[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. Mosby-Year Book. 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. Coronal T2-weighted image of the ankle reveals a central depression in the tarsal navicular (arrowhead) consistent with osteochondritis dissecans. Osteochondritis dissecans; grading scales; knee; magnetic resonance imaging. 2017. 1988. The incidence of osteochondritis dissecans in the condyles of the femur. Am J Sports Med. 2020 Jan. [Medline]. Sports Med Arthrosc Rev. 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. Osteochondritis dissecans of the tarsal navicular bone: imaging findings in four patients. A review of arthroscopic classification systems for osteochondritis dissecans of the knee. [27, 28]. Curr Opin Pediatr. MRI provides a more precise evaluation of the size of the lesion and structure of the overlying cartilage. OCD of the glenoid is usually a much larger and eccentrically located lesion (see the last 4 images below). [Medline]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. Satake et al found that MRI had a sensitivity of 84% for OCD, Int Orthop. Osteochondritis dissecans occurs in approximately 15 to 29 per 100,000 patients. Acta Radiol. Often, the adjacent metaphysis reveals mild osteoporosis resulting from active hyperemia of the metaphysis. Jacobs JC Jr, Archibald-Seiffer N, Grimm NL, Carey JL, Shea KG. A completely detached fragment is a loose body. 89718-overview Joints. Bauer M, Jonsson K, Linden B. Osteochondritis dissecans of the ankle. 1994 Feb. (299):305-12. [Medline]. However, osteochondritis dissecans has been linked to: Repetitive trauma or stress on a joint, such as from playing sports; Genetic predisposition in some patients; Osteochondritis Dissecans Diagnosis and Treatment. [Medline]. Note the central location and absence of subchondral bone marrow edema. 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. An osteochondral fragment may be present in situ, incompletely … When detectable, osteochondral lesions appear as lucencies in the articular epiphysis. CONCLUSION. [Medline]. 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. [Medline]. Developmental defect of the glenoid is a small focal defect within the center of the glenoid and without associated subchondral bone marrow edema. 68(6):862-5. McCullough RW, Gandsman EJ, Litchman HE. This is a normal variant. 40 (2):363-86. Necrotic bone may lose its structural support, which results in compression and flattening of the articular surface. Bachmann G, Jurgensen I, Siaplaouras J. Please confirm that you would like to log out of Medscape. Radiography of the elbow for evaluation of patients with osteochondritis dissecans of the capitellum. [15, 16, 17, 18, 19, 20, 21], Ultrasonography has been used to evaluate osteochondritis dissecans of the knee and humeral capitellum. 282 (3):798-806. The shortcomings of CT are applied radiation, especially in pediatric patients, and lack of cartilage visualization. Cystic lesion of the talar dome, cortical depression, or a loose bony fragment within the osteochondral defect may be demonstrated. Ly JQ, Bui-Mansfield LT, Kline MJ, DeBerardino TM, Taylor DC. Pappas AM. AJR Am J Roentgenol. In some cases, you or your doctor will be able to feel a loose fragment inside your joint. [Medline]. Bowen JR, Kumar VP, Joyce JJ 3d. Preoperative Evaluation of the Grade and Stability of Osteochondritis Dissecans of the Knee by Magnetic Resonance Imaging. Jans LB, Ditchfield M, Anna G, Jaremko JL, Verstraete KL. 2007 Feb. 28(2):154-61. It occurs when a small segment of bone begins to separate from its surrounding region … Osteochondritis dissecans … Lateral view of the ankle reveals loss of the sharp cortical line (arrowhead) in the posterior aspect of the tibial plafond. Skeletal Radiol 1997; 26:463-467. [74, 22, 20, 23, 24, 25, 26], Kida et al reported 100% positive predictive value for ultrasound screening for OCD and suggested that a distinctive loss of the smooth articular surface on ultrasound was a good indicator of an osteochondral lesion. Kijowski R, Blankenbaker DG, Shinki K, et al. Utilizing the ICRS classification system, for all three readers combined, the respective sensitivity, specificity, and accuracy of MR imaging to determine lesion stability were 70%, 81%, and 76%. [Medline]. MRI correlates best with surgical staging. 1253074-overview Management of osteochondritis dissecans of the knee: current concepts review. [Full Text]. A radiological and anatomical study of one case. [Medline]. 