Osteochondritis dissecans is a disorder in which a fragment of cartilage and subchondral bone separates from an articular surface. The etiology is uncertain, although trauma and ischemia have been implicated. The knee is most commonly affected, but the elbow and ankle may also be involved. Patients typically present during their adolescent or early adult years with nonspecific knee pain and swelling that worsens with activity. The diagnosis is confirmed by radiographic findings. Management decisions are based on the patient's age and the stability, location, and size of the lesion.
Osteochondritis dissecans (OCD) should be considered in young, active patients who have generalized or anterior knee pain. A careful physical exam includes a Wilson test, thigh girth measurements, diagnostic tunnel view radiographs, and other imaging studies as needed for grading and prognosis. Two case reports demonstrate the signs and symptoms of OCD. Treatment by primary care physicians with sports medicine training may be conservative if lesions are medial and in situ and if patients are not skeletally mature; otherwise, referral is advised. Prompt surgical treatment is generally successful.
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