Can you, or should you, put off surgery until the end of a sports season? Are you at risk for doing more damage by waiting and having surgery later? In this week’s Ask Dr. Geier video, I answer that question from a reader who wants his son to play his senior year with an OCD lesion in his knee.

Dev asks:

My just-turned 18-yr old was diagnosed with OCD in his knee at age 11. After a year of rest and PT, the doctor released him for full activity. He has had occasional swelling but no real issues until last week when he felt something catch in his knee. He could feel something moving around. Another X-ray and MRI showed a 3.5cm x 2.5cm crater at the end of the femur. The doctor wants to perform a bone graft. My question is, can this be put off until after soccer season so he can play his senior year or not? We are in the middle of recruiting and about to start high school soccer season. What are the risks of continuing to play soccer?

Osteochondritis dissecans is a problem that affects mainly young athletes, but occasionally the residual effects of an OCD lesion can be seen in an adult. The lesion involves the bone under the articular cartilage in part of the knee (almost always the lateral aspect of the medial femoral condyle) starting to die. Early on the cartilage over this diseased bone is intact, but it can later break off with the underlying bone and float freely within the knee joint.

In young athletes who are not finished growing, there is often a good chance that the lesion will heal on its own. Treatment in this situation often involves making the athlete nonweightbearing for many weeks to try to decrease stress on the lesion.

Also read:
Osteochondritis Dissecans

If the lesion has broken away, nonsurgical treatment is not indicated. Surgery to try to put the lesion back in place and hold it with screws or pins can occasionally be attempted successfully. Other times it is a free-floating piece of bone and cartilage that is removed and filled with cylinders of bone and cartilage from the athlete’s knee or from a donor.

In this video, I explain the risk involved with delaying surgery and continuing to play sports. There are many variables to consider with osteochondritis dissecans lesions, so it is important to discuss your options with your orthopedic surgeon.

Also read:
Osteochondritis dissecans in a young athlete

Surgical image of an OCD lesion in the knee

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