AskThePedipod
Farokh Wadia
What is a Knee Osteochondral injury?
Mr Farokh Wadia, Consultant Paediatric Orthopaedic Surgeon
1 August 2026
Direct impact to the knee can cause damage to the lining cartilage and bone underneath
What it is: This involves damage to the cartilage and the bone immediately beneath it. In children and adolescents it often takes the form of osteochondritis dissecans (OCD), where a small segment of bone and cartilage loses its blood supply and may begin to separate.
Signs and symptoms: Aching knee pain, swelling, catching or locking, and symptoms that worsen with activity.
Diagnosis: X-rays can show the affected area, and an MRI scan is used to assess how stable the fragment is and whether the cartilage surface is intact.
Treatment: Stable lesions in a growing child often heal with activity modification and time. Unstable or detached fragments may need keyhole surgery to fix the fragment or stimulate healing.
Outlook: Younger children with open growth plates have the best healing potential. Early diagnosis greatly improves the outcome.
When to seek advice: If your child has ongoing knee pain or swelling that doesn't settle, particularly with catching or locking.
FAQs
What is an osteochondral lesion in a child’s joint?
An osteochondral lesion (or Osteochondritis Dissecans) is a condition where a small segment of bone and its overlying protective cartilage lose their blood supply, causing the fragment to crack, loosen, or separate from the surrounding joint. This condition most frequently affects the knee, ankle, or elbow joints of active, growing adolescents.
Key stages and treatment pathways for OCD:
Stable lesions: Rest, casting, or specialized unloader bracing can allow the bone fragment to naturally revascularize and heal if the growth plates are still open.
Unstable fragments: Surgery is required if the piece becomes loose or detaches completely, creating a loose body inside the joint space.
Surgical fixation: Procedures range from drilling tiny holes to stimulate fresh blood flow to physically securing the loose fragment back into place with pins.