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Pediatrics
Diagnosis
Musculoskeletal
Trauma: General
Osteochondritis Dissecans
Osteochondritis Dissecans
Arthur B. Meyers, MD; A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Osteochondritis dissecans (OCD)

            • Synonyms

              • Osteochondral lesion, juvenile OCD (JOCD), adult OCD

            • Definitions

              • Focal joint disorder with progressive changes in subchondral bone & overlying articular cartilage that may lead to early joint degeneration
              • JOCD is limited to skeletally immature patients (open physes)
                • Most common in young adolescent athletes
                • Differentiation from variant irregular ossification of distal femoral epiphysis can be difficult
                • Etiology is unclear; likely multiple contributing factors (traumatic, ischemic, genetic) resulting in symptomatic growth disturbance of epiphyseal secondary physis
                  • Favored etiology: Repetitive stress (microtrauma)

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Fabricant PD et al: Osteochondritis dissecans of the knee: an interrater reliability study of magnetic resonance imaging characteristics. Am J Sports Med. 48(9):2221-9, 2020
                                            2. Masquijo J et al: Juvenile osteochondritis dissecans (JOCD) of the knee: current concepts review. EFORT Open Rev. 4(5):201-12, 2019
                                            3. Haeri Hendy S et al: Juvenile osteochondritis dissecans of the knee: does magnetic resonance imaging instability correlate with the need for surgical intervention? Orthop J Sports Med. 5(11):2325967117738516, 2017
                                            4. Wall EJ et al: The reliability of assessing radiographic healing of osteochondritis dissecans of the knee. Am J Sports Med. 45(6):1370-5, 2017
                                            5. Yellin JL et al: The surgical management of osteochondritis dissecans of the knee in the skeletally immature: a survey of the Pediatric Orthopaedic Society of North America (POSNA) Membership. J Pediatr Orthop. 37(7):491-9, 2017
                                            6. Carey JL et al: Novel arthroscopic classification of osteochondritis dissecans of the knee: a multicenter reliability study. Am J Sports Med. 44(7):1694-8, 2016
                                            7. Roßbach BP et al: Discrepancy between morphological findings in juvenile osteochondritis dissecans (OCD): a comparison of magnetic resonance imaging (MRI) and arthroscopy. Knee Surg Sports Traumatol Arthrosc. 24(4):1259-64, 2016
                                            8. Uppstrom TJ et al: Classification and assessment of juvenile osteochondritis dissecans knee lesions. Curr Opin Pediatr. 28(1):60-7, 2016
                                            9. van Bergen CJ et al: Osteochondritis dissecans of the capitellum in adolescents. World J Orthop. 7(2):102-8, 2016
                                            10. Penttilä P et al: Diagnosis of knee osteochondral lesions with ultrasound imaging. Arthrosc Tech. 4(5):e429-33, 2015
                                            11. Zbojniewicz AM et al: Juvenile osteochondritis dissecans: correlation between histopathology and MRI. AJR Am J Roentgenol. 205(1):W114-23, 2015
                                            12. Eismann EA et al: Management strategies for osteochondritis dissecans of the knee in the skeletally immature athlete. J Orthop Sports Phys Ther. 44(9):665-79, 2014
                                            13. Itsubo T et al: Magnetic resonance imaging staging to evaluate the stability of capitellar osteochondritis dissecans lesions. Am J Sports Med. 42(8):1972-7, 2014
                                            14. Jacobs JC Jr et al: A review of arthroscopic classification systems for osteochondritis dissecans of the knee. Clin Sports Med. 33(2):189-97, 2014
                                            15. Talusan PG et al: Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. Clin Sports Med. 33(2):267-84, 2014
                                            16. Vannini F et al: Treatment of juvenile osteochondritis dissecans of the talus: current concepts review. Joints. 2(4):188-91, 2014
                                            17. Zbojniewicz AM et al: Imaging of osteochondritis dissecans. Clin Sports Med. 33(2):221-50, 2014
                                            18. Pascual-Garrido C et al: Osteochondritis dissecans of the knee in children and adolescents. Curr Opin Pediatr. 25(1):46-51, 2013
                                            19. Shea KG et al: Osteochondritis dissecans knee histology studies have variable findings and theories of etiology. Clin Orthop Relat Res. 471(4):1127-36, 2013
                                            20. Laor T et al: Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? AJR Am J Roentgenol. 199(5):1121-8, 2012
                                            21. Moktassi A et al: Imaging of osteochondritis dissecans. Orthop Clin North Am. 43(2):201-11, v-vi, 2012
                                            22. Chambers HG et al: Diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg. 19(5):297-306, 2011
                                            23. Kijowski R et al: Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology. 248(2):571-8, 2008
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Osteochondritis dissecans (OCD)

