Juvenile osteochondritis dissecans

Case contributed by Dr Jeremy Jones

Presentation

Failure of complete extension. Doesn't feel like a pseudoblock. No pain except when trying to extend fully.

Patient Data

Age: 13 years
Gender: Male
X-ray

2 cm osteochondral defect on the lateral weight-bearing surface of the medial femoral condyle with associated fragmentation. No loose body.

2 cm osteochondral defect on the lateral weight-bearing surface of the medial femoral condyle. Fragmentation demonstrated on the plain film is visible. Associated marrow edema.

Overlying cartillage is intact (DESS).

Minor edema in Hoffa's fat pad. Trace of fluid in the joint.

No loose body. Normal cruciates, collaterals and menisci.

Photo

Arthroscopic images.

  • normal patellofemoral joint
  • Hoffa fat-pad inflammation
  • normal ACL (probe)
  • normal lateral compartment
  • normal lateral meniscus (probe)
  • normal lateral femoral condyle
  • medical compartment
  • normal medial meniscus (probe)
  • probe at softened, stable medial condyle cartilage
  • wide-view flattened weight-bearing femoral cartilage
  • 1.1 mm wire drilling affected area
  • final view of treated area

Case Discussion

This case highlights a relatively asymptomatic patient with a large osteochondral defect. The DESS sequence is helpful to confirm cartillage integrity and allows the orthopedic surgical team to make plans for micro-drilling of the lesion.

If the cartillage is fissured or there is evidence of loosening (fluid behind the lesion), disolvable plastic screws can be used to hold the fragment in place while it heals.

It is important to treat these patients to ensure the OCD doesn't delaminate.

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Case information

rID: 68470
Published: 3rd Jun 2019
Last edited: 7th Nov 2019
System: Paediatrics
Inclusion in quiz mode: Included
Institution: NHS Lothian