Study Group Given IMPACT Award for Advancing Knee Osteochondritis Care

The 2026 IMPACT Award (Improving Musculoskeletal Patient Care Through Outcomes Research) has been presented to Kevin Shea, M.D., and the Research in Osteochondritis of the Knee (ROCK) Research Study Group in recognition of 15 years of collaborative work to advance prevention and treatment strategies for knee osteochondritis dissecans (OCD).

OCD predominantly affects adolescents and, if left untreated, can rapidly progress to osteoarthritis. Without substantial evidence-based research to inform decision-making, this research helped clinicians better understand OCD etiology, clinical presentation, imaging appearance, and treatment.

“OCD often affects young athletes at the peak of their athletic activity,” said Dr. Shea, lead researcher and orthopedic surgeon at Stanford University. “In the short term, the loss of physical activity can have a substantial psychosocial impact. In the long term, research shows that untreated OCD can lead to osteoarthritis in less than 15 years. Our goal is to maximize joint function so people can stay physically active for the rest of their lives.”

In 2010, the American Academy of Orthopaedic Surgeons (AAOS) released a Clinical Practice Guideline (CPG) on the Diagnosis and Treatment of OCD,  which includes a series of recommendations to help clinicians make decisions based on the best available evidence. This CPG highlighted areas where research was limited, pointing to the need for further understanding the condition.

Consequently, ROCK was established by Dr. Shea, Theodore Ganley, M.D., (Children’s Hospital Philadelphia) and Eric Wall, M.D., (Cincinnati Children’s Hospital). Its members include: James Carey, M.D., (University of Pennsylvania); John Polousky, M.D., (Akron Children’s Hospital); Carl Nissen, M.D., (University of Connecticut); Henry B. Ellis Jr., M.D., (Texas Scottish Rite for Children); Eric Edmonds, M.D., (Rady Children’s Hospital); and Matt Milewski, M.D., and Benton Heyworth, M.D., (both of Boston Children’s Hospital).

ROCK currently is an international, multicenter research consortium comprising more than 70 active members, including surgeons, veterinarians, physical therapists, and radiologists, working on more than 100 open research questions. Since 2014, ROCK members have enrolled more than 1,900 patients across 25 academic centers and published numerous etiology, classification, epidemiologic, healing prediction, and surgical journal articles.

Reliability Studies for Radiographs, MRI, and Arthroscopy Classification

Without consistent classification standards for the clinical or radiographic description of knee OCD, it was difficult for orthopedic surgeons to assess disease severity, prognosis, and healing across studies. One ROCK study reviewed 300 knee OCD arthroscopy videos and developed a highly reliable six-category arthroscopic classification system.

“We examined X-ray, MRI and arthroscopy classification systems using standardized case examples,” Dr. Shea stated. “Large groups of surgeons reviewed these cases and classified each to assess consistency. While X-ray and arthroscopy demonstrated overall reliability, MRI proved more challenging for classification. We will continue to refine MRI classification as an ongoing priority.”

Prospective Cohort Studies to Identify Independent Healing Predictors

With a reliable classification system in place, ROCK built a comprehensive database to collect high-quality data from participating centers. All patients younger than 25 whose knee pain needed further evaluation and had MRI and/or X-ray evidence of an OCD lesion were invited to participate in the registry.

Using machine learning tools, the group developed prediction algorithms that account for age, sex, lesion size and stability, and skeletal maturity, among others. These multivariate models help predict the lesions that are most likely to heal without surgery. The study identified lesion location at the posterior aspect of the condyle on sagittal MRI (a side view) and at the medial or lateral-most locations on coronal MRI (a view separating the anterior from the posterior) as significant predictors of increased nonoperative treatment success.

“We know that over 50% of patients with knee OCD do not heal with nonoperative treatment and ultimately require surgery, and the healing rates for older adolescents and young adults are even lower,” Dr. Shea noted. “These algorithms allow us to give families data-informed estimates of the healing potential of nonoperative treatment. While it’s not perfect, it provides a patient- and family-centered tool that supports shared decision making. As our database grows, these prediction algorithms will improve.”

Randomized Controlled Trials to Establish Optimal Surgical Technique

ROCK also conducted a randomized controlled trial to determine the optimal surgical methodology for two primary OCD drilling techniques, since there was a lack of data to compare the relative effectiveness.

Over a five-year period, ROCK studied patients who had undergone trans-articular drilling, which passes through intact cartilage, compared with those who received retro-articular drilling, which avoids cartilage and drills into the bone behind it. The drilling aims to stimulate blood flow into bone regions that need more circulation.

Moving forward, ROCK is focused on using advanced machine learning to enhance patient care precision and consistency. By developing an artificial intelligence (AI)-driven platform capable of automatically identifying and quantifying clinically relevant features from radiographs, CT scans, and MRI studies, such as lesion size, fragment stability, subchondral bone quality, and cartilage integrity, ROCK aims to advance personalized treatment strategies and improve patient outcomes for knee OCD. Additionally, future research will examine the role of biological stimulants and adjuvants to healing, including growth factors, bone grafting, stem cell therapies, and other biologic approaches beyond surgical technique alone.

Funding is provided by OREF and ORS.

The IMPACT Award recognizes exemplary outcomes-based research that has measurably advanced musculoskeletal patient care, informed clinical practice, or influenced healthcare policy. It is focused on researchers whose work demonstrates direct and sustained impact on care quality or health system improvement. Funding is provided by the Orthopaedic Research and Education Foundation (OREF) and the Orthopaedic Research Society (ORS).

With more than 39,000 members, AAOS is the world’s largest medical association of musculoskeletal specialists. The organization advances musculoskeletal health by providing comprehensive education to help orthopedic surgeons and allied health professionals best treat patients in their daily practices. AAOS is the source for information on bone and joint conditions, treatments, and related musculoskeletal healthcare issues; and it leads the healthcare discussion on advancing quality.