Assessing and managing juvenile osteochondritis dissecans of the knee

Juvenile osteochondritis dissecans can affect the knees of children and is especially problematic among youth athletes. This disorder involves a lesion that appears on the subchondral bone in the knee, and it affects between 15 and 29 children per 100,000.

Boys are much likelier to develop the condition than are girls. Without proper assessment and treatment, the condition may cause permanent knee damage and prevent the children from further participation in sports. Fortunately, the lesion can often be reversed with treatment.

Assessing juvenile osteochondritis dissecans of the knee

Juvenile osteochondritis dissecans may be subjectively and objectively assessed. Patients often report feeling pain near their patella bones, but the pain may be nonspecific. In most cases, the pain will intensify with exercise. Patients may also experience knee stiffness or swelling, and in more advanced stages, they may also experience locking caused by loose bone fragments.

There are several objective assessments that doctors may use for the disorder, including:

  • Observation of the knee to check for effusion
  • Observation of the gait
  • Palpitation of the knee to check for tenderness
  • Checking for internal or external rotations
  • X-rays of the knee
  • Magnetic resonance imaging

Once the condition has been diagnosed, there are several ways in which a doctor may treat it so that the knee can heal properly.

Managing juvenile osteochondritis dissecans of the knee

Nonsurgical methods are normally indicated in the treatment and management of osteochondritis dissecans in children. The normal treatment protocol proceeds through three primary phases. In the first phase, the child will have his or her knee immobilized with a brace, and he or she may also use crutches. Before the management can progress into the second phase, the child must report being pain-free. The first phase lasts up to six weeks.

In the second management phase, which lasts from six to 12 weeks, the children will still be restricted from sports. They will no longer have to wear braces and will be able to bear weight as they can tolerate it. Knee rehabilitation happens during this stage with an emphasis on low-impact strength-training exercises targeted on the quadriceps and hamstrings. Before they can progress to the third treatment phase, the knee must demonstrate clinical signs of healing as observed with radiographic imaging.

In the third management phase, the youth will gradually begin to add loading exercises, including jumping and running. Eventually, they will be able to return to playing sports. In order to increase the intensity of the exercises, they must first be completely symptom-free. During this final management phase, which lasts from three to four months, the doctors will use MRIs in order to make certain that the lesions are healing.

With the proper assessment and management of juvenile osteochondritis dissecans of the knee, children may experience full healing. This can help them to avoid developing permanent damage that could cause them to experience ongoing knee problems and could force them to stop participating in sports. It is important for people to follow all of their recommended treatment phases in order to reverse the lesions.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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