Osteochondritis dessicans is a condition that is increasingly seen as a cause of joint pain in young adults, thought to be due to earlier and higher-demand participation in competitive sport.
Definition: A localized injury and subsequent separation of articular cartilage and subchondral bone. Often found in capitellum, talus, and knee.
Etiology: Repetitive movements and weight-bearing causing vascular insufficiency and microtrauma. Commonly found in competitive athletes, e.g. capitellum involvement in gymnasts and throwing sports. History of trauma is more common with knee and talus (i.e. ankle sprains) involvement.
Presentation: Insidious, gradual onset of joint pain which is related to activity and poorly localized. The patient may have catching, locking, grinding, restricted range of motion in late stages as loose bodies develop. Tenderness, effusion, and decreased range of motion may be found on exam.
Patients with knee involvement may walk with an external rotation gait to unload the medial femoral condyle.
In osteochondritis dissecans involving the ankle, pain is found at the posteromedial aspect of dorsiflexed ankle or anterolateral aspect of plantar-flexed ankle.
Tenderness at the lateral aspect of the elbow, best palpated with the elbow in full flexion, indicates involvement the radiocapitellar joint.
Imaging: Initial XR may reveal bone defect, lucency or fragmentation. For the knee, obtain a tunnel (notch) view to best see the posterolateral aspect of the medial femoral condyle. MRI should be done if XR negative and high clinical suspicion.
Treatment: Referral to orthopedics to determine non-operative vs. operative treatment. Non-operative management is possible if caught early and may include activity modification, short-term immobilization, protected weight-bearing, and pain relief with NSAIDs or acetaminophen. If surgery is required, fixation or excision/debridement of any loose fragments is likely performed.
Prognosis: Could take 6-18 months to heal non-operatively. Long-term risk of arthritic changes. Younger age of onset correlates with better prognosis.
BMJ Best Practice
Ryan Shields, MD, MSc, CCFP
PGY-3 Sport and Exercise Medicine
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine