Osteochondritis dissecans

Majority of patients are adolescent or young adult athletes.

Main joints involved include the knee, ankle, and radiocapitellar joint of the elbow.

Bilateral in up to 25%.

Variable presentation: traumatic or atraumatic, insidious onset, non-specific joint pain, exacerbation of symptoms with exercise (especially stair- or hill-climbing), recurrent effusion, catching or locking.

Radiographs: minimum of 2 views of the involved joint (more specified for knee and ankle) performed for diagnosis.

While the aetiology remains unclear, early recognition is essential as many treatment options exist.

Osteochondritis dissecans is an acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilage involvement and instability. [1] Clanton TO, DeLee JC. Osteochondritis dissecans: history, pathophysiology and current treatment concepts. Clin Orthop Relat Res. 1982;167:50-64. http://www.ncbi.nlm.nih.gov/pubmed/6807595?tool=bestpractice.com [2] Cahill BR. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg. 1995;3:237-247. http://www.ncbi.nlm.nih.gov/pubmed/10795030?tool=bestpractice.com [3] Kocher MS, Tucker R, Ganley TJ, et al. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med. 2006;34:1181-1191. http://www.ncbi.nlm.nih.gov/pubmed/16794036?tool=bestpractice.com It is increasingly seen as the cause of joint pain in adolescent and young adult athletes, thought to be due to earlier and higher-demand participation in competitive sport. However, no clear evidence is available to support this belief, and despite much speculation the cause of both juvenile and adult osteochondritis dissecans remains unclear. [4] Robertson W, Kelly BT, Green DW. Osteochondritis dissecans of the knee in children. Curr Opin Pediatr. 2003;15:38-44. http://www.ncbi.nlm.nih.gov/pubmed/12544270?tool=bestpractice.com