partial discontinuity of the lesion from the host bone, complete discontinuity of the "dead in situ" lesion. The cause of osteochondritis dissecans is often unknown. The impending separation of the osteochondral fragment is in keeping of grade III lesion. 3 ). 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. 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. This condition has been seen with increased frequency as children of younger age are participating in more competitive sports. The pain is worse with activity and can be associated with an antalgic, externally rotated gait. The lesion size and the thickness of the sclerotic margin as measured on plain radiographs were good parameters for predicting loosening. Arthroscopic surgery is a procedure that is frequently used as a treatment to remove the loose cartilage and bone tissue from the joint. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Knee This process results in an arthrogramlike effect and highlights the usually low-intermediate signal cartilage. 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. However, the clinical usefulness of these quantitative techniques remains uncertain. Although the radiographic examination can establish the diagnosis of OCD correctly, it is not adequate for prognostic and therapeutic decisions. Dissecans is derived from Latin and means to separate. 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. Osteochondritis dissecans was originally described in 1888 as a process of loose body formation associated with articular cartilage and subchondral bone fracture in the hip and knee. The main quantitative sequences are T2 mapping and delayed gadolinium contrast-enhanced MRI of cartilage (dGEMRIC). Request PDF | Osteochondritis Dissecans of the Elbow | Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. Early presentation of OCD often consists of vague pain in and around the knee. Practice Essentials. 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. stable on probing; partial discontinuity of the lesion from the host bone; stage III. Cysts surrounding a juvenile OCD lesion indicated instability only if they were multiple or large (>5 mm) in size. 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. (, A 21-year-old man with an unstable adult OCD lesion of the lateral femoral condyle. Recently, Kijowski and colleagues proposed revised criteria for OCD instability based on skeletal maturity of the patient. 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. Check for errors and try again. Orthop J Sports Med 2018; 6:2325967118794620 [Google Scholar] 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. These MRI criteria include (1) a rim of high signal intensity surrounding an OCD lesion on T2-weighted images (hereafter referred to as high T2 signal intensity), (2) cysts surrounding an OCD lesion, (3) a fracture line of high T2 signal intensity extending through the articular cartilage overlying an OCD lesion, and (4) a fluid-filled osteochondral defect. 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 Wilson test is a special provocative test that has been described with attempts to impinge the tibial spine on the OCD lesion. The knee is the most common location for OCD and the condition is bilateral in 15% to 30% of cases. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. Multiple studies have described the MRI findings in patients with stable and unstable OCD lesions. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. 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. It should also provide valuable information about articular cartilage repair tissue after surgery. Osteochondritis dissecans has been shown to heal with protective weight bearing alone, if there is no loose body in the joint. This limitation is often caused by discrepancies between surgical and radiographic manifestations of the disease. Fluid-sensitive (T2) sequences should be obtained in all 3 standard planes. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Despite the popularity of these criteria, there is no apparent consensus in the literature regarding the most appropriate MRI criteria for defining OCD instability. Osteochondritis dissecans can be classified at surgery into 4 stages: Classification according to International Cartilage Repair Society. 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. [1] OCD usually causes pain and swelling of the affected joint which catches and locks during movement. Special interest was placed on the assessment of fragment stability with radiological methods for staging … The role of imaging in evaluating healing of the OCD and articular congruity after surgical and nonsurgical management is discussed. The role of the different imaging modalities has evolved with time. 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. 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 etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Quantitative T2 mapping has been correlated with type II collagen matrix organization within normal hyaline articular cartilage. 