Summary
Definition
Anamnesis y examen
Principales factores de diagnóstico
- 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
Otros factores de diagnóstico
- 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
- crepitus
- Wilson test
- quadriceps atrophy
Factores de riesgo
- repetitive throwing/valgus stress
- gymnastics/weight-bearing on upper extremity
- ankle sprain/instability
- competitive athletics
- family history
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- knee radiographs
- ankle radiographs
- full-length lower extremity film
- elbow radiographs
Pruebas diagnósticas que deben considerarse
- CT
- MRI
- MR arthrogram
- diagnostic arthroscopy
Algoritmo de tratamiento
knee
elbow
ankle (talus)
Colaboradores
Autores
Henry G. Chambers, MD
Professor of Clinical Orthopedic Surgery
University of California, San Diego
Rady Children’s Hospital
San Diego
CA
Divulgaciones
HGC is an author of a number of references cited in this topic.
Agradecimientos
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.
Divulgaciones
JLC is an author of a number of references cited in this topic. JD, MN, and CO declared that they had no competing interests.
Revisores por pares
James E. McGrory, MD
Orthopedic Surgeon
The Hughston Clinic PC
Columbus
GA
Divulgaciones
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
Divulgaciones
NM declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Kocher MS, Tucker R, Ganley TJ, et al. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med. 2006 Jul;34(7):1181-91. Resumen
American Academy of Orthopaedic Surgeons. Diagnosis and treatment of osteochondritis dissecans. Dec 2023 [internet publication].Texto completo
Perumal V, Wall E, Babekir N. Juvenile osteochondritis dissecans of the talus. J Pediatr Orthop. 2007 Oct-Nov;27(7):821-5. Resumen
Baker CL 3rd, Baker CL Jr, Romeo AA. Osteochondritis dissecans of the capitellum. Am J Sports Med. 2010 Sep;38(9):1917-28. Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Osteochondral fracture
- Meniscal tear
- Septic arthritis
Más DiferencialesGuías de práctica clínica
- Osteochondritis dissecans: diagnosis and treatment
Más Guías de práctica clínica
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad