TABLE IV.

Grades of Recommendation for OCD^*

Recommendation	Grade†
OCD occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle and may lead to premature osteoarthritis.	A
While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition.	B
Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel MRI protocols potentially enabling early detection and staging.	A
Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have failed conservative management or have unstable lesions.	B
Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value.	A
There is currently no association between gadolinium deposition in the brain and poorer health outcomes in children; however, gadolinium-based contrast agents should be used judiciously and avoided when possible.	I

^*OCD = osteochondritis dissecans, and MRI = magnetic resonance imaging.

^†According to Wright²⁶⁴, grade A indicates good evidence (Level-I studies with consistent findings) for or against recommending intervention; grade B, fair evidence (Level-II or III studies with consistent findings) for or against recommending intervention; grade C, poor-quality evidence (Level-IV or V studies with consistent findings) for or against recommending intervention; and grade I, insufficient or conflicting evidence not allowing a recommendation for or against intervention.