Osteochondritis Dissecans Treatment
Osteochondritis dissecans — commonly abbreviated as OCD — is a condition in which a segment of bone just beneath the cartilage surface of a joint loses its blood supply, causing the affected bone and its overlying cartilage to soften, crack, and potentially separate from the surrounding healthy bone. The knee is the most commonly affected joint, especially the knee’s medial femoral condyle (the weight-bearing surface on the inner side of the thighbone), though OCD can also occur in the ankle, elbow, hip, and shoulder. The condition develops most frequently in active adolescents and young adults between the ages of 10 and 20, and while no single cause has been definitively identified, repetitive stress and microtrauma to the joint during sports appear to play a significant role. When the affected bone fragment remains in place, the lesion may heal with rest and activity modification. When the fragment loosens or separates entirely, it can become a loose body within the joint — causing catching, locking, pain, and progressive cartilage damage that requires surgical intervention.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with specialized training in pediatric orthopedics through a rotation at Harvard University’s Boston Children’s Hospital and over 30 years of experience treating cartilage and bone conditions in young athletes. OCD of the knee sits at the intersection of pediatric orthopedics, sports medicine, and cartilage restoration — and Dr. Glashow brings expertise in all three disciplines. His practice offers the full range of OCD treatment options, from conservative management with activity modification and monitoring to advanced arthroscopic techniques including drilling, cartilage repair, fragment fixation, and cartilage transplantation for more advanced lesions. As Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers, he manages articular cartilage injuries in professional athletes where preserving the joint surface is paramount. Named a Castle Connolly Top Doctor every year since 2000, he evaluates and treats osteochondritis dissecans at his Upper East Side practice in New York City.
What Is Osteochondritis Dissecans?
Osteochondritis dissecans occurs when blood supply is restricted to the end of a bone in a major joint. The bottom of the femur in the knee joint is the most common bone affected by this disease, but it can also occur in the ankle, hip, shoulder and elbow. The loss of blood supply can cause the end of the femur or other bone to soften and die. The end of the bone, including the attached cartilage, can break from the rest of the bone, becoming loose in the joint.
Symptoms of Osteochondritis Dissecans
Osteochondritis dissecans occurs most commonly in active youth from ages 10-20, but it can affect those of any age. There is no known cause, but it is more common in young athletes that suffer repeated stress to the joints. The process of bone deterioration occurs over many months, and symptoms may not be immediately apparent. When symptoms do occur, they may include:
- Limited range of motion in the knee or joint
- Pain, swelling and weakness in the joint after activity
- Stiffness in the joint after periods of rest
- Popping or clicking sound when moving the joint
- Locked knee or joint sticking in one position
At Jonathan Glashow, MD, Orthopedic Surgery & Sports Medicine, we offer advanced treatments for osteochondritis dissecans to relieve pain and improve joint function. We offer both surgical and non-surgical options, depending on the extent of damage to the bone and joint. For a diagnosis and treatment options for osteochondritis dissecans, contact our clinic in UES NYC.
Frequently Asked Questions About Osteochondritis Dissecans
What causes osteochondritis dissecans?
The exact cause of OCD is not fully understood, but it is believed to result from repetitive microtrauma and stress to the joint surface — particularly in young athletes whose bones are still developing. Repeated impact from running, jumping, and pivoting may disrupt the blood supply to a small area of bone beneath the cartilage, causing that segment to weaken and potentially separate. Genetic factors, vascular abnormalities, and rapid skeletal growth during adolescence may also contribute. OCD is more common in athletes who participate in high-impact sports such as basketball, soccer, gymnastics, and baseball.
How is osteochondritis dissecans diagnosed?
Dr. Glashow begins with a clinical examination that assesses joint pain, swelling, range of motion, and any mechanical symptoms such as catching or locking. X-rays are typically the first imaging study and can reveal the OCD lesion in many cases. An MRI is usually ordered to evaluate the size and stability of the lesion, assess the condition of the overlying cartilage, and determine whether the fragment is still attached or has begun to separate — information that is critical for guiding treatment decisions. Same-day imaging is available at his Upper East Side practice.
Can osteochondritis dissecans heal without surgery?
In younger patients with open growth plates and a stable OCD lesion — where the bone fragment has not separated from the surrounding bone — conservative treatment often allows the lesion to heal over time. This typically involves a period of activity restriction or immobilization, sometimes with crutches to reduce weight-bearing, followed by a gradual return to activity as the lesion heals. Dr. Glashow monitors healing with periodic imaging to ensure the lesion is progressing. Stable lesions in skeletally immature patients have the best chance of healing without surgery, particularly when the condition is caught early.
When is surgery needed for OCD?
Surgery is recommended when the OCD lesion is unstable (the fragment has partially or fully separated), when the lesion is large or involves a weight-bearing surface, when the patient is skeletally mature with a closed growth plate and healing is unlikely with conservative treatment alone, or when a trial of non-operative management has failed. The specific surgical approach depends on the stability and size of the lesion and the condition of the overlying cartilage.
What surgical options are available for OCD of the knee?
Dr. Glashow offers several surgical techniques depending on the individual lesion. For stable lesions that need stimulation to heal, arthroscopic drilling through the intact cartilage promotes blood flow to the affected bone. For partially detached fragments with viable cartilage, the fragment can be fixed back into place with pins or screws. For lesions where the fragment has fully separated or the cartilage surface is damaged beyond repair, cartilage restoration procedures — including microfracture, osteochondral autograft transfer, or allograft transplantation — may be used to reconstruct the joint surface. Dr. Glashow evaluates the full clinical picture and recommends the approach most likely to restore a smooth, functional joint surface.
What does recovery look like after OCD surgery?
Recovery timelines depend on the specific procedure performed. Drilling and fragment fixation cases typically require four to six weeks of protected weight-bearing followed by progressive physical therapy, with return to sports in three to six months. Cartilage restoration procedures may require a longer recovery — often six to twelve months — because the transplanted or regenerated cartilage needs time to mature and integrate with the surrounding joint surface. Dr. Glashow coordinates rehabilitation closely with physical therapists and monitors cartilage healing with follow-up imaging to ensure each patient progresses safely before returning to high-impact activity.
