Osteochondritis dissecans. History, pathophysiology and current treatment concepts

The past and current status of osteochondritis dissecans suggests that there is still no clear cut etiology. The etiologic mechanism is generally assumed to be multifactorial and related to minor trauma occurring at a susceptible location. The existence of two clinical patterns is important. Conservative treatment should be emphasized in the young patient who has open physes and a more aggressive approach in the older symptomatic patient. Drilling has a use in the loose unseparated fragment. Free fragments should be replaced when possible if they involve a portion of the weight-bearing articular surface. When replacement is impossible, treatment must be individualized, either by trephining or spongialization followed by joint ranging exercises with nonweight-bearing, or in cases which involve a large portion of the weight-bearing surface of the femoral condyle, a more radical treatment, including osteotomy, hemiarthroplasty, or allograft.