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CASE REPORT Open Access
Osteochondritis dissecans located on the
medial tibial plateau: a case report
Yimin Zhang* and Xiaoguang Liu*
Abstract
Background: Osteochondritis dissecans are typically located mainly on the femoral condyle, with reported but less
common cases of patella involvement. In this case report, we reported a rare case of osteochondritis dissecans
located on the medial tibial plateau.
Case presentation: A 26-year-old Han Chinese woman presented with a lesion on her left medial tibial plateau.
She was treated by arthroscopy for her knee condition. During the operation, a primary diagnosis of
osteochondritis dissecans on her medial tibial plateau was indicated by an osteochondral fragment. Arthroscopic
removal of the fragment was then performed. Histological examination which was done by a pathologist after the
operation supported the positive pathology of osteochondritis dissecans.
Conclusions: The common site of osteochondritis dissecans development in the knee is on the femoral condyle,
and some develop on the patella. In this case report, it was proven that osteochondritis dissecans can also take
place on the tibial plateau, although it is very uncommon.
Keywords: Osteochondritis dissecans, Knee, Tibial plateau
Background
The term osteochondritis dissecans (OCD) was first
coined in 1887 by König [1], who suggested that this
pathology was mainly due to inflammation, not trauma.
But, at present, OCD is regarded as an acquired lesion
of subchondral bone characterized by degrees of osse-
ous resorption, collapse, and sequestrum formation
with possible involvement of the articular cartilage
through delamination without acute osteochondral
fracture. Thus, many causes, such as trauma, inflam-
mation, genetics, vascular abnormalities, and constitu-
tional factors [2] were postulated for the etiologies
responsible for OCD. The exact pathophysiology, nat-
ural history, and treatment remain unclear, but some
advancement has been made in our understanding of
OCD [3].
Common sites for OCD of the knee include the lateral
aspect of the medial femoral condyle, the central portion
of the medial femoral condyle, the lateral femoral con-
dyle, the medial aspect of the medial femoral condyle,
and the patella [4]. In this case report we reported a case
of OCD on the medial tibial plateau, which is far more
uncommon.
Case presentation
A 26-year-old Han Chinese woman presented with a
lesion on her left medial tibial plateau. She was an of-
fice employee with no athletic history; she denied any
injury or symptom before she experienced a sudden
sharp pain and instability of the affected knee while
going downstairs. Her symptoms did not spontan-
eously relieve after 2 days of rest so she presented to
our hospital. A physical examination revealed a swol-
len knee joint with Floating patellar test (+), Anterior
drawer test (−), Posterior drawer test (−), Lachman
test (−), Abduction stress test (−), and Adduction
stress test (−). A McMurray sign could not be done
accurately due to pain and swelling in her knee from
20° of extension to 120° of flexion. She had no neuro-
logical symptoms and no other physical signs were
apparent. Of interest, a mistaken diagnosis of a lower
insertion avulsion fracture of anterior cruciate liga-
ment could be made at first glance at X-ray and
magnetic resonance imaging (MRI) (Figs. 1 and 2).* Correspondence: ymzh69@hotmail.com; 15216361135@163.comWeifang People’s Hospital, Weifang, China
© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Zhang and Liu Journal of Medical Case Reports  (2017) 11:1 
DOI 10.1186/s13256-016-1164-4
She was treated with arthroscopy (Fig. 3). During the
operation, a primary diagnosis of OCD on her medial
tibial plateau was indicated by an osteochondral frag-
ment near the lower insertion of her anterior cruciate
ligament, and the fragment was removed arthroscopi-
cally. Microfracture of the defect area was then per-
formed. Histological examination which was done by a
pathologist after the operation supported the positive
pathology of OCD.
Postoperatively, weight-bearing was disallowed for the
repair of the osteochondral defect where the microfrac-
ture was done, whereas quadriceps muscle training, such
as straight leg raising, was encouraged. Continuous pas-
sive motion was also used for extension and flexion of
her knee for 3 weeks after her operation. Three weeks
later, rehabilitation began from partial weight-bearing up
to total weight-bearing with no effusion of her knee
joint. At 3 months of follow-up, she could walk and ride
a bicycle freely except for a little pain after lengthy activ-
ity, particularly when going upstairs and downstairs. She
was asked to avoid competitive activities for at least half
a year or even for all her life, but muscle training was
necessary; we suggested some helpful sports such as
swimming. At 6 months, she was told that she could en-
gage in long walks and even jogging with full knee
flexion and extension.
Discussion
OCD is a well-recognized yet poorly understood condi-
tion. The etiology and treatment of this pathology still
remain controversial. On many occasions, the symptoms
of OCD are not very clear, leading to a delayed or diffi-
cult diagnosis. Radiography may be helpful as an X-ray
is reliable for a diagnosis and MRI can be obtained for
further characterization of the lesion [5].