2003 Jan-Feb. 23(1):102-8. Wood JB, Klassen RA, Peterson HA. Omer GE Jr. Primary articular osteochondroses. Filardo G, Andriolo L, Soler F, Berruto M, Ferrua P, Verdonk P, Rongieras F, Crawford DC. Acta Orthop Belg. Evaluation and treatment of osteochondritis dissecans lesions of the knee. 1989 Sep. 14(5):818-21. Drawing of osteochondritis dissecans of the capitellum with localized subchondral bony flattening and a normal articular surface. Acta Orthop Scand. It is defined as a localized fragmentation of bone overlying the capitellum cartilage. 2013 Apr. The lack of cartilage visualization can be overcome by using intra-articular contrast material. 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]. Skeletal Radiol. 2014 Apr. 2005 Aug. 71(4):484-8. [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. CT is obtained in the direct axial and coronal planes at 1.5-mm-slice thickness with sagittal reformations. Aghasi M, Rzetelni V, Axer A. Osteochondritis dissecans of the carpal scaphoid. Anterior longitudinal sonogram reveals a stable lesion with localized subchondral bony flattening (arrows) and a normal outline of the articular cartilage (courtesy of Dr Masatoshi Takahara). National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. [71, 71], Satake et al found that MRI had a sensitivity of 84% for OCD, Results: 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 … [Medline]. JB JS Open Access. [Medline]. A 20-year follow-up study. Nguyen JC, Degnan AJ, Barrera CA, Hee TP, Ganley TJ, Kijowski R. Osteochondritis Dissecans of the Elbow in Children: MRI Findings of Instability. Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans. The Pritsch arthroscopic staging of osteochondral lesions of the talus is as follows doi: 10.2106/JBJS.OA.19.00031. 2009 Mar. Juvenile versus adult osteochondritis dissecans … J Bone Joint Surg [Am]. Anterior longitudinal sonogram demonstrates an unstable lesion with a capitellar defect (arrow; courtesy of Dr Masatoshi Takahara). 7 Iyer R, Thapa M, Khanna P, Chew F. Pediatric Bone Imaging: Imaging Elbow Trauma in Children-A Review of Acute and Chronic Injuries. Many patients with OCD of the femoral capital epiphysis have a prior history of Legg-Calve-Perthes Disease. [Medline]. 2000 Sep-Oct. 24(5):744-7. 2000 Nov. 175(5):1305-8. J Bone Joint Surg [Am]. [Medline]. [Medline]. In the second stage, the epiphysis reveals an irregular contour and a thinning of the subcortical zone of rarefaction. Knee Surg Sports Traumatol Arthrosc. 12:91-2. [13]. 17 (1):25-30. 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. 163(1):38-44. Magnetic Resonance Imaging Staging to Evaluate the Stability of Capitellar Osteochondritis Dissecans Lesions. It is felt that the osteochondritis dissecans can be explained on the basis of the history of trauma, which was slight but repeated in character. Conclusions: 2019 Apr. van Bergen CJ, van den Ende KI, Ten Brinke B, Eygendaal D. Osteochondritis dissecans of the capitellum in adolescents. Maruyama M, Takahara M, Satake H. Diagnosis and treatment of osteochondritis dissecans of the humeral capitellum. Javier Beltran, MD Chair, Department of Radiology, Maimonides Medical CenterDisclosure: Nothing to disclose. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Sustained Results in Long-Term Follow-Up of Autologous Chondrocyte Implantation (ACI) for Distal Femur Juvenile Osteochondritis Dissecans (JOCD). [1, 2, 3]  Osteochondritis dissecans occurs in approximately 15 to 29 per 100,000 patients. Blood vessels within the epiphysis are incompetent because of thrombosis or microfractures of the trabeculae, which results in poor healing. Ann Biomed Eng. The Berndt and Harty radiographic classification of osteochondral lesions of the talus is as follows 1992. 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?. Arthroscopy. [Medline]. [Medline]. [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). [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. Osteochondritis dissecans following Perthes' disease. [4, 48, 49, 50, 51, 52, 53, 54], Occasionally, OCD of the tarsal navicular (see the images below) is seen on ankle radiographs. 1989 Sep. 71(8):1143-52. 1992. 2016 Feb 18. Churchill RW, Munoz J, Ahmad CS. 21(2):106-15. 2019 Dec 5;4(4):e0031.1-9. Magnetic Resonance Imaging of Osteochondritis Dissecans: Validation Study for the ICRS Classification System In this paper, we utilize arthroscopy as the gold standard to determine if MRI can predict OCD … A preliminary report. The patella is a less common site for osteochondritis dissecans (OCD) of the knee. [Medline]. 471 (4):1137-43. Wall EJ, Polousky JD, Shea KG, Carey JL, Ganley TJ, Grimm NL, et al. [Medline]. [Medline]. Orthop Clin North Am. 1994. 