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OCD may present in any joint and throughout the articular surface but most commonly presents at the lateral aspect of the medial femoral condyle. Knee pain is the most commonly presenting symptom, and nearly one\u2010third of patients present with bilateral lesions. Clinical and radiographic markers of stability (or instability) commonly dictate initial treatment. Risk factors for lesion instability include those related to the clinical presentation (i.e., chronologic age \u226514 years, effusion on physical examination, and any loss of range of motion). Preliminary imaging should include bilateral radiographs (anteroposterior, tunnel, lateral, and patella view) and an assessment of alignment. Magnetic resonance imaging is the advanced imaging of choice because of its ability to assess for lesion instability, primarily defined by the presence of an articular breach. For stable OCD lesions, nonoperative management with activity and temporary weight\u2010bearing restrictions (with or without a brace) is often successful\u2014favoring younger patients (aged &lt; 12 years or with open physes) and smaller lesions in non\u2013weight\u2010bearing locations (far medial\/lateral or posterior). Surgical management is reserved for patients in whom nonsurgical treatment fails, who have a high risk of failure, or who present with an unstable lesion. Surgical treatment of stable lesions includes retroarticular or transarticular drilling. Unstable lesions, if repairable, are treated with drilling and fixation with or without grafts. Some lesions are not amenable to fixation and thus warrant either cell\u2010based (autologous chondrocyte implantation) or structural\u2010based (osteochondral autograft or allograft) cartilage treatments. Return\u2010to\u2010sport rates are high (&gt;85%) in skeletally immature knee OCD patients, regardless of treatment.<\/jats:p>","DOI":"10.1016\/j.arthro.2025.07.021","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T01:38:23Z","timestamp":1761183503000},"page":"3843-3845","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"title":["Juvenile Knee Osteochondritis Dissecans"],"prefix":"10.1002","volume":"41","author":[{"given":"Brendon C.","family":"Mitchell","sequence":"first","affiliation":[{"name":"Children's Hospital of Philadelphia Philadelphia Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin G.","family":"Shea","sequence":"additional","affiliation":[{"name":"Stanford University Medical Center Stanford California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore J.","family":"Ganley","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia Philadelphia Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip L.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Scottish Rite for Children Department of Orthopaedic Surgery UT Southwestern Medical Center Dallas Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry B.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Scottish Rite for Children Department of Orthopaedic Surgery UT Southwestern Medical Center Dallas Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"e_1_2_3_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(05)80113-6"},{"key":"e_1_2_3_3_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.71B4.2768313"},{"key":"e_1_2_3_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516637175"},{"key":"e_1_2_3_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-013-2837-6"},{"key":"e_1_2_3_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-012-2290-y"},{"key":"e_1_2_3_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231165290"},{"key":"e_1_2_3_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/23259671241297145"},{"key":"e_1_2_3_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241296133"},{"key":"e_1_2_3_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241272464"},{"key":"e_1_2_3_11_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.24.31724"},{"key":"e_1_2_3_12_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.01103"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806325005110?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806325005110?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2025.07.021","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2025.07.021","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2025.07.021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T09:11:35Z","timestamp":1773565895000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2025.07.021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":11,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1016\/j.arthro.2025.07.021"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2025.07.021","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This 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