History and exam

Key diagnostic factors

common

presence of risk factors

Key factors include repetitive loading activities, weight-bearing exercise of the upper extremity (e.g., gymnastics, tumbling), throwing, ankle trauma, and competitive athletics.

pain is exacerbated by activity

Pain may be exacerbated with increased activity and use of the involved joint.[5][23]

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 examination.

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

If patient is 11 to 23 years old, osteochondritis dissecans should be considered.[7]If 7 to 12 years old, Panner's disease should be considered.[23]

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: non-steroidal 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's 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's 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 aetiology 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 aetiology 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 sport. Year-round training and early specialisation in athletics probably further contribute to the rising number of patients seen.[3]

weak

family history

Epiphyseal dysplasia has been postulated as a subgroup of osteochondritis dissecans and therefore would have a genetic predisposition.[9] However, data have failed to show any pattern of familial inheritance.[11]

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