Osteochondritis dissecans of the knee: Epidemiology, etiology, and natural history

Abstract

Osteochondritis dissecans of the knee is a disease that typically affects skeletally immature patients. Clinically manifested with knee pain, limping, and joint disfunction, this condition has remained misunderstood and undervalued for a long period. Although being a rare condition, its awareness is of utmost clinical interest because of the possible severe consequences it can bring when misrecognized or inadequately treated. Its etiology remains unclear and is still debated. Many theories have been proposed, including inflammation, local ischemia, subchondral ossification abnormalities, genetic factors, and repetitive mechanical microtrauma, with a likely interplay of the same. This review article aims to deliver and discuss current and up-to-date concepts on epidemiology, etiology, and natural history of this pediatric condition. Level of evidence: level V.

Keywords: Osteochondritis dissecans; children; epidemiology; etiology; knee.

Figure 1.

Two cases of spontaneous healing of OCD. Case 1: 14 years old boy. X-ray notch view of the right knee (a) shows a stable OCD of the right medial femoral condyle. X-ray (b) after 6 months of sports restriction shows a complete spontaneous healing of OCD. Case 2: 12 years old, female. Detection of OCD on MRI after 18 months of knee pain. Coronal T1-weighted (c) and sagittal T2-weighted (d) MRI images show the area of OCD of the medial lateral condyle with low-signal intensity lesion on T1-images and a signal suggestive of bone marrow edema on T2-images. There is no sign of instability. Coronal T1-weighted (e) and sagittal T2-weighted (f) MRI images after 12 months of sporting activity restriction show OCD healing.