Treatment of juvenile osteochondritis dissecans and osteochondritis dissecans of the knee.

JOCD and OCD are distinct conditions. The former has a much more favorable prognosis than the latter. Unrecognized trauma cumulating from activities of daily living and sports produces subchondral stress fractures that eventually become symptomatic and are recognized as JOCD. If JOCD does not heal by bony union prior to distal femoral epiphyseal closure, OCD results. Since JOCD is a fracture, any method used to stimulate fracture healing, except joint immobilization, should be employed. Careful monitoring of the patient's progress is essential and is most sensitively accomplished with joint scintigraphy. Historical evidence of the benign nature of JOCD is dubious and not consistent with clinical observations. The surgical precepts for treating patients in whom conservative treatment of JOCD fails and patients with OCD are traditional orthopedic concepts. Revascularization of the fragment followed by joint motion are the dictums of surgical success.