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Osteochondritis Dissecans: Wilson’s Sign Revisited

From the Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina

^* Address correspondence and reprint requests to Carl L. Stanitski, MD, Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, #708 CSB, Charleston, SC 29425

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.

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