Return to Play
Return to play is allowed once the OCD lesion has healed and quadriceps strength has returned to within normal limits. If the athlete was treated surgically, he or she may return to play when the OCD lesion has healed and any obstructive retained hardware has been removed.
Complications
A nonunion of the OCD fragment may occur and progress to dissociation, leading to intra-articular loose body symptoms. This, in turn, may lead to a type of reconstructive procedure such as OATS or ACI (see Surgical Intervention in Acute Phase). Regardless of treatment, degenerative articular changes may develop over time.
Prognosis
The general rule for the prognosis of OCD is the younger the patient, the better the prognosis. The prognosis also depends on the size and severity of the lesion.
A study by Nakayama et al examined 37 patients to understand factors affecting the prognosis of conservative treatment for stable juvenile osteochondritis dissecans of the lateral femoral condyle. The study found that 32.6% of the 43 knees studied had no signs of radiologic healing at 6 month follow-up. A discoid meniscus was identified in all of these knees with no healing. Another risk factor for poor non-opertative healing was a time period ≥ 6 months from onset to consultation. [11]
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Anteroposterior and lateral radiographs of medial femoral condyle osteochondritis dissecans.
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Anteroposterior MRI of medial femoral condyle osteochondritis dissecans.
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Lateral MRI of osteochondritis dissecans.
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Herbert screw stabilization of medial femoral condyle osteochondritis dissecans.
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Anteroposterior radiograph of medial femoral condyle osteochondritis dissecans.
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Lateral radiograph of osteochondritis dissecans.
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Arthroscopic view of medial femoral condyle osteochondritis dissecans, hinged medially. Note the large size and thickness of the fragment.
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Anteroposterior MRI of medial femoral condyle osteochondritis dissecans, hinged medially.
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Arthroscopic view of osteochondritis dissecans of the medial femoral condyle. The osteochondral fragment has been elevated from the crater. Note the sclerotic crater with an interposed fibrocartilaginous layer. This lesion has been previously treated with drilling; an old drill hole can be seen faintly at the upper aspect of the crater.
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Arthroscopic debridement of the osteochondritis dissecans bed to bleeding bone.
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Replacement of the fragment and temporary Kirschner wire stabilization.
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Completed osteochondritis dissecans stabilization with 2 Herbert screws. On initial examination, the most lateral defect was comminuted and removed; the larger weight-bearing surface was maintained and stabilized.