2014 Aug. 42 (8):1972-7. 2019 Feb 1. [Medline]. 2002 Mar. Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. [Medline]. 2018 Jun. [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. Coronal T1-weighted image 2 weeks after injury is unremarkable. [Medline]. 38 (5):e296-e299. [11, 12, 9]  The shortcomings of CT are applied radiation, especially in pediatric patients, and lack of cartilage visualization. 19 (5):307-9. 1976 Dec. 121(3 Pt. 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. Am J Sports Med. 81 (6):1306-10. OCD is limited to the articular epiphysis. Singer KM, Roy SP. In 7 patients with OCD of the humeral head (all males ranging in age from 12 to 44 year), 5 of the patients (71%) demonstrated lesions in the right shoulder, suggesting an association with right-handedness. [49], Sagittal T2-weighted image of the right shoulder reveals a central depression within the glenoid (arrowhead) without associated subchondral bone marrow edema. In addition, tarsal OCD does not demonstrate either partial or complete sagittal fracture line on CT or MRI. Injury of the articular cartilage allows an influx of synovial fluid into the epiphysis, creating a subchondral cyst (see the images below). 2019. [Medline]. [Medline]. Crawford DC, Safran MR. Osteochondritis dissecans of the knee. 2007 Aug 31. Osteochondritis dissecans is an aseptic necrosis of subchondral bone and the overlying cartilage. The OCD criteria of the ICRS were applied to arthroscopy and imaging interpretations. [31], In the knee joint, the medial femoral condyle is the most commonly involved site. Reassessment of the MR criteria for stability of osteochondritis dissecans … Kijowski R, Blankenbaker DG, Shinki K, Fine JP, Graf BK, De Smet AA. Two arthroscopic classifications of osteochondral lesions of the talus are the Pritsch and Cheng surgical classifications, which are based on the appearance of the overlying articular cartilage as seen on arthroscopy. [Medline]. 2014 Aug. 42 (8):1963-71. [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. J Pediatr Orthop. Aichroth P. Osteochondritis dissecans of the knee. New Orleans, LA. J Hand Surg [Am]. 12(4):317-22. 11 (2):129-136. [Medline]. Sagittal T2-weighted image 1 year after injury reveals a subchondral cyst (arrow), an articular defect in the lateral tibial plateau, and a large knee effusion (arrowhead). [Full Text]. [Medline]. 6 De Smet A. Radiology of Osteochondritis Dissecans. Tarsal navicular OCD does not demonstrate the classic radiographic appearance of Mueller-Weiss syndrome, which includes comma-shaped deformity of the navicular resulting from collapse of the lateral portion of the bone, bipartite navicular resulting from fracture, or protrusion of portions of the bone or the entire navicular bone, medially or dorsally. Epub 2019 Jan 16. Occasionally, mirror-image osteochondral defects of the talus and distal tibia occur, suggesting trauma as a potential cause of both lesions. The cause of this lesion remains elusive. OCD of the glenoid is best detected on MRI. USA.gov. J Bone Joint Surg [Br]. The purpose of this study was to investigate the performance of MRI criteria for predicting instability of osteochondritis dissecans (OCD) lesions of the elbow in children. [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. 2007 Oct-Nov. 27(7):821-5. Clinical Value of MRI in Assessing the Stability of Osteochondritis Dissecans Lesions: A Systematic Review and Meta-Analysis. Epub 2018 Dec 6. Takahara M, Ogino T, Tsuchida H. Sonographic assessment of osteochondritis dissecans of the humeral capitellum. 2017 Dec 20;39(6):768-773. doi: 10.3881/j.issn.1000-503X.2017.06.006. Your doctor will also check other structures around the joint, such as the ligaments.Your doctor will also ask you to move your joint in different directions to see whether the joint can move smoothly through its normal range of motion. 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. Note the fluid in the subacromial/subdeltoid bursa and the supraspinatus tendon tear. [Medline]. 46 (4):247-252. A joint is where two bones come together. Potential locations are the lateral aspect of the medial femoral condyle (75%), the weight-bearing surface of the medial (10%) and lateral femoral condyles (10%), and the anterior intercondylar groove or patella (5%). Shoulder Elbow. [Medline]. 1981 Jul-Aug. (158):33-40. Guelpa G, Chamay A, Lagier R. Bilateral osteochondritis dissecans of the carpal scaphoid. A comparison with conventional radiology and arthroscopy]. [Full Text]. J Orthop Sci. Yoshizuka M, Sunagawa T, Nakashima Y, Shinomiya R, Masuda T, Makitsubo M, et al. Orthop Trans. 