Evaluation and Surgical Management of Knee Osteochondritis Dissecans and Adolescent Cartilage Injuries.

Osteochondritis dissecans and cartilage injuries of the knee are among the most challenging clinical entities that pediatric sports medicine specialists encounter. As a weight-bearing joint with significant long-term implications on mobility and overall physical health, the knee also happens to be the most injured or adversely affected joint in preadolescent and adolescent athletes. However, cartilage injuries are unique among other musculoskeletal pathologies in children, in that the healing potential of articular cartilage tissue is limited, and minor injuries or small focal defects can have devastating implications on the lifelong health of the joint. Although the most common form of degenerative joint disease affecting the general population is, of course, osteoarthritis, other conditions such as osteochondritis dissecans or acute, traumatic osteochondral shear injuries can activate their own arthritic pathway, whereby focal injuries precipitate an eventual cascade of diffuse degeneration. Thus, it is important for sports medicine and pediatric orthopaedic specialists alike to understand, diagnose, and initiate early, evidence-based management for cartilage conditions of the knee in pediatric patients. This chapter reviews principles of diagnosis and management of both knee osteochondritis dissecans (a chronic condition of subchondral bone that often secondarily affects the articular cartilage) and acute traumatic cartilage shear injuries. Although the two entities are quite different from an etiologic standpoint, there is significant overlap in technical considerations and treatment principles between these two conditions.