The Journal of Bone & Joint Surgery

The Journal of Bone & Joint Surgery, Volume 94, Issue 14

Evidence-Based Orthopaedics | July 18, 2012

American Academy of Orthopaedic Surgeons Clinical Practice Guideline on: The Diagnosis and Treatment of Osteochondritis Dissecans

Henry G. Chambers, MD; Kevin G. Shea, MD; Allen F. Anderson, MD; Tommy J. (JoJo) Brunelle, PT, DPT; James L. Carey, MD; Theodore J. Ganley, MD; Mark Paterno, DPT, MS, MBA; Jennifer M. Weiss, MD; James O. Sanders, MD; William C. Watters, III, MD; Michael J. Goldberg, MD; Michael W. Keith, MD; Charles M. Turkelson, PhD; Janet L. Wies, MPH; Laura Raymond, MA; Kevin M. Boyer; Kristin Hitchcock, MLS; Patrick Sluka, MPH; Catherine Boone, BS; Nilay Patel, MA

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J Bone Joint Surg Am, 2012 Jul 18;94(14):1322-1324. doi: 10.2106/JBJS.9414ebo

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Abstract

Update:

This article was updated on February 13, 2013, because of a previous error. On page 1322, the name of one of the members of the Work Group (Jennifer M. Weiss, MD) had not been listed. This name is now included in the list of Work Group members.

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Introduction

The Diagnosis and Treatment of Osteochondritis Dissecans

Summary of Recommendations

The following is a summary of the recommendations in the AAOS’ clinical practice guideline, The Diagnosis and Treatment of Osteochondritis Dissecans (OCD) of the Knee. The scope of this guideline is specifically limited to Osteochondritis Dissecans of the Knee. This summary does not contain rationales that explain how and why these recommendations were developed nor does it contain the evidence supporting these recommendations. All readers of this summary are strongly urged to consult the full guideline and evidence report for this information. We are confident that those who read the full guideline and evidence report will also see that the recommendations were developed using systematic evidence-based processes designed to combat bias, enhance transparency, and promote reproducibility. This summary of recommendations is not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician and other healthcare practitioners.

In a patient with knee symptoms (pain, swelling, locking, catching, popping, giving way) and/or signs (tenderness, effusion, loss of motion, crepitus), x-rays (including AP, lateral, sunrise/Merchant, and tunnel views) are an option.
Strength of Recommendation: Weak*
*To see the description of the evidence linked to the strength of the recommendations, please refer to Table 1; “Strength of Recommendation descriptions” in the guideline.
We are unable to recommend for or against x-rays on the contralateral asymptomatic knee in patients with confirmed OCD of one knee.
Strength of Recommendation: Inconclusive
In a patient with a known OCD lesion on x-ray, an MRI of the knee is an option to characterize the OCD lesion or when concomitant knee pathology is suspected such as meniscal pathology, ACL injury, or articular cartilage injury.
Strength of Recommendation: Weak
We are unable to recommend for or against non-operative treatment (casting, bracing, splinting, unloader brace, electrical or ultrasound bone stimulators, or activity restriction alone) for asymptomatic skeletally immature patients with OCD.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against a specific non-operative treatment (casting, bracing, splinting, unloader brace, electrical or ultrasound bone stimulators, or activity restriction alone) for symptomatic skeletally immature patients with OCD.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against arthroscopic drilling in symptomatic skeletally immature patients with a stable lesion(s) who have failed to heal with non operative treatment for at least three months.
Strength of Recommendation: Inconclusive
In the absence of reliable evidence, it is the opinion of the work group that symptomatic skeletally immature patients with salvageable unstable or displaced OCD lesions be offered the option of surgery.
Strength of Recommendation: Consensus
We are unable to recommend for or against a specific cartilage repair technique in symptomatic skeletally immature patients with unsalvageable fragment.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against repeat MRI for asymptomatic skeletally mature patients.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against treating asymptomatic skeletally mature patients with OCD progression (as identified by X-ray or MRI) like symptomatic patients.
Strength of Recommendation: Inconclusive
In the absence of reliable evidence, it is the opinion of the work group that symptomatic skeletally mature patients with salvageable unstable or displaced OCD lesions be offered the option of surgery.
Strength of Recommendation: Consensus
We are unable to recommend for or against a specific cartilage repair technique in symptomatic skeletally mature patients with unsalvageable OCD lesions.
Strength of Recommendation: Inconclusive
In the absence of reliable evidence, it is the opinion of the work group that patients who remain symptomatic after treatment for OCD have a history and physical examination, x-rays and/or MRI to assess healing.
Strength of Recommendation: Consensus
We are unable to recommend for or against physical therapy for patients with OCD treated non-operatively.
Strength of Recommendation: Inconclusive
In the absence of reliable evidence, it is the opinion of the work group that patients who have received surgical treatment of OCD be offered post-operative physical therapy.
Strength of Recommendation: Consensus
We are unable to recommend for or against counseling patients about whether activity modification and weight control prevents onset and progression of OCD to osteoarthritis (osteoarthrosis).
Strength of Recommendation: Inconclusive

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Disclaimer: An AAOS physician volunteer Work Group developed this clinical practice guideline based on a systematic review of the current scientific and clinical information as well as accepted approaches to treatment and/or diagnosis. This clinical practice guideline is not intended to be used as a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. Clinical patients may not necessarily be the same as those found in a clinical trial. Patient care and treatment should always be based on a clinician's independent medical judgment, given the individual patient's clinical circumstances.

The complete AAOS guideline can be found at http://www.aaos.org/research/guidelines/OCD_guideline.pdf

Topics

osteochondritis dissecans ; clinical practice guideline

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Henry G. Chambers, Kevin G. Shea, Allen F. Anderson, Tommy J. (JoJo) Brunelle, James L. Carey, Theodore J. Ganley, Mark Paterno, Jennifer M. Weiss, James O. Sanders, William C. Watters, III, Michael J. Goldberg, Michael W. Keith, Charles M. Turkelson, Janet L. Wies, Laura Raymond, Kevin M. Boyer, Kristin Hitchcock, Patrick Sluka, Catherine Boone, Nilay Patel; American Academy of Orthopaedic Surgeons Clinical Practice Guideline onThe Diagnosis and Treatment of Osteochondritis Dissecans. The Journal of Bone & Joint Surgery. 2012 Jul;94(14):1322-1324.

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