Treatment of osteochondritis dissecans.

It has been known for more than a decade that osteochondritis dissecans of the knee joint in children will heal with rest or even spontaneously (Decker 1938, Wiberg 1941, Strange 1944, Smillie 1946, Van Demark 1952, Green and Banks 1953). This capacity is lost with maturity and may not extend beyond adolescence (Wiberg 1943). Current treatment thereafter consists of symptomatic removal of the loose bodies which separate into the joint ; and months or years later, of palliative measures directed to the pain of the osteoarthritis which develops in lesser or greater degree depending on the size and location of the lesion and the physical demands of occupation. This paper records the experience of an attempt to treat osteochondritis dissecans in a more idealistic way. It confirms the possibility of healing in children by conservative means. It proposes to show that timely operative intervention can prevent separation of fragments and result in healing. Finally, it proposes to show that timely operative intervention can restore the anatomy of the part and result in healing even after fragments have separated.