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Knee Osteochondritis Dissecans
Aka: Knee Osteochondritis Dissecans, Knee OCD, Osteochondritis Dissecans of the Knee
- Epidemiology
- Knee is most common site for Osteochondritis Dissecans
- Incidence: 30 to 60 per 100,000
- Bilateral knee involvement in 30 to 40%
- Males affected 3 times more often than females
- Peak Incidence
- Children under age 12 years
- Young adults
- Often missed at time of injury when it occurs
- Found later on Knee XRay
- Pathophysiology
- Avascular subchondral bone necrosis
- Articular fragments may also separate
- Types: Sites involved
- Medial femoral condyle (80 to 85%)
- Lateral aspect most often affected
- Lateral femoral condyle (10 to 15%)
- Patella (5%)
- Symptoms
- Poorly localized aching Knee Pain and swelling
- Knee locking, catching or giving-way sensation
- Occurs if loose body present
- Morning stiffness
- Knee Effusion may be recurrent
- Knee Pain provocative factors
- Strenuous activity
- Twisting knee motion (tibia internal rotation)
- Signs
- Full knee range of motion
- Quadriceps atrophy on affected side
- Decreased thigh circumference
- Tenderness at affected femoral condyle with knee flexed
- Wilson Test
- Imaging
- Knee XRay (AP, Lateral, PA Tunnel and Merchant View)
- Subchondral bone defect at sites above
- Loose body may be present
- Bone scan
- Knee MRI
- Management: Conservative (esp. if Growth Plates open)
- Relative rest initially for 1-2 weeks
- Knee Immobilization
- Minimal weight bearing
- Modify activity level for 6 to 12 weeks
- Avoid rapid or strenuous activity (High Impact)
- Running
- Cutting
- Jumping
- Consider low impact alternative Exercises
- Bicycling
- Swimming
- No modification to upper body Exercise and ADLs
- Criteria for return to full activity
- No subjective pain
- Normal physical exam
- XRay shows signs of heeling
- Isometric quadriceps Exercises
- Anticipate healing over time
- Surgical arthrotomy or arthroscopic surgery
- Indicated if Fracture fragments > 1 cm diameter
- Lateral femoral condyle
- References
- Ralston (1996) Phys Sportsmed, 24(6):73-80 [PubMed]