Orthopedics of the Upper and Lower Limb by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030432867
Publisher: Springer International Publishing

Presentation and Investigation

Patients typically present with nonspecific knee pain, which can cause mechanical symptoms following an insidious onset if the lesion is unstable and loose. Mechanical symptoms include locking, catching, pain on active motion, and crepitus on physical examination. It is crucial to illicit from the history of trauma and other concomitant soft tissue knee injuries such as ACL and meniscal injuries. Up to 25% of cases involve the contralateral knee, which is crucial to enquire and examine bilateral knees [8]. Quadriceps atrophy can be present to indicate the chronicity of the pathology. A Wilson’s test can be used to elicit discomfort when internally rotating the tibia during extension of the knee between 30° and 90° and relieved with internal rotation of the tibia as this corresponds to the most common site of the OCD, which is the lateral aspect of the distal medial femoral condyle [8, 16].

As with cartilage injuries to the knee, it is important to obtain baseline investigations such as plain film radiographs, and MRI remains the gold standard modality to illustrate other associated pathologies. Plain film radiograph views include AP, lateral, and notch views which can be useful to visualize the posterior aspect of the femoral condyles.

MR imaging can be used to classify juvenile OCD (Fig. 21.2). It has been demonstrated that patients with the presence of high signal line behind the fragment on MRI had the highest rate of failed nonoperative management, which is best visualized in gadolinium-enhanced scans [8]. Besides that, size and site, extent of bony edema, presence of loose bodies, and involvement of subchondral bone can be assessed from the MR images [8].

Fig. 21.2MRI classification for juvenile OCD [8]

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