History and exam
Key diagnostic factors
common
history of ankle trauma
The majority of osteochondritis dissecans lesions of the talus are related to trauma. In a meta-analysis of the literature, 96% of lateral lesions and 62% of medial lesions were associated with direct trauma. Osteochondral injuries occur in an estimated 6.5% of all ankle sprains.[6]
history of repetitive throwing or weight-bearing exercise of the upper extremity
Repetitive valgus compressive stress on the vulnerable chondroepiphysis of the radiocapitellar joint in the skeletally immature patient appears to be the etiology behind osteochondritis dissecans involving the capitellum.[23]
Weight-bearing on the upper extremity, such as gymnastics, puts excessive valgus compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in the skeletally immature patient. This is supported in the literature as the etiology of osteochondritis dissecans of the capitellum.[23]
history of competitive athletics
The incidence of osteochondritis dissecans has been increasing over recent years, and the average age of onset decreases as more and more children are involved in competitive sports. Year-round training and early specialization in athletics likely further contribute to the rising number of patients seen.[3]
pain is exacerbated by activity
location of pain anteromedial aspect of the knee with the knee flexed to 90º
Anteromedial aspect of the knee with the knee flexed to 90º corresponds to a classic osteochondritis dissecans lesion involving the lateral aspect of the medial femoral condyle.[5]
location of pain lateral aspect of elbow
Lateral aspect of elbow with osteochondritis dissecans involving the radiocapitellar joint.[23]
location of pain posteromedial aspect of dorsiflexed ankle or anterolateral aspect of plantar-flexed ankle
In osteochondritis dissecans involving the ankle, pain is found at the posteromedial aspect of dorsiflexed ankle or anterolateral aspect of plantar-flexed ankle.[6]
effusion present
This demonstrates intra-articular pathology. Effusion is not specific for osteochondritis dissecans, but can confirm the presence of intra-articular pathology on physical exam.
uncommon
locking of joint
This is a mechanical symptom and may correlate with an intra-articular loose body.
catching of joint
This is a mechanical symptom and may correlate with an intra-articular loose body.
decreased range of motion
Can be present in all involved joints. It may be related to a large effusion or mechanical block from an intra-articular loose body. Loss of extension is commonly seen with osteochondritis dissecans of the capitellum.[23]
Other diagnostic factors
common
knee involvement, age 10 to 20 years
Common age of onset is 10 to 20 years old.[3]
elbow involvement, age 11 to 21 years
talus involvement, second to fourth decade
Common age of onset is second to fourth decade, with the average age being 27 years.[6]
absence of history of trauma involving the knee or elbow
The majority of osteochondritis dissecans lesions involving the knee and elbow do not involve a known traumatic injury and are more insidious in onset.
This is in contrast to lesions involving the talus, which are commonly associated with injury.
antalgic gait in osteochondritis dissecans involving the knee or talus
The patient may ambulate with an antalgic gait protecting the involved extremity in osteochondritis involving the knee or talus.
external rotation gait in osteochondritis dissecans involving the knee
The patient may ambulate with an external rotation gait, attempting to unload the lateral aspect of the medial femoral condyle from the medial tibial spine.
uncommon
relieving factors: nonsteroidal anti-inflammatory drugs (NSAIDS), rest, ice, elevation
NSAIDs, inactivity, rest, ice, and elevation may provide relief in the involved joint.
crepitus
May present with a large osteochondritis dissecans lesion and either incongruity of the joint surface or exposed subchondral bone.
Wilson test
Pain with tibial internal rotation and extension of the knee from flexion of 90º to 30º may be elicited from impaction of the medial tibial eminence on the lateral aspect of the medial femoral condyle. The predictive value of the Wilson test is known to be poor.[23]
quadriceps atrophy
May be seen in chronic osteochondritis dissecans involving the knee.
Risk factors
strong
repetitive throwing/valgus stress
Repetitive valgus compressive stress on the vulnerable chondroepiphysis of the radiocapitellar joint in the skeletally immature patient appears to be the etiology behind osteochondritis dissecans involving the capitellum.[23]
gymnastics/weight-bearing on upper extremity
Weight-bearing on the upper extremity puts excessive valgus compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in the skeletally immature patient. This is supported in the literature as the etiology of osteochondritis dissecans of the capitellum.[23]
ankle sprain/instability
The majority of osteochondritis dissecans lesions of the talus are related to trauma. In a meta-analysis of the literature, 96% of lateral lesions and 62% of the medial lesions were associated with direct trauma. Osteochondral injuries occur in an estimated 6.5% of all ankle sprains.[6]
competitive athletics
The incidence of osteochondritis dissecans has been increasing over recent years, and the average age of onset decreases, as more and more children are involved in competitive sports. Year-round training and early specialization in athletics likely further contribute to the rising number of patients seen.[3]
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