Osteochondritis Dissecans of the Ankle

Abstract

The pathological condition known as osteochondritis dissecans has a surprisingly long history in medical literature. Various writers have pointed out that Alexander Munro (18) recognized the condition in 1738. It was not until 1887, however, that König (13) gave the first accurate description of the anatomy and pathology of the condition. Both men based their reports on surgical operations and dissection of cadavers. With the widespread use of diagnostic roentgenology the diagnosis is no longer a rarity. The name “osteochondritis dissecans” was suggested by König (14) in 1905. Although, as Burr (4) points out, it is not entirely appropriate, in that it suggests an inflammatory condition, it has become hallowed by usage and will no doubt remain along with many other terms which the march of medical progress has rendered inaccurate. Osteochondritis dissecans is an aseptic necrosis of subchondral bone and the overlying cartilage. Usually a small area of bone adjacent to the articulating surface is affected. When it becomes necrotic, the overlying cartilage is devitalized, and frequently the entire fragment separates out and forms an intra-articular loose body. Recurrent pain, effusion, weakness, and the development of osteoarthritic changes constitute the usual sequence of events if the condition is untreated. It seems likely that the lesion properly belongs, as Phemister (20) has pointed out, in the group of aseptic necrosing lesions of bone, which includes necrosis of the fractured femoral head, Kienböck's disease, Legg-Perthes' disease Köhler's, Freiberg's, Osgood-Schlatter's, and others. The early writers all referred to involvement of the knee joint, but many reports have since appeared describing the lesion in other areas, including the femoral head, the head of the humerus, the capitellum of the humerus, the ankle, the metacarpophalangeal joints, and recently the supratrochlear septum of the humerus (Crysler and Morton, 8). It appears that the condition is rather uncommon in the ankle, as few reports are to be found in the literature, and only a very occasional one in English. The earliest accounts of ankle involvement appeared in the German literature in 1927 (Breitländer, 2; Harms, 10). Subsequently, a few additional cases were published, the majority of them in foreign-language journals until, at the time of Mensor and Melody's (17) excellent review in 1941, a total of 19 cases had been recorded. Their case brought the total up to 20. Four further papers on the subject have appeared in the past five years, but unfortunately only two of these are available to us. This paper is a presentation of four additional proved cases. Three of these were seen in the Atlantic Command of the Royal Canadian Navy and one at the McGregor Clinic, Hamilton, Ontario. The etiology of the condition has been the subject of considerable discussion, which has been well summarized by Conway (7).