Osteochondritis Dessicans

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Osteochondritis Dessicans

  1. 1.  17 yo otherwise healthy male soccer player c/o nagging pain to Left knee for several months, with occasional swelling. He denies acute injury, stating pain is usually worse when exercising. Has begun to walk with limp in order to reduce pain. Denies fever, rashes, dysuria and sexual activity.  AFVSS  Gen: WDWN, A&Ox4  Neuro: CNs 2-12 intact, Nml 5/5 motor strength and sensation x 4. Nml reflexes.  MSK: Pain and crepitation on forcible compression to medial femoral epicondyle during knee extension and flexion. No effusion, warmth, or erythema to knee. Walks with LLE slightly externally rotated.
  2. 2. Thin rim of calcium separated from underlying bone. MRI showing subchondral defect in medial femoral condyle
  3. 3.  Initial X-rays may have occult fx, often missed unless advanced changes are present  Tx is different in adults vs children:  Adults: usually require surgery to prevent premature degenerative arthritis  Children: long-leg splint/Ortho referral, minimumweight bearing immobilization for minimum of 6 weeks  If loose body fragment is present in joint space, arthroscopic surgery recommended for all patients.  NSAIDS for analgesia
  4. 4.  Separation of joint surface cartilage/subchondral bone from the underlying bone  MC in the lateral aspect of medial femoral condyle (also in elbow and ankle)  Unilateral (74% of cases)  Twice as common in Males  Classically occurs below age of 18  Rare conditions of unclear etiology – most likely from wear and tear, overloading on joint surface  Loose bodies may cause joint locking, pts may walk with leg externally rotated to avoid impingement of lesion on the femoral condyle  Prognoses:  Better if: immature growth plate or bony fragment not detached – Usually heals with non-operative tx  Worse if: growth plate closed or detached bony fragment (leaves defect in weight bearing region) – Arthroscopic tx with possible ORIF
  5. 5. Loose bony fragment, medial femoral epicondyle Demonstrating defect of articular carilage and subchondral bone
  6. 6.  Gaillard F, Weerakkidy Y, et al. Osteochondritis dissecans, Radiology Reference Article: http://radiopaedia.org/articles/osteochondritis_dissecans  Simon RR, Sherman SC: Emergency Orthopedics, 6th ed. Chapter 9: Cervical Spine Trauma. www.accessemergencymedicine.com  Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th ed. Chapter 255: Spine and Spinal Cord Trauma  http://www.wheelessonline.com/ortho/osteochondritis_di ssecans_of_the_knee

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