Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA.
Clin Orthop Relat Res. 2013 Apr;471(4):1186-90. doi: 10.1007/s11999-012-2324-5.
Osteochondritis dissecans (OCD) has been defined as a localized process in which a focus of subchondral bone and adjacent articular cartilage separates from the surrounding bone. With the knee being the most common location for OCD development and the propensity for this lesion to be found in those who participate in sports, a repetitive microtrauma hypothesis for its cause has gained favor. However, the cause of OCD remains controversial, as does the most appropriate treatment for the varying degrees of OCD lesions.
We present a unique case of three OCD lesions in one knee. The patient was a young, athletic boy who developed three separate OCD lesions in his right knee over the course of 4 years. Temporally, the OCD lesions developed first in the lateral femoral condyle, then in the medial femoral condyle, and finally in the trochlea.
Our literature review yielded a few reports of bicondylar OCD lesions. We identified no previous reports of three separate OCD lesions found in a single joint.
This report illustrates how a uniquely affected knee with three OCD lesions was treated in three different ways with resolution of symptoms. Each of the OCD lesions was evaluated individually and treatment for each based on the severity of the lesion from the physical examination, imaging studies, and arthroscopic findings.
剥脱性骨软骨炎（OCD）被定义为一种局限性病变，其中一个骨软骨下骨和相邻关节软骨的焦点与周围骨骼分离。由于膝关节是 OCD 发展最常见的部位，并且这种病变容易发生在参与运动的人群中，因此重复性微创伤假说已被广泛接受。然而，OCD 的病因仍存在争议，其各种程度的 OCD 病变的最佳治疗方法也存在争议。
我们报告了一个独特的膝关节内三个 OCD 病变的病例。该患者是一位年轻的运动员男孩，在 4 年内右膝关节先后出现了三个独立的 OCD 病变。从时间上看，OCD 病变首先出现在外侧股骨髁，然后出现在内侧股骨髁，最后出现在滑车。
我们的文献复习仅发现少数关于双髁 OCD 病变的报告。我们没有发现以前有报告指出在单个关节内发现三个独立的 OCD 病变。
本报告说明了如何以三种不同的方式治疗一个独特受累的膝关节，该膝关节有三个 OCD 病变，症状得到缓解。每个 OCD 病变都单独进行评估，并根据体格检查、影像学研究和关节镜检查结果，根据病变的严重程度进行治疗。
