Despite cases that have supported a de novo mechanism in the adult form, many experts believe that the adult lesions represent acute injury or are a persistent form of JOCD.
Since early recognition of JOCD is critical in the management, and ultimately the prognosis of the pathology, awareness of the subtle clinical symptoms and a high degree of suspicion in young individuals with non-specific knee pain are important.
The clinical presentation of JOCD of the knee is heavily dependent on the stage of pathology, including the size and stability of the lesion.
As stressed above, it is imperative for JOCD to be detected in an early stage so that adequate time is reserved for growth plate fusion, to increase the likelihood of more complete healing and a better prognosis.
Cahill and Ahten (6) reported characteristic trends observed in patients diagnosed with JOCD.
Wilson's sign has been a traditional orthopedic test designed to aid in the diagnosis of JOCD, as the test attempts to impinge the tibial spine into the lesions at the classic location of the posterolateral aspect of the medial femoral condyle.
Due to the nonspecific nature of the clinical signs and symptoms of this pathology, diagnosis and characterization of JOCD is dependent on imaging.
Most authors agree that conventional radiography should be the initial step for the diagnosis of JOCD and other osseous differentials in the knee as it allows determination of the location and size of the lesion as well as the skeletal maturity of the patient.
Nuclear medicine, specifically technetium-99m methylene disphosphonate bone scans, has been used for assessment of JOCD lesions.
However, this modality has also been of limited use in providing information on JOCD lesion's stability or healing potential as its ability to assess the non-calcified aspect of the joint, which is necessary to determine prognosis, is poorly visualized.
Currently, magnetic resonance imaging (MRI) is the preferred imaging modality for both diagnosis and the assessment of healing potential of JOCD of the knee due to its ability to provide excellent anatomical detail of both the bone and soft tissues structures with the absence of harmful ionizing radiation.
It has been noted the presence of a T2 signal intensity surrounding the JOCD lesion only indicates instability if it has the same signal intensity as the adjacent joint fluid, is surrounded by a second rim of low T2 signal intensity, or has multiple breaks in the subchondral bone plate.