Osteochondritis dissecans is an idiopathic lesion of subchondral bone.
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, nonspecific joint pain, exacerbation of symptoms with exercise (especially stair- or hill-climbing), recurrent effusion, catching, or locking.
Radiographs: minimum of two views of the involved joint (more specified for knee and ankle) performed for diagnosis.
While the etiology 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. 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 sports. 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.
History and exam
Key diagnostic factors
- history of ankle trauma
- history of repetitive throwing or weight-bearing exercise of the upper extremity
- history of competitive athletics
- 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
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: nonsteroidal anti-inflammatory drugs (NSAIDS), rest, ice, elevation
- Wilson test
- quadriceps atrophy
- repetitive throwing/valgus stress
- gymnastics/weight-bearing on upper extremity
- ankle sprain/instability
- competitive athletics
- family history
1st investigations to order
- knee radiographs
- ankle radiographs
- full-length lower extremity film
- elbow radiographs
Investigations to consider
- MR arthrogram
- diagnostic arthroscopy
- Osteochondral fracture
- Meniscal tear
- Septic arthritis
- Osteochondritis dissecans: diagnosis and treatment
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