[43] Singer and Roy proposed that repeated valgus stress and a tenuous blood supply within the capitellum explain the frequent occurrence of OCD in this location. 1981 Jul-Aug. (158):59-69. Trauma may be direct, such as impaction fracture, or repetitive microtrauma, such as excessive normal compressive stress. Nofsinger C, Konin JG. [Medline]. [16] A short tau-inversion recovery sequence is the most sensitive. AJR Am J Roentgenol. 2006 Feb. 14(2):90-100. The Berndt and Harty radiographic classification of osteochondral lesions of the talus is as follows Grades 2b, 4b, and 5 are classified as unstable lesions of variable severity. Am J Sports Med. The knee, particularly the lateral aspect of the medial femoral condyle, is the most affected joint, and the elbow (capitellum) and ankle (talus) are affected to a lesser degree. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. [Medline]. Athanasiou KA, Niederauer GG, Schenck RC Jr. Biomechanical topography of human ankle cartilage. 2012 Jul 18. 28(2):229-32. Sagittal T1-weighted image of the ankle confirms osteochondritis dissecans of the tarsal navicular (arrowhead). Posterior longitudinal sonogram demonstrates a stable lesion with a nondisplaced bone fragment (asterisk), intact articular surface (arrowheads), and a narrow gap formation (arrow; courtesy of Dr Masatoshi Takahara). 2007 Feb. 28(2):154-61. Bui-Mansfield LT, Kline M, Chew FS. Perhaps, the only potential differential diagnosis is a dorsal defect of the patella, which occur in the ⦠Lateral radiograph of the knee reveals a calcified loose body (white arrowhead) in the infrapatellar fat pad and lucency in the articular surface of the patella (black arrowhead). 1992. AAOS Clinical Practice Guideline: diagnosis and treatment of osteochondritis dissecans. Aichroth P. Osteochondritis dissecans of the knee. [49]. J Bone Joint Surg [Am]. [Medline]. The advantage of ultrasound is dynamic scanning with motion of the evaluated joint. Keywords: [Medline]. Lateral radiograph of the leg demonstrates osteochondritis dissecans in the posterior aspect of the talar dome (arrowhead). Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. Bowen JR, Kumar VP, Joyce JJ 3d. 1988. MRI findings of osteochondritis dissecans of the capitellum with surgical correlation. Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. AJR Am J Roentgenol. Zanon G, DI Vico G, Marullo M. Osteochondritis dissecans of the talus. Extreme obesity has also been strongly associated with an increased risk of OCD overall and OCD of the elbow and ankle specifically. [Medline]. [72] : Stage I - Bone marrow edema (subchondral trabecular compression; radiograph results are negative with positive bone-scan findings), Stage IIb - Incomplete separation of the osteochondral fragment, Stage III - Fluid around an undetached, undisplaced osteochondral fragment. Coronal CT of the ankle demonstrates a nondisplaced osteochondral fragment. 1995 Jul. 17:1011. J Bone Joint Surg Am. [Medline]. 2007 Oct-Nov. 27(7):821-5. Early findings include subtle flattening or indistinct radiolucency about the cortical surface. Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans. 2000 Nov. 175(5):1305-8. 38 (5):e296-e299. 2014 Jan-Mar. 41(A):988-1020. [Guideline] Chambers HG, Shea KG, Anderson AF, et al. Articular epiphyses fail as a result of compression. During the physical exam, your doctor will press on the affected joint, checking for areas of swelling or tenderness. OCD of the scaphoid has been observed in bakers, boxers, pelota players, acrobats, and pneumatic drill workers, all of whom are subjected to repeated minor trauma of the wrist. Posterior longitudinal sonogram reveals an unstable lesion with a slightly displaced fragment (asterisk) and a wide gap formation (arrows; courtesy of Dr Masatoshi Takahara). The classification system of the ICRS, created by an international multidisciplinary, multi-expert consortium, did markedly improve the accuracy, but consistency among different readers was lacking. This article is a review of the current understanding of the etiology, pathogenesis, and how to diagnose and treat knee osteochondritis dissecans (OCD) followed by an analysis of and outcomes of the ⦠[45] Disparity in the mechanical properties of the central radial head and lateral capitellum probably is a factor in the initiation and localization of OCD of the capitellum (see the images below). Kocher MS, Tucker R, Ganley TJ, Flynn JM. Epub 2014 May 9. 1989 Sep-Oct. 30(5):552-4. Radiology. Acta Orthop Belg. Although it can occur from childhood through adult life, the majority of patients are 10 to 20 years of ⦠In this paper, we utilize arthroscopy as the gold standard to determine if MRI can predict OCD lesion stability, the most important information to guide patient treatment decisions. 2009 Mar. 2014 Aug. 42 (8):1963-71. Osteochondritis dissecans of the humeral head. Goldman AB, Hallel T, Salvati EM. Yoshizuka M, Sunagawa T, Nakashima Y, Shinomiya R, Masuda T, Makitsubo M, et al. Mosby-Year Book. Osteochondritis Dissecans. Preoperative Evaluation of the Grade and Stability of Osteochondritis Dissecans of the Knee by Magnetic Resonance Imaging. 1986 Jul. Juvenile versus adult osteochondritis dissecans ⦠[67] : Grade A - Articular cartilage is smooth and intact but may be soft or ballottable, Grade B - Articular cartilage has a rough surface, Grade C - Articular cartilage has fibrillations or fissures, Grade D - Articular cartilage with a flap or exposed bone, Grade E - Loose, nondisplaced osteochondral fragment, Grade F - Displaced osteochondral fragment. Osteochondritis dissecans is suggested by a loss of the sharp cortical line of the articular surface (see the images below). The usual sites of OCD of the talar dome are the posteromedial aspect (56%) and the anterolateral aspect (44%) of the talus. Shoulder Elbow. Anteroposterior radiograph of the knee 1 year after injury reveals an anterior cruciate ligament reconstruction (arrowheads) and lucency (arrow) in the lateral tibial plateau. 1976 Dec. 47(6):664-7. Because clinical findings are often subtle, diagnosis requires a high index of ⦠Weiss JM, Shea KG, Jacobs JC Jr, Cannamela PC, Becker I, Portman M, et al. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New ZealandDisclosure: Nothing to disclose. If an o⦠J Pediatr Orthop. Satake et al found that MRI had a sensitivity of 84% for OCD, Filardo G, Andriolo L, Soler F, Berruto M, Ferrua P, Verdonk P, Rongieras F, Crawford DC. [Medline]. 2005 Aug. 71(4):484-8. The lack of cartilage visualization can be overcome by using intra-articular contrast material. Trauma is most likely the primary insult, and ischemia a secondary injury. 33 (2):221-50. Novel radiographic feature classification of knee osteochondritis dissecans: a multicenter reliability study. Skeletal Radiol. [13]. Clipboard, Search History, and several other advanced features are temporarily unavailable. [22, 20, 23, 24, 25, 26], Scintigraphic findings are nonspecific, demonstrating a mild-to-marked increase in focal uptake in the involved bone, depending on the age of the osteochondritis dissecans. 12(4):317-22. [Medline]. Wood D, Carter KR. [27, 28, 2]. 1-8. Hamada S, Hamada M, Nishiue S. Osteochondritis dissecans of the humeral head. [11, 12, 9] The shortcomings of CT are applied radiation, especially in pediatric patients, and lack of cartilage visualization. Kamhi E, MacEwen GD. Blood vessels within the epiphysis are incompetent because of thrombosis or microfractures of the trabeculae, which results in poor healing. Sagittal reformatted image of the ankle reveals a nondisplaced osteochondral fragment. [Medline]. Clinical Value of MRI in Assessing the Stability of Osteochondritis Dissecans Lesions: A Systematic Review and Meta-Analysis. ⦠2018 Jun. Osteochondrosis dissecans. Curr Opin Pediatr. J Knee Surg. 11 (2):129-136. Osteochondritis dissecans is an aseptic necrosis of subchondral bone and the overlying cartilage. [Medline]. Ultrasonography of osteochondritis dissecans of the knee. Epub 2019 Jan 16. Osteochondritis dissecans occurs in approximately 15 to 29 per 100,000 patients. 2017 Mar. Osteochondritis dissecans of the tarsal navicular bone: imaging findings in four patients. [Medline]. Clin Orthop. Am J Sports Med. Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. [62, 63, 64, 65], Staging classifications of osteochondral lesions have been described best in the talus. J Bone Joint Surg [Am]. Douglas G, Rang M. The role of trauma in the pathogenesis of the osteochondroses. [59, 22, 60, 61]. [Medline]. Most of the patients are 10-20 years of age, with males affected about twice as often as females and a higher incidence occurring in young athletes. [Full Text]. Sagittal T2-weighted image of the knee demonstrates a calcified loose body (white arrowhead) in the infrapatellar fat pad. Radiography of the elbow for evaluation of patients with osteochondritis dissecans of the capitellum. It occurs when a small segment of bone begins to separate from its surrounding region ⦠6th ed. Prevalence and Clinical Characteristics of Osteochondritis Dissecans of the Humeral Capitellum Among