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.
Physical Examination
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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Anteroposterior and lateral radiographs of medial femoral condyle osteochondritis dissecans.
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Anteroposterior MRI of medial femoral condyle osteochondritis dissecans.
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Lateral MRI of osteochondritis dissecans.
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Herbert screw stabilization of medial femoral condyle osteochondritis dissecans.
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Anteroposterior radiograph of medial femoral condyle osteochondritis dissecans.
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Lateral radiograph of osteochondritis dissecans.
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Arthroscopic view of medial femoral condyle osteochondritis dissecans, hinged medially. Note the large size and thickness of the fragment.
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Anteroposterior MRI of medial femoral condyle osteochondritis dissecans, hinged medially.
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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.
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Arthroscopic debridement of the osteochondritis dissecans bed to bleeding bone.
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Replacement of the fragment and temporary Kirschner wire stabilization.
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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.
