Osteochondritis dissecans

Last reviewed: 22 Aug 2023
Last updated: 31 Mar 2022



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
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: nonsteroidal anti-inflammatory drugs (NSAIDS), rest, ice, elevation
  • crepitus
  • Wilson 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 radiographs
  • ankle radiographs
  • full-length lower extremity film
  • elbow radiographs
More 1st investigations to order

Investigations to consider

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

Treatment algorithm




ankle (talus)



Henry G. Chambers, MD

Professor of Clinical Orthopedic Surgery

University of California, San Diego

Rady Children’s Hospital

San Diego



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


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.


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




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




NM declares that he has no competing interests.

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