Osteochondritis Dissecans (OCD): Diagnosis, Treatment & Recovery Guide
Osteochondritis Dissecans (OCD) is a joint disorder where a fragment of subchondral bone and its overlying cartilage begins to separate due to disrupted blood supply and repetitive microtrauma. While most common in the knee (85% of cases), it also affects the elbow and ankle. Left untreated, it can lead to chronic pain, mechanical symptoms, and early-onset osteoarthritis.
This evidence-based guide—written by an orthopedic surgeon—covers diagnosis, ICRS classification, non-operative and surgical treatments (including OATS, mosaicplasty, and high tibial osteotomy), rehabilitation, and long-term outcomes for both patients and clinicians.
What Is Osteochondritis Dissecans?
OCD occurs when repetitive stress causes microfractures in the subchondral bone, disrupting blood flow and leading to bone necrosis, cartilage delamination, and potential fragment detachment. The loose fragment is called a “joint mouse” and can cause mechanical symptoms.
It primarily affects athletes aged 10–20 years:
- Knee OCD: Soccer, basketball, gymnastics (jumping/landing)
- Elbow OCD: Baseball pitchers, gymnasts (weight-bearing)
Diagnosis: Imaging Protocol
1. Plain Radiographs (X-rays)
First-line imaging. Use AP, lateral, and tunnel views (knee) or oblique views (elbow).
Figure 1: AP radiograph of the knee demonstrating a classic osteochondritis dissecans lesion in the medial femoral condyle with subchondral lucency and irregularity.
Figure 2: Lateral knee radiograph confirming the OCD lesion with subtle contour irregularity of the medial femoral condyle.
2. MRI (Gold Standard)
Determines fragment stability and cartilage integrity.
Figure 3: Sagittal T2-weighted MRI showing a Grade III osteochondritis dissecans lesion with fluid signal beneath the fragment, indicating instability.
Figure 4: Coronal T2-weighted MRI demonstrating the full extent of the OCD lesion in the medial femoral condyle with associated cartilage delamination.
3. Varus Alignment Assessment
In medial compartment OCD, mechanical axis evaluation is critical.
Figure 5: Long-standing AP weight-bearing radiograph showing significant varus malalignment, a key indication for high tibial osteotomy in medial femoral condyle OCD.
ICRS Classification: Guiding Treatment
The International Cartilage Repair Society (ICRS) system is the global standard:
| Grade | Pathology | Treatment Approach |
|---|---|---|
| I | Intact cartilage, stable fragment | Non-operative management |
| II | Cartilage breach, fragment partially detached | Non-operative or drilling |
| III | Fragment detached but in place | Surgical fixation |
| IV | Fragment displaced (“loose body”) | Surgical removal + repair |
Surgical Treatment: Real Clinical Outcomes
For complex cases, combined procedures yield the best results.
Figure 6: Postoperative AP and lateral radiographs showing successful high tibial osteotomy (open-wedge) combined with mosaicplasty for a large medial femoral condyle OCD lesion. Note the bone graft in the tibial wedge and the osteochondral plugs in the defect site.
Rehabilitation Protocol
| Procedure | Weight-Bearing | Return to Sports |
|---|---|---|
| Drilling/Fixation | Non-weight-bearing × 6 weeks | 6 months |
| OATS/Mosaicplasty | Toe-touch × 8 weeks | 7–9 months |
| HTO | Protected weight-bearing × 10–12 weeks | 9–12 months |
Frequently Asked Questions (FAQs)
Can OCD heal without surgery?
Yes—in skeletally immature patients with stable lesions, non-operative management succeeds in 50–70% of cases. Strict activity restriction is essential.
Is OCD genetic?
Not directly inherited, but familial clustering suggests genetic susceptibility. Endocrine disorders (e.g., hypothyroidism) increase risk.
What’s the difference between OCD and osteochondral fracture?
OCD is a chronic, stress-induced process with poor vascularity. Osteochondral fracture is an acute traumatic injury with normal blood supply—better healing potential.
When is HTO recommended for OCD?
For medial femoral condyle OCD with varus malalignment (>5°). HTO shifts load to the lateral compartment, promoting healing.
Can I return to sports after OATS?
Yes—85% of athletes return to pre-injury level by 9 months. Contact sports require longer recovery.
References
- Kocher MS, et al. Osteochondritis dissecans of the knee in children and adolescents. J Am Acad Orthop Surg. 2022;30(5):e456-e465.
- Cahill BR. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Bone Joint Surg Am. 1995;77(7):1080-1086.
- Mithöfer K, et al. Articular cartilage repair in athletes. Am J Sports Med. 2020;48(10):2555-2567.
- Yonetani Y, et al. Osteochondritis dissecans of the knee: prospective long-term follow-up. Arthroscopy. 2021;37(2):561-569.
- Zhang Y, et al. High tibial osteotomy combined with cartilage repair for knee OCD: a meta-analysis. J Bone Joint Surg Am. 2023;105(8):589-597.
- Nationwide Children’s Hospital. Osteochondritis Dissecans (OCD). 2025.
- Mayo Clinic. Osteochondritis dissecans. Updated 2024.
- ICRS Classification System. International Cartilage Repair Society. 2024.