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Special Test

Wilson Test

Wilson Test is a provocative test that can be performed when osteochondritis dissecans of the knee is suspected.

See Also: Osteochondritis Dissecans

How do you perform the Wilson Test?

With the patient in a supine position, the examiner grasps the knee above the patella with one hand and simultaneously palpates the area around the medial joint space. He or she passively flexes the patient’s hip and knee to 90 degrees.

Then he or she asks the patient to actively extend the knee gradually while maintaining the tibia in internal rotation and to let the examiner know if pain occurs (This causes impingement of the ACL against the osteochondritis dissecans lesion on the medial cartilaginous surfaces).

From this position, the patient is instructed to externally rotate the tibia.

See Also: Knee Ligaments Anatomy
Wilson Test procedure

Another method to perform the Wilson’s Test:

The patient is Sitting with the knee flexed to 90°, the patient actively extends the knee while maintaining the tibia in internal rotation. The patient is told to stop the motion and hold the knee in the position in which pain is experienced. If pain is experienced, the patient is instructed to externally rotate the tibia while the knee is held at its present point of flexion.

Positive test if pain experienced during extension with internal tibial rotation that is relieved by externally rotating the tibia

Wilson’s Test
While the tibia is internally rotated, (A) the patient extends the knee. When pain is experienced, the patient externally rotates the tibia (B). In the presence of some OCDs, pain is relieved during the external rotation.

What does a positive Wilson Test mean?

In osteochondritis dissecans, joint pain occurs between 20 and 30° from the pressure on the joint and from the palpating fingers. The pain is typically reduced by external rotation of the lower leg.

The test is positive if pain experienced during extension with internal tibial rotation is relieved by externally rotating the tibia.

The classic site for osteochondritis dissecans and the pain that radiates from it is on the medial femoral condyle near the intercondylar fossa.

Wilson Test
Pain experienced during extension with internal tibial rotation
Wilson Test
Pain is relieved by externally rotating the tibia

Test Reliability

Wilson’s sign was of minimal clinical diagnostic value. When positive, the sign is useful as a clinical monitor during treatment.

It is not frequently used and has been shown to have a low rate of sensitivity.

Notes

This maneuver is meant to impinge the ACL against the classic osteochondritis dissecans lesion located adjacent to the intercondylar notch on the lateral aspect of the medial femoral condyle.

Osteochondritis dissecans is an aseptic necrosis that arises in the subchondral bone of the articular surfaces and disrupts the overlying cartilage. In its advanced stages, separation of parts of articular cartilage and underlying bone can occur, creating intra-articular loose bodies (joint mice).

The result is fragmentation (dissection) of both cartilage and bone, and the free movement of these osteochondral fragments within the joint space, causing pain and further damage.

Osteochondritis dissecans (OCD) is a rare cause of anterior knee or elbow pain in the young athlete.

Osteochondritis dissecans should always be considered in adolescents presenting with joint effusion and knee pain.

References

  1. Wilson IN: A diagnostic sign in osteochondritis dissecans of the knee. J Bone Joint Surg Am. 1967;49:477-480.
  2. Conrad JM, Stanitski CL. Osteochondritis dissecans: Wilson’s sign revisited. Am J Sports Med. 2003 Sep-Oct;31(5):777-8. doi: 10.1177/03635465030310052301. PMID: 12975201.
  3. Clinical Tests for the Musculoskeletal System 3rd Edition.
  4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
Last Reviewed
May 25, 2022
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

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