Guideline sources The following summarized guidelines for the evaluation and management of osteochondritis dissecans are prepared by our editorial team based on guidelines from the American College of 1 Radiology (ACR 2018) and the American Academy of Orthopaedic Surgeons (AAOS 2012). 2 Guidelines 1. Diagnostic investigations Knee radiography: As per ACR 2018 guidelines, obtain knee X-ray as initial imaging in 5 years old patients with chronic knee pain. B As per AAOS 2012 guidelines: Consider obtaining knee X-ray (including anteroposterior, lateral, sunrise/Merchant, and tunnel views) in patients with knee symptoms (pain, swelling, locking, catching, popping, giving way) and/or signs (tenderness, effusion, loss of motion, crepitus). C https://web.pathway.md/diseases/recH2bqx9kshIkv4P 1/4 6/30/23, 1:24 AM Osteochondritis dissecans Pathway Insufficient evidence to recommend for or against X-rays on the contralateral asymptomatic knee in patients with confirmed osteochondritis dissecans of one knee. I Knee magnetic resonance imaging: As per ACR 2018 guidelines, obtain knee MRI in 5 years old patients with chronic knee pain with initial knee radiographs demonstrating osteochondritis dissecans. B As per AAOS 2012 guidelines, consider obtaining knee MRI to characterize the osteochondritis dissecans lesion in patients with a known osteochondritis dissecans lesion on X-ray, or when concomitant knee pathology is suspected, such as meniscal pathology, ACL injury, or articular cartilage injury. C 2. Medical management Indications for treatment: insufficient evidence to recommend for or against treating asymptomatic skeletally mature patients with osteochondritis dissecans progression (as identified by X-ray or MRI) like symptomatic patients. I Non-operative management: Insufficient evidence to recommend for or against nonoperative treatment in asymptomatic skeletally immature patients with osteochondritis dissecans. I Insufficient evidence to recommend for or against a specific nonoperative treatment (casting, bracing, splinting, unloader brace, electrical or ultrasound bone stimulators, or activity restriction alone) in symptomatic skeletally immature patients with osteochondritis dissecans. I 3. Nonpharmacologic interventions Lifestyle modifications: insufficient evidence to recommend for or against counseling patients about whether activity modification and weight control prevent the onset and progression of osteochondritis dissecans to OA. I Physical therapy: Consider offering postoperative physical therapy in patients undergone surgical treatment for osteochondritis dissecans. E Insufficient evidence to recommend for or against physical therapy in patients with osteochondritis dissecans treated nonoperatively. I 4. Therapeutic procedures Arthroscopic drilling: insufficient evidence to recommend for or against arthroscopic drilling in symptomatic skeletally immature patients with stable lesions not responding to nonoperative treatment for at least 3 months. I https://web.pathway.md/diseases/recH2bqx9kshIkv4P 2/4 6/30/23, 1:24 AM Osteochondritis dissecans Pathway 5. Surgical interventions Indications for surgery: consider offering surgery in symptomatic (whether skeletally immature or mature) patients with salvageable unstable or displaced osteochondritis dissecans lesions. E Cartilage repair technique: insufficient evidence to recommend for or against a specific cartilage repair technique in symptomatic (whether skeletally immature or mature) patients with unsalvageable fragments. I 6. Follow-up and surveillance Serial clinical and imaging assessment: Obtain clinical (history and physical examination) and imaging (X-ray and/or MRI) monitoring to assess healing in patients remaining symptomatic after treatment for osteochondritis dissecans. E Insufficient evidence to recommend for or against repeat MRI in asymptomatic skeletally mature patients. I Clinical findings Symptoms Past medical history Ankle locking OA Ankle pain Obesity Ankle popping Stickler syndrome Elbow locking Anthropomorphic exam Elbow pain Elbow popping Dwarfism Knee locking Imaging findings Knee pain Knee popping Knee joint effusion Social history Sports participation Musculoskeletal exam Ankle crepitus Ankle instability Ankle tenderness Elbow tenderness Knee crepitus Knee instability Knee swelling https://web.pathway.md/diseases/recH2bqx9kshIkv4P 3/4 6/30/23, 1:24 AM Osteochondritis dissecans Pathway Limping Quadriceps atrophy elbow ROM knee ROM References 1. Expert Panel on Musculoskeletal Imaging:, Michael G Fox, Eric Y Chang et al. ACR Appropriateness Criteria Chronic Knee Pain. J Am Coll Radiol. 2018 Nov;15 11S S302 S312. Open 2. Henry G Chambers, Kevin G Shea, Allen F Anderson et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis and treatment of osteochondritis dissecans. J Bone Joint Surg Am. 2012 Jul 18;94 14 1322 4. Open https://web.pathway.md/diseases/recH2bqx9kshIkv4P 4/4