I am 52 years old, and have run for 22 years and played all kinds of other sports. I no longer run on pavement. My right knee was diagnosed with osteochondritis dissecans (OCD) and I had meniscus surgery on the same knee a year and a half ago. At the follow-up my surgery recommended that I have

Wayne Marseus

Williamsburg, VA

[Ed. notes: In OCD, which usually affects knees and elbows, a loose piece of bone and cartilage separates from the end of the bone because of a loss of blood supply. The loose piece may fall into the joint space, making the joint unstable. This causes pain and feelings that the joint "sticks."

During OATS, a size-matched donor graft (allograft) is obtained and the diseased cartilage is mapped, and a single, large cylinder of the poor cartilage and underlying bone is removed. The allograft donor cylinder is then inserted into the socket, restoring a normal joint contour.]

There are many issues with osteochondritis and OATS procedure brings more into play. I assume that if allograft is anticipated there must be large OCD lesions, otherwise autograft tissue might be preferable.

I would probably avoid surgery until you do not have other options. Patella-centering braces, NSAIDS, quadrieeps strengthening exercises, and cross-training would all likely be helpful. I would avoid stairs, hills, and the like and never train to excess. Some use glucosamine to their advantage and also injections of viscous material like Synvics.

In the right circumstances OATS is a good procedure. However, if the lesion is small with intact articular cartilage, the bone scan normal, and your symptoms minor, then the real value of the procedure is less evident.

Larry D. Hull, MD

Centralia, WA

In order to make an assessment we'd have to see your MRI as well as an A/P longstanding view of both lower extremities to determine the size of the OCD defect, your weight-bearing alignment, and associated intraarticular knee disease.

My experience with allograft osteochondral grafting have been very encouraging. Results, at least in the short term, are excellent.

Rob Meislin, MD

New York, NY