Osteochondritis Dissicans

What is it? Disorder of an ossification site Affects the: Can affect one or more joints Affects the: Subchondral layer Articular cartilage Bone fragment and articular cartilage separate from underlying bone Fragments create loose bodies in the joint

Classification Based on bone maturity Juvenile lesions Open distal femoral physes Adolescents Closing distal femoral physes Adults Fully closed distal femoral physes Also based on radiographic imaging Size and location of the lesion Stability and loose fragments

Etiology Genetics-hereditary Vascular Trauma (40%) Tibia vara Legg-Calve-Perthes disease Stickler’s syndrome Epiphyseal dysplasia Vascular Trauma (40%) Repetitive/persistent microtrauma

Commonly affected areas Medial femoral condyle Lateral portion Inferiocentral Lateral femoral condyle Anterior Occurs bilaterally in many cases

Population at risk 10-15 years old Males > females

Symptoms Pain with activity Swelling Giving way Wilson’s sign Pain increased with passive knee extension and internal tibial rotation Pain decreases with tibial external rotation

Diagnosis Confirmed by radiographic images

Management Depends on the extent of the damage and age Non-operative management Activity modification Protected weight bearing Immobilization 4-6 weeks followed by Quadriceps strengthening Gradual return to activity Surgical If loose bodies are present or unsuccessful conservative treatment

References Goodman, Catherine C., Fuller, Kenda. 2009. Pathology: Implications for the Physical Therapist, 3rd ed. Saunders/Elsevier. St. Louis, Mo. DeLee, Jesse C., Drez, David Jr. 2003. DeLee & Drez’s Orthopaedic Sports Medicine: Principles and Practice, 3rd ed. Saunders. Philadelphia, PA.