1. Osteochondritis Dissicans

2. What is it? Disorder of an ossification site Affects the:
Can affect one or more joints
Affects the:
Subchondral layer
Articular cartilage
Bone fragment and articular cartilage separate from underlying bone
Fragments create loose bodies in the joint

3. Classification Based on bone maturity
Juvenile lesions
Open distal femoral physes
Adolescents
Closing distal femoral physes
Adults
Fully closed distal femoral physes
Also based on radiographic imaging
Size and location of the lesion
Stability and loose fragments

4. Etiology Genetics-hereditary Vascular Trauma (40%) Tibia vara
Legg-Calve-Perthes disease
Stickler’s syndrome
Epiphyseal dysplasia
Vascular
Trauma (40%)
Repetitive/persistent microtrauma

5. Commonly affected areas
Medial femoral condyle
Lateral portion
Inferiocentral
Lateral femoral condyle
Anterior
Occurs bilaterally in many cases

6. Population at risk
10-15 years old
Males > females

7. Symptoms Pain with activity Swelling Giving way Wilson’s sign
Pain increased with passive knee extension and internal tibial rotation
Pain decreases with tibial external rotation

8. Diagnosis
Confirmed by radiographic images

9. Management Depends on the extent of the damage and age
Non-operative management
Activity modification
Protected weight bearing
Immobilization 4-6 weeks followed by
Quadriceps strengthening
Gradual return to activity
Surgical
If loose bodies are present or unsuccessful conservative treatment

10. References
Goodman, Catherine C., Fuller, Kenda Pathology: Implications for the Physical Therapist, 3rd ed. Saunders/Elsevier. St. Louis, Mo.
DeLee, Jesse C., Drez, David Jr DeLee & Drez’s Orthopaedic Sports Medicine: Principles and Practice, 3rd ed. Saunders. Philadelphia, PA.