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Osteochondritis dissecans

What's new

Updated 2023 AAOS guidelines for the diagnosis and management of osteochondritis dissecans.

Guidelines

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 Academy of Orthopaedic Surgeons (AAOS 2023,2012) and the American College of Radiology (ACR 2018). ...
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Diagnostic investigations

Knee X-ray
As per AAOS 2023 guidelines:
Consider obtaining knee X-ray (including anteroposterior, lateral, sunrise/Merchant, and tunnel views) in patients with knee symptoms (pain, swelling, locking, catching, popping, giving way) and/or signs (tenderness, effusion, loss of motion, crepitus).
C
Consider obtaining knee MRI in patients with a known osteochondritis dissecans lesion on X-ray to characterize the osteochondritis dissecans lesion or when concomitant knee pathology, such as meniscal pathology, ACL injury, or articular cartilage injury, is suspected.
B
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  • Knee MRI

Medical management

Indications for treatment: as per AAOS 2012 guidelines, 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.
I

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  • Nonoperative management

Nonpharmacologic interventions

Lifestyle modifications: as per AAOS 2012 guidelines, 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.
I

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  • Physical therapy

Therapeutic procedures

Arthroscopic drilling: as per AAOS 2012 guidelines, 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.
I

Surgical interventions

Indications for surgery: as per AAOS 2023 guidelines, consider offering surgery in symptomatic patients (either skeletally immature or mature) with unstable or displaced osteochondritis dissecans.
C

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  • Cartilage repair technique

Follow-up and surveillance

Postoperative care
As per AAOS 2023 guidelines:
Consider offering postoperative physical therapy in patients with osteochondritis dissecans.
E
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