Patients with an OCD lesion often present with complaints of knee pain and swelling. In addition, patients may note sensations of locking (motion of the knee is halted), catching (motion is partially inhibited), popping, or giving way. Physical examination may reveal tenderness, effusion, loss of motion, or crepitus.
AAOS conducted a systematic review that identified one diagnostic study which evaluated the diagnostic performance of clinical examination with radiographs and of selective MRI in the evaluation of intra-articular knee disorders by comparing these findings with arthroscopic findings.40 Clinical diagnosis was made on the basis of history, physical examination, and standard radiographs (AP, lateral, Merchant, and tunnel views). MRI studies were ordered selectively on the basis of clinical discretion.
Arthroscopic evaluation was performed in the subset of patients that required surgery, based on clinical diagnosis and MRI findings if an MRI was performed. The clinical diagnosis (from the initial visit), MRI diagnosis (from the MRI report), and the arthroscopic diagnosis (from the operative report) were retrospectively reviewed and compared. Since only a subset of all patients that underwent evaluation of intra-articular knee disorders proceeded to arthroscopic evaluation, this diagnostic study does not universally apply the reference standard of arthroscopy. Consequently, we assessed this retrospective diagnostic study without a universally applied reference standard as a Level II study. Since only a single study is available to support this recommendation, the strength of recommendation is limited.
Supporting Evidence
One Level II study reports the diagnostic performance of a clinical exam by a pediatric orthopaedic surgeon, including consideration of AP, lateral, tunnel, and Merchant radiographs.40 This study enrolled 125 patients with various knee lesions, 22 of which were diagnosed as osteochondritis dissecans (OCD) during arthroscopic examination.
Diagnostic performance estimates from this study reflect the value of cumulative patient history, examination, and radiographs to distinguish OCD from other lesions.
Analysis of likelihood ratios (LR) and associated confidence intervals indicates clinical exam by a pediatric orthopaedic surgeon with consideration of radiographs is a good or moderately good rule in test for OCD and a moderately good, weak, or poor rule out test for OCD ( able 4).
- (40) Kocher MS, DiCanzio J, Zurakowski D, Micheli LJ. Diagnostic performance of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents. Am J Sports Med 2001;29(3):292-296.
- Kamei, G., Adachi, N., Deie, M., Nakamae, A., Nakasa, T., Shibuya, H., Okuhara, A., Niimoto, T., Kazusa, H., Ohkawa, S., Takazawa, K., Eguchi, A., Ochi, M. Characteristic shape of the lateral femoral condyle in patients with osteochondritis dissecans accompanied by a discoid lateral meniscus. J Orthop Sci 2012; 2: 124-8
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- Takigami, J., Hashimoto, Y., Tomihara, T., Yamasaki, S., Tamai, K., Kondo, K., Nakamura, H. Predictive factors for osteochondritis dissecans of the lateral femoral condyle concurrent with a discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2018; 3: 799-805
- Wechter, J. F., Sikka, R. S., Alwan, M., Nelson, B. J., Tompkins, M. Proximal tibial morphology and its correlation with osteochondritis dissecans of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 12: 3717-22
- Siegall, E., Faust, J. R., Herzog, M. M., Marshall, K. W., Willimon, S. C., Busch, M. T. Age Predicts Disruption of the Articular Surface of the Femoral Condyles in Knee OCD: Can We Reduce Usage of Arthroscopy and MRI?. J Pediatr Orthop 2018; 3: 176-180