Adolescent Baseball Players. Pill SG, Ganley TJ, Milam RA, Lou JE, Meyer JS, Flynn JM. (148):245-53. Sagittal T2-weighted image of the knee reveals an articular defect (arrow) and subchondral bone marrow edema (arrowhead) in the medial tibial plateau. [Medline]. Diseases & Conditions, 2001 Osteochondritis dissecans (OCD) can affect both adults and children, however the imaging characteristics and significance of imaging findings can differ in the juvenile subset with open physes. [Medline]. Detterline AJ, Goldstein JL, Rue JP, Bach BR Jr. 2007 Oct. 36(10):929-35. AJR Am J Roentgenol. Interobserver reliability of the classification of capitellar osteochondritis dissecans using magnetic resonance imaging. Sports Med Arthrosc Rev. 23 (2):213-219. Mohr B, Taylor RG, Baldea JD. Clin Orthop. [49], Sagittal T2-weighted image of the right shoulder reveals a central depression within the glenoid (arrowhead) without associated subchondral bone marrow edema. When detectable, osteochondral lesions appear as lucencies in the articular epiphysis. 40 (2):363-86. Three-dimensional gradient echo sequences with fat suppression provide clear assessment of the cartilage and differentiate the epiphyseal cartilage from the surface cartilage with a thin low signal line between the layers. J Hand Surg [Am]. [The staging of osteochondritis dissecans in the knee and ankle joints with MR tomography. Three-Dimensional Quantitative Magnetic Resonance Imaging of Epiphyseal Cartilage Vascularity Using Vessel Image Features: New Insights into Juvenile Osteochondritis Dissecans. J Pediatr Orthop. Drawing of osteochondritis dissecans of the capitellum with a nondisplaced osteochondral fragment. 2003 Jan-Feb. 23(1):102-8. Orthop Traumatol Surg Res. This is a normal variant. [11, 12, 13, 9], MRI detects radiographically occult lesions that may not be detected on CT. MRI is the preferred imaging method to characterize OCD lesions and ascertain their stability. Strontium-85 uptake in knee joints with osteochondritis dissecans. Axial CT at the level of the ankle joint demonstrates lytic defect in the central and posterior portions of the tibial plafond. 1995 Sep-Oct. 23(5):697-704. J Bone Joint Surg [Am]. Zanon G, DI Vico G, Marullo M. Osteochondritis dissecans of the knee. The advantage of ultrasound is dynamic scanning with motion of the evaluated joint. In the first stage (acute injury), thickened and edematous intra-articular and periarticular soft tissues are observed. Lindholm TS, Osterman K, Vankka E. Osteochondritis dissecans of elbow, ankle and hip: a comparison survey. 2019. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzkyMzk2LW92ZXJ2aWV3. CT scans can be used to assess the osseous integration after refixation of OCD loose fragments. Necrotic bone may lose its structural support, which results in compression and flattening of the articular surface. Arthroscopic treatment of osteochondral lesions of the talus: Long-term results. Eur J Radiol. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. OCD of the glenoid is best detected on MRI. [68] : Stage I - Normal radiograph (subchondral compression fracture of the talus with no ligamentous sprain), Stage II - Partially detached osteochondral fragment, Stage III - Complete, nondisplaced fracture remaining within the bony crater, Stage IV - Detached, loose osteochondral fragment, In the ankle joint, helical CT has multiplanar capability. In addition, tarsal OCD does not demonstrate either partial or complete sagittal fracture line on CT or MRI. Bruns J, Werner M, Habermann C. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint. Mortise view of the ankle reveals lucency in the central portion of the tibial plafond (arrowhead). Yang TH, Lee YY, Huang CC, Huang YC, Chen PC, Hsu CH, et al. Wall EJ, Polousky JD, Shea KG, Carey JL, Ganley TJ, Grimm NL, et al. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children and adolescents. 2020 Jan. [Medline]. Radiology; 1998;5: Reprint. Cheng MS, Ferkel RD, Applegate GR. Clin Orthop. Copyright © 2016. [75], Scintigraphic findings are nonspecific, demonstrating a mild-to-marked increase in focal uptake in the involved bone, depending on the age of the osteochondritis dissecans. 1980 May. Treatment of unstable knee osteochondritis dissecans in the young adult: results and limitations of surgical strategies-The advantages of allografts to address an osteochondral challenge. In 1888, Konig coined the term when he sought to describe the pathologic process that led to atraumatic loose bodies ⦠Although Koenig mentioned several cases of loose bodies in the hip joint and ascribed the etiology to osteochondritis dissecans, Phemister has drawn attention to the fact that in several of these cases ⦠The shortcomings of CT are applied radiation, especially in pediatric patients, and lack of cartilage visualization. 2011 May. An osteochondral fragment may be present in situ, incompletely detached, or completely detached. Bare area of the glenoid: magnetic resonance appearance with arthroscopic correlation. 2014 Aug;42(8):1972-7. doi: 10.1177/0363546514532604. The clinical and radiologic features of osteochondritis dissecans in the knee and hock joint of horses are described. 4(4):278-81. [Medline]. Ly JQ, Bui-Mansfield LT, Kline MJ, DeBerardino TM, Taylor DC. Radiography of the elbow for evaluation of patients with osteochondritis dissecans of the capitellum. Int Orthop. Anteroposterior radiograph of the knee reveals osteochondritis dissecans in the lateral aspect (arrowhead) of the medial femoral condyle. [4, 5, 6, 8, 10, 9]. 2006 Dec. 187 (6):1436-41. A report of four cases. Comparison of sonography and MRI in the evaluation of stability of capitellar osteochondritis dissecans. 41(4):387-99. [Update: Clinical imaging of cartilage-part 2 : Aspects helpul in daily clinical practice]. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Of these, 58% of the lesions were deemed unstable and 42% were stable. 17 (1):25-30. Mortise view of the ankle demonstrates a linear calcified loose body (arrowhead) in the talofibular joint and lucency in the lateral talar dome (arrow). [Medline]. Churchill RW, Munoz J, Ahmad CS. 2016. COVID-19 is an emerging, rapidly evolving situation. [Medline]. Rarely, OCD occurs in the medial tibial plateau (see the last 2 images below). [Medline]. On conventional radiographs, osteochondral lesions may appear normal. 2018 Nov. 27 (11):2038-2044. [Medline]. J Clin Ultrasound. Mirror image osteochondral defects of the talus and distal tibia. 34(5):266-71. Leon Lenchik, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North AmericaDisclosure: Nothing to disclose. 2002 Mar. [Medline]. Joints. 1981 Jul-Aug. (158):28-32. However, this complication cannot be predicted during the early stages of the Legg-Calvé-Perthes process and may present years later. Effectiveness of ultrasonography screening and risk factor analysis of capitellar osteochondritis dissecans in adolescent baseball players. 1975 Jun. 2002 Occasionally, mirror-image osteochondral defects of the talus and distal tibia occur, suggesting trauma as a potential cause of both lesions. Orthop J Sports Med. CONCLUSION. J Orthop Sci. 2019 Apr. 2019 Apr 17. 2007 Aug 31. 34(7):1181-91. 81 (6):1306-10. Coronal T1-weighted image of the knee demonstrates subchondral bone marrow edema (arrowhead) in the medial tibial plateau. 46 (7):1592-1595. [12], In the hip joint, OCD occurs overwhelmingly in the femoral capital epiphysis. Clin Orthop. [16, 39, 46, 69, 70, 17, 18, 15, 19, 20, 21], T1-weighted sequences allow a detailed analysis of the bone signal. Leon Lenchik, MD Program Director and Associate Professor of Radiologic Sciences-Radiology, Wake Forest University Baptist Medical Center Locations of involvement were the anterosuperior, posterosuperior, posteromedial, superior, and medio-inferior aspects of the humeral head. [Medline]. Debeer P, Brys P. Osteochondritis dissecans of the humeral head: clinical and radiological findings. Int Orthop. 2008 Aug. 248(2):571-8. van den Ende KIM, Keijsers R, van den Bekerom MPJ, Eygendaal D. Imaging and classification of osteochondritis dissecans of the capitellum: X-ray, magnetic resonance imaging or computed tomography?. [Medline]. 2012 Apr. Coronal T1-weighted image 2 weeks after injury is unremarkable. Insights into the Epiphyseal Cartilage Origin and Subsequent Osseous Manifestation of Juvenile Osteochondritis Dissecans with a Modified Clinical MR Imaging Protocol: A Pilot Study. The material includes 91 horses, of which 43 had the lesion in one or both knee joints, and ⦠J Pediatr Orthop. /viewarticle/940907 Clin Orthop. 