201 Views

1404 - Acute right knee pain in an adult following paintball activity

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

PS

Peter Scriven, DO

Resident Physician
Ohio State University
Grove City, Ohio, United States

Co-Author(s)

KA

Karan Arul, MD

Resident Physician
Ohio State University
Columbus, Ohio, United States
MK

Michael Krill, MD

Attending Physician
Ohio State University
Columbus, Ohio, United States

Case Diagnosis: Osteochondritis dissecans

Case Description: A 30-year-old male with no significant past medical history presented to a sports medicine clinic with complaint of right medial knee pain for six weeks, which was severely limiting ambulation. His pain began while playing paintball, which involved repetitive squatting down movements and knee flexion. After paintball, he had worsening, intermittent, right knee pain, which was exacerbated by deep squats and sitting on a toilet. Symptoms improved with activity modification, ibuprofen, ice, and heat. Physical exam demonstrated a right knee effusion, pain with palpation at the medial and lateral joint line, medial and lateral patellar border, and pain with knee hyperflexion. He had full range of motion with 5/5 muscle strength throughout. Initial right knee radiograph demonstrated a large osteochondral defect of the lateral surface of the medial femoral condyle with loose body and was later confirmed by MRI. He was referred to orthopedics for surgical evaluation.

Discussions: Osteochondritis dissecans (OCD) is a relatively rare condition most often seen in male children and adolescents, but can be seen in adults. The etiology is unknown, but multiple theories exist including repetitive trauma, ischemia, or genetic predisposition. Work-up involves plain radiographs to diagnose OCD with MRI being utilized for grading lesions or in cases of high suspicion with negative radiographs. Treatment varies depending on age, location of disease, and severity. Management includes avoiding aggravating activity, immobilization with cast, splint, or brace, utilizing anti-inflammatory medications, physical therapy, or surgery.

Conclusions: While osteochondritis dissecans is relatively rare, it is an important diagnosis to maintain a high index of suspicion for. Osteochondritis dissecans has subtle clinical findings and can often mimic other causes of knee pain. Early diagnosis with appropriate management may prevent long-term sequelae such as osteoarthritis, joint damage, pain, or debility.