                                                      • Synonyms

                                                        • Osteochondral lesion, juvenile OCD (JOCD), adult OCD

                                                      • Definitions

                                                        • Focal joint disorder with progressive changes in subchondral bone & overlying articular cartilage that may lead to early joint degeneration
                                                        • JOCD is limited to skeletally immature patients (open physes)
                                                          • Most common in young adolescent athletes
                                                          • Differentiation from variant irregular ossification of distal femoral epiphysis can be difficult
                                                          • Etiology is unclear; likely multiple contributing factors (traumatic, ischemic, genetic) resulting in symptomatic growth disturbance of epiphyseal secondary physis
                                                            • Favored etiology: Repetitive stress (microtrauma)

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Fabricant PD et al: Osteochondritis dissecans of the knee: an interrater reliability study of magnetic resonance imaging characteristics. Am J Sports Med. 48(9):2221-9, 2020
                                                                                      2. Masquijo J et al: Juvenile osteochondritis dissecans (JOCD) of the knee: current concepts review. EFORT Open Rev. 4(5):201-12, 2019
                                                                                      3. Haeri Hendy S et al: Juvenile osteochondritis dissecans of the knee: does magnetic resonance imaging instability correlate with the need for surgical intervention? Orthop J Sports Med. 5(11):2325967117738516, 2017
                                                                                      4. Wall EJ et al: The reliability of assessing radiographic healing of osteochondritis dissecans of the knee. Am J Sports Med. 45(6):1370-5, 2017
                                                                                      5. Yellin JL et al: The surgical management of osteochondritis dissecans of the knee in the skeletally immature: a survey of the Pediatric Orthopaedic Society of North America (POSNA) Membership. J Pediatr Orthop. 37(7):491-9, 2017
                                                                                      6. Carey JL et al: Novel arthroscopic classification of osteochondritis dissecans of the knee: a multicenter reliability study. Am J Sports Med. 44(7):1694-8, 2016
                                                                                      7. Roßbach BP et al: Discrepancy between morphological findings in juvenile osteochondritis dissecans (OCD): a comparison of magnetic resonance imaging (MRI) and arthroscopy. Knee Surg Sports Traumatol Arthrosc. 24(4):1259-64, 2016
                                                                                      8. Uppstrom TJ et al: Classification and assessment of juvenile osteochondritis dissecans knee lesions. Curr Opin Pediatr. 28(1):60-7, 2016
                                                                                      9. van Bergen CJ et al: Osteochondritis dissecans of the capitellum in adolescents. World J Orthop. 7(2):102-8, 2016
                                                                                      10. Penttilä P et al: Diagnosis of knee osteochondral lesions with ultrasound imaging. Arthrosc Tech. 4(5):e429-33, 2015
                                                                                      11. Zbojniewicz AM et al: Juvenile osteochondritis dissecans: correlation between histopathology and MRI. AJR Am J Roentgenol. 205(1):W114-23, 2015
                                                                                      12. Eismann EA et al: Management strategies for osteochondritis dissecans of the knee in the skeletally immature athlete. J Orthop Sports Phys Ther. 44(9):665-79, 2014
                                                                                      13. Itsubo T et al: Magnetic resonance imaging staging to evaluate the stability of capitellar osteochondritis dissecans lesions. Am J Sports Med. 42(8):1972-7, 2014
                                                                                      14. Jacobs JC Jr et al: A review of arthroscopic classification systems for osteochondritis dissecans of the knee. Clin Sports Med. 33(2):189-97, 2014
                                                                                      15. Talusan PG et al: Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. Clin Sports Med. 33(2):267-84, 2014
                                                                                      16. Vannini F et al: Treatment of juvenile osteochondritis dissecans of the talus: current concepts review. Joints. 2(4):188-91, 2014
                                                                                      17. Zbojniewicz AM et al: Imaging of osteochondritis dissecans. Clin Sports Med. 33(2):221-50, 2014
                                                                                      18. Pascual-Garrido C et al: Osteochondritis dissecans of the knee in children and adolescents. Curr Opin Pediatr. 25(1):46-51, 2013
                                                                                      19. Shea KG et al: Osteochondritis dissecans knee histology studies have variable findings and theories of etiology. Clin Orthop Relat Res. 471(4):1127-36, 2013
                                                                                      20. Laor T et al: Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? AJR Am J Roentgenol. 199(5):1121-8, 2012
                                                                                      21. Moktassi A et al: Imaging of osteochondritis dissecans. Orthop Clin North Am. 43(2):201-11, v-vi, 2012
                                                                                      22. Chambers HG et al: Diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg. 19(5):297-306, 2011
                                                                                      23. Kijowski R et al: Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology. 248(2):571-8, 2008