Salvage Techniques in Osteochondritis Dissecans John D. Polousky, MD a, *, Jay Albright, MD b INTRODUCTION The central objective in the treatment of any osteochondritis dissecans (OCD) lesion is to preserve the native articular cartilage and bone. Unfortunately, there are those cases that either fail to heal despite appropriate treatment or present in such a dete- riorated state that primary fixation is not possible. This situation is generally deter- mined by the condition of the progeny fragment. If the progeny has comminuted into multiple small fragments or is incongruous with the donor site, or the articular cartilage is excessively deteriorated, primary fixation may not be the most viable option. In the case of an unsalvageable fragment, the surgeon is faced with several options, which are discussed in this article. a The Rocky Mountain Youth Sports Medicine Institute, 14000 East Arapahoe Road, Centennial, CO 80111, USA; b Children’s Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA * Corresponding author. E-mail address: johnpolousky@msn.com KEYWORDS  Osteochondritis dissecans lesion  Osteochondral allografts  Osteochondritis dissecans (OCD)  Osteochondral allograft  Autologous chondrocyte implantation  Cartilage  Salvage  Autologous cartilage implantation KEY POINTS  Large articular cartilage defects caused by osteochondritis dissecans pose a challenging problem for the patient and orthopedic surgeon.  Although clinical results of simple excision and debridement of unsalvageable lesions pro- vide good symptomatic relief in the short-term, those good early results deteriorate over time.  Autologous cartilage implantation and fresh osteochondral allografts have demonstrated good clinical results in long-term studies for the salvage of large cartilage defects.  There are also promising new technologies on the horizon that may reduce the need for multiple procedures while providing an equivalent clinical result. Clin Sports Med 33 (2014) 321–333 http://dx.doi.org/10.1016/j.csm.2014.01.004 sportsmed.theclinics.com 0278-5919/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.