AAOS Changes Clinical Guidelines for Osteochondritis Dissecans

Earlier this month, the American Academy of Orthopaedic Surgeons (AAOS) updated and changed its clinical guidelines for osteochondritis dissecans of the femoral condyle, also known as OCD knee. OCD presents challenges for physicians because the condition is rare enough that a large controlled study requiring patients is difficult. However, as more and more adolescent girls become involved in competitive sports, the number of patients with OCD (juvenile OCD, or JOCD) increases.

Although the 2015 guidelines released this month concur with 2010 recommendations that treatment ultimately remains at the discretion of the physician, these new guidelines take a distinctly more conservative approach and advises JOCD surgery only after non-surgical approaches have failed.

JOCD, currently estimated to affect 15 to 30 people per 100, 000, occurs from repetitive wear-and-tear of tissues and bone. Knee joints, especially young and growing knees, are the most common site for this injury and adolescents aged 10 to 15 and even 20 are most susceptible because their bodies are going through growth spurts and their bones still have open growth plates.

OCD is rarely a familial condition.

The injury occurs when a small piece of bone breaks away from the femur because of inadequate blood supply and causes a loosening of tissues around knee cartilage. Symptoms include soft tissue swelling of the knee joint, reduced flexibility, difficulty putting weight on the affected knee, and persistent pain.

Aside from the obvious reasons of needing to treat patients in pain, treatment is important because if OCD is misdiagnosed or even left undiagnosed and untreated, OCD can lead to osteoarthritis in up to 50% of patients—usually before they reach middle-age. This percent is proportional to the size and severity of OCD in the patient. It’s also harder to treat OCD using conservative methods in adults. So earlier diagnosis and conservative treatment may help prevent later surgical intervention.

Robin Quinn, M.D., Appropriate Use Criteria section leader of the AAOS Committee on Evidence-based Quality and Value, says while there is no “magic bullet, ” for this poorly understood condition, the just-released criteria is “the best attempt to narrow down treatment methods that have proved most effective thus far.”

Non-surgical options include bracing and immobilizing the knee, having the patient keep weight off it for 4 to 6 weeks, and once the patient is pain-free, beginning light weight-bearing exercises and physical therapy. It is also imperative to discontinue competitive sports for at least three to four months or more. Case studies have suggested there is a 50% chance of spontaneous healing if these measures are taken.