Osteochondritis dissecans (OCD) is the destruction of joint cartilage and the first layer of bone under the cartilage (subchondral bone). It affects the knee most often and develops in active teens between the ages of 10 and 15 years old. Repetitive trauma (usually from sports such as skateboarding, snowboarding, or skiing) is the primary risk factor.
The end of the femur (thigh bone) is the most common location, but the patella (knee cap) or top of the tibia (lower leg bone as it meets the femur to form the knee joint) can also be affected. It is possible to develop OCD in other joints such as the elbow, wrist, ankle, and top of the femur.
Anyone who has ever had OCD as a teenager is also at increased risk for a return of this condition called adult osteochondritis dissecans or AOCD. The juvenile form in teens is called juvenile osteochondritis dissecans (JOCD). The adult form really is just a failure to heal from the juvenile form. The adults most likely to develop AOCD are those who never knew they had the juvenile form. There were no symptoms.
Treatment is always advised because of the risk of recurrence and/or the development of osteoarthritis later in life. Progressive destruction of the affected joint can be painful and disabling. Treatment for OCD of the knee is most successful when the condition is caught early and treated before long-lasting damage can be done.
The surgeon makes the treatment decision with the patient’s interests in mind but by taking into consideration the size and depth of the lesion. Conservative (nonoperative) care may be possible. The presence of loose fragments complicates the decision, making surgery almost inevitable. Most people do not heal on their own and require some kind of intervention. The patient should expect a long recovery of many months to several years.