issued guidelines by conducting reviews of high quality articles that were published between 1996 and 2010
• The workgroup formulated the following treatment guidelines after researching through these articles

1. Symptomatic skeletally immature patients with loose or completely detached lesions should be offered surgery as an option. There is, however, no evidence for any particular kind of surgery;
2. Patients who remain symptomatic after treatment for OCD should have a repeat history and physical examination, X-rays, and/or MRI to assess healing;
3. Patients who receive surgical treatment of OCD should be offered postoperative physical therapy.
4. The working group is unable to recommend for or against counseling patients about whether activity modification and weight control prevents onset and progression of OCD to osteoarthritis (osteoarthrosis)

• Even undertaking this research on evaluating the recommendation of OCD of the knee, the AAOS working group believes that are a lot of areas that needs further research.
• The following were described as the areas where further research would be necessary:-

1. Inter- and intraobserver reliability studies on lesion classification for radiographs, MRI, and arthroscopy.
2. Prospective cohort studies of knee OCD lesions treated nonsurgically should be conducted to identify the independent predictors of success of nonsurgical management of an OCD lesion.
3. Randomized controlled trials should be conducted to establish the optimal physical therapy and nonsurgical treatment strategies and physical therapy interventions for patients with OCD of the knee.
4. Randomized controlled trials should be conducted to establish the optimal surgical treatment strategies for OCD of the knee.
5. Randomized controlled trials should be conducted to determine the optimal postoperative management of patients with OCD of the knee.

Further reading:

1. http://www.aaos.org/news/aaosnow/feb11/cover1.asp