Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- a dor é exacerbada pela atividade
- local da dor na região anteromedial do joelho com o joelho fletido a 90°
- local da dor na região lateral do cotovelo
- local da dor na região posteromedial do tornozelo dorsifletido ou região anterolateral do tornozelo em flexão plantar
- presença de derrame
- bloqueio da articulação
- travamento da articulação
- amplitude de movimentos reduzida
Other diagnostic factors
- comprometimento do joelho, idade de 10 a 20 anos
- comprometimento do cotovelo, idade entre 11 a 21 anos
- comprometimento do tálus, da segunda à quarta década
- ausência de história de trauma envolvendo o joelho ou cotovelo
- marcha antálgica na osteocondrite dissecante comprometendo o joelho ou tálus
- marcha de rotação externa na osteocondrite dissecante comprometendo o joelho
- fatores de alívio: anti-inflamatórios não esteroidais (AINEs), repouso, gelo, elevação
- crepitação
- teste de Wilson
- atrofia do quadríceps
Risk factors
- estresse valgo/arremesso repetitivo
- ginástica/levantamento de peso nos membros superiores
- entorse/instabilidade do tornozelo
- atividades atléticas competitivas
- história familiar
Diagnostic investigations
1st investigations to order
- radiografias do joelho
- radiografias do tornozelo
- radiografia panorâmica do membro inferior
- radiografias do cotovelo
Investigations to consider
- tomografia computadorizada (TC)
- RNM
- Artrorressonância
- artroscopia diagnóstica
Treatment algorithm
joelho
cotovelo
tornozelo (tálus)
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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. Abstract
American Academy of Orthopaedic Surgeons. Diagnosis and treatment of osteochondritis dissecans. Dec 2023 [internet publication].Full text
Perumal V, Wall E, Babekir N. Juvenile osteochondritis dissecans of the talus. J Pediatr Orthop. 2007 Oct-Nov;27(7):821-5. Abstract
Baker CL 3rd, Baker CL Jr, Romeo AA. Osteochondritis dissecans of the capitellum. Am J Sports Med. 2010 Sep;38(9):1917-28. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Fratura osteocondral
- Ruptura do menisco
- Artrite séptica
More DifferentialsGuidelines
- Osteochondritis dissecans: diagnosis and treatment
More Guidelines
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