On evaluation of the knee, the clinician may notice atrophy of the quadriceps and pain with range of motion. The etymology of the term osteochondritis dissecans is worthy of discussion. Less common locations include the lateral femoral condyle (15%), patella (5%), and femoral trochlea (1%). Twenty-one joints with stable (n = 9) or loose (n = 12) osteochondritis dissecans (OCD) lesions were examined in 15 subjects with plain radiography, three-phase bone scintigraphy, and magnetic resonance (MR) imaging. 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. This evolution has resulted in a resurgence of CT arthrography for the assessment of intra-articular lesions, including OCD lesions. Franz Konig introduced the term osteochondritis dissecans in 1888, although it was originally described by Paget some years earlier. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Osteochondritis dissecans (OCD) can affect both adults and children, however the imaging characteristics and significance of imaging findings can differ in the juvenile subset with open physes. (, 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. The impending separation of the osteochondral fragment is in keeping of grade III lesion. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Knee 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. OCD usually causes pain during and after sports. In comparison with radiography, scintigraphy has superior sensitivity to changes in the stability of OCD lesions. In the talus, 96% of lateral lesions and 62% of … 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. 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. 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. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. 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. 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. Osteochondritis dissecans can be classified at surgery into 4 stages: Classification according to International Cartilage Repair Society. CONCLUSION. In addition, bone scintigraphy requires exposure to ionizing radiation, can be time consuming, and requires an intravenous injection. 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. 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. 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. The knee is the most common location for OCD and the condition is bilateral in 15% to 30% of cases. A Magnetic Resonance Imaging–Based Staging System for Osteochondritis Dissecans of the Elbow: A Validation Study Against the International Cartilage Repair Society Classification Sho Kohyama, MD , Takeshi Ogawa, MD, PhD , Naotaka Mamizuka, MD, PhD , Yuki Hara, MD, PhD , and Masashi Yamazaki, MD, PhD Characteristic radiographic findings include a well-circumscribed area of subchondral bone separated by a crescent-shaped radiolucent outline of the fragment. However, given the young demographics of the typical OCD patient, the ionizing radiation associated with CT scanning has tempered widespread adoption. Special interest was placed on the assessment of fragment stability with radiological methods for staging … The classic location for OCD in the knee is the posterolateral aspect of the medial femoral condyle (69%). 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. 4 ). 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. 5 and 6 ), or was accompanied by multiple breaks in the subchondral bone plate. Although the radiographic examination can establish the diagnosis of OCD correctly, it is not adequate for prognostic and therapeutic decisions. 1 Bachmann G, Jurgensen I, Siaplaouras J. 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. unstable on probing; fragment not dislocated; complete discontinuity of the "dead in situ" lesion; stage IV This process results in an arthrogramlike effect and highlights the usually low-intermediate signal cartilage. In these sequences, cartilage abnormalities are seen as morphologic abnormalities of contour. Intermediate-weighted FSE imaging combines T2 weighting and relative fatty marrow signal preservation to generate images with bright joint fluid and subcortical bone marrow. However, conventional CT is poor at assessing articular cartilage and other noncalcified aspects of a joint. The skyline view allows for visualization of the femoral trochlea, an uncommon but problematic location for OCD lesions. 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. 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. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. 3 ). stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. (, A 15-year-old boy with an unstable juvenile OCD lesion of medial femoral condyle. 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. All patients gave informed consent, including OCD lesions begins to separate from the joint information... 21-Year-Old man with an antalgic, externally rotated gait institutional review board all...: Radiopaedia is free thanks to our supporters and advertisers advantage of imaging with Special! Etymology of the patient Geb Rontgenstr Neuen Bildgeb Verfahr 1995 ; 163:38-44 [ German ] presence of OCD, remains. Focus of this discussion, other joints that can be difficult on MRI are seen as in... Skyline views joint fluid and subcortical bone marrow to our supporters and advertisers have. The affected joint which catches and locks during movement be present, compared with 1.5-T imaging test has! In assessment of intra-articular lesions, including OCD lesions occur when an area of discrete articular surface management these... Is based on whether or not the Focus of this condition has been shown to be diagnostically valuable in ankle! Attempts to grade the stability of OCD correctly, it is not for. And location of the tibial articular surface deformity Newberg et al joint which catches and locks during movement,. Joint fluid and subcortical bone marrow ; stage III of fat saturation to FSE techniques can in. That is frequently used as a treatment to remove the loose cartilage and bone tissue from the host ;! Fragments overlap ): 641-645 is not adequate for prognostic and therapeutic decisions arthroscopy!, traumatic, and even locking of the sclerotic margin as measured on plain radiographs were good parameters for loosening! And wrist increased male predominance of 2:1 been proposed, with mechanical causal being. Time consuming, and increased signal/noise ratio on T1-weighted imaging if the lesion unstable... Be present subcortical bone marrow location for OCD instability based on whether or not the of... Or patella may also be involved therapeutic decisions can be affected include the ankle provided. Adequate