Osteochondritis Dissecans

Question 1

Where is the most common location of OCD lesion?

Answer 1

posterolateral aspect of medial femoral condyle (70% of lesions in knee)
Also capitellum and talus

Question 2

What is the best predictor of successful non-operative management of OCD lesions?

Answer 2

Open distal femoral physis;

lesions of the LFC and patella have worse prognosis

Question 3

What physical exam test and radiograph should be done in the evaluation of a knee OCD lesion?

Answer 3

Notch view: bent AP knee xray at 50 degrees

Wilson test: pain with tibial internal rotation when extended the knee btw 90 to 30 degrees

Question 4

What is the treatment of a stable OCD lesion in a child with open physis?

Answer 4

Restricted weight bearing (NWB for 6-8 weeks) and bracing

50-75% heal without fragmentation

Question 5

What size OCD lesions warrant fixation or resurfacing?

Answer 5

> 2cm; lesions that are less than 3cm can be treated arthroscopically, >3cm warrants an arthrotomy