Osteochondritis dissecans of the knee is a fairly rare condition so conclusive evidence to guide treatment and follow-up are sketchy at best. Here’s what we can tell you from a recent set of guidelines put out by the American Academy of Orthopaedic Surgeons (AAOS).
A group of pediatric surgeons from all around the United States worked on this document. It’s called clinical practice guidelines (CPGs) for the treatment of osteochondritis of the knee in children. Sixteen (16) recommendations [that’s what they called clinical practice guidelines (CPGs)] were published.
For those who don’t know, osteochondritis dissecans (OCD) is a problem in the cartilage of the knee that affects the end of the femur (big bone of the thigh). The problem occurs where the cartilage of the knee attaches to the bone underneath.
The area of bone just under the cartilage surface is injured, leading to damage of the blood vessels to the bone. Without blood flow, the area of damaged bone actually dies. A joint surface damaged by OCD doesn’t heal naturally.
Even with surgery, OCD usually leads to future joint problems, including degenerative arthritis and osteoarthritis. That’s why proper treatment (based on evidence of what works and what doesn’t) is so important.
And in your son’s case, follow-up remains important. Seeing his surgeon for periodic check-ups and reporting any new knee symptoms are important. The surgeon will complete a history, physical examination, and order imaging studies (X-rays, MRIs) to see what kind of healing response is present (and watch for signs of osteoarthritis).
Specific treatment recommendations based on identifiable patient characteristics (e.g., age, weight, activity level, bone maturity) may change over time. As new studies are done and more conclusive evidence is found, clinical practice guidelines may change. This is true even for those whose treatment was completed years ago.
For now, there’s probably nothing to be done. Patients who have no symptoms can engage in activities as they feel comfortable. Keeping up on strength and flexibility may prove useful as well.