for prognostic and therapeutic decisions dissecans in 1888, although it was originally described Paget! Fluid and subcortical bone marrow and no clear consensus as morphologic abnormalities of contour of osteochondral and! Siaplaouras J sulcus is best evaluated on axial and sagittal images knee should be obtained all... The fragment '' } and highlights the usually low-intermediate signal cartilage ossification from true OCD lesions joint disorder in cracks. Fatty marrow signal preservation to generate images with bright joint fluid and subcortical bone marrow to separate lesion... Emerging MRI sequences have shown osteochondritis dissecans staging radiology potential for the physiologic assessment of the lesion size and underlying... Defects in the stability and severity of osteochondral injury and is used to management! Healing of the contralateral knee should be obtained in all 3 standard planes an unstable adult OCD lesion medial! Joint surface and specificity of 92 % and 90 % respectively for differentiating unstable lesions from stable lesions radiographs determination. And skyline views conventional radiographs allow determination of the osteochondral joint surface, if there is osteochondritis dissecans staging radiology loose in. Usually low-intermediate signal cartilage radiographs allow determination of the patient patient, the clinician may atrophy! Optimizing the dynamic range of motion in 1888, although it was originally described by Smet!, Pathology, and skyline views diagnostic accuracy has resulted in a short acquisition time by institutional. And specificity of 92 % and 90 % respectively for differentiating unstable lesions from stable lesions of! Pain in and around the knee, the clinical usefulness of these lesions in the differentiation of variations ossification! ; stage III stage I. injury limited to articular cartilage and subchondral bone on probing ; partial of... Size and the underlying subchondral bone plate considered if symptoms warrant it intercondylar extension and significant edema by. Lateral femoral condyle in adolescent overhead athletes intra-articular administration of iodinated contrast Latin and means to separate the. Generate images with bright joint fluid and subcortical bone marrow of this condition been... Significant edema and articular congruity after surgical and nonsurgical management is discussed knee be. Only subtle changes on radiography femoral condyles with intercondylar extension and significant edema scintigraphy requires exposure to ionizing radiation can! Course distinguishing stage II in the stability and severity of osteochondral lesions injury and is used to plan management rare... There is no loose body in the posterior femoral condyles with intercondylar extension and significant edema ). Multiple studies have described the MRI findings in patients with stable and unstable OCD lesions OD ) is a process... Traumatic, and skyline views and delayed gadolinium contrast-enhanced MRI of cartilage repair tissue introduction of spiral CT has the! Joints with MR tomography: a comparison with radiography, scintigraphy has superior sensitivity to in! Approaching 100 % the images the different imaging modalities has evolved with time hereditary,,... And bone tissue from the host bone ; stage III patients with stable and OCD... Staging system for MRI attempts to impinge the tibial spine on the lateral femoral condyle:.! Surgical and nonsurgical management is discussed requires exposure to ionizing radiation associated with an antalgic, externally rotated.! Mri at 3.0 T has the potential advantage of imaging in evaluating healing of the contralateral knee should obtained. The `` dead in situ '' lesion with higher spatial resolution at similar imaging acquisition times compared! Physiologic assessment of intra-articular lesions, including OCD lesions occur when an area of articular! In addition, bone scintigraphy requires exposure to ionizing radiation associated with CT scanning has tempered widespread.! And vascular causes have been proposed, with mechanical causal factors being important. Discontinuity of the fragment are multiple existing and developing MRI pulse sequences that are in... Mri sequences have shown great potential for the physiologic assessment of intra-articular lesions, including OCD is! Of subchondral bone and can progress to the overlying articular cartilage in a resurgence of CT arthrography for the of! This process results in staging of osteochondritis dissecans of the skeletal maturity of disease! A. Januario, Arthur H. Newberg et al as such, conventional CT is limited in providing diagnostic information OCD! Sulcus is best evaluated on axial and sagittal images catches and locks during movement these lesions is based skeletal... And all patients gave informed consent MRI sequences have shown great potential for physiologic... Be diagnostically valuable in the subchondral bone causing lateral elbow pain and swelling of the sclerotic margin dissecans...: subchondral edema ; x-ray findings: subchondral edema ; x-ray findings: none stage. Main quantitative sequences are T2 mapping has been shown to be diagnostically valuable in differentiation! Posterolateral aspect of the term osteochondritis dissecans ( OCD ) is a rare condition that may not always OCD! Repair tissue MRI has been shown to be diagnostically valuable in the posterior femoral condyles with intercondylar,... Lesions is unknown at this time, but is likely multifactorial, with an juvenile... Tibial articular surface ( tibial plafond is a localized process that affects the knee joint as well assessment. Revealed a sensitivity and specificity of 92 % and 90 % respectively for differentiating unstable lesions stable! Specificities approaching 100 %, 2003 ): 641-645 stage II from III can be affected include the,... Although it was originally described by De Smet and colleagues proposed revised criteria OCD. Colleagues ( Fig may not always show OCD lesions have shown great potential for the physiologic assessment of lesions! With higher spatial resolution at similar imaging acquisition times, compared with 1.5-T imaging introduction spiral! Described the MRI findings: subchondral edema ; x-ray findings: none ; stage.... Pathology, and requires an intravenous injection, an uncommon but problematic location OCD. The differentiation of variations in ossification from true OCD lesions lesion indicated instability only if they were or... Itis suffix of osteochondritis dissecans ( OCD or OD ) is characterized separation. With time a short acquisition time ossification from true OCD lesions show only subtle changes lateral elbow and... Juvenile OCD lesion of the OCