Osteochondral Defects (OCD) of the Knee in Adults
An osteochondral defect is damage to the joint cartilage and underlying bone. In adults, this most commonly occurs following trauma or as a result of localised degenerative arthritis.
Common locations
- Weight-bearing surfaces of the femur (thigh bone)
- Tibial plateau (shin bone)
- Under the patella, often associated with severe chondromalacia due to chronic patellar maltracking
Symptoms
- Knee pain and swelling
- Catching or locking sensation
- Reduced movement
- Frequently associated with meniscal tears, so symptoms may arise from both conditions
Investigations
- Weight-bearing X-rays: identify the lesion and assess the degree of arthritis
- MRI scan: sensitive for localisation of the defect and detection of associated injuries such as meniscal tears and loose bodies
Clinical assessment
Findings are non-specific but may include:
- Knee effusion
- Mechanical locking if the fragment is displaced
Treatment
Non-operative management
- Physiotherapy
- Steroid with local anaesthetic injection for symptom relief
This may help control symptoms but does not restore damaged cartilage.
Operative Treatment
Indicated for persistent pain, mechanical symptoms, or restricted movement.
Acute OCD (viable fragment)
- Arthroscopic assessment
- Stabilisation using pins or absorbable screws
- Microfracture to stimulate healing
- Associated injuries (e.g. meniscal tears) treated simultaneously
Chronic OCD (non-viable fragment)
- Removal of loose fragment
- Microfracture
- Cartilage restoration using autologous graft or synthetic graft (suitable for localised defects)
Recovery
- Early range-of-motion exercises encouraged
- Weight-bearing restricted for the first few weeks
- Structured physiotherapy rehabilitation
Serial MRI scans may be used to monitor healing of the treated lesion.
