Conditions & Treatments - Osteochondritis Dissecans of the Knee

Osteochondritis Dissecans (OCD) is a condition which involves the subchondral bone becoming avascular resulting in the lesion of articular cartilage and its adjacent underlying subchondral bone from the articular surface of a joint (1, 2, 3). The etiology of OCD is idiopathic and not completely understood (2, 3). Some suggested etiological factors include: trauma (chronic or repetitive), deficient blood supply, endocrinopathies, and genetic factors (2, 3). This condition can occur at multiple joints but the femoral condyles at the knees account for 75% of the lesions with the medial condyle being more commonly affected versus the lateral femoral condyle or inferior surface of the patella (2, 3) OCD is most commonly found in individuals who are in the pre/early teens to early twenties (10-21 years of age) (2, 3).

Symptoms of Osteochondritis Dissecans (OCD) of the Knee
The severity and stability of the lesion at the knee will present with varying degrees of symptoms for the patient (2, 3). Individuals who present with OCD usually present with vague poorly localized pain around the condyle and swelling at the knee which can be accompanied by insidious onset of clicking, popping, catching, giving way and locking (2, 3, 4).

PT Findings in Patients’ with Osteochondritis Dissecans of the Knee
Individuals with OCD of the knee may present with atrophy of the thigh secondary to relative disuse and ambulate with the affected extremity externally rotated to relieve pressure on the lesion (3). A special test, known as the Wilson Test, can be performed by the therapist to evaluate for medial OCD lesions (3, 5). "This test is performed by having the therapist hold the patient's foot in internal rotation with the knee flexed at 90 degrees. The patient then extends his or her leg against resistance. The test is considered positive when the patient feels pain at approximately 30degrees of flexion. The discomfort is believed to result from impingement of the tibial spine against the lesion. Pain usually is relieved when the leg is allowed to come out if internal rotation (3, 5)." Other medical tests such a radiograph (tunnel view) and MRI could be performed to to confirm OCD or determine any other pathology (3, 4).

Treatment Options for Osteochondritis Dissecans of the Knee
In cases where the OCD lesion at the knee is stable, conservative treatment such as physical therapy may be recommended to allow for spontaneous healing and to assist with any deficits which may include ROM, strength, gait, function, posture and pain management. If conservative methods are unsuccessful surgical methods such as: arthroscopic lavage or debridement, radiofrequency energy, bone drilling, osteochondral autografts or allografts, internal fixation of bone fragments, and autologous chondrocyte implantation may be performed (2, 3).   

Osteochondritis Dissecans Treatment Options for a PT (2, 3)
• Rest, Physical Activity Modification to Limitation of Weight Bearing
• Postural/Functional Training
• ROM exercises (see videos 14a, 14b & 16 for hip/groin/knee)
• Stretching (see videos 31 & 28 for hip/groin/knee)
• Strengthening/Stabilization (see videos 17 & 18 for hip/groin/knee)
• Manual Therapy
• Modalities - iontophoresis
 

Last revised: November 21, 2012
by Chai Rasavong, MPT, MBA

References
1) Taber's Cyclopedic Medical Dictionary. 19th ed. Philadelphia, PA: FA Davis Co; 2001.
2) Johnson, M. Physical Therapist Management of an Adult with Osteochondritis Dissecans of the Knee. Physical Therapy. 2005 July 85;7: 665-675.
3) Detterline A, et al. Evaluation and Treatment of Osteochondritis Dissecans Lesions of the Knee. 2008 April 21;2:106-115.
4) Brotzman S.B., Wilk K. (2003). Clinical Orthopaedic Rehabilitation. Philadelphia, PA: Mosby.
5) Wilson J. A Diagnostic Sign in Osteochondritis Dissecans of the Knee. J Bone Joint Surg Am. 1967;49:477-480.