Narrative review by Heyworth and Kocher (Boston Children's Hospital) synthesizing the epidemiology, diagnosis, classification, and staged operative and nonoperative management of osteochondritis dissecans of the knee, with treatment algorithms stratified by lesion stability and skeletal maturity.
When evaluating a preadolescent or adolescent with knee pain and a femoral condyle lesion on MRI, use the Hefti classification to determine stability (stages 1–2 = stable, 3–5 = unstable) and physis status to guide treatment: stable + open physis → minimum 3 months nonoperative; stable + closed physis or failed nonoperative → drilling; unstable → fixation with screws or bioabsorbable implants, reserving allograft or ACI for failed fixation or deficient progeny bone.
Narrative review by Heyworth and Kocher (Boston Children's Hospital) synthesizing the epidemiology, diagnosis, classification, and staged operative and nonoperative management of osteochondritis dissecans of the knee, with treatment algorithms stratified by lesion stability and skeletal maturity.
When evaluating a preadolescent or adolescent with knee pain and a femoral condyle lesion on MRI, use the Hefti classification to determine stability (stages 1–2 = stable, 3–5 = unstable) and physis status to guide treatment: stable + open physis → minimum 3 months nonoperative; stable + closed physis or failed nonoperative → drilling; unstable → fixation with screws or bioabsorbable implants, reserving allograft or ACI for failed fixation or deficient progeny bone.