Osteochondritis dissecans: Wilson's sign revisited.
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 degrees and 30 degrees 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.


OBJECTIVE
To assess the validity of Wilson's assertions.


METHODS
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.
Conrad
Jeffrey M
JM
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Stanitski
Carl L
CL
D000293:Adolescent; D001696:Biomechanical Phenomena; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D010008:Osteochondritis Dissecans / Q000150:complications / Q000175:diagnosis*; D010146:Pain / Q000209:etiology*; D010808:Physical Examination; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013977:Tibia / Q000473:pathology; D014102:Torsion Abnormality