Arthroscopic OCD (osteochondritis dissecans) repair addresses focal lesions in the shoulder where a segment of subchondral bone has lost its blood supply and the overlying cartilage is at risk of separation. The procedure preserves cartilage when stable, fixes unstable fragments, or replaces displaced fragments depending on lesion stage. OCD is less common in the shoulder than in the knee or elbow but follows similar principles.
What Is Arthroscopic OCD Repair?
OCD lesions are focal areas where subchondral bone loses its blood supply, softens, and can separate from the surrounding bone with the overlying cartilage. In the shoulder, OCD most commonly affects the humeral head, particularly in skeletally immature throwing athletes.
Surgical treatment depends on lesion stability:
- Stable lesions with intact cartilage: drilling to stimulate revascularization
- Unstable in-situ fragments: fixation with bioabsorbable implants or metal screws
- Displaced fragments: removal of loose body and replacement with osteochondral graft if the fragment is not salvageable
The goal is to preserve the patient’s native cartilage when possible and to restore the joint surface when not.
Who Is a Candidate?
Candidates for surgical OCD repair typically have:
- Symptomatic OCD documented on MRI
- Mechanical symptoms (catching, locking) suggesting an unstable or displaced fragment
- Failure of non-surgical treatment for stable lesions in skeletally immature patients
- Functional limitation in active patients
- Defects of a size and location amenable to arthroscopic treatment
Stable lesions in skeletally immature patients are typically observed for six to 12 months of rest and protected activity before surgery is considered.
How the Procedure Is Performed
The procedure is performed arthroscopically through standard portals. The lesion is identified and probed to assess stability.
For stable lesions, multiple small holes are drilled through the subchondral bone to stimulate revascularization and healing. The overlying cartilage is preserved.
For unstable in-situ fragments, the fragment is gently elevated, the underlying bone is prepared, and the fragment is fixed with bioabsorbable pins or screws that compress the fragment back to its native bed.
For displaced fragments, the loose body is retrieved. If the fragment is salvageable and the recipient bed is adequate, it can be reattached. If not, the defect is treated with osteochondral autograft transfer or allograft transplantation.
Recovery and Rehabilitation
Recovery depends on the procedure:
- After drilling: sling for two to four weeks, progressive motion, return to non-throwing activity at two to three months, return to throwing at four to six months
- After fragment fixation: sling for four to six weeks, progressive motion, return to throwing at six to nine months
- After osteochondral grafting: longer protected loading, return to throwing at nine to 12 months
Risks and Outcomes
Risks include failure of the fragment to heal, progression to displaced lesion, persistent pain, and progression to arthritis. Outcomes are best in juvenile OCD lesions treated early, where healing potential is highest. Adult OCD and chronic displaced lesions have less predictable outcomes.
Why Dr. Chudik for Arthroscopic OCD Repair
Dr. Chudik treats OCD across the spectrum of athletic populations, from skeletally immature throwers to older recreational athletes. His arthroscopic experience and treatment selection (drilling, fixation, or grafting) is informed by lesion characteristics on MRI and intraoperative assessment. Early evaluation and intervention preserve the most treatment options.