Osteochondritis Dissecans: Wilson's Sign Revisited

• Published in: The American journal of sports medicine 2003-09, Vol.31 (5), p.777-778
• Main Authors: Conrad, Jeffrey M., Stanitski, Carl L.
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Biomechanical Phenomena; Bones; Case studies; Child; Diagnosis; Diagnosis, Differential; Female; Gait; Humans; Investigative techniques, diagnostic techniques (general aspects); Knee; Male; Medical sciences; Osteoarticular system. Muscles; Osteochondritis; Osteochondritis Dissecans - complications; Osteochondritis Dissecans - diagnosis; Osteochondrosis; Osteopathic medicine; Pain - etiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Physical Examination; Range of Motion, Articular; Retrospective Studies; Skeletal system; Sports medicine; Surgery; Tibia - pathology; Torsion Abnormality
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/03635465030310052301

Background In 1967, Wilson described a clinical sign that he thought was diagnostic of medial femoral osteochondritis dissecans. He postulated that impingement of the tibial eminence on the osteochondritic lesion caused pain and a resultant compensatory lateral rotation during gait. He described reproducing the pain by internally rotating the patient's tibia during knee extension between 90° and 30° of flexion and then relieving that pain by externally rotating the tibia. He correlated healing of the lesion with conversion of the sign from positive to negative. Purpose To assess the validity of Wilson's assertions. Study Design Retrospective clinical and radiographic case analysis. Methods Case records from 17 juvenile patients (ages 9 to 12) and 15 adolescent patients (ages 13 to 17) with medial femoral osteochondritis dissecans were reviewed for the presence or absence of Wilson's sign at initial and subsequent visits. Results: Of the 32 patients, 24 (75%) with radiographically evident osteochondritis dissecans at the initial visit had negative signs. The remaining eight patients with positive signs had conversion of the sign to negative with lesion resolution. Conclusions In this series, Wilson's sign was of minimal clinical diagnostic value. When positive, the sign is useful as a clinical monitor during treatment.