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