3. Osteochondral fracture of the lateral femoral condyle is a rare injury of the knee joint, which mostly occurs in adolescence 1.In adolescence, the cartilage‐bone interface is the weakest transitional area in the knee joint, and there is no obvious boundary between calcified and uncalcified cartilage 2.The biomechanical strength of immature osteochondral junction was lower … Int Orthop. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. MRI assessment of osteochondral allografts includes evaluation of graft signal intensity, defect fill, cartilage edge integration at host-graft junction, articular surface congruity, subchondral bone plate congruity and bone marrow signal, osseous integration, and presence of cystic changes of graft. (A) Osteochondral defect: the bone defect is smaller than the overlying chondral defect. Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. In up to 40% of cases, patients give a history of trauma as the inciting event 3. Numerous surgical approaches have been tried, including drilling, bone grafting, replacement of bone fragment and pinning 5. Joint effusions and synovitis are often present. Kocher MS, Tucker R, Ganley TJ et-al. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. AJR Am J Roentgenol. The abnormality is subtle and is best appreciated on the magnified lateral image. It is often associated with intraarticular loose bodies. Significant improvements in pain and function of the knee joint were identified by the evaluation at 12 months after surgery. A chondral defect is a defect in the articular (hyaline) cartilage at the end of the bones. The Extraosseous and Intraosseous Arterial Anatomy of the Adult Elbow *(dagger). The exact incidence and prevalence within … © Copyright osteochondritis dissecans surgical staging, differential diagnosis of erosive arthritis, repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity, valgus stress / compressive force on the vulnerable  chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the aetiology for OCD of the capitellum, In the talus, 96% of lateral lesions and 62% of medial lesions were associated with direct trauma, family history: epiphyseal dysplasia has been postulated as a subset of OCD, femoral condyles are most common site accounting for ~95% of all cases:Â, variable signal overall with intermediate to low signal adjacent to fragment and variable fragment signal, the high signal line demarcating fragment from bone usually indicates an unstable lesion however false positives can result from oedema, low signal loose bodies, outlined by high signal fluid, donor defect filled with high signal fluid, enhancement indicates the viability of the lesion, high signal intensity rim at the interface between the fragment and the adjacent bone on T2-weighted MR image, high signal intensity line extending through the articular cartilage overlying the lesion, focal osteochondral defect filled with joint fluid, indicating complete detachment of the fragment, persistent pain with activity: ~ 2/3 following surgical management of knee and 40% following surgical management of elbow, normal irregular distal femoral epiphyseal ossification. Resnick D, Kransdorf MJ. St Vincent's University Hospital Radiology Department 2020, Neuropathic joint – Charcot-Marie-Tooth disease, Avascular necrosis – subchondral collapse. Plain radiographs should be the first step in the evaluation of knee pain, however, unless advanced changes are present and/or a meticulous technique employed, early findings of osteochondritis dissecans may be occult. The intercondylar "notch" view is very helpful. The combined use of standard and newer magnetic resonance (MR) imaging techniques makes it possible to evaluate both the morphologic status and the biochemical contents of the repair tissue (,1–,9). Blue arrow points to crescentric lucency in the convex surface of the medial condyle of the knee. Epub 2017 Jun 22. It was first described by the German surgeon Franz Konig in 1888. (2003) ISBN:0781738954. To test for osteochondral defects, physicians may extract a sample of fluid from your swollen knee with a small needle. They are a common source of knee problems in children and young adults. Also, smaller osteochondral defects can be treated with technique 1. (2006) ISBN:3131405619. When surgery is performed, the results in most cases are only "fair". 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. The exact aetiology is uncertain and controversial, with the majority of cases thought to be the result of trauma 4. His radiographs show an osteochondral defect involving the lateral aspect of his medial femoral condyle (the most common location to see this condition). It is known from long-term followup studies, such as those conducted by Linden, 7 that osteochondritis dissecans diagnosed in adulthood is likely to lead to the development of early onset osteoarthritis. 79 (11): 1653. Ribbing S. The hereditary multiple epiphyseal disturbance and its consequences for the aetiogenesis of local malacias--particularly the osteochondrosis dissecans. 4.8a–c. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 13. 38 (5): 1478-1495. (2003) Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. The Plan operates in Massachusetts under the trade name Boston Medical Center HealthNet Plan and in other states under the trade name Well Sense Health Plan. Osteochondral lesions are acquired, potentially reversible injuries of the subchondral bone with or without associated articular cartilage involvement. (2000) Foot & ankle international. Maeurer J. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. 1. Osteochondral defects (OCD) or lesions (OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone plate and subchondral cancellous bone. The next most common location to see an … Long-term results after operative treatment of osteochondritis dissecans of the knee joint-30 year results. 7. Imaging strategies for the knee. The articular cartilage imaging group of the International Cartilage Repair Society has issued detailed recommendations with r… Symptoms are variable and range from asymptomatic to significant pain and locking (suggesting loose body formation). 15. An osteochondral lesion is seen at the posterior weightbearing surface of the medial femoral condyle. The Athlete's Shoulder. 1990;155 (3): 549-53. 6. This 26 year old man has right knee pain. 19 (5): 477-84. Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint resulting in chronic pain in the knee and difficulties performing normal activities of daily living. W B Saunders Co. (2005) ISBN:0721602703. A Consensus Statement. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the aetiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Red arrows point to osteochondral defect and bone edema on T1 and stir OCD usually causes pain during and after sports. (2006) The American journal of sports medicine. Osteochondritis dissecans (OCD) most commonly affects the knee. (2018) RadioGraphics. A hyaline-like cartilage completely filled the defect and was congruent with the surrounding normal cartilage as revealed by magnetic resonance imaging (MRI), a second-look arthroscopy and histological assessment. 8. 24 (4): 286-99. 4. The most commonly affected joint is the knee, with the majority of lesions located in the femoral condyle and/or patellofemoral articulation (Wheeless, 2012). (1997) The Journal of Bone and Joint Surgery (american Volume). Keywords: Knee, Cartilage, Synovitis, Pigmented villonodular Pigmented villonodular synovitis (PVNS) is a rare, benign, but potentially recurrent condition with an estimated incidence of 1.8 per million. 2. {"url":"/signup-modal-props.json?lang=gb\u0026email="}. 2 article feature images from this case 13 public playlist includes this case Glossary of terms for musculoskeletal radiology. Autologous chondrocyte implantation segmental-sandwich technique. The defect was debrided down to the subchondral bone with an arthroscopic shaver and sized with the osteochondral autograft transplantation system, as shown in Fig. ... (20)Department of Radiology, Emek Medical Center, Clalit Healthcare Services, Afula, Israel. Unable to process the form. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Recognition and Treatment of Osteochondritis Dissecans of the Femoral Condyles. Thieme Publishing Group. 21 (2): 119-26. The abnormality is subtle and is best appreciated on the magnified lateral image. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. ~50% (range 35-70%) of patients achieve a "good to excellent" clinical outcome 3 but even in these cases, the majority develop osteoarthritis. Osteochondritis dissecans. A fluid-filled break in the articular surface (arrowhead) is present, and there is fluid at the anterior interface of the fragment (arrow). 34 (7): 1181-91. The four classic signs of instability described at MRI include 14 : Spontaneous healing is usual unless there is an unstable fragment, and treatment revolves around rest and immobilisation for up to a year 5. Onset is between childhood and young adults age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. MRI is the modality of choice, with high sensitivity (92%) and specificity (90%) 4 in the detection of separation of the osteochondral fragment. 11. Osteochondral defect. 10. As the process progresses, more pronounced contour abnormalities, fragmentation and density changes (both lucency and sclerosis) become evident. Management of osteochondritis dissecans of the knee: current concepts review. Recently established procedures like autologous chondrocyte implantation or matrix-associated chondrocyte implantation yield good results, but include the disadvantage of two-step procedures. 1A, 1B, and 1C), whereas in five (50%) of the 10 patients, the chondral defects were isolated to the midlateral weight-bearing portion of the lateral femoral condyle (Figs. Cause of a “locking knee” Osteochondritis dissecans. Check for errors and try again. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint Cartilage. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 1994;29 (4): 302-306. Early findings include subtle flattening or indistinct radiolucency about the cortical surface. Findings are similar to those seen on plain radiographs. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. Objective: To identify preoperative imaging-based indicators of knee degeneration that correlate with graft failure risk and postoperative clinical outcome scores after osteochondral graft treatment for chondral defects of the knee. It was decided to use the superomedial aspect of the trochlea as the donor sight for the osteochondral autograft. Tol JL, Struijs PA, Bossuyt PM et-al. Osteochondral defects are focal areas of damage of the cartilage and underlying bone. 2008;32 (2): 217-21. (21)Department of Radiology, PennMedicine, Philadelphia, PA, USA. Osteochondral defects (OCDs), often used interchangeably with osteochondritis dissecans in the juvenile population, are focal areas of articular cartilage wear/damage resulting in a loss of cartilage and inflammation of the adjacent subchondral bone (Juneau et al., 2016; Modarresi & Jude, 2015; Wheeless, 2012). See osteochondritis dissecans article for a general discussion. Edema is present in the bed of the defect (asterisk). De smet AA, Fisher DR, Graf BK et-al. A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). (2018). Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. Plain film showed an osteochondral defect in the medial femoral condyle. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. The defect may be found on the femoral condyle, tibial plateau, patella, talus, humerus or on other articular surfaces. Sailors ME. Osteochondritis dissecans of the elbow. A modified MR imaging classification is suggested based on a combination of the appearances of such lesions at MR imaging and their short-term osteochondral sequelae. J Athl Train. (1955) Acta orthopaedica Scandinavica. For the same photo without the arrows, click here. Treatment of osteochondral lesions of the knee remains a major challenge in orthopedic surgery. Zhenyu Cai, Zhao Wei, Mei Wu, Saeed Jerban, Hyungseok Jang, Shaolin Li, Xuchun Yuan, Ya-Jun Ma, Knee osteochondral junction imaging using a fast 3D T1-weighted ultrashort echo time cones sequence at 3T, Magnetic Resonance Imaging, 10.1016/j.mri.2020.08.003, 73, (76-83), (2020). A significant number of osteochondral injuries involve the midlateral weight-bearing portion of the lateral femoral condyle and are more posterior than would be expected after transient dislocation of the patella. Osteochondral Treatments for Defects of the Knee + Plan refers to Boston Medical Center Health Plan, Inc. and its affiliates and subsidiaries offering health coverage plans to enrolled members. Tetyana Gorbachova, Yulia Melenevsky, Micah Cohen et-al. In the talus, 96% of lateral lesions and 62% of … Osteochondritis dissecans (OCD) is the end result of the aseptic separation of an osteochondral fragment with the gradual fragmentation of the articular surface and results in an osteochondral defect. Steadman JR, Briggs KK, Rodrigo JJ et-al. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. 5. Osteochondral defect is a term for a localized defect of the articular cartilage and subchondral bone. Michael JW, Wurth A, Eysel P et-al. Introduction. William Palmer, Laura Bancroft, Fiona Bonar et-al. When the fragment is unstable or displaced, without treatment patients are susceptible to premature secondary osteoarthritis. Kevin E. Wilk, Michael M. Reinold, James Rheuben Andrews. This is essential in determining management. Osteochondral autograft transplantation surgery was initially conducted in small chondral defects of the knee but has been used in multiple other joints like the hip, ankle, shoulder and elbow in the meantime. On MRI the defect was measured to be in excess of 1.2 cm and a partial tear of the ACL and oedema in the medial facet of the anterior patellofemoral compartment was demonstrated. Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. Osteochondral defect. 2018 Oct;9(4):346-362. doi: 10.1177/1947603517715736. Bone and joint imaging. 9. Osteochondritis dissecans (OCD) : general. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. Bauer M, Jonsson K, Josefsson PO et-al. Dähnert W. Radiology review manual. Authors ... other techniques reconstruct the defect with additional osteochondral grafts or cell-based procedures such as chondrocyte transplantation. (1992) Clinical orthopaedics and related research. If an osteochondral fragment becomes unstable and displaced, then donor site and intra-articular fragment may be seen. The next most common location to see an osteochondral defect is in the dome of the talus. The advent of new procedures for repairing cartilage in knee and ankle joints has increased the need for accurate noninvasive methods to objectively evaluate the success of repair. Large osteochondral defects involving the femoral condyles of the knee have frustrated orthopaedic surgeons for generations. (B) Preparation of the bone defect: a high-speed bur, usually 8 mm in diameter, removed all subchondral sclerotic bone back to … A long-term follow-up study. Treatment strategies in osteochondral defects of the talar dome: a systematic review. His radiographs show an osteochondral defect involving the lateral aspect of his medial femoral condyle (the most common location to see this condition). It occurs when a small segment of bone begins to crack and separate from its surrounding region due to a lack of blood supply. Other postulated causes include 4: Many joints can be affected, but typical locations include: See osteochondral injury staging and osteochondritis dissecans surgical staging. Scaffolds for Knee Chondral and Osteochondral Defects: Indications for Different Clinical Scenarios. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. CT has the advantage of sectional imaging through the joint and multiplanar reformats. Lippincott Williams & Wilkins. It is a morphologic finding that may be seen in various conditions and that produces a scalloped defect along the articular surface of the bone (Fig 1). This 26 year old man has right knee pain. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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