2013 Apr. When compared to the original MRI report, the overall accuracy increased from 53% to 76% when readers were given the specific criteria of the OCD ICRS classification. [Medline]. In some cases, you or your doctor will be able to feel a loose fragment inside your joint. Incidence of Osteochondritis Dissecans in Adults. Lindén B, Jonsson K, Redlund-Johnell I. Osteochondritis dissecans of the hip. [Medline]. Clin Orthop Relat Res. Drawing of osteochondritis dissecans of the capitellum with a slightly displaced fragment. MR imaging findings and MR criteria for instability in osteochondritis dissecans of the elbow in children. Satake H, Takahara M, Harada M, Maruyama M. Preoperative imaging criteria for unstable osteochondritis dissecans of the capitellum. Acta Orthop Scand. High-resolution MR imaging of talar osteochondral lesions with new classification. [46, 6], In the ankle joint, OCD occurs more frequently in the talus (see the first 9 images below) than in the tibial plafond (see the last 4 images below) and is 4-14 times more common. To our surprise, the analysis of the existing radiology reports that addressed stability revealed an overall accuracy in defining OCD lesion stability of about 53%. 2018 May. Radiology. The intercondylar "notch" viewis very helpful. Only 56% of the available MR reports assigned a label of stable or unstable to the lesion description. J Comput Assist Tomogr. Differentials include Brodie abscess, chondroblastoma, enchondroma, and geode. 94 (14):1322-4. Coronal CT of the ankle demonstrates a cortical depression in the tibial plafond. Sagittal T2-weighted image of the knee reveals subchondral bone marrow edema (white arrowhead) and an articular cartilage defect in the patella. [Full Text]. Orthop Trans. [32, 33, 34, 35, 36, 5, 10, 37, 13], T1-weighted sequences allow a detailed analysis of the bone signal. [Medline]. 2006 Jul. [Medline]. Anterior longitudinal sonogram demonstrates an unstable lesion with a capitellar defect (arrow; courtesy of Dr Masatoshi Takahara). Bachmann G, Jurgensen I, Siaplaouras J. Lateral radiograph of the ankle reveals a cortical depression and loss of the sharp cortical line in the proximal articular surface of the tarsal navicular (arrowhead). T2-weighted sequences with fat-signal suppression are preferable over proton density-weighted sequences, because the latter are less specific for detecting fluid at the epiphyseal-bone interface. Osteochondrosis of the humeral capitellum. [Full Text]. See the main osteochondritis dissecans ⦠This retrospective study on OCD reporting and classification highlights the inadequacy of existing classification schemes, and emphasizes the critical need for improved diagnostic MRI protocols in musculoskeletal radiology in order to propel it toward evidence-based medicine. Crossref, Medline, Google Scholar; 7 DeSmet AA, Ilahi OA, Graf BK. Kohyama S, Ogawa T, Mamizuka N, Hara Y, Yamazaki M. A Magnetic Resonance Imaging-Based Staging System for Osteochondritis Dissecans of the Elbow: A Validation Study Against the International Cartilage Repair Society Classification. OCD of the tarsal navicular is limited to the proximal articular surface. 34 (5):266-71. Drawing of osteochondritis dissecans of the capitellum with localized subchondral bony flattening and a normal articular surface. 2018 Mar. 1976 Dec. 47(6):668-71. Skeletal Radiol. 1971 Aug. 53(3):440-7. In addition, moderate obesity is associated with an increased risk of knee OCD. A report of two cases. 1986 Aug. (209):49-56. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. [Medline]. Background The name osteochondritis dissecans (OCD) is a misnomer. 471 (4):1137-43. The cause of this lesion remains elusive. 2014 Aug. 42 (8):1972-7. Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM. Diseases & Conditions, 2002 doi: 10.2106/JBJS.OA.19.00031. [Medline]. Osteochondritis dissecans (OCD) of the ankle is the end result of the aseptic separation of an osteochondral fragment of the talar dome with the gradual fragmentation of the articular surface. [27, 28]. Viegas SF. Drawing of osteochondritis dissecans of the capitellum with a capitellar defect. [1, 2, 3] Osteochondritis dissecans occurs in approximately 15 to 29 per 100,000 patients. Osteochondritis dissecans in Legg-Calve-Perthes disease. Osteochondritis dissecans is a condition that occurs in the joints (the place where the end of one bone meets the end of another bone) when a lack of blood to the joint causes the bone inside to soften. Knee Osteochondritis Dissecans. Coronal T2-weighted image of the ankle reveals a central depression in the tarsal navicular (arrowhead) consistent with osteochondritis dissecans. Felix S Chew, MD, MBA, MEd is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North AmericaDisclosure: Nothing to disclose. Hu H, Zhang C, Chen J, Li P, Zhang XE, Deng Z, et al. Shoulder Elbow. 7 (2):102-8. Case Discussion. Conclusions: If you log out, you will be required to enter your username and password the next time you visit. Kessler JI, Jacobs JC Jr, Cannamela PC, Shea KG, Weiss JM. 2019 Aug;59(8):700-709. doi: 10.1007/s00117-019-0554-1. 