Nuclear medicine technetium-99m methylene diphosphonate (MDP) bone scans have been investigated and used as a potential dynamic study to evaluate the healing potential of OCD defects. In 1888 Konig was the first author to use the term osteochondritis dissecans to describe loose bodies found in the knee joint; he believed them to be fragments from an avascular bone lesion ( 1 ). In general, conventional radiographs are poor at establishing the stability and size of the lesion and are unable to assess the status of the overlying cartilage. 1. Potential limitations of such sequences include their long acquisition times as well as their susceptibility to metal artifacts, which may be an important consideration after surgery. (, A 21-year-old man with an unstable adult OCD lesion of the lateral femoral condyle. The itis suffix of osteochondritis denotes the previously understood cause of inflammation of the osteochondral joint surface. However, these advantages come at the cost of converting a noninvasive examination (conventional MRI) to an invasive procedure, and there are the potential complications inherent to intra-articular injection of contrast material. Features are consistent with osteochondritis dissecans of the ankle joint. The MRI-based staging system corresponded well with the ICRS classification, providing an accurate preoperative assessment of OCD lesions of the elbow, even with minimal subchondral bone information. The widespread difference of opinion may relate to a lack of distinction between the juvenile and adult forms OCD and the potentially different imaging features of stability/instability seen between juvenile and adult forms of the disease. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement. A prospective study was performed on 72 patients with osteochondritis dissecans (OD) of the knee and ankle to compare plane radiography, MRI and arthroscopy before therapeutic procedures. The incidence of OCD has been estimated to be between 0.02% and 0.03% by radiography, and as high as 1.2% by arthroscopy. Imaging of the contralateral knee should be considered if symptoms warrant it. Staging of osteochondritis dissecans in the knee and ankle joints with MR tomography: a comparison with conventional radiology and arthroscopy. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. This limitation is often caused by discrepancies between surgical and radiographic manifestations of the disease. 5 and 6 ), or was accompanied by multiple breaks in the subchondral bone plate. cartilage injury with associated subchondral fracture but without detachment; thin sclerotic margin Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. [1] OCD usually causes pain and swelling of the affected joint which catches and locks during movement. Imaging modalities used for assessment of OCD include conventional radiography, nuclear medicine, computed tomography (CT), CT arthrography, magnetic resonance imaging (MRI), and magnetic resonance (MR) arthrography. These higher field strength scanners are increasingly available in clinical practice; however, randomized controlled trials are necessary to evaluate the diagnostic efficacy of this new technology. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. The pain is worse with activity and can be associated with an antalgic, externally rotated gait. Osteochondritis dissecans (OCD) is characterized by separation of an osteochondral fragment from the articular surface. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint Cartilage . Fat-suppressed 3D SPGR and FLASH acquisitions provide high-resolution images with high contrast between the bright cartilage and dark fluid, bone, fat, and muscle. Multiple studies have described the MRI findings in patients with stable and unstable OCD lesions. Clinical management of these lesions is based on whether or not the fragments are attached. The cause of osteochondritis dissecans is often unknown. (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Orthobiologics in Pediatric Sports Medicine, Spectrum of Shoulder Injuries in Skeletally Immature Patients, Pediatric Knee Osteochondritis Dissecans Lesions, “One Step” Treatment of Juvenile Osteochondritis Dissecans in the Knee: Clinical Results and T2 Mapping Characterization, Orthopedic Clinics of North America Volume 43 Issue 2. unstable on probing; fragment not dislocated; complete discontinuity of the "dead in situ" lesion; stage IV Objective: To assess the diagnostic performance of combined three-dimensional (3D) gradient-echo (GRE) T1-weighted and routine MR imaging protocol for the evaluation of osteochondritis dissecans (OCD). The impending separation of the osteochondral fragment is in keeping of grade III lesion. Franz Konig introduced the term osteochondritis dissecans in 1888, although it was originally described by Paget some years earlier. Discrepancies include underestimation of fragment size, or fragments that appear radiographically separated can be covered by normal cartilage at surgery, and vice versa ( Fig. stable on probing; partial discontinuity of the lesion from the host bone; stage III. Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. The Wilson test is a special provocative test that has been described with attempts to impinge the tibial spine on the OCD lesion. 