Osteochondritis Dissecans

Key Features

• A wedge-shaped necrotic area of bone and cartilage develops adjacent to the articular surface

• Most common sites

  • Knee (medial femoral condyle)

  • Elbow joint (capitellum)

  • Talus (superior lateral dome)

Clinical Findings

• Joint pain is the usual presenting complaint

• Local swelling or locking may be present, particularly if a fragment is free in the joint

Diagnosis

• Laboratory studies are normal

Treatment

• Treatment consists of protection of the involved area from mechanical damage

• Stable/attached lesions are generally treated with activity modification and immobilization for 3–6 months

• Unstable/dislodged lesions are treated surgically with arthroscopic drilling, in order to bring new blood flow to the area, and fixation to stabilize the lesion

• For some marginal lesions, it may be worthwhile to drill the necrotic fragment to encourage more rapid vascular in-growth and replacement

• If a fragment is free within the joint as a loose body, it must be removed