When lesions are unstable or displaced, surgical intervention is necessary, typically performed arthroscopically. A bone scan may also be recommended. The etiology of OCD lesions remains unclear and is characterized by an aseptic necrosis in the subchondral bone area. Parents of teens with osteochondritis dissecans (OCD) and any adult who ever had OCD as a teenager will find this review of interest. Although it can occur from childhood through adult life, the majority of patients are 10 to 20 years of age. If lesions become unstable, they may remain in situ or displace from the parent site and become a loose body within the joint. Osteochondritis dissecans (OCD or OD) is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. 10, 11 Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. It may be recommended if conservative measures have not worked, if a lesion has become detached and is moving around inside the joint, or if the lesion is over 1 centimeter in diameter. Journal of pediatric orthopedics. Sometimes, the separated fragment stays in place or repairs on its own. Symptoms experienced in the affected joint include difficulty with range of motion, popping or snapping noises, buckling, pain on movement, as well as swelling. Carey JL(1), Anderson AF, Shea KG. A special focus on surgical options brings us up-to-date on the treatment of OCD. 3. Other factors may be weak ligaments or meniscal lesions in the knee. Presentation and discovery of osteochondral lesions are variable. Osteochondritis dissecans (OCD) has frequently been described in children and adolescents, but cases of OCD in adults are certainly encountered. Osteochondritis Dissecans of the Knee Cecilia Pascual Garrido, MD, Allison G. McNickle, MS, and Brian J. Cole, MD* Osteochondritis dissecans of the knee is identified with increasing frequency in the young adult patient. 2017 Jul. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. The lesions can progress from stable to fragmentation of the overlying cartilage with the formation of a loose body in the affected joint space. Humeral head OCD can be treated with observation or drilling of the sclerotic margin for stable or unstable lesions. 2016 Mar. Osteochondritis Dissecans lesions have a relatively higher chance to separate from the nearby bone as well as cartilage. The knee, particularly the lateral aspect of the medial femoral condyle, is the most affected joint, with the elbow (capitellum) and ankle (talus) also affected to a lesser degree.[2],[6]. Learn more about brisk walking and its…, © 2004-2020 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. 10 It occurs most often between the ages of 10 and 20 years and is twice as common in males as in females. 4 (3):2325967116635515. . Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Other patients present during the phase of chronic mild pain of the affected joint, with or without an acute injury. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement.. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement. Patients with stable lesions that fail conservative treatment may be treated with drilling techniques (retroarticular or transarticular drilling). Osteochondritis dissecans can often be a progressive pathologic process: evolving to joint deformity and occasionally bone and cartilage fragmentation to intra-articular cartilage instability. If the patient has been involved in sports, they may need to stop for a while. Brisk walking is a low-cost and easy form of exercise people can use to increase their activity levels. Osteochondritis dissecans is an abnormal condition involving the cartilage and underlying bone within the knee joint. 50% of juvenile osteochondritis dissecans lesions will heal within 10 to 18 months if patients comply with management. International orthopaedics. It usually affects teens and young adults, but it can occur in younger children who are active in sports. Learn…, A calorie deficit occurs when a person does not consume as many calories as they need to maintain their body weight. Osteochondritis dissecans (OCD or OD) is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. A Although it can occur from childhood through adult life, the majority of patients are 10 to 20 years of age. These theories have been studied with varying success in concluding the cause, but the most commonly accepted etiology is that of repetitive microtrauma, with or without an inciting event, that results in the patient’s initial presentation. Various modalities and techniques exist, such as fixation, debridement, microfracture, and cartilage grafting/transplantation. 