Osteochondritis Dessicans



Background

  • A presumed compression fracture of the articular cartilage
  • A fracture fragment may be attached or detached (loose body in joint) from cartilage
  • Injury may be cause a single compression fragment or recurrent micro fractures
    • Initial local inflammation with micro fracture
    • Subcortical thinning (x-ray epiphyseal sclerosis) and later
    • Remodeling with weaker bone (subchondral cysts), compression fracture with loss of cartilage volume

Location

Commonest locations include:

  • Knee - med femoral condyle (alt aspect), wt bearing areas both condyles and intercondylar groove.
    • Rarely patella or tibial plateau.
  • Elbow - capitellum (? xs valgus stress)
  • Ankle - talar dome
  • Foot - Navicular (DDx stress #)
  • Hip - femoral epiphysis (esp. if PMHx of Perthe's)
  • Wrist rare - scaphoid
Knee Osteochondritis Knee Osteochondritis labelled

Clinical

  • Young adults or teens report pain on wt bearing
  • Atraumatic joint pain, (ofetn with effusion) ± locking
  • Pain on limit of ROM
  • Traumatic effusion and occasional instability
  • OA can develop
  • Loose body symptoms generally late

Beware

  • Frequently missed
  • May require bone scan or CT to confium
  • If in doubt, non-weight-bearing (NWB) & ortho OPD referral

Content by Dr Íomhar O' Sullivan 15/11/2007. Last reviewed ÍOS 28/05/21.