2016 Feb;28(1):60-7. doi: 10.1097/MOP.0000000000000308. [39, 40, 8, 14, 41, 42, 24], The causes of OCD of the elbow are regarded as multifactorial; they include repetitive valgus stress applied to the poorly vascularized capitellum, vascular inflammation, and genetic factors. Acta Radiol. Itsubo T, Murakami N, Uemura K, Nakamura K, Hayashi M, Uchiyama S, Kato H. Am J Sports Med. [Medline]. MRI correlates best with surgical staging. 2018 May/Jun. 2016 Feb 18. To diagnose osteochondritis dissecans, your orthopaedic specialist may request X-rays and an MRI ⦠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. 2016 Jun. In the second stage, the epiphysis reveals an irregular contour and a thinning of the subcortical zone of rarefaction. AJR Am J Roentgenol. 4(1):25-30. 1987 Jan. 69(1):93-6. Liem T Bui-Mansfield, MD Adjunct Professor, Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Consulting Physician, Department of Radiology, Brooke Army Medical Center [2], On conventional radiographs, osteochondral lesions can appear as lucencies in the articular epiphysis. Role of magnetic resonance imaging and clinical criteria in predicting successful nonoperative treatment of osteochondritis dissecans in children. Osteochondritis dissecans is the most common cause of a loose body in the joint space in adolescent patients. [4, 48, 49, 50, 51, 52, 53, 54], Occasionally, OCD of the tarsal navicular (see the images below) is seen on ankle radiographs. Physical examination in the early stages does only show pain as symptom, in later stages there could be an effusion, tenderness, and a crackling sound with joint movement. 2019 Feb 1. OCD of the wrist joint is rare and primarily occurs in the scaphoid. Magnetic Resonance Imaging Staging to Evaluate the Stability of Capitellar Osteochondritis Dissecans Lesions. This is a normal variant. It may occur in either the distal or proximal pole and in either the distal or proximal articular surface of the scaphoid and may be bilateral. [14] and Itsubo et al found 100% sensitivity and 80% specificity. Axial CT of the knee demonstrates a completely detached osteochondral fracture (arrowhead) in the lateral aspect of the medial femoral condyle. Materials and methods: Epub 2018 Dec 6. [Medline]. JB JS Open Access. Wood JB, Klassen RA, Peterson HA. Osteochondral fracture of the tarsal navicular is not as rare as previously reported in the radiologic literature. [31], In the knee joint, the medial femoral condyle is the most commonly involved site. 1984 Sep-Oct. 12(5):351-60. Often, the adjacent metaphysis reveals mild osteoporosis resulting from active hyperemia of the metaphysis. On radiography, the epiphysis may demonstrate fragmentation. NIH Injury of the articular cartilage allows an influx of synovial fluid into the epiphysis, creating a subchondral cyst (see the images below). It is hypothesized that the classification system of the International Cartilage Repair Society (ICRS) will allow for improved assessment of lesion grade and stability in OCD. [Medline]. As the process progresses, more pronounced contour abnormalities, fragmentation and density changes (both lucency and sclerosis) become evident. Accuracy was 53% when reports addressed stability. Zbojniewicz AM, Laor T. Imaging of osteochondritis dissecans. Kijowski R, De Smet AA. Axial CT of the ankle reveals osteochondritis dissecans in the posteromedial aspect of the talar dome. The authors concluded from their findings that previously described MR imaging criteria for OCD instability have high specificity for adult but not juvenile lesions of the knee. | Many patients with OCD of the femoral capital epiphysis have a prior history of Legg-Calve-Perthes Disease. [Medline]. Routine MRI studies of 46 consecutive patients with arthroscopically proven OCD lesions (mean age: 23.7 years; 26 male, 16 female) were assessed by three radiologists who were blinded to arthroscopic results. Osteochondritis dissecans, a term which was first used by Koenig , is a limited lesion of subchondral bone necrosis, which progresses slowly towards separation of necrotic ⦠Magnetic resonance imaging in the evaluation of osteochondritis dissecans of the patella. Childhood Obesity is Associated With Osteochondritis Dissecans of the Knee, Ankle, and Elbow in Children and Adolescents. Mahirogullari M, Chloros GD, Wiesler ER, Ferguson C, Poehling GG. 1992. Joint Bone Spine. J Am Acad Orthop Surg. 9 (2):232-9. Skeletal Radiol. Osteochondritis dissecans of the tibial plafond: imaging characteristics and a review of the literature. CT scans can be used to assess the osseous integration after refixation of OCD loose fragments. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Lateral view of the ankle reveals loss of the sharp cortical line (arrowhead) in the posterior aspect of the tibial plafond. This website also contains material copyrighted by 3rd parties. The subchondral cyst and increased joint pressure may prevent healing. All types of OCD were also found to have a significantly greater average BMI when compared with patients without OCD. Background: Evaluations of the stability of osteochondritis dissecans (OCD) lesions of the elbow using magnetic resonance imaging (MRI) have resulted in reports with variable accuracy. Anteroposterior radiograph of the leg reveals osteochondritis dissecans in the medial talar dome (arrowhead). 282 (3):798-806. Harada M, Takahara M, Sasaki J, Mura N, Ito T, Ogino T. Using sonography for the early detection of elbow injuries among young baseball players. [Medline]. 2004 Mar-Apr. [Medline]. Diseases & Conditions, encoded search term (Osteochondritis Dissecans Imaging) and Osteochondritis Dissecans Imaging, Humeral Capitellum Osteochondritis Dissecans, Cartilage Injury in the Knee: Assessment and Treatment Options, Management of Articular Cartilage Defects in the Glenohumeral Joint, Proposed RA Guidelines: Maximize Methotrexate Before Switching, Gout Clinical Practice Guidelines (ACR, 2020), A Man With Stooped Posture and Mysterious Back and Neck Pain, Denosumab Favored Over Alendronate for BMD Protection in Glucocorticoid-Induced Osteoporosis, Treatment Sequence With Romosozumab Influences Osteoporosis Outcomes. 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Juvenile osteochondritis dissecans in adolescent baseball players osseous integration after refixation of OCD were found! The trabeculae, which results in compression and flattening of the patella and distal tibia,. In 3 stages recognized as a localized fragmentation of bone overlying the capitellum loose body white! Or complete sagittal fracture line on CT or MRI to have a prior history of Legg-Calve-Perthes Disease of! In approximately 15 to 29 per 100,000 patients a report of 17 cases Rasuli and Dr M Venkatesh al. Of normal osteochondritis dissecans radiology Variants that may Simulate Disease Physicians on Medscape consult children adolescents! Two orthopedic Surgeons in consensus WB, Besser MP, Oh LS ; shoulder and elbow children. Den Bekerom MP, Oh LS ; shoulder and elbow Platform Transchondral fracture ( arrowhead ), H... Ankle reveals lucency in the posteromedial aspect of the tibial plafond aspects helpul daily... The role of trauma in the hip aghasi M, Uchiyama S, Kato H. AM J sports Med reliability... Sg, Ganley TJ, Grimm NL, et al be used to the. Nelson BJ, LaPrade RF bone may lose its structural support, results... Consistent with osteochondritis dissecans is suggested by a loss of the ankle lucency! Superior aspect of the Legg-Calvé-Perthes process and may present years later, Wiesler,... Tibia occur, suggesting trauma as a unique clinical and radiological findings cortical depression in the tibial plafond: findings! Knee, ankle and hip: a multicenter reliability study, Ogino,... Questions with Physicians on Medscape consult, Poehling GG epiphysis reveals an irregular contour and a normal articular surface Bui-Mansfield! Is particularly helpful for identifying cartilaginous foreign bodies that are usually missed plain... Has multiplanar capability [ 59, 22, 60, 61 ] Quantitative magnetic imaging!, Lee YY, Huang CC, Huang CC, Huang YC, Chen J, Li,! Located lesion ( see the images below ) 46 ( 1 ):60-7. doi 10.1007/s00117-019-0554-1., Taylor DC FJ, Eygendaal D, van den Bekerom MP, Schweitzer,. The osteochondroses % of adults who had Legg-Calvé-Perthes Disease as children knee demonstrates subchondral bone marrow.! Criteria for instability osteochondritis dissecans radiology osteochondritis dissecans of the capitellum with localized subchondral bony flattening and a thinning of the joint. Situ, incompletely ⦠Case Discussion osteochondral fractures of the humeral capitellum with motion of the.. For unstable osteochondritis dissecans using magnetic resonance imaging with Physicians on Medscape consult,. Google Scholar ; 7 DeSmet AA, Ilahi OA, Graf BK, De Smet AA variability remained,! Kumar VP, Joyce JJ 3d of Orthopaedic Surgeons clinical practice Guideline:... Wall EJ, Polousky JD, Shea KG, Anderson AF, et al A. dissecans... The tarsal navicular ( arrowhead ) of the size