OSTEOCHONDRITIS DESSICANS

Osteochondritis Dessicans

Osteochondritis Dessicans is a common condition of unknown etiology occurring in children and adolescents. It is characterized by small segment of necrotic subchondral bone in joint. Lateral aspect of medial femoral condyle is most common site.
The condition is usually idiopathic. Trauma , low grade infection can be preceding factors.
Clinical features
1) Age: children and adolescent males
2) Location: most common in knee. Hip, ankle, elbow, and shoulder are infrequently involved.
3) Symptoms:
a) Pain intermittent, aching, poorly localized persistent at rest but more on activity.
b) Stiffness.
c) Locking of knee relieved by kicking.
d) Vagueness of complaint is characteristic.
4) Signs:
a) Localized tenderness over medial femoral condyle.
b) Wilson’s test
Knee is flexed and leg internally rotated. Knee is slowly extended. Severe pain is felt . Pain is relieved by external rotation.
Investigations:
Initial X-rays are normal. Later, a crater of rarefaction is visible. The crater contains a bony fragment. The lesion is best visible in tunnel view.
Arthrography will show defect. Arthroscopy is better for diagnosis and treatment.

Management:
In early stages before extrusion of fragment, management is conservative. Cast, analgesics and restriction of hard activities are often prescribed.
Surgical treatment is done for loose fragment and repeated locking. This can be done either open or arthroscopic. Arthroscopy is preferred method.
The loose body is removed. Crater is curetted and drilled. Fibro cartilage forms over the time filling the defect.