A 34 year old presents with a 2 year history of intermittent left knee swelling. He recalls no particular injury. He hikes several times a week upwards of 40km per week. He plays no other sports and does not work out. When his knee is swollen, he has difficulty with flexing and fully straightening his knee. He has no buckling, giving way, catching or locking though.
He has a moderate effusion in his knee. There is no joint line tenderness. He describes pressure when you passively flex his left knee. There is a 5 degree loss of flexion and some mild pain with extension. There is no loss of extension. He is able to extend his knee. Ligamentous testing for ACL, PCL MCL and LCL are all normal. His meniscal testing including: Passive flexion and rotation, McMurray, Thessaly and Ebe’s testing result in no discomfort or clicking. His patellofemoral joint exam was also normal.
Figures 1,2,3 Axial, Coronal and Sagital Views.
Diagnosis: Osteochondritis Dissecans
Plan: Discussed with patient with symptoms and likelihood of worsening with time. I recommended a referral to orthopedic surgeon for arthroscopy for unstable components. Patient declined referral and decided to return to work abroad. He stated if he got mechanical symptoms or if it worsened he would considered despite advice that this is likely to result in early osteoarthritis in his knee.
Dr. Neil Dilworth (Dec 1, 2014)