Osteochondritis dissecans is a joint injury that is more common in young people than adults. Surgery may be necessary if other less-invasive treatments aren’t effective.
Osteochondritis dissecans, also called avascular necrosis or osteonecrosis, is a bone and cartilage injury that usually affects the knee. It can also develop in the ankles, elbows, shoulders, and other joints.
The injury occurs when a small portion of bone attached to cartilage in a joint dies due to poor blood flow. A fragment of bone and cartilage can partially or completely break loose within the joint, reducing joint strength and flexibility. This can cause pain and other problems.
In mild cases, rest, bracing, or using a cast may be enough to allow the joint to fully recover. For more serious cases, osteochondritis dissecans surgery is necessary to repair the affected joint.
Here’s more information about the types of osteochondritis dissecans surgery and what to expect with recovery after the procedure.
Osteochondritis dissecans surgery can take several forms depending on the severity of the injury and which joint is affected.
Your age is also a factor, especially when considering whether your bones have stopped growing. Younger people also have a better chance of healing — something called regenerative potential.
The goal of any type of osteochondritis dissecans surgery is to repair the injured joint. This may involve removing the loose bone fragment in the joint and reshaping the bone or reattaching the fragment. It may also involve taking a graft of cartilage and bone from one region or a donor and placing it into the defect.
The two main approaches used for osteochondritis dissecans surgery include:
- Arthroscopic surgery: Arthroscopic surgery is done with small incisions to repair the joint. It usually leads to a faster recovery than open surgery because it’s less invasive.
- Open surgery: Open surgery is done with a large incision. It’s often necessary if the bone fragment can’t be treated arthroscopically, or if the injury requires a better view for the surgeon than can be obtained with an arthroscope.
The procedures themselves include:
- Fragment repair: The fragment is reattached to the bone.
- Allograft transplant: Bone and tissue from a donor helps rebuild the affected bone once the fragment has been removed (excised).
- Osteochondral autograft: Bone and cartilage tissue is taken from elsewhere in your body, usually near the injury site, to attach (graft) it onto the portion of the bone that broke away.
A new approach called autologous chondrocyte implantation is being developed. It uses a person’s cartilage cells (chondrocytes) to help grow new cartilage that can be placed into the joint.
It’s an especially good technique for children who have smaller lesions.
A 2020 study suggests autologous chondrocyte implantation resulted in generally durable joint function for up to 25 years.
Osteochondritis dissecans usually affects children and adolescents, often those who play sports, dance, or otherwise do activities that put extra burden on the joints.
It’s not always clear why the condition develops. Repetitive stress on the joints is often associated with osteochondritis dissecans.
Having a genetic predisposition to the condition, known as familial osteochondritis dissecans, has been found in rare cases.
You might need osteochondritis dissecans surgery if noninvasive approaches don’t help. Surgery may also be necessary if a bone fragment has completely broken loose and your doctor determines that the joint can’t heal properly unless the fragment is surgically reattached or removed.
It’s also important to treat osteochondritis dissecans. If the lesions are not repaired, osteoarthritis eventually develops in the affected joint.
If you have arthroscopic surgery, you may receive a local anesthetic or general anesthesia.
Open surgery usually requires general anesthesia. Procedures can take a couple of hours to perform. In many cases, you can return home the same day.
Before the procedure, you may have additional X-rays or an MRI to give the surgeon detailed images of the size, location, and severity of the injury.
You may also undergo an arthroscopic procedure so your surgeon can see the injury and determine whether arthroscopic or open surgery is necessary.
Make sure someone can drive you home after the surgery and stay with you to help you get around during the first few days postsurgery.
If your home has stairs, you may need to adjust your living arrangements before surgery to avoid having to climb stairs.
If surgery is performed on the knee, you can expect to use crutches and avoid putting weight on that knee for 6 weeks, followed by 2–4 months of physical therapy, according to the American Academy of Orthopaedic Surgeons.
When osteochondritis dissecans surgery is performed on another joint, you may need to avoid strenuous activity involving that joint for several weeks, again followed by a couple of months of physical therapy.
For young athletes, osteochondritis dissecans surgery can mean a few months without sports.
You need to allow time for the graft or new cartilage cells to integrate into the existing cartilage and bone until the joint is strong enough for weight bearing again.
Osteochondritis dissecans surgery is usually effective in restoring strength and function to injured joints.
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A 2017 study suggests that osteochondritis dissecans surgery that removes a bone fragment may be associated with higher rates of osteoarthritis and subsequent arthroplasty procedures than osteochondral defect grafting.
Researchers also found that a higher body mass index (BMI), older age at diagnosis, and a larger area replaced during the surgery correlated with a higher risk of developing osteoarthritis.
Potential risks and side effects are always associated with any surgery.
Some of the more common complications of osteochondritis dissecans surgery include the need for possible follow-up procedures if the joint does not heal completely or regain its full flexibility or range of motion after the surgery.
Eventually, some people with severe osteochondritis dissecans may need joint replacement surgery.
Other possible complications include infection or blood clot formation. These are uncommon, but it’s important to discuss all the risks associated with the surgery and what to look out for when you’re recovering.
Osteochondritis surgery costs more than conservative treatments, such as a brace, but in some cases, an operation is necessary to ensure better knee function down the road.
A 2019 study suggests an average cost of $4,224 per joint. Arthroscopic surgery may be less expensive than open surgery.
Most health insurance providers will cover standard osteochondritis dissecans surgery if a doctor verifies that other conservative measures were not effective or possible based on the severity of the injury.
Before surgery, your doctor may advise alternative treatments, starting with rest.
You may also be fitted with a brace, cast, or walking boot to provide stability and support for the affected joint. You may also need to modify your activities, at least temporarily, to allow the injured joint to heal.
Doctors often recommend physical therapy with or without surgery to strengthen the muscles around the joint and preserve the joint’s flexibility and range of motion.