Internal Fixation of Unstable OCD Lesions with Metal Compression Screws: Techniques and Outcomes

Osteochondritis dissecans (OCD) is a pathologic condition that affects the subchondral bone and overlying articular cartilage with variable degrees of instability and detachment. The specific etiology is frequently unknown; however, it is thought to result from multifactorial contributions including acute trauma, recurrent microtrauma, inflammation, or inherited diseases involving vascular perfusion and ossification anomalies. Treatment is largely dictated by patient symptoms and their association with lesion stability, location, skeletal maturity, activity goals, and surgeon preference. Stable lesions can frequently be treated nonoperatively, but unstable lesions typically require surgical intervention that addresses lesion instability where possible. Arthroscopy is used to initially visualize and evaluate the lesion, followed by reduction and internal fixation. If the fragment is salvageable with a bony base, internal fixation with metal compression screws is a reliable strategy for enhancing patient outcomes with low rates of reoperation and failure. This review will focus on the surgical indications, techniques, and outcomes of internal fixation with metal compression screws in unstable OCD lesions of the knee.