Osteochondritis Dissecans of the Patella and Trochlea

Osteochondritis dissecans (OCD) affecting the patella and/or trochlea that causes anterior knee pain is quite an uncommon condition. The lesion is osteochondral by definition and generally affects one of the articulating surfaces of the patellofemoral joint. However, it less frequently affects both. It is basically a disease of children and adolescents. Almost 50% of the patients have open physes. Moreover, it is more prevalent in males. Although factors that include the vascular supply, genetics, and trauma have been involved, the precise etiology of OCD is unknown. Patients with OCD can present with swelling in the knee, knee pain as well as quadriceps muscle atrophy in chronic cases. Since radiographs do not reveal the condition in the initial stages, magnetic resonance imaging is the standard to correctly identify and size those injuries. Treatment for OCD can be either conservative or surgical. Conservative treatment is reserved for stable juvenile cases and consists of refraining from high-impact physical activity and eventually using patellar taping and quadriceps muscle strengthening. Surgical treatment is another option. It consists of either a reparative or a restorative procedure that is selected based upon patient symptoms and the status of the lesion. While treatment generally alleviates the symptoms, patients with articular cartilage loss may have persistent patellofemoral crepitus and discomfort.