Knee Osteochondritis Dissecans Workup

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

Imaging Studies

Images of osteochondritis dissecans of the knee are depicted below:

Anteroposterior and lateral radiographs of medial Anteroposterior and lateral radiographs of medial femoral condyle osteochondritis dissecans. Anteroposterior MRI of medial femoral condyle osteAnteroposterior MRI of medial femoral condyle osteochondritis dissecans. Lateral MRI of osteochondritis dissecans. Lateral MRI of osteochondritis dissecans. Anteroposterior radiograph of medial femoral condyAnteroposterior radiograph of medial femoral condyle osteochondritis dissecans. Lateral radiograph of osteochondritis dissecans. Lateral radiograph of osteochondritis dissecans.

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. However, to determine lesion instability in young patients, MRI should not be used in isolation; it should be used in conjunction with clinical symptoms (eg, locking, catching, and swelling) and physical examination to determine if the lesion is unstable and may require surgical fixation.[5] In this setting, MRI can be 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.

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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.

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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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