When considering an OCD diagnosis, the presenta-
tion, clinical signs, and a radiographic examination
are indispensable. Once the diagnosis has been estab-
lished, treatment strategies such as conservative ther-
apy, arthroscopic drilling [6], screw fixation, bone
grafting, fixation with autograft osteochondral plugs,
and salvage procedures (autologous chondrocyte im-
plantation and fresh osteochondral allografts) should
be considered [4].
In this report, we briefly examined the evolution of
our understanding of OCDs from Professor König’s first
description in 1887 until the present. The diagnosis of
an OCD was mainly dependent on imaging, such as an
X-ray or MRI; the location of the OCD could also be
fully characterized.
Fig. 1 X-ray image showing an osteochondral fragment on the tibial
plateau that may be confused for an avulsion fracture of the tibial
insertion of the anterior cruciate ligament (red arrow)
Fig. 2 The Osteochondral fragment and its location on medial tibial plateau in magnetic resonance images. (a) Red arrow revealed the
osteochondral fragment and its location on medial tibial plateau in sagittal magnetic resonance images. (b) Red arrow revealed the
osteochondral fragment and its location on medial tibial plateau in coronal magnetic resonance images
Zhang and Liu Journal of Medical Case Reports  (2017) 11:1 Page 2 of 3
The most common site of OCD development in the
knee is the lateral aspect of the medial femoral condyle,
which occurs in 51% of cases according to Hefti et al. [4].
In their multicenter series of 509 knees in 452 patients,
the authors found other sites that were involved less fre-
quently: the central medial femoral condyle (19%), the lat-
eral femoral condyle (17%), the medial side of the medial
femoral condyle (7%), and the patella (7%). Irregular ossifi-
cation centers of the distal femoral condyle tend to be
found more posterior on the condyle (although they can
be anywhere on the condyle) and are associated with pa-
tients of a younger age. In the literature, some authors
have reported that OCD can occur on the lateral tibial
plateau [7], and we supplemented occurrences of OCD lo-
cated on the medial tibial plateau through this case. So,
the pathogenesis of such a lesion should be discussed in
future studies.
Conclusions
The common site of OCD development in the knee is
on the femoral condyle, and some develop on the pa-
tella. In this case report, it is proven that OCD can also
take place on the tibial plateau, although it is very
uncommon.
Abbreviation
OCD: Osteochondritis dissecans
Acknowledgements
None.
Funding
We have no sources of funding to declare at this time.
Availability of data and materials
Not applicable.
Authors’ contributions
Both authors were concerned with the treatment. Both authors drafted the
manuscript. Both authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patient for publication of
this case report and any accompanying images. A copy of the written
consent is available for review by the Editor-in-Chief of this journal.
Ethics approval and consent to participate
Not applicable.
Received: 30 June 2016 Accepted: 30 November 2016
References
1. König F. Ueber freie korper in den gelenken. Dtsch Z Chir. 1887;27:90–109.
2. Jacobi M, Wahl P, Bouaicha S, et al. Association between mechanical axis of
the leg and osteochondritis dissecans of the knee: radiographic study on
103 knees. Am J Sports Med. 2010;38:1425–8.
3. Chambers HG, Shea KG, Carey JL. AAOS Clinical Practice Guideline: diagnosis
and treatment of osteochondritis dissecans. J Am Acad Orthop Surg.
2011;19:307–9.
4. Hefti F, Beguiristain J, Krauspe R, et al. Osteochondritis dissecans: a
multicenter study of the European Pediatric Orthopedic Society. J Pediatr
Orthop B. 1999;8:231–45.
5. Kijowski R, Blankenbaker DG, Shinki K, et al. Juvenile versus adult
osteochondritis dissecans of the knee: appropriate MR imaging criteria for
instability. Radiology. 2008;248:571–8.
6. Edmonds EW, Albright J, Bastrom T, et al. Outcomes of extra-articular, intra-
epiphyseal drilling for osteochondritis dissecans of the knee. J Pediatr
Orthop. 2010;30:870–8.
7. Towbin J, Towbin R, Crawford A, et al. Osteochondritis dissecans of the
tibial plateau. A case report. J Bone Joint Surg Am. 1982;64(5):783–4.
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Fig. 3 The normal distal anterior cruciate ligament insertion and the osteochondral fragment on the medial tibial platear during arthroscopy. (a)
Red arrow revealed the normal distal anterior cruciate ligament insertion. (b) Red arrow revealed the osteochondral fragment on the medial tibial
plateau near the insertion as seen during arthroscopy
Zhang and Liu Journal of Medical Case Reports  (2017) 11:1 Page 3 of 3


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