The management of osteochondritis dissecans depends on the age and skeletal maturity of the patient, the location of the lesion, and the stage of the lesion Conservative therapy consisting of restricted activity and relief of stress on the involved joint is the first line of treatment in children who have not reached skeletal maturity and for those diagnosed at an early stage of the disease Early diagnosis and rest provides the best chance for recovery Lesions recognized in the early stages are more likely to heal with nonoperative management Full immobilization in a cast remains controversial A hasty return to sports may increase the risk of arthritis or further joint disease Patients should be followed closely by an orthopedic surgeon both for resolution of clinical symptoms and evidence of healing on serial radiographs or MRIs Most stable lesions occurring in patients prior to physeal closure go on to heal; however, a few will progress to separation Lesions occurring in adults generally not heal without surgery Surgical intervention is generally recommended if lesions fail to improve clinically or radiographically after months of rest The presence of an unstable or free-floating fragment is also considered an indication for surgery Most corrective surgical procedures can now be performed arthroscopically Fine transarticular or retroarticular drilling through the subchondral fragment into healthy bone appears to stimulate revascularization and promote healing in stable lesions Fragments are replaced whenever possible Loose fragments and larger free bodies may be reduced and fixed in place with the use of screws, bioabsorbable implants, or osteochondral plugs removed from nonarticulating surfaces in the knee When free bodies must be removed from the joint space, the resulting defects may be repaired with the use of a bone graft or through stimulation of fibrocartilage or scar tissue formation to restore congruity to the articular surface