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Arthroscopic removal of fragment
4%
139/3853
Arthroscopic open reduction and internal fixation
7%
283/3853
Arthroscopic microfracture drilling
5%
190/3853
Non-weight bearing for 6-8 weeks
73%
2804/3853
Full weight bearing with avoidance of athletic acticity
11%
417/3853
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The radiograph and MRI show an osteochondritis dissecans (OCD) lesion on the medial femoral condyle. On the MRI image, the cartilage appears to be intact and the lesion is not displaced. A clear fluid line behind the fragment would indicate a poorer prognosis for healing with non-operative treatment. However, an initial period of non-operative treatment would be recommended for an intact lesion in a skeletally immature patient. Safran et al describes Wilson's test of the knee. External rotation of the tibia during gait indicates compensation for impingement of the tibial eminence on an OCD lesion of the medial femoral condyle. Wilson’s test involves reproduction of pain on examination by internally rotating the tibia during extension of the knee between 90° and 30°, then relieving the pain with tibial external rotation. External rotation moves the eminence away from the lesion, relieving the pain. This patient has open physes and a stable appearing lesion. Thus nonoperative treatment should be tried initially.
2.7
(45)
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