Okay, so we’ve heard all the dire warnings our son’s surgeon has given us about resting and avoiding activities that hurt his knee because he has osteochondritis. But really, we have an older son who had the same problem and he ignored all his surgeon’s advice. He gutted through the pain and came out fine in the end. So how can we convince the younger son to do as the surgeons says, not as his brother did?

That’s a tough problem — especially given the fact that there really isn’t enough high-quality evidence to prove that rest, activity restrictions, and immobilization really make a difference. They may but it just hasn’t been proven with randomized controlled studies.

Randomized controlled studies involve one group of patients with osteochondritis dissecans (OCD) receiving treatment, while another group with the same problem do not receive any treatment. It is not considered ethical to withhold a treatment (proven or believed beneficial) from patients — and especially in the case of OCD when children and teens are the ones affected most often.

It certainly makes sense that a joint damaged by OCD should be given every opportunity to heal itself without ongoing load, shear force, and compression. In the case of unstable or displaced OCD, a piece of cartilage has been gouged out of the joint surface and has moved or shifted.

Now there is a free floating fragment in the joint that may create more trauma and damage to the joint surface as the affected person continues to use that joint. That’s when surgery is usually advised to repair or remove the fragment.

In the end, we know that the overall natural history of OCD (i.e., what happens over time) is that the cartilage will either heal itself or not. We don’t have any clear means of predicting ahead of time which lesions will go on to heal and which ones won’t.

A joint surface damaged by OCD doesn’t heal naturally. Even with surgery, OCD often leads to future joint problems, including degenerative arthritis and osteoarthritis. That’s why surgeons make the recommendations they do — rest, immobilization, and activity modification. Give the joint every opportunity to heal well. Yes, it’s possible to ignore these guidelines and suffer through the pain. But there are long-term consequences that should be considered.