Young athletes whose knees enjoy a successful recovery from the pain of osteochondritis dissecans (OCD) probably don’t realize they’ve had more than 30 orthopaedic surgeons from around the world working on them.

The surgeons are members of ROCK – for Research in OsteoChondritis of the Knee – a group co-founded 10 years ago by Eric Wall, MD, director of Orthopaedic Sports Medicine at Cincinnati Children’s.

OCD of the knee is Wall’s specialty. It is likely due to repetitive sports’ stress on the young bone that supports the knee cartilage, which gives way. “You develop a pothole in your knee, in the surface of the cartilage,” he says. Untreated, it becomes extremely painful and can worsen and turn into osteoarthritis.

Although the condition is relatively uncommon, Wall treats some 40 new patients with the condition every year, most of them between the ages of 8 to 16.

“Many of these kids are high-level, hard-charging athletes, very active. We’re not sure what causes the condition. It’s likely overuse – we think it’s repetitive trauma,” he says. “These kids have growing bones and cartilage, and it can’t sustain these heavy loads. The condition generally doesn’t come from acute trauma. It just comes on silently and all of a sudden causes pain, and that’s how it presents.”

Although Wall specializes in treating the condition, there was little data he could find from other surgeons on best practices – until ROCK. The group now includes 30 centers around the world that collaborate on and publish research, share data and treatment approaches, and keep a database of outcomes.

“For as long as I’ve been doing this, we didn’t know much about the condition – its causes or its treatment. Most reporting on the condition was by a single surgeon,” Wall says. Now, the ROCK group is working to get alignment on basic parameters – what the condition is, how to classify the lesions and how to determine when they are healed. This year, they have undertaken a study to determine MRI classifications for OCD lesions. “It’s tedious work, but we all have to agree on parameters,” Wall says.

The first line of treatment for most cases of OCD is resting the knee, a process that can take from four months to a year. “Two-thirds of the kids will respond to a non-operative approach,” Wall says, “but they don’t like it. It takes forever to heal.”

For patients whose injuries require surgery, “We try to bring in new blood flow and bone to stimulate the lesions. Cartilage needs bone to support it. The subchondral bone supporting the cartilage dissolves away, so we try to get the bone to come back to support the surface.”

Surgical approaches range from drilling small holes in the lesion to stimulate this process, to osteochondral grafts. To help identify the best course of treatment, the centers participating in ROCK have formed a prospective database of 400 patients whose outcomes they are following. “We can look at results and see which approach heals quicker and better,” says Wall.

Collaboration by ROCK members is already improving outcomes for patients. “Over the last 10 years, just talking with and learning from colleagues, my outcomes have improved,” Wall says. “Now we are getting kids healed at a much higher rate and in a shorter period of time. It’s been great for patients.”