Knee Osteochondritis Dissecans Clinical Presentation

Updated: Apr 28, 2017
  • Author: Brian A Jacobs, MD, FACSM; Chief Editor: Craig C Young, MD  more...
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Presentation

History

See the list below:

  • 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

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  • 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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