Juvenile osteochondritis dissecans - unstable

Case contributed by Jeremy Jones
Diagnosis certain

Presentation

Intermittent swelling and pain right knee for 2 months. Injury post-football.

Patient Data

Age: 13 years
Gender: Male

Irregularity of the anterior surface of the lateral femoral condyle. No other injury.

The irregularity on the plain film represents a displaced unstable osteochondral fragment from an osteochondritis lesion. 

Following orthopedic discussion, the decision was to treat conservatively with the recognition that healing of an unstable fragment would be very unlikely.

3 months later

mri

The previously visible detached osteochondral fragment is now sitting anterior to the trochlear notch (best seen on the sagittal PDfs. The donor site has an irregular base, but there is some infilling with cartilage. Moderate joint effusion.

Case Discussion

In this case, there was a decision to treat this displaced osteochondritis lesion conservatively. It is very unlikely that such a lesion will heal without fixation.

In this case further minor trauma resulted in a displaced fragment and the patient went on to have arthroscopy, removal of fragment and micro-fracturing of the base of the lesion. There was early hyalinization of the base.

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