Osteochondritis dissecans

Last reviewed: 4 Sep 2022
Last updated: 31 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pain is exacerbated by activity
  • location of pain anteromedial aspect of the knee with the knee flexed to 90º
  • location of pain lateral aspect of elbow
  • location of pain posteromedial aspect of dorsiflexed ankle or anterolateral aspect of plantar-flexed ankle
  • effusion present
  • locking of joint
  • catching of joint
  • decreased range of motion
More key diagnostic factors

Other diagnostic factors

  • knee involvement, age 10 to 20 years
  • elbow involvement, age 11 to 21 years
  • talus involvement, second to fourth decade
  • absence of history of trauma involving the knee or elbow
  • antalgic gait in osteochondritis dissecans involving the knee or talus
  • external rotation gait in osteochondritis dissecans involving the knee
  • relieving factors: non-steroidal anti-inflammatory drugs (NSAIDS), rest, ice, elevation
  • crepitus
  • Wilson's test
  • quadriceps atrophy
Other diagnostic factors

Risk factors

  • repetitive throwing/valgus stress
  • gymnastics/weight-bearing on upper extremity
  • ankle sprain/instability
  • competitive athletics
  • family history
More risk factors

Diagnostic investigations

1st investigations to order

  • knee x-rays
  • ankle x-rays
  • full-length lower extremity film
  • elbow x-rays
More 1st investigations to order

Investigations to consider

  • CT
  • MRI
  • MR arthrogram
  • diagnostic arthroscopy
More investigations to consider

Treatment algorithm

ACUTE

knee

elbow

ankle (talus)

Contributors

Authors

Henry G. Chambers, MD

Professor of Clinical Orthopedic Surgery

University of California, San Diego

Rady Children’s Hospital

San Diego

CA

Disclosures

HGC is an author of a number of references cited in this topic.

Acknowledgements

Dr Henry G. Chambers would like to gratefully acknowledge Dr James L. Carey, Dr Jon Divine, Dr Michael Nett, and Dr Cedric Ortiguera, the previous contributors to this topic.

Disclosures

JLC is an author of a number of references cited in this topic. JD, MN, and CO declared that they had no competing interests.

Peer reviewers

James E. McGrory, MD

Orthopedic Surgeon

The Hughston Clinic PC

Columbus

GA

Disclosures

JEM declares that he has no competing interests.

Nicola Maffulli, MD, MS, PhD, FRCS(Orth)

Centre Lead and Professor of Sports and Exercise Medicine

Consultant Trauma and Orthopaedic Surgeon

Barts and The London School of Medicine and Dentistry

Institute for Health Sciences Education

Centre for Sports and Exercise Medicine

Queen Mary University of London

Mile End Hospital

London

UK

Disclosures

NM declares that he has no competing interests.

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