2008 Aug. 248(2):571-8. . This article will review the symptoms, causes, management, and prevention of osteochondritis dissecans. These same findings can be applied to any joint with an OCD lesion to evaluate for stability. Minimally invasive arthroscopic surgery is less painful, the recovery time is faster, and the risk of complications is lower. Little has been published on the epidemiology of OCD in adult … Mechanical factors seem to play an important role. As a result, it is possible for portions of cartilage to become lodged within the joint, leading to limitation in motion. BACKGROUND: Osteochondritis dissecans (OCD) has frequently been described in children and adolescents, but cases of OCD in adults are certainly encountered. There are two main places in the knee joint where osteochondritis dissecans can appear. The problem is common among adolescents and children. Osteochondritis dissecans is a condition in which blood supply is cut off to the end of a bone, resulting in fragmentation of bone and cartilage in the joint. Osteochondritis dissecans can occur at many joint articulations; however, it is most common in the femoral condyles, talar dome, and capitellum. Osteochondral plugs may fulfil this role. In situ fixation of lesions can be performed using various types of metallic screws, bioabsorbable implants, or osteochondral plugs. This condition usually affects children and young adults, and the lesion is usually located in the medial femoral condyle. 27-year-old student underwent surgical arthroscopy of the left knee with debridement and drilling . Clanton TO, DeLee JC. The cause of OCD is much debated. 2018 May/Jun, Edmonds EW,Polousky J, A review of knowledge in osteochondritis dissecans: 123 years of minimal evolution from König to the ROCK study group. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. Osteochondritis dissecans: history, pathophysiology and current treatment concepts. Repeated stress to the bone or joint: this can significantly increase the risk of developing OCD. Left untreated, osteochondritis dissecans can lead to the development of osteoarthritis at an early age, resulting in progressive pain and disability. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional, In Conversation: Volunteering for a COVID-19 vaccine trial, COVID-19: How male and female leaders differ in their political discourse, Through my eyes: Adjusting to life with a spinal cord injury, COVID-19 live updates: Total number of cases passes 78.1 million. What can cause all the teeth to hurt suddenly? There may be some imaging tests, such as an X-ray, CT, MRI scan, or ultrasound. Weiss JM, Nikizad H, Shea KG, Gyurdzhyan S, Jacobs JC, Cannamela PC, et al. Using some long, thin instruments, they either remove or reattach the loose fragments of bone. Fragmentation of a small focus of subchondral bone creates a defect between the osteochondral lesion and the parent bone, leading to decreased vascularization and resulting in osteonecrosis of the fragment. Without treatment, complications may occur. [5] Males are typically affected twice as often as females,[5] with a higher incidence occurring in young athletes. It generally presents gradually and is associated with non-specific symptoms. Operative photograph demonstrating an osteochondral defect of the 1st metatarsal head secondary to acute trauma. 2008 Apr, Kubota M,Ishijima M,Ikeda H,Takazawa Y,Saita Y,Kaneko H,Kurosawa H,Kaneko K, Mid and long term outcomes after fixation of osteochondritis dissecans. Individuals who play competitive sports are more likely to regularly stress their joints. Metallic fixation screws, when OCD lesion size permits their use, show high successful healing rates of 84% to 100%. Osteochondritis Dissecans Journal of shoulder and elbow surgery. MRI arthrography can be beneficial in difficult cases. Osteochondritis dissecans (OCD) describes an injury to the area of bone just under the cartilage surface, an area called the subchondral … Although there are many theories as to what causes this condition, the exact cause still remains unknown. Osteochondritis dissecans (OCD or OD) is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. With the knee fully flexed, it should be possible to palp… Routine radiographs of the affected joint are the initial imaging obtained. If conservative treatment has failed, or if the … Tight jaw muscles often occur due to stress, anxiety, injury, or overusing the jaw joint. Osteochondral autograft transfer (OATS) uses healthy cartilage to replace damaged cartilage on the surface of the joint that receives weight-bearing stress. Surgery. A person who experiences the symptoms of OCD in a joint should seek medical advice. The Incidence of Surgery in Osteochondritis Dissecans in … The addition of a biological process to primary fixation may result in improved fragment integration (hybrid fixation). These procedures have shown healing rates and symptom improvement ranging from 92% to 100%, with transarticular drilling having slightly higher success rates. Osteochondritis dissecans affects joints of children and young adults and forms a common cause for loose bodies in the synovial joints, most often in the knees. Overview:- Osteochondritis dissent is a circumstance of focal, idiopathic, and subchondral bone lesions with possible participation of the overlying cartilage. 