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 … CT arthrography consists of thin-slice CT evaluation following intra-articular administration of iodinated contrast. Characteristic radiographic findings include a well-circumscribed area of subchondral bone separated by a crescent-shaped radiolucent outline of the fragment. In comparison with radiography, scintigraphy has superior sensitivity to changes in the stability of OCD lesions. 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. 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. (, A 15-year-old boy with an unstable juvenile OCD lesion of medial femoral condyle. 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. In contrast with conventional CT, CT arthrography has been used for cartilage imaging, providing reliable information regarding the integrity of articular cartilage overlying an OCD lesion. Fluid-sensitive (T2) sequences should be obtained in all 3 standard planes. In addition, radiographs may not always show OCD lesions consistently or definitively. 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. (, 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. Less common locations include the lateral femoral condyle (15%), patella (5%), and femoral trochlea (1%). 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. Staging of osteochondritis dissecans in the knee and ankle joints with MR tomography: a comparison with conventional radiology and arthroscopy. (, Large partially ossified osteochondral fragment. Although not the focus of this discussion, other joints that can be affected include the ankle, elbow, hip, and wrist. The De Smet criteria initially revealed a sensitivity and specificity of 92% and 90% respectively for differentiating unstable lesions from stable lesions. The ultimate cause of OCD lesions is unknown at this time, but is likely multifactorial, with mechanical causal factors being most important. 180, no. Orthop J Sports Med 2018; 6:2325967118794620 [Google Scholar] The role of the different imaging modalities has evolved with time. Special interest was placed on the assessment of fragment stability with radiological methods for staging … 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. A 14-year-old male patient with an OCD lesion on the lateral femoral condyle. 2018 Oct;9(4):346-362. doi: 10.1177/1947603517715736. The introduction of spiral CT has provided the additional ability to obtain thin, overlapping CT sections with excellent secondary sagittal and coronal reformations. Osteochondritis dissecans (OCD) most commonly affects the knee. Materials and methods: This prospective study was approved by our institutional review board and all patients gave informed consent. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement. It should also provide valuable information about articular cartilage repair tissue after surgery. MRI has been shown to be diagnostically valuable in the differentiation of variations in ossification from true OCD lesions. Request PDF | Osteochondritis Dissecans of the Elbow | Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. 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 ). The cause of osteochondritis dissecans is often unknown. MR imaging is useful in diagnosing and staging osteochondral lesions. 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. 3 (March 1, 2003): 641-645. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Knee The etymology of the term osteochondritis dissecans is worthy of discussion. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. This limitation is often caused by discrepancies between surgical and radiographic manifestations of the disease. Stability is the most important prognostic factor for determining the likelihood of an OCD lesion healing with nonoperative therapy. Prevalence of this condition ranges between 15 and 29 per 100,000, with an increased male predominance of 2:1. Intermediate-weighted and T2-weighted FSE acquisitions provide high-resolution, high-contrast imaging of articular cartilage in a short acquisition time. However, the clinical usefulness of these quantitative techniques remains uncertain. A Magnetic Resonance Imaging-Based Staging System for Osteochondritis Dissecans of the Elbow: A Validation Study Against the International Cartilage Repair Society Classification However, given the young demographics of the typical OCD patient, the ionizing radiation associated with CT scanning has tempered widespread adoption. Despite the popularity of these criteria, there is no apparent consensus in the literature regarding the most appropriate MRI criteria for defining OCD instability. 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. Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. The cause of this lesion remains elusive. 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). 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. Discrepancies include underestimation of fragment size, or fragments that appear radiographically separated can be covered by normal cartilage at surgery, and vice versa ( Fig. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. “MR Imaging Features of Osteochondritis Dissecans of the Femoral Sulcus.” Am. (, A 12-year-old boy with ossification defect at the lateral femoral condyle. 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. 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. 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. The itis suffix of osteochondritis denotes the previously understood cause of inflammation of the osteochondral joint surface. Ossification variability is typically seen as irregularity in the farposterior condyles without intercondylar extension, and without associated edema ( Fig. Check for errors and try again. 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. The tunnel view provides improved visualization of the posterior aspect of the femoral condyle as it is brought into view with knee flexion ( Fig. The addition of fat saturation to FSE techniques can help in the evaluation of articular cartilage by optimizing the dynamic range of the images. stable on probing; partial discontinuity of the lesion from the host bone; stage III. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. Recently, Kijowski and colleagues proposed revised criteria for OCD instability based on skeletal maturity of the patient. Osteochondritis dissecans can be classified at surgery into 4 stages: Classification according to International Cartilage Repair Society. 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. The knee is the most common location for OCD and the condition is bilateral in 15% to 30% of cases. Early presentation of OCD often consists of vague pain in and around the knee. MRI is now commonly used to evaluate and confirm the presence of an OCD lesion but, more importantly, to assess stability of OCD lesions of the knee. 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. Imaging of the contralateral knee should be considered if symptoms warrant it. Although the radiographic examination can establish the diagnosis of OCD correctly, it is not adequate for prognostic and therapeutic decisions. {"url":"/signup-modal-props.json?lang=us\u0026email="}. CONCLUSION. 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. Initial radiographic evaluation of patients with suspected OCD should include anterior-posterior (AP), lateral, tunnel, and skyline views. In the talus, 96% of lateral lesions and 62% of … 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. For example, OCD involving the trochlear sulcus is best evaluated on axial and sagittal images. Osteochondritis dissecans is best diagnosed with imaging studies. 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. As such, conventional CT is limited in providing diagnostic information regarding OCD lesion stability or healing potential. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint Cartilage . 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. Comparison of combined 3D GRE and routine MRI and arthroscopic results in staging of osteochondritis dissecans lesions for reader 2. 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. Features are consistent with osteochondritis dissecans of the ankle joint. 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. Osteochondritis dissecans typically affects the lateral surface of the medial femoral condyle in adolescent males. Value of MR Imaging in Staging Osteochondral Lesions of the Talus (Osteochondritis Dissecans): Results in 14 Patients - PubMed Osteochondral lesions (osteochondritis dissecans) of the talus are common articular lesions that are usually traumatic in origin. In these sequences, cartilage abnormalities are seen as morphologic abnormalities of contour. 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. 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. 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. See osteochondritis dissecans article for a general discussion. MR imaging can detect the presence of OCD in the early stages when radiographs are normal or show only subtle changes. Osteochondritis dissecans (OCD) is an uncommon, localized process that affects the subchondral bone and can result in delamination and destabilization of the overlying articular cartilage. However, subsequent studies using the revised criteria of Kijowski and colleagues showed sensitivities and specificities approaching 100%. 1 The first description of these lesions in the ankle was provided in 1922. 1 Bachmann G, Jurgensen I, Siaplaouras J. A (1.9 x 2 cm) non-displaced osteochondral fragment inner aspect of medial femoral condyle with marrow edema, in keeping with grade II osteochondritis dissecans. 5 and 6 ), or was accompanied by multiple breaks in the subchondral bone plate. OCD lesions occur when an area of discrete articular surface begins to separate from the damaged underlying subchondral bone. Symptoms include joint pain, stiffness, and even locking of the joint. Imaging and Staging. 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. In a study of 32 skeletally immature patients using arthroscopy as the reference standard, Kijowski and colleagues found that the presence of T2 signal intensity rim or cysts surrounding an OCD lesion may be a sign of instability only in adults. Osteochondritis dissecans (OCD or OD) is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. 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. cartilage injury with associated subchondral fracture but without detachment; thin sclerotic margin In contrast, true OCD lesions on MRI are seen as defects in the posterior femoral condyles with intercondylar extension and significant edema. 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. 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