20. See osteochondritis dissecans article for a general discussion. MR imaging is useful in diagnosing and staging osteochondral lesions. Osteochondritis dissecans has been shown to heal with protective weight bearing alone, if there is no loose body in the joint. Arthroscopic surgery is a procedure that is frequently used as a treatment to remove the loose cartilage and bone tissue from the joint. Rationale and objectives: In this retrospective case series, we utilize arthroscopy as the gold standard to determine if magnetic resonance imaging (MRI) of the knee can predict osteochondritis dissecans (OCD) lesion stability, the most important information to guide patient treatment decisions. OCD usually causes pain during and after sports. Magnetic resonance imaging can accurately predict the presence and extent of chondral fragments, and it appears that a magnetic resonance staging classification has been developed that allows preoperative staging of lesions of the talus and the knee. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Purpose: To retrospectively compare the sensitivity and specificity of previously described magnetic resonance (MR) imaging criteria for the detection of instability in patients with juvenile or adult osteochondritis dissecans (OCD) of the knee, with arthroscopic findings as the reference standard. (, A 12-year-old boy with ossification defect at the lateral femoral condyle. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. 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. Imaging and Staging. 4 ). Early presentation of OCD often consists of vague pain in and around the knee. The knee is the most common location for OCD and the condition is bilateral in 15% to 30% of cases. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In these sequences, cartilage abnormalities are seen as morphologic abnormalities of contour. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Ossification variability is typically seen as irregularity in the farposterior condyles without intercondylar extension, and without associated edema ( Fig. Request PDF | Osteochondritis Dissecans of the Elbow | Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. Because of the nonspecific nature of the clinical signs and symptoms of OCD, imaging plays a central role in the diagnosis and prognosis of this disease. Bone scintigraphy also provides no anatomic information on articular surface deformity. This evolution has resulted in a resurgence of CT arthrography for the assessment of intra-articular lesions, including OCD lesions. Unable to process the form. Practice Essentials. This technique was initially thought useful in determining the need for operative intervention for lesions that show increased activity on bone scan despite conservative treatment. FSE imaging also allows diagnostic evaluation of other intra-articular structures, including subchondral bone. In addition, radiographs may not always show OCD lesions consistently or definitively. MRI has been shown to be diagnostically valuable in the differentiation of variations in ossification from true OCD lesions. Another proposed advantage of scintigraphy is its ability to differentiate anomalies of ossification versus true OCD, with ossification anomalies having minimal, if any, increased radiotracer uptake. There are multiple existing and developing MRI pulse sequences that are valuable in assessment of osteochondral lesions. Although the radiographic examination can establish the diagnosis of OCD correctly, it is not adequate for prognostic and therapeutic decisions. Intermediate-weighted FSE imaging combines T2 weighting and relative fatty marrow signal preservation to generate images with bright joint fluid and subcortical bone marrow. Some investigators have also recommended using direct MR arthrography for evaluating patients with OCD, looking for signs of instability and differentiation of partial versus complete separation of fragments indicated by contrast subsiding the OCD fragment ( Fig. The cause of this lesion remains elusive. The dGEMRIC imaging technique, which displays the distribution of negatively charged gadolinium-based MRI contrast material (gadopentetate dimeglumine) within cartilage, has been validated as an accurate marker of cartilage tissue glycosaminoglycan (GAG) concentration. 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. The addition of fat saturation to FSE techniques can help in the evaluation of articular cartilage by optimizing the dynamic range of the images. However, given the young demographics of the typical OCD patient, the ionizing radiation associated with CT scanning has tempered widespread adoption. The introduction of spiral CT has provided the additional ability to obtain thin, overlapping CT sections with excellent secondary sagittal and coronal reformations. Direct MR arthrography also provides advantages of distention, increased intra-articular pressure from the fluid volume, and increased signal/noise ratio on T1-weighted imaging. 1 Bachmann G, Jurgensen I, Siaplaouras J. Initial radiographic evaluation of patients with suspected OCD should include anterior-posterior (AP), lateral, tunnel, and skyline views. 7 ). This condition has been seen with increased frequency as children of younger age are participating in more competitive sports. However, the clinical usefulness of these quantitative techniques remains uncertain. Osteochondritis dissecans can be classified at surgery into 4 stages: Classification according to International Cartilage Repair Society. CT arthrography consists of thin-slice CT evaluation following intra-articular administration of iodinated contrast. Osteochondritis dissecans (OCD) of the talus is a subchondral bone pathology that presents as an osteochondral lesion of the talar dome with consequent articular cartilage abnormalities. 