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The juvenile form of OD has a much better prognosis than adult OD.^{14, 15} Stability of the OD articular cartilage lesion is the main prognostic factor in determining the likelihood of the OD lesion healing with conservative therapy.^{16, 17} Conservative therapy is defined as cessation from all sporting activity until all symptoms resolve, which can often last months to even years.^{18, 19} Because it is difficult to restrict the activity of a child or teenager, an immobilizer, splint, or cast may be used.

J.C. had an unstable OD lesion as evidenced by the osteochondral fragment barely attached to the subchondral bone at one discreet location. This would be called a flap lesion, with a definable fragment that is displaceable but still attached partially by some cartilage.²⁰ Generally all unstable OD lesions require surgical intervention either to fix internally or to remove the fragment. Surgeries include drilling, pinning, bone grafting, or simple excision of the fragment with or without curettage or drilling of the base.^{20, 21, 22} Unfortunately, these procedures predispose the young person to long-term osteoarthritis.^{15, 23, 24, 25}

Prolotherapy was thought to be an appropriate treatment for these cases because the primary author (RH) has treated numerous growth plate injuries and young athletes with sports injuries using Prolotherapy.¹¹

L.M. back to pitching without restriction after Prolotherapy.

The concept of Prolotherapy is radical compared to traditional treatments for chronic pain and sports injuries, yet its mechanism is simple. Inject a mild irritant or proliferant at the site of the pain or injury to stimulate healing to the specific area. In J.C.’s case, this involved Prolotherapy to the medial and lateral collateral ligaments, as well as an intraarticular injection with human growth hormone. Prolotherapy has been shown to stimulate articular cartilage, ligament and tendon repair.^{11, 12, 13, 26, 27} In L.M.’s case, this involved Prolotherapy in and around the bony attachments of both the medial and lateral elbows. The quick response to Prolotherapy seen in each case most likely relates to stabilization of the OD lesion, as well as tightening of the ligament laxity around his knee. Ligament laxity has been postulated as a factor in the development of OD.²⁸

The patients’ abilities to continue to play sports while receiving Prolotherapy, as well as after completing the treatment series, in addition to the MRI evidence of resolution of the osteochondritis dissecans, speaks to the success of Prolotherapy. Because this represents just two cases of osteochondritis dissecans, larger, more controlled studies are suggested to determine if Prolotherapy should be a first line therapy to consider in cases of osteochondritis dissecans.

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