eMedicine Specialties > Sports Medicine > Knee

Knee Osteochondritis Dissecans: Differential Diagnoses & Workup

Author: Brian Jacobs, MD, FACSM, Clinical Assistant Professor, Indiana University School of Medicine; Consulting Staff, Private Practice, Family Medicine of South Bend
Coauthor(s): Janos P Ertl, MD, Clinical Assistant Professor, Department of Orthopedic Surgery, Chief of Orthopedic Trauma, University of California at Davis; Director of Amputee Clinic, Kaiser Hospital; Gyorgy Kovacs, MD, Department of Orthopedic Surgery, Consulting Surgeon, GOC Clinic; Julie A Jacobs, PA-C, Department of Emergency Medicine, EPMG at Lakeland Hospital, Saint Joseph and Niles, Michigan
Contributor Information and Disclosures

Updated: Jul 28, 2006

Differential Diagnoses

Meniscus Injuries

Other Problems to Be Considered

Chondral fracture
Osteophytes
Synovial chondromatosis

Workup

Imaging Studies

  • Plain radiography (anteroposterior, lateral, and tunnel views) shows OCD lesions as well-circumscribed crescent-shaped areas of radiolucency above an area of subchondral bone, separated from the femoral condyle. In 75% of cases, the lesion is located on the posterolateral aspect of the MFC.
  • Arthrography, which is not used routinely, may be helpful but is invasive; MRI can obtain similar data.
  • Bone scanning may be helpful with a high index of suspicion or in patients with occult bilateral involvement; however, it cannot determine the age of the lesion.
  • With gadolinium enhancement, MRI is helpful for determining the vascularity of the lesion, for determining whether involvement is bilateral, and for determining if smaller lesions are present. MRI also helps determine the degree of loosening of the lesion. MRI is helpful in determining appropriate treatment and tracking the extent of healing.
  • CT scanning may helpful in determining the appropriate treatment and is used when MRI is unavailable or contraindicated.

Procedures

  • Knee arthroscopy can be used as a diagnostic tool and a therapeutic tool. Results of arthroscopic evaluation allow determination of the size and stability of the lesion and allow tracking the lesion for evidence of healing. In addition, arthroscopic treatment of OCD, by whatever means, is possible and avoids formal knee arthrotomy.

More on Knee Osteochondritis Dissecans

Overview: Knee Osteochondritis Dissecans
Differential Diagnoses & Workup: Knee Osteochondritis Dissecans
Treatment & Medication: Knee Osteochondritis Dissecans
Follow-up: Knee Osteochondritis Dissecans
Multimedia: Knee Osteochondritis Dissecans
References
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References

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

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

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

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

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

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Further Reading

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Keywords

intra-articular osteochondrosis, OCD, osteochondral fracture, articular osteochondrosis, intra-articular segmental osteonecrosis, ossification disorder, knee injury, loose body formation, knee loose body, disordered enchondral ossification, subchondral avascular necrosis

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Contributor Information and Disclosures

Author

Brian Jacobs, MD, FACSM, Clinical Assistant Professor, Indiana University School of Medicine; Consulting Staff, Private Practice, Family Medicine of South Bend
Brian 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, Clinical Assistant Professor, Department of Orthopedic Surgery, Chief of Orthopedic Trauma, University of California at Davis; Director of Amputee Clinic, Kaiser Hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Hungarian Medical Association of America, Orthopaedic Trauma Association, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

Gyorgy Kovacs, MD, Department of Orthopedic Surgery, Consulting Surgeon, 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.

Medical Editor

Leslie Milne, MD, Department of Emergency Medicine, Assistant Clinical Instructor, 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon Whitehurst, MD, Consulting Staff, Rockford Orthopedic Associates
Disclosure: Nothing to disclose.

Chief Editor

Wylie D Lowery, Jr, MD, Department of Orthopedic Surgery, Associate Professor, George Washington University
Wylie D Lowery, Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Medical Society of Virginia, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
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