The injury results when a small piece of bone breaks away from the femur due to inadequate blood supply, and loosens surrounding cartilage in the knee joint. The reason why blood supply decreases is unknown, but physicians believe some cases happen because of repetitive stress or motion with the bone.
Osteochondritis dissecans of the femoral condyles are rare, occurring mainly in patients between ages 10 to 20. Without successful treatment, patients can develop degenerative arthritis while they are still young.
“There is no magic bullet for this poorly understood condition,” said Robert Quinn, MD, AUC Section Leader for the AAOS Committee on Evidence-Based Quality and Value. “It is very challenging to find consensus about appropriate treatment because much evidence of good outcomes is inconclusive. These criteria are the best attempt to narrow down what treatment methods under what conditions have been effective so far.”
The new AUC “Appropriate Use Criteria for Management of Osteochondritis Dissecans of the Femoral Condyle” rates therapies based on whether they are reasonable and acceptable given the patient’s condition, and are likely to improve outcomes.
For example, restricting physical activity that produces impact or pain, and performing physical therapy to regain strength, mobility and function were rated “appropriate.” In addition, bracing the knee instead of immediate surgical treatment was rated “may be appropriate.” However, the AUC notes that surgical removal of the bone fragment is “rarely appropriate.”
Dr. Quinn said physicians should use their professional discretion to determine the best course of action for patients, especially since little clear evidence exists to support treatment choices. As progress is made in treating this bone disorder, the AUC will be updated.
Similarly, AAOS’ clinical practice guideline published in 2010, “The Diagnosis and Treatment of Osteochondritis Dissecans (OCD) of the Knee,” showed little agreement on treatment, and noted that recommendations were based on physician opinions in the absence of reliable evidence. The guideline supported offering surgery to patients with salvageable, unstable or displaced fractures, in addition to postoperative therapy.
The American Academy of Orthopaedic Surgeons
With more than 40,000 members, the American Academy of Orthopaedic Surgeons (AAOS) is the world’s largest association of musculoskeletal specialists. The AAOS provides education programs for orthopaedic surgeons and allied health professionals, champions and advances the highest musculoskeletal care for patients, and is the authoritative source of information on bone and joint conditions, treatments, and related issues.
Visit AAOS at:
Newsroom.aaos.org for bone and joint health news, stats, facts, images and interview requests.
ANationinMotion.org for inspirational patient stories, and orthopaedic surgeon tips on maintaining bone and joint health, avoiding injuries, treating musculoskeletal conditions and navigating recovery.
Orthoinfo.org for patient information on hundreds of orthopaedic diseases and conditions.