🦵 Section 718.3 · Juvenile Osteochondritis Dissecans (OCD)

Nelson Textbook of Pediatrics 22nd Edition | Juvenile OCD: localized pathologic process of subchondral bone affecting articular cartilage. Most common site: lateral aspect of medial femoral condyle (75% of knee OCD). Presents with vague activity-related knee pain, swelling, mechanical symptoms. Imaging: radiographs (tunnel view critical), MRI to assess stability (fluid behind fragment, cartilage breach). Better prognosis in skeletally immature (30-60% healing with nonoperative care). Stable lesions → rest, activity restriction, protected WB. Unstable → drilling, fixation, cartilage restoration. Arthroscopy gold standard for stability assessment.

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📋 30 Clinical Scenarios — Juvenile Osteochondritis Dissecans

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🩺 Clinical Recognition: Juvenile OCD

Select a presentation to review diagnostic clues and management per Nelson 718.3.

📋 Stepwise Management of Juvenile OCD

🔑 Key Principles — Nelson Section 718.3
• Definition: Localized avascular necrosis of subchondral bone, secondary effect on articular cartilage. Juvenile OCD = open physes (better prognosis).
• Most common site: Lateral aspect of medial femoral condyle (75% of knee OCD). Also lateral femoral condyle, patella, talus, capitellum.
• Presentation: Vague, activity-related knee pain, swelling, mechanical symptoms (locking, catching) if unstable.
• Imaging: Tunnel (PA 45° flexed) view essential. MRI to assess stability: fluid between fragment and subchondral bone, cysts, cartilage breach → unstable.
• Treatment: Stable/skeletally immature → rest, activity restriction, protected WB 3-6 months. Unstable or failed conservative → arthroscopic drilling ± fixation ± cartilage restoration.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Juvenile Osteochondritis Dissecans (Nelson 718.3)