Diagnosis and Treatment of OCDs

In this video, Dr. Grant Garcia builds on his introduction to Osteochondritis Dissecans (OCDs) by walking through the exact protocol for diagnosing and treating the condition.

Here is a summary of the description and key points discussed in the video:

• The Diagnostic Next Steps: If an OCD is found on a patient's X-ray and they are experiencing symptoms, the definitive next step is getting an MRI. The MRI is critical because it reveals the exact size and location of the lesion, and tells the surgeon if there is fluid underneath it—which signals a loose piece that could potentially pull off.
• Common and Rare Locations: In the knee, it is most commonly found on the medial femoral condyle (the inside weight-bearing surface of the thigh bone). However, it can rarerly appear on the kneecap (patella), trochlea, lateral femoral condyle, or tibial plateau.
• Non-Surgical and Minimally Invasive Treatments: If the lesion is secure but painful, the primary treatment is making the patient completely non-weight bearing. If that fails, doctors might try "drilling" to bring fresh blood supply to the area and promote healing. This can be done retrograde (drilling backwards from the bone to avoid the cartilage) or antegraded (making tiny pinprick holes straight through the cartilage).
• Surgical Fixation: For a loose or highly unstable OCD, surgery is required. Dr. Garcia performs this arthroscopically, lifting the lesion like a "trapdoor" to clean up the underlying unhealed bone surface before securing it back down.
• Hardware Innovation: While traditional metal screws work well, they require a secondary surgery to be removed. Dr. Garcia highlights modern options, such as bio-absorbable screws that dissolve over time or advanced materials that eventually turn directly into bone, eliminating the need for a second hardware-removal procedure.