Approach to Osteochondritis Dissecans
Principles of Treatment
– age is a huge factor – before or after 12 is a big deal. You look at these patient populations kinda differently
– size of fragment is important
– stability of fragment is important – can be assessed on MRI.
In the Patient 12 Years of Age
– in this population, you are leaning to fix the lesion. They do not heal as well with the conservative approach. MRI on almost all of these.
– MRI: is the cartilage intact? Is there fluid behind? Is the piece unstable? Has the piece displaced completely already?
– if symptomatic and stable – lean towards scoping and drilling
– if symptomatic and unstable – be prepared to scope then open the thing up, even take the lesion out, bone graft the base, and fix it.