3 (March 1, 2003): 641-645. Special interest was placed on the assessment of fragment stability with radiological methods for staging … Coronal 1.5-T fat-suppressed T2-weighted FSE MR image of an OCD lesion surrounded by an inner rim of high T2 signal intensity (, MR arthrogram of an unstable adult OCD lesion of the medial femoral condyle. Prevalence of this condition ranges between 15 and 29 per 100,000, with an increased male predominance of 2:1. However, conventional CT is poor at assessing articular cartilage and other noncalcified aspects of a joint. 2018 Oct;9(4):346-362. doi: 10.1177/1947603517715736. Fluid-sensitive (T2) sequences should be obtained in all 3 standard planes. This article reviews current imaging modalities for the assessment of OCD including conventional radiography, nuclear medicine, computed tomography (CT), CT arthrography, magnetic resonance (MR) and MR arthrography. The role of the different imaging modalities has evolved with time. MRI has been shown to be an ideal diagnostic technique for evaluation of OCD lesions because of its noninvasive nature, absence of ionizing radiation, excellent anatomic detail, and soft tissue contrast allowing cartilage visualization. Osteochondritis dissecans typically affects the lateral surface of the medial femoral condyle in adolescent males. 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. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Knee Comparison of combined 3D GRE and routine MRI and arthroscopic results in staging of osteochondritis dissecans lesions for reader 2. Osteochondritis dissecans Cartilage Ossification variation Magnetic resonance imaging (MRI) Radiography Knee Elbow Ankle KEY POINTS Osteochondritis dissecans (OCD) can affect both adults and children, however the imag-ing characteristics and significance of imaging findings can differ in the juvenile subset with open physes. Characteristic radiographic findings include a well-circumscribed area of subchondral bone separated by a crescent-shaped radiolucent outline of the fragment. Recently, Kijowski and colleagues proposed revised criteria for OCD instability based on skeletal maturity of the patient. Two classes of pulse sequence acquisition have been most widely used in this regard: intermediate and T2-weighted fast spin echo (FSE) techniques, and three-dimensional (3D) spoiled gradient echo (SPGR) or fast low-angle shot (FLASH) sequences. It should also provide valuable information about articular cartilage repair tissue after surgery. An ideal MRI protocol for accurate assessment of OCD lesions and OCD repair should provide accurate assessment of cartilage thickness, signal changes within cartilage, the cartilage and bone interface, and the subchondral bone. Symptoms include joint pain, stiffness, and even locking of the joint. 3 ). stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. The overall accuracy of MR findings in determining the staging was 90% (37 of 41) for reader 1 and 83% (34 of 41) for reader 2. However, subsequent studies using the revised criteria of Kijowski and colleagues showed sensitivities and specificities approaching 100%. With the vague clinical symptoms and signs of OCD, imaging plays a vital role in making the diagnosis and helping with the prognosis of OCD lesions. If the lesion is unstable, mechanical symptoms may be present. The tunnel view provides improved visualization of the posterior aspect of the femoral condyle as it is brought into view with knee flexion ( Fig. With radionuclide scanning, findings between stable and unstable fragments overlap. 2 ). Less common locations include the lateral femoral condyle (15%), patella (5%), and femoral trochlea (1%). CT offers excellent anatomic delineation of mineralized/ossified structures within the knee joint. Hence, although bone scintigraphy can serve to localize a lesion to a specific joint, it often offers little specificity in distinguishing OCD lesions from other joint abnormalities. Abstract. Osteochondritis dissecans can be classified at surgery into 4 stages: stage I. stable; lesion in continuity with the host bone; covered by intact cartilage; stage II. partial discontinuity of the lesion from the host bone, complete discontinuity of the "dead in situ" lesion. As such, conventional CT is limited in providing diagnostic information regarding OCD lesion stability or healing potential. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondritis Dissecans Osteochondritis dissecans is best diagnosed with imaging studies. (, A 15-year-old boy with an unstable juvenile OCD lesion of medial femoral condyle. 1 The first description of these lesions in the ankle was provided in 1922. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Bone scintigraphy has not been shown to provide reliable information about an OCD lesion’s stability; as such, it has limited usefulness in differentiating surgical versus nonsurgical lesions. These techniques have been investigated as potential tools to characterize the histologic and biochemical composition and temporal maturation of repair tissue following osteochondral repair procedures. Radiography and magnetic resonance imaging (MRI) are the primary modalities used to aid in diagnosis, to define a treatment plan, to monitor progress, to assess surgical intervention, and to identify … Check for errors and try again. Although not the focus of this discussion, other joints that can be affected include the ankle, elbow, hip, and wrist. Cysts surrounding a juvenile OCD lesion indicated instability only if they were multiple or large (>5 mm) in size. 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