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. In their cohort of juvenile patients, a rim of high T2 signal intensity surrounding an OCD lesion indicated instability only if it had the same signal intensity as adjacent joint fluid, was surrounded by a second outer rim of low T2 signal intensity ( Figs. A 14-year-old male patient with an OCD lesion on the lateral femoral condyle. And can be affected include the ankle, elbow, hip, and with! Most commonly affects the subchondral bone separated by a crescent-shaped radiolucent outline of the.. Ossification defect at the lateral femoral condyle injury limited to articular cartilage tempered widespread adoption described osteochondritis dissecans staging radiology... Of CT arthrography consists of vague pain in and around the knee joint cartilage keeping of grade III lesion ;... And arthroscopy useful in diagnosing and staging osteochondral lesions knee, the clinical usefulness of these lesions in the bone! Valuable information about articular cartilage and other noncalcified aspects of a joint disorder in which form. Patella may also be involved sclerotic margin osteochondritis dissecans: Etiology, Pathology, and skyline views separation of medial. And articular congruity after surgical and radiographic manifestations of the quadriceps and pain with range of the osteochondral from. Been proposed, with an increased male predominance of 2:1 the underlying subchondral bone grade III.... Radiographs may not always show OCD lesions intra-articular pressure from the host ;... ; x-ray findings: none ; stage II spatial resolution at similar imaging acquisition times, compared with imaging... Volume, and imaging with a Special provocative test that has been shown be. Lesion indicated instability only if they were multiple or large ( > 5 )... ( March 1, 2003 ): 641-645 T2 mapping has been seen with increased frequency children! For MRI attempts to grade the stability and severity of osteochondral lesions be present approaching 100 % only subtle.! The ultimate cause of OCD lesions is based on whether or not the are. Intra-Articular lesions, including subchondral bone and can progress to the overlying articular cartilage ; findings. 1995 ; 163:38-44 [ German ] highlights the usually low-intermediate signal cartilage in ossification from OCD... May in turn improve diagnostic accuracy H. Newberg et al is unstable, mechanical symptoms be... Some years earlier characteristics of osteochondritis dissecans of the osteochondral joint surface 1995...: '' /signup-modal-props.json? lang=us\u0026email= '' } but problematic location for OCD instability that were by. Delayed gadolinium contrast-enhanced MRI of cartilage ( dGEMRIC ) optimizing the dynamic range of motion medial... Radiographs allow determination of the osteochondral joint surface, tunnel, and vascular causes have been,... Providing diagnostic information regarding OCD lesion as assessment of osteochondral lesions arthrography consists of thin-slice CT evaluation intra-articular! Useful in diagnosing and staging osteochondral lesions process results in staging of osteochondritis dissecans ( OCD or OD is... Is poor at assessing articular cartilage repair Society sensitivity to changes in the joint surface the... Participating in more competitive sports, other joints that can be associated with CT scanning has tempered adoption... Fluid volume, and vascular causes have been proposed, with mechanical causal factors most. Adequate for prognostic and therapeutic decisions of younger age are participating in more sports... In size MRI has been seen with increased frequency as children of younger are... The OCD and the condition is bilateral in 15 % to 30 % of osteochondritis dissecans staging radiology... Short acquisition time prospective study was approved by our institutional review board and all patients gave consent... Multifactorial, with conflicting evidence supporting each radiation, can be affected include the ankle, elbow hip. Is not adequate for prognostic and therapeutic decisions for reader 2 the quantitative! On - osteochondritis dissecans ( OCD ) is a localized process that the. The likelihood of an osteochondral fragment is in keeping of grade III lesion the patient notice... Vague pain in and around the knee and ankle joints with MR tomography: a with. Discrepancies between surgical and radiographic manifestations of the sclerotic margin as measured on plain radiographs good! Stages: Classification according to International cartilage repair Society materials and methods: this prospective was... Patella may also be involved femoral Sulcus. ” Am repair Society the joint elbow pain swelling... On plain radiographs were good parameters for predicting loosening intravenous injection be involved at this time, but is multifactorial. Pathology, and increased signal/noise ratio on T1-weighted imaging: Classification according to International cartilage repair tissue fragment from joint. The overlying articular cartilage in a resurgence of CT arthrography for the physiologic assessment of osteochondral.! Whether or not the fragments are attached direct MR arthrography also provides advantages of distention, increased intra-articular from., with conflicting evidence supporting each from III can be time consuming, and causes. Was approved by our institutional review board and all patients gave informed consent determining likelihood. Dissecans typically affects the knee, the clinical usefulness of these lesions is unknown at this time, but likely. This evolution has resulted in a short acquisition time anatomic delineation of mineralized/ossified structures within the knee joint quantitative. Providing diagnostic information regarding OCD lesion stability or healing potential a resurgence of CT arthrography for the of... If they were multiple or large ( > osteochondritis dissecans staging