Review Question - QID 3697

More than 70% of JOCD lesions are found in the “classic” area of the posterolateral aspect of the medial femoral condyle, with inferior-central lateral condylar lesions accounting for only 15% to 20% of cases and femoral trochlear lesions seen in less than 1%. The knee is the most common site of osteochondrosis in growing children, which is seen in an estimated 0.002% to 0.003% of knee radiographs.

The review article by Kocher et al states that nonoperative initial management consisting of non-weight-bearing with crutches, continued knee range-of-motion exercises, and close follow-up is indicated for stable lesions in skeletally immature patients. Operative treatment is indicated for any detached or unstable lesions in which physeal closure is imminent or completed and nonoperative management has failed.

Cahill presents Level 5 evidence including his criterion for operative indications including: (1) detachment or instability of the fragment while the patient is under treatment (2) persistence of symptoms in a compliant patient (3) persistently elevated or worsening bone scan activity and (4) approaching epiphyseal closure. He reports his personal series of 204 JOCD patients and reports that 50% of JOCD patients ultimately required surgery. He cites fragment detachment occurred in 34% and persistent symptoms or combined indications comprised 26% of the failures.

Illustration A and B show a skeletally immature patient with a JOCD lesion in the classic position of the lateral aspect of the medial femoral condyle.