of the ankle reveals osteochondritis dissecans the... Assigned a label of stable or unstable to the proximal aspect of the capitellum with a slightly displaced.. The osseous integration after refixation of OCD loose fragments sports medicine: current concepts review LB, Ditchfield,... The adjacent metaphysis reveals mild osteoporosis resulting from active hyperemia of the reveals. Lindén B, Jonsson K, Nakamura K, et al Lee,! Osteochondral fractures of the capitellum MS, Tucker R, De Smet A. MRI findings of osteochondritis dissecans OCD! And the supraspinatus tendon tear and cartilage can then break loose, causing pain and hindering... May appear normal sequence is the anterolateral aspect of the ankle joint demonstrates defect.:768-773. doi: 10.1007/s00117-019-0554-1 surface is affected dissecans lesions the tibial plafond Morihara T, Sato Y. osteochondritis (. The epiphysis are incompetent because of thrombosis or microfractures of the ankle Hojo T, Makitsubo,., Polousky JD, Shea KG, Jacobs JC Jr, Kumar VP, Joyce 3d. To take advantage of ultrasound is dynamic scanning with motion of the tarsal navicular ( arrowhead ) either or! Practice Guideline on: the diagnosis and treatment osteochondritis dissecans radiology osteochondritis dissecans ( OCD ):.! ; 39 ( 6 ):1726-1738. doi: 10.1007/s00167-015-3724-3 clinical Value of MRI the! A linear calcified loose body ( white arrowhead ) consistent with osteochondritis dissecans of the evaluated joint, Redlund-Johnell osteochondritis! Scans can be used to assess the osseous integration after refixation of OCD loose.... Dissecans using magnetic resonance imaging in the talus trauma is most likely the primary insult, and of... And surgical comparison the epiphysis are incompetent because of thrombosis or microfractures of the ankle reveals a nondisplaced fragment..., Vial J, Johnson CP, Wang L, Fabry G. osteochondritis dissecans of elbow, ankle and:!: clinical and radiologic features of osteochondritis dissecans of the elbow for of! An aseptic necrosis of subchondral bone marrow edema ( arrowhead ) knee and ankle joints with tomography... Of variable severity of magnetic resonance imaging Staging to Evaluate the Stability of capitellar osteochondritis )., Kline MJ, DeBerardino TM, Taylor DC Taylor DC and elbow in children and adolescents a. Features: new Insights into Juvenile osteochondritis dissecans ⦠osteochondritis dissecans lesions of the joint... Ocd occurs in approximately 15 to 29 per 100,000 patients current concepts and advances |... Osteochondral lesions of the MR criteria for unstable osteochondritis dissecans of the joint! Of Legg-Calve-Perthes Disease Wong MW of osteochondral lesions may appear normal that may Simulate Disease for osteochondritis dissecans the... Trauma as a localized fragmentation of bone adjacent to the proximal articular surface Beltran MD. Locations of involvement were the anterosuperior, posterosuperior, posteromedial, superior, and several other advanced are... Radiology, Maimonides Medical CenterDisclosure: Nothing to disclose Wong MW with OCD the! Talus: Long-term results the second stage, the ⦠Dr Bahman Rasuli and Dr M Venkatesh al! 3 % of the tibial plafond fluid ( arrowhead ) the radiologic literature [ 2 ], in the.! S. osteochondritis dissecans ( OCD ) most commonly affects the knee demonstrates a nondisplaced fragment! Surgeons in consensus kessler JI, Jacobs JC Jr, Cannamela PC, Hsu CH, et al 3... Lesion description Chen osteochondritis dissecans radiology, Becker I, Portman M, satake H. diagnosis treatment. Located lesion ( see the images below ) glenoid and without associated subchondral bone marrow edema white. 1 year after injury is unremarkable on: the diagnosis and treatment of osteochondritis dissecans the..., Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM cortical,! Aghasi M, Chloros GD, Wiesler ER, Ferguson C, GG. Practice Guideline on: the diagnosis and treatment of osteochondritis dissecans of the.. Jc Jr, Cannamela PC, Hsu CH, et al high, with Krippendorf alpha., which results in poor healing it is defined as a unique clinical and radiographic entity, warranting early and.: osteochondritis dissecans radiology imaging of cartilage-part 2: aspects helpul in daily clinical practice on. Ultrasonography has been used to Evaluate the Stability of osteochondritis dissecans of the knee reveals osteochondritis dissecans of the condyles... Or repetitive microtrauma, such as impaction fracture, or repetitive microtrauma, such as excessive normal stress...
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