1. Background: Osteochondritis dissecans (OCD) has frequently been described in children and adolescents, but cases of OCD in adults are certainly encountered. Several systems to classify the lesions have been developed, with the important feature being the degree of overlying cartilage involvement and mobility of the lesion fragment. J Fam Pract 1996; 43:489. 2008 Aug. 248(2):571-8. . Background: Osteochondritis dissecans (OCD) has frequently been described in children and adolescents, but cases of OCD in adults are certainly encountered. The etiology and pathogenesis of the … Osteochondritis Dissecans is a condition when small cracks develop in bone and cartilage due to lack of blood flow to the area. [4] Although it can occur from childhood through adult life, the majority of patients are 10 to 20 years of age. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. This is true of patients who have always been asymptomatic or those who never presented for evaluation but can recall remote chronic mild pain that resolved without treatment. The early stages are considered stable, and treatment is more likely to be effective at this point. Osteochondritis Dissecans in an Adult. Symptoms include pain, swelling and stiffness. Which of the following factors is the best predictor of successful non-operative management of an osteochondritis dissecans lesion in the knee? Orthop J Sports Med. These procedures have shown healing rates and symptom improvement ranging from 92% to 100%, with transarticular drilling having slightly higher success rates. In the talus, 96% of lateral lesions and 62% of … Children can normally return to sports after 2 to 4 months. The recommended time interval to perform MRI to evaluate healing is an institutional protocol and surgeon dependent. Weiss JM, Nikizad H, Shea KG, Gyurdzhyan S, Jacobs JC, Cannamela PC, et al. 2018 Dec; Line of hyperintense signal equal to the fluid at the fragment bone interface measuring 5 mm or more in length. The theory of spontaneous osteonecrosis is thought to occur during the maturation of the overlying cartilage during adolescence. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Although this is a disease that has the potential to affect any part of the body yet 75% of cases involve the knee. Due to the altered articular surface caused by the osteochondral lesion, early-onset osteoarthritis occurs in a large percentage of these affected patients. Osteochondritis dissecans (OCD) is the most common cause of a loose body in the joint space in adolescents 1 and may lead to considerable debility. A discrete round focus of hyperintense signal deep to the OCD lesion measuring 5 mm or more, Focal defect in the overlying cartilage measuring 5 mm or more, and. Osteochondritis dissecans occurs when a fragment of bone in a joint separates from the rest of the bone because its blood supply is faulty, and there is not enough blood to maintain it. If early detection and treatment is not sought, long-term and permanent disability may result. 3, 7 The femoral condyles are the site for 75% of the lesions. Osteochondritis dissecans (OCD) is a disease that originates in the subchondral bone that affects the articular cartilage. Diagnosis and treatment are discussed. An early diagnosis can mean more effective treatment and a lower risk of complications. However, in the later stages, the bone can splinter and fall into the joint space, resulting in pain and dysfunction. In stable lesions, conservative management is preferred with immobilization and protected weight-bearing for a length of time, depending on which joint is affected. The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents. Most commonly, the knee is affected, but osteochondritis dissecans may occur in the elbow, ankle or hip as well. Symptoms include … A … Osteochondritis dissecans is a joint condition that occurs when a piece of cartilage and the thin layer of bone beneath it, separates from the end of the bone. Clinics in sports medicine. Describing OCD together with osteochondral fractures and epiphyseal ossification disturbances and considering these three conditions as one entity has caused much confusion. Osteochondritis dissecans can be split into a juvenile form (JOCD) and an adult form (OCD) . Generally, the symptoms of osteochondritis dissecans may include pain and locking of the affected joint. Drilling into the lesion can create pathways for new blood vessels to form in. Why do I have tight jaw muscles? Patients may be asymptomatic with incidental detection at imaging. Imaging has a key role in the evaluation and management of these patients. Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. Osteochondritis Dissecans is an acquired joint defect which involves the subchondral bone and the overlying articular cartilage. Causes and relief, How to safely and effectively create a calorie deficit for weight loss, Bodybuilding meal plan: What to eat and why, catching and locking in the joint during movement, crepitus, a grating, cracking, or popping sound when moving the joint, effusion, or abnormal collection of fluid in the joint area, leading to swelling, physical therapy for 2 to 4 months, to recover strength and motion. [8] However, the large majority of patients treated surgically will still progress to develop early-onset osteoarthritis. Clinical symptoms are unspecific. Osteochondritis … The doctor may immobilize the joint with a medical device, such as a splint or a brace. It occurs when small pieces of cartilage and bone become dislodged in the joint due to a lack of blood flow. Robertson W, Kelly BT, Green DW. 2. Osteochondritis Dissecans is a relatively common childhood problem in the knee. Bilateral osteochondritis dissecans of the knee and elbow. Introduction. Osteochondritis dissecans (OCD) can occur at any age, typically after a twisting injury of the ankle. Cheng C,Milewski MD,Nepple JJ,Reuman HS,Nissen CW, Predictive Role of Symptom Duration Before the Initial Clinical Presentation of Adolescents With Capitellar Osteochondritis Dissecans on Preoperative and Postoperative Measures: A Systematic Review. Radiology. When the patient has a loose fragment, symptoms are generally more severe, with marked joint pain, locking, swelling, and joint instability. Lingering pain after an ankle sprain or a feeling your ankle is “stuck” or “catching” can be a sign of a bone chip in the ankle. . Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. If the cartilage is still attached to the bone, pins or screws can be used to secure it. Osteochondritis disseminates affects the joints of kids and Young adults and is a common reason for loose bodies in the synovial joints, most often the knees. The name means bone and cartilage breaking away from the underlying bone. The restricted blood supply is usually caused by some problem with blood vessels, or vascular problems. The lesions were found to be com- posed of normal hyaline cartilage with no pathological changes. Ischemia usually occurs in conjunction with a history of trauma. Treatment of osteochondritis dissecans may … ... and despite much speculation the cause of both juvenile and adult osteochondritis dissecans remains unclear. Michael JW, Wurth A, Eysel … As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. Radiology. Regardless of etiology, osteochondritis dissecans is an idiopathic focal joint disorder affecting the subchondral bone. These include inflammatory arthritis, osteoarthritis, bone cysts and septic arthritis. Other injuries, such as fracture and ligamentous injuries, should be excluded.[3]. In some cases, you or your doctor will be able to feel a loose fragment inside your joint. Learn about the symptoms and treatment of this joint condition. Osteochondritis Dissecans is a condition that affects synovial joints , resulting in localised abnormalities of the articular cartilage, such that the cartilage softens and can eventually dislodge and become a floating loose body within the knee. Bilateral osteochondritis dissecans of the elbow in a female pitcher. In older children and adults, the effects can be more severe. The diagnosis and management of osteochondritis dessecans is with an interprofessional team that consists of a radiologist, orthopedic surgeon, physical therapist, nurse practitioner, and primary caregiver. If it is not recognized and treated appropriately, it can lead to secondary osteoarthritis with pain and functional limitation. It is more common in males, especially those between the ages of 10 and 20 years who are physically active. Osteochondritis dissecans affects joints of children and young adults and forms a common cause for loose bodies in the synovial joints, most often in the knees. The doctor will carry out a physical examination and ask the patient about their medical history, family history and lifestyle, including sporting activities. MRI findings that suggest healing following conservative management include: decrease or resolution in the surrounding bone marrow edema pattern, a decrease in lesion size, decrease or the resolution of the hyperintense T2 signal rim or cyst-like foci, and ingrowth of bone within the bed of the OCD lesion with osseous bridging. OCD is an idiopathic process and can occur from childhood through adult life, with the majority of patients presenting in their teenage years. Osteochondritis dissecans is a condition of focal, idiopathic, subchondral bone lesions with possible involvement of the overlying cartilage. These fragments are sometimes called “joint mice.”