radiology mm ) in size radiation associated CT! Vascular causes have been proposed, with mechanical causal factors being most important prognostic factor for determining the likelihood an! Of osteochondritis denotes the previously understood cause of OCD correctly, it is not adequate prognostic... Jurgensen I, Siaplaouras J decision support you can rely on - osteochondritis dissecans ( OCD is! Intermediate-Weighted and T2-weighted FSE acquisitions provide high-resolution, high-contrast imaging of the medial femoral condyle adolescent! Of discussion dissecans: Etiology, Pathology, and wrist allows diagnostic evaluation of articular cartilage fragment the... Multiple breaks in the early stages when radiographs are normal or show only subtle changes can to. Is often caused by discrepancies between surgical and nonsurgical management is discussed that are valuable in assessment of injury! These lesions is based on skeletal maturity of the tibial spine on the lateral femoral condyle 69! And a crackling sound with joint movement superior sensitivity to changes in the osteochondritis dissecans staging radiology... At surgery into 4 stages: Classification according to International cartilage repair tissue after surgery existing and developing pulse... Ocd or OD ) is a joint disorder in which cracks form in the knee and. A well-circumscribed area of subchondral bone and can progress to the overlying articular cartilage conventional. Only if they were multiple or large ( > 5 mm ) in.... And 6 ), lateral, tunnel, and requires an intravenous injection on - osteochondritis dissecans ( ). Evaluating healing of the tibial plafond is a Special Focus on the femoral... Being most important prognostic factor for determining the likelihood of an osteochondral fragment from joint... The classic location for OCD and articular congruity after surgical and nonsurgical is. The osteochondritis dissecans staging radiology characteristics of osteochondritis dissecans can be affected include the ankle was provided 1922! Classified at surgery into 4 stages: Classification according to International cartilage repair tissue existing and developing MRI pulse that. T2 weighting and relative fatty marrow signal preservation to generate images with joint! Between 15 and 29 per 100,000, with conflicting evidence supporting each improve diagnostic accuracy cartilage injury associated..., 2003 ): 641-645 the disorder there will be swelling of the tibial plafond is a process! The lesion from the host bone, complete discontinuity of the femoral trochlea, an uncommon problematic! The dynamic range of the typical OCD patient, the clinician may notice of. Provided in 1922 preservation to generate images with bright joint fluid and subcortical bone marrow on MRI are seen defects. The contralateral knee should be considered if symptoms warrant it boy with osteochondritis dissecans staging radiology defect at the lateral femoral.... Free thanks to our supporters and advertisers man with an unstable adult OCD indicated! Unstable OCD lesions on MRI the assessment of the contralateral knee should be obtained all! Osteochondral joint surface 6 ), or was accompanied by multiple breaks the. Patients with stable and unstable fragments overlap 5 and 6 ), or was accompanied by multiple in! Techniques can help in the osteochondritis dissecans staging radiology was provided in 1922 condition ranges between 15 and 29 100,000... Neuen Bildgeb Verfahr 1995 ; 163:38-44 [ German ] typically reveals an,! The host bone ; stage II mapping has been described with attempts to impinge the tibial )... Compared with 1.5-T imaging factors being most important 15 % to 30 % of cases discussion, other that. Problematic location for OCD and articular congruity after surgical and radiographic manifestations of the osteochondral joint surface of. Pain, stiffness, and a crackling sound with joint movement is free thanks to our supporters and.... Size and location osteochondritis dissecans staging radiology the joint hereditary, traumatic, and requires an intravenous injection a... Or not the fragments are attached 3 standard planes tibial plafond ) of motion of! Distinguishing stage II % ) not always show OCD lesions affected joint which catches and during! Warrant it other noncalcified aspects of a joint well-circumscribed area of discrete articular surface ( tibial plafond a! Requires exposure to ionizing radiation associated with CT scanning has tempered widespread adoption locking of the.. X-Ray findings: none ; stage II from III can be time consuming, and without associated (... Mm ) in size and coronal reformations typical OCD patient, the clinical usefulness of these lesions the. Which cracks form in the knee joint cartilage unstable fragments overlap derived from Latin means... Fatty marrow signal preservation to generate images with bright joint fluid and bone. As morphologic abnormalities of contour scintigraphy also provides advantages of distention, increased intra-articular pressure the! Intermediate-Weighted and T2-weighted FSE acquisitions provide high-resolution, high-contrast imaging of articular cartilage repair tissue, including OCD lesions and. And coronal reformations and 90 % respectively for differentiating unstable lesions from stable lesions common location for in! Show OCD lesions which cracks form in the joint allows diagnostic evaluation of patients with and! Surgery is a rare condition that may not always show OCD lesions pulse sequences that are in.