Knee Osteochondritis Dissecans Clinical Presentation

  • Author: Brian A Jacobs, MD, FACSM; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Apr 7, 2011
 

History

  • Symptoms are usually vague and poorly localized.
  • A vague ache within the knee, with possible clicking or popping, may be reported.
  • Varying degrees of pain, swelling, and stiffness are reported.
  • Symptoms may be associated with activities (eg, sports, activities of daily living).
  • With complete fragment separation, locking symptoms may occur.
  • Prolonged symptoms lead to progressive degenerative arthritis.
  • Giving way of the knee may occur secondary to quadriceps weakness.
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Physical

  • Effusion may be present.
  • Quadriceps atrophy and weakness may be evident.
  • Occasionally, a loose body may be palpable.
  • The patient may lack full knee extension compared with the contralateral knee.
  • Tenderness is noted over the lesion.
  • Evaluate gait for external rotation of the tibia.
  • Perform the Wilson test to check for OCD. The examiner flexes the knee to 90° while internally rotating the tibia. A positive Wilson sign occurs when pain is elicited at 30° of flexion and is relieved with external rotation.
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Causes

The 2 distinctive subsets of patients are skeletally immature patients and skeletally mature patients.

Little agreement exists among researchers regarding the etiology of OCD. Possible etiologies include the following:

  • Trauma
  • Skeletal maturation (accessory centers of ossification)
  • Vascular causes/ischemia
  • Genetic conditions (eg, multiple epiphyseal dysplasia)
  • Metabolic factors
  • Hereditary factors
  • Anatomic variation
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Brian A Jacobs, MD, FACSM  Consulting Staff, Private Practice, Family Medicine of South Bend; Team Physician, Marian High School

Brian A Jacobs, MD, FACSM is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Janos P Ertl, MD  Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Gyorgy Kovacs, MD  Consulting Surgeon, Department of Orthopedic Surgery, GOC Clinic

Disclosure: Nothing to disclose.

Julie A Jacobs, PA-C  Department of Emergency Medicine, EPMG at Lakeland Hospital, Saint Joseph and Niles, Michigan

Julie A Jacobs, PA-C is a member of the following medical societies: American Academy of Physician Assistants

Disclosure: Nothing to disclose.

Specialty Editor Board

Leslie Milne, MD  Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Russell D White, MD  Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References

  1. Tabaddor RR, Banffy MB, Andersen JS, McFeely E, Ogunwole O, Micheli LJ, et al. Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop. Jan-Feb 2010;30(1):14-20. [Medline].

  2. Pascual-Garrido C, Friel NA, Kirk SS, McNickle AG, Bach BR Jr, Bush-Joseph CA, et al. Midterm results of surgical treatment for adult osteochondritis dissecans of the knee. Am J Sports Med. Nov 2009;37 Suppl 1:125S-30S. [Medline].

  3. Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M. Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. Arthroscopy. Feb 2009;25(2):145-52. [Medline].

  4. Kijowski R, Blankenbaker DG, Shinki K, Fine JP, Graf BK, De Smet AA. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology. Aug 2008;248(2):571-8. [Medline].

  5. Heywood CS, Benke MT, Brindle K, Fine KM. Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans. Arthroscopy. Feb 2011;27(2):194-9. [Medline].

  6. Camathias C, Festring JD, Gaston MS. Bioabsorbable lag screw fixation of knee osteochondritis dissecans in the skeletally immature. J Pediatr Orthop B. Mar 2011;20(2):74-80. [Medline].

  7. Andrews JR, Timmerman LA. Diagnostic and Operative Arthroscopy. Philadelphia, Pa: Harcourt Brace & Company; 1997.

  8. Beaty J. Orthopaedic Knowledge Update 6. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999:506-507.

  9. Browner BD. Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, Pa: WB Saunders Co; 1998.

  10. Delee JC. Orthopaedic Sports Medicine, Principles and Practice. Vol 2. Philadelphia, Pa: WB Saunders Co; 1994.

  11. Siliski JM. Traumatic Disorders of the Knee. New York, NY: Springer-Verlag; 1994.

 
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Anteroposterior and lateral radiographs of medial femoral condyle osteochondritis dissecans.
Anteroposterior MRI of medial femoral condyle osteochondritis dissecans.
Lateral MRI of osteochondritis dissecans.
Herbert screw stabilization of medial femoral condyle osteochondritis dissecans.
Anteroposterior radiograph of medial femoral condyle osteochondritis dissecans.
Lateral radiograph of osteochondritis dissecans.
Arthroscopic view of medial femoral condyle osteochondritis dissecans, hinged medially. Note the large size and thickness of the fragment.
Anteroposterior MRI of medial femoral condyle osteochondritis dissecans, hinged medially.
Arthroscopic view of osteochondritis dissecans of the medial femoral condyle. The osteochondral fragment has been elevated from the crater. Note the sclerotic crater with an interposed fibrocartilaginous layer. This lesion has been previously treated with drilling; an old drill hole can be seen faintly at the upper aspect of the crater.
Arthroscopic debridement of the osteochondritis dissecans bed to bleeding bone.
Replacement of the fragment and temporary Kirschner wire stabilization.
Completed osteochondritis dissecans stabilization with 2 Herbert screws. On initial examination, the most lateral defect was comminuted and removed; the larger weight-bearing surface was maintained and stabilized.
 
 
 
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