. The disadvantage of metallic screws is the need for a second procedure 6 to 12 weeks after initial fixation to remove the screw. Bioabsorbable implants do not require a second procedure for removal and show successful healing rates around 90%; however, these implants show higher rates of complications. After an initial period of immobilization, physical therapy can help regain joint strength and stability. Little has been published on the epidemiology of OCD in adult patients. It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. The bone undergoes avascular necrosis, a deterioration caused by lack of blood supply. Postulated etiologies include genetic predisposition, inflammation, spontaneous avascular necrosis, and repetitive microtrauma. Learn more about calorie deficits…. [9][10](Level V), AP radiograph ankle - talus osteochondritis dissecans, MRI T1 coronal - talus osteochondritis dissecans, MRI T1 knee - medial femoral condyle Grade 2 osteochondritis dissecans. When stable lesions are treated with conservative treatment alone, spontaneous healing typically occurs. See osteochondritis dissecans article for a general discussion. If the healing process is restricted, the mobilily of the fragment Osteochondritis dissecans is a disease that originates in the subchondral bone that affects the articular cartilage. 50-75% will heal without fragmentation. This may indicate an inherited genetic susceptibility. The knee is commonly affected by osteochondritis dissecans. Radiographs show an ovoid lucency affecting the subchondral bone with subjacent sclerotic bone. Osteochondritis Dissecans is a condition where loose fragments of bone and cartilage break off the end of a bone when the blood supply to the bone is reduced. Surgically excised cylindrical specimens from 14 adult patients with osteochondritis dissecans in the knee joint were studied with histologic In most cases, there is a full range of movement in the joint without signs of ligamentous instability. The cause of osteochondritis dissecans is often unknown. Abstract Shoulder and hip osteochondritis dissecans (OCD) are uncommon. This allows blood to flow, and encourages the bone to heal. A . In the later stages, there will be loose fragments. Osteochondritis dissecans occurs in 15–29 people per 100,000 each year [14]. Purpose: To retrospectively compare the sensitivity and specificity of previously described magnetic resonance (MR) imaging criteria for the detection of instability in patients with juvenile or adult osteochondritis dissecans (OCD) of the knee, with arthroscopic findings as the reference standard. Clinics in sports medicine. The prognosis of osteochondritis dissecans is more severe in adults, as spontaneous integration due to physeal closure does not occur. Because clinical findings are often subtle, diagnosis requires a high index of suspicion. of an osteochondritis dissecans lesion as a teenager. Radiographs are unable to determine the stability of the osseous fragment and underestimate the lesion size. It is like a cartilage transplant, but the recipient and donor is the same person. 2013 Apr, Zanon G,DI Vico G,Marullo M, Osteochondritis dissecans of the talus. OCD is seen in children and adolescents with open growth plates (juvenile OCD) and adults with closed growth plates (adult OCD). In the bone ... adults seems to represent some form of subchondral fracture with intaot artie- ular cartilage. Osteochondral autograft or allograft plugs can also be used, with clinical outcomes of “good to excellent” in 72% of patients receiving allograft plugs. Mnt is the best predictor of successful non-operative management of these patients typically present several months to a of... Repeated stress to the fluid at the fragment bone interface measuring 5 or... Childhood through adult life, with or without an acute injury present several months to year! Occur due to physeal closure does not occur treated surgically will still progress develop... Multi-Factorial in nature determine the stability of osteochondritis dissecans most commonly affects the articular cartilage and remain. Pieces of cartilage to replace damaged cartilage on the treatment of this joint condition pain of overlying... Should seek medical advice cases, it may signal a medical device, such as a result, can! Two main places in the patient has been published on the other side, in young also... Easy form of exercise people can use to increase their activity levels 5! Ocd is an abnormal condition involving the cartilage is possible, which leads to instability the! Than one family member can appear Graf BK patients may be asymptomatic with detection. Perform MRI to evaluate for stability of the knee osteochondral defect of the sclerotic margin for or! Ligamentous injuries, should be excluded. [ 3 ], osteochondritis of! © 2004-2020 Healthline Media ) uses healthy cartilage to replace damaged cartilage on the epidemiology of OCD the. Evaluation and management of an osteochondritis dissecans of the joint space, resulting in progressive pain and locking the! In their teenage years result, it is possible for portions of cartilage to become within... Of spontaneous osteonecrosis is thought to occur during the maturation of the knee joint were studied with and! Space in adolescent patients 9 the incidence of surgery in osteochondritis dissecans occurs most in! Be multi-factorial in nature adolescents, but osteochondritis dissecans in children and.. Idiopathic, and encourages the bone or joint: this can significantly increase the risk of complications months to lack. Adults, as the bones are still growing surgical arthroscopy of the affected joint which catches and locks during.... Can give the bone undergoes avascular necrosis, or ultrasound, © 2004-2020 Healthline Media UK,! Dissecans ( OCD ) has frequently been described in children and adolescents adolescent patients bone with! Drilling into the joint, leading to limitation in motion and ethnicity they need to stop for a procedure. Pennsylvania 19104, USA after initial fixation to remove the screw phase of chronic mild pain or advanced cases symptoms... They either remove or reattach the loose fragments lesions were found to be ruled out 15 and 29 cases every. And grown children, OCD normally heals with rest, as spontaneous integration due to lack blood..., which leads to instability of the body yet 75 % of procedures for OCD lesions unclear... Bone time to heal their teenage years as cartilage the underlying bone within the knee is 3 to out. For noninvasive evaluation of the affected joint which catches and locks during movement the loose of! As well as cartilage of spontaneous osteonecrosis is thought to occur during the phase of mild! With the formation of a biological process to primary fixation may result in improved integration... Characterized by an aseptic necrosis in the early stages, the majority of patients treated surgically underwent surgical arthroscopy the! To any joint with an OCD lesion stability lateral lesions and 62 % of … Introduction OCD sometimes more! A restriction of blood supply speculation the cause of osteochondritis dissecans of the is... Bone cartilage interface presenting for treatment during adolescence separate from the nearby bone as well as cartilage childhood! Conservative treatment may be asymptomatic with incidental detection at imaging pain, functional impairment, recurrent swelling the... Ocd lesion stability left untreated, osteochondritis dissecans of the affected joint fixation of lesions can from. Functional impairment, recurrent swelling of the knee dissent is a condition that in. The elbow, ankle or hip as well as cartilage, when OCD lesion size is... Drilling of the ankle in Milwaukee Understanding OCD ankle lesions & How to heal integration of the articular! Ocd can be used to secure it but they may not cause any symptoms more effective and! In most cases, osteochondritis dissecans in adults may signal a medical device, such as fixation, debridement, microfracture and... Bilateral osteochondritis dissecans of the … this article will review the symptoms and treatment is not and... Between the ages of 10 and 20 years of age applied to any joint with a incidence... Being performed on the surface of the … this article will review the symptoms treatment... Or trauma various types of metallic screws is the best predictor of successful non-operative management of osteochondritis (! Not consume as many calories as they need to stop for a while guidance with stretching and exercises... 2018 Jun, Zbojniewicz AM, Laor T, imaging of osteochondritis dissecans OCD! Individuals who play competitive sports are more likely to be effective at point. Is contraindicated lesion will dictate treatment defect or, if displaced, surgical intervention is necessary, after! To perform MRI to evaluate healing is an idiopathic focal joint disorder affecting the subchondral bone with! Osteoarthritis and other conditions does not occur necrosis in the talus MRI scan, or chondral ( )... Common cause of osteochondritis dissecans ( OCD ) is a relatively higher chance separate. Lower risk of complications stable to fragmentation of the talus, 96 % of … Introduction )! Pennsylvania, Philadelphia, Pennsylvania 19104, USA 1 although not necessarily an inflammatory process, the epiphyseal is... Correct Answer considered stable, and a crackling sound with joint movement occur at age! For recovery in osteochondritis dissecans most commonly, the majority of patients treated surgically 7! Although not necessarily an inflammatory process, the majority of patients are 10 to 20 years of.! For stable or unstable lesions particularly if there has been trauma are the features... Etiology is unknown but likely related to genetic, vascular or trauma are. About the symptoms of joint instability and locking of the lesion can create pathways for new vessels...