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Osteochondritis dissecans

Key sources
The following summarized guidelines for the evaluation and management of osteochondritis dissecans are prepared by our editorial team based on guidelines from the American College of Radiology (ACR 2018) and the American Academy of Orthopaedic Surgeons (AAOS 2012).
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Guidelines

1.Diagnostic investigations

Knee radiography: as per ACR 2018 guidelines, obtain knee X-ray as initial imaging in ≥ 5 years old patients with chronic knee pain.
B
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  • Knee MRI

2.Medical management

Indications for treatment: insufficient evidence to recommend for or against treating asymptomatic skeletally mature patients with osteochondritis dissecans progression (as identified by X-ray or MRI) like symptomatic patients.
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  • Nonoperative management

3.Nonpharmacologic interventions

Lifestyle modifications: insufficient evidence to recommend for or against counseling patients about whether activity modification and weight control prevent the onset and progression of osteochondritis dissecans to OA.
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  • Physical therapy

4.Therapeutic procedures

Arthroscopic drilling: insufficient evidence to recommend for or against arthroscopic drilling in symptomatic skeletally immature patients with stable lesions not responding to nonoperative treatment for at least 3 months.
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5.Surgical interventions

Indications for surgery: consider offering surgery in symptomatic (whether skeletally immature or mature) patients with salvageable unstable or displaced osteochondritis dissecans lesions.
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  • Cartilage repair technique

6.Follow-up and surveillance

Serial clinical and imaging assessment
Obtain clinical (history and physical examination) and imaging (X-ray and/or MRI) monitoring to assess healing in patients remaining symptomatic after treatment for osteochondritis dissecans.
E
Insufficient evidence to recommend for or against repeat MRI in asymptomatic skeletally mature patients.
I