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. 2014 Dec;58(4):384-94.

Juvenile Osteochondritis Dissecans in a 13-year-old male athlete: A case report

Kevin D'Angelo  1 , Peter Kim  2 , M Lucas Murnaghan  3
Affiliations

Juvenile Osteochondritis Dissecans in a 13-year-old male athlete: A case report

Kevin D'Angelo et al. J Can Chiropr Assoc. 2014 Dec.

Abstract
in English, French

Objective: To present the clinical management of juvenile osteochondritis dissecans (OCD) of the knee and highlight the importance of a timely diagnosis to optimize the time needed for less invasive, non-operative therapy.

Clinical features: A 13-year-old provincial level male soccer player presenting with recurrent anterior knee pain despite ongoing manual therapy.

Intervention and outcome: A multidisciplinary, non-operative treatment approach was utilized to promote natural healing of the osteochondral lesion. The plan of management consisted of patient education, activity modification, manual therapy, passive modalities and rehabilitation, while being overseen by an orthopaedic surgeon.

Conclusions: Considering the serious consequences of misdiagnosing osteochondritis dissecans, such as the potential for future joint instability and accelerated joint degeneration, a high degree of suspicion should be considered with young individuals presenting with nonspecific, recurrent knee pain. A narrative review of the literature is provided to allow practitioners to apply current best practices to appropriately manage juvenile OCD and become more cognizant of the common knee differential diagnoses in the young athletic population.

Objectif: Présenter le traitement clinique de l’ostéochondrite disséquante juvénile (OCD) du genou et souligner l’importance d’un diagnostic précoce en vue d’optimiser le temps nécessaire pour un traitement non chirurgical moins invasif.

Caractéristiques cliniques: Un joueur de soccer de 13 ans, au niveau provincial, présente des douleurs antérieures du genou (récurrentes) malgré un programme de thérapie manuelle en cours.

Intervention et résultats: Une approche de traitement multidisciplinaire non chirurgical a été utilisée pour favoriser la guérison naturelle de la lésion ostéochondrale. Le plan de traitement comportait la sensibilisation du patient, la modification des activités, la thérapie manuelle, les modalités passives et la réadaptation, sous la supervision d’un chirurgien orthopédiste.

Conclusions: Compte tenu des conséquences graves d’un mauvais diagnostic de l’ostéochondrite disséquante, telles que la possibilité d’une instabilité articulaire et d’une dégénérescence accélérée des articulations à l’avenir, il faut être extrêmement suspicieux avec les jeunes qui présentent des douleurs récurrentes non spécifiques du genou. Un examen narratif des revues scientifiques est offert pour permettre aux professionnels d’avoir recours aux pratiques exemplaires actuelles pour traiter adéquatement l’OCD juvénile et de se sensibiliser davantage aux diagnostics différentiels communs du genou chez les jeunes sportifs.

Keywords: ROCK; case report; knee injuries; medial femoral condyle; non-specific knee pain; osteochondral lesions; osteochondritis dissecans.

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Figures

Figure 1A
Figure 1A
This image illustrates anterior-posterior presentations of OCD on the articular surface of distal femur. The medial (M) and lateral (L) condyles are labeled in image A for reference. OCD lesions may appear on the medial condyle in the classic (A), extended classic (B) and inferocentral locations (C). Image D shows the inferocentral location on the lateral femoral condyle.
Figure 1B
Figure 1B
Osteochondral lesions at the knee may present on the anterior portion of the articular surface (A) or most commonly, at the weight-bearing posterior portion of the articular surface (B).
Figure 2
Figure 2
Conventional AP and lateral radiograph views of the right knee. The osteochondral defect (white arrows) is observed in the posterolateral aspect of the right medial femoral condyle.
Figure 3
Figure 3
Coronal T1 TSE and sagittal T2 SPAIR MR images demonstrating a stable osteochondral lesion in the right knee (solid arrow). Marrow edema (open arrow) is observed with high signal intensity on the sagittal view.
See this image and copyright information in PMC

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