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. Ishibe M, Ogino T, Sato Y. Osteochondritis dissecans of the distal radioulnar joint. 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%. … In patients with capitellar OCD, MRI is particularly helpful for identifying cartilaginous foreign bodies that are usually missed by plain radiographs. The third stage is the period of repair in which granulation tissue gradually replaces the necrotic tissue. 2019 Apr 17. Osteochondritis dissecans complicating Legg-Perthes disease. Choi YS, Cohen NA, Potter HG, Mintz DN. Grades 2b, 4b, and 5 are classified as unstable lesions of variable severity. 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 … eCollection 2019 Oct-Dec. Radiologe. 2006 Jul. Osteochondritis dissecans of the tibial plafond: imaging characteristics and a review of the literature. All types of OCD were also found to have a significantly greater average BMI when compared with patients without OCD. Ellermann JM, Ludwig KD, Nissi MJ, Johnson CP, Strupp JP, Wang L, Zbýň Š, Tóth F, Arendt E, Tompkins M, Shea K, Carlson CS. Radiology; 1998;5: Reprint. [2], On conventional radiographs, osteochondral lesions can appear as lucencies in the articular epiphysis. 34(5):266-71. 1986 Aug. (209):49-56. J Bone Joint Surg [Am]. Paper presented at: Annual Meeting of the Academy of Orthopaedic Surgeons;. [Medline]. Knee Osteochondritis Dissecans. Anteroposterior radiograph of the knee is unremarkable. However, this complication cannot be predicted during the early stages of the Legg-Calvé-Perthes process and may present years later. Magnetic resonance imaging in the evaluation of osteochondritis dissecans of the patella. Ferkel RD, Sgaglione NA. 2016. Schenck RC Jr, Athanasiou KA, Constantinides G. A biomechanical analysis of articular cartilage of the human elbow and a potential relationship to osteochondritis dissecans. [Medline]. Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM. AJR Am J Roentgenol. J Pediatr Orthop. Sagittal T2-weighted image of the knee reveals subchondral bone marrow edema (white arrowhead) and an articular cartilage defect in the patella. Anteroposterior radiograph of the knee demonstrates lucency (arrow) in the central and superior aspect of the patella. Untreated osteochondritis dissecans of the femoral condyles: prediction of patient outcome using radiographic and MR findings. Eur J Radiol. Perhaps, the only potential differential diagnosis is a dorsal defect of the patella, which occur in the … 2014 Aug;42(8):1972-7. doi: 10.1177/0363546514532604. 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. Keywords: Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. 2018 Sep. 6 (9):2325967118794620. Case Discussion. Inter-rater correlation statistics and accuracy of magnetic resonance (MR) grading with respect to arthroscopy were determined. 6(4):351-2. [Medline]. Canosa J. Discrepancy between morphological findings in juvenile osteochondritis dissecans (OCD): a comparison of magnetic resonance imaging (MRI) and arthroscopy. Int Orthop. Mirror image osteochondral defects of the talus and distal tibia. 2020 Jan. [Medline]. Joint Bone Spine. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzkyMzk2LW92ZXJ2aWV3. Foot Ankle Int. Drawing of osteochondritis dissecans of the capitellum with a capitellar defect. Only case reports exist of patients with OCD of the acetabulum. Unstable osteochondritis dissecans … 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 … Griffith MRI classification of osteochondral lesions of the talus, showing the grade description of osteochondral lesions, is as follows Pill SG, Ganley TJ, Milam RA, Lou JE, Meyer JS, Flynn JM. For a general discussion of osteochondritis dissecans … … Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. 2020 Aug;12(4):284-293. doi: 10.1177/1758573218821151. When it becomes necrotic, the … Mahirogullari M, Chloros GD, Wiesler ER, Ferguson C, Poehling GG. Ultrasonography of osteochondritis dissecans of the knee. Arthroscopic treatment of osteochondritis dissecans of the scaphoid. [16]   A short tau-inversion recovery sequence is the most sensitive. [59, 22, 60, 61]. [50, 55, 56, 57, 58], OCD rarely occurs in the shoulder joint, where it involves either the humeral head or the glenoid. Materials and methods: [44] In a cadaveric study of the articular surfaces of the radiocapitellar joint, Schenck et al demonstrated significant topographic differences in the mechanical properties and thickness of cartilage in the capitellum and radial head. 23 (2):213-219. [Medline]. 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