Management of Cartilage Lesions Based on Etiology : OCD versus Acute Traumatic Lesions

Treatment of articular cartilage lesions in the knee remains a challenge. A wide range of options is available nowadays, including conservative measures, simple arthroscopic interventions, marrow tapping techniques, osteochondral auto/allografting, cell-based techniques, growth factors and emerging gene therapy techniques. Osteochondritis dissecans (OCD) is first described by Konig in 1888. Its prevalence is estimated at 15 to 30 cases per 100.000. The lateral aspect of the medial femoral condyle is the classic site, repetitive trauma with microscopic fractures below the surface of the joint of clogging of the tiny blood vessels inside the bone associated with a number of differing medical conditions. OCD is commonly found in older children and adolescents who actively participate in sports. It is different from acute traumatic cartilage lession, as they happen due to a direct compaction injuries, such as occur in the patellofemoral joint. The more common mechanism is a rotational injury to the knee or shearing force across the articular cartilage. Patellar dislocation may lead to osteochondral fracture through this mechanism and is responsible for 40-50% of osteochondral lesions around the femoral condyles. It is most common in young active patients aged 20-40 years. Treatment options are variable and dependent on many factors, including patient age and activity level, location and size of the defect, meniscal status, limb alignment, concomitant knee pathologies, chronicity, and comorbidities. Treatment of cartilage lesions is differentiated not based on its etiology but based on the severity of the cartilage lesions such as size, depth, shape and description of the walls (contained, partially contained or opened), and the resource capabilities of each centre. What needs to be understood is that OCD lesions are disease-related, whereas acute traumatic lesions may occur in otherwise healthy cartilage due to mechanical trauma.