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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


  • Laboratory studies are normal


  • 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

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