An osteochondral injury involves the separation of a segment of articular cartilage along with its underlying bone. Such injuries occur when repetitive and prolonged joint overloading or a sudden impact produce high compressive stress to the tissue and high shear stress at the subchondral bone junction.(15) The documented history of these lesions dates back to at least 1558 when Ambrose Pare removed loose bodies from joints.(27) Recently an increasing amount of attention has been given to these injuries because they primarily affect a young athletic population and often lead to long-term disability. Many new treatment modalities are now in various stages of development. There still remains confusion between an osteochondral injury and osteochondritis dissecans. Many causes have been proposed, including trauma, vascular insult, genetics, endocrinopathies, hormonal abnormalities, ossification abnormalities, and multifactorial causes.(7, 9, 12, 28, 31) Although most evidence seems to support trauma as the primary contributory factor, there is a lack of traumatic history in many instances and a reported incidence of bilaterality in 20% to 30% of cases.(7, 12, 37) Many authors believe all of these lesions are fractures secondary to trauma,(6, 10, 29) although the traumatic event is not always significant enough or recent enough to be remembered. Aichoth,(1) in 1971, concluded that these lesions were fractures and that failure to unite represented osteochondritis dissecans. This article addresses the history and physical examination for the areas most commonly involved. The knee is affected most, and probably includes 75%(12, 28, 31) Of all osteochondral injuries. The surface of any diarthrodial joint is susceptible to an osteochondral injury, but the main areas of involvement include the knee, elbow and ankle. Osteochondral injuries commonly involve an active and athletic population, usually ranging from the second to the fourth decades in age.(7, 37) They are rarely seen before the age of 10 and seldom after the age of 50.(12) Osteochondral injuries occur two to three times more frequently(7, 37) in men than in women; however, the incidence in females has increased secondary to rising emphasis on participation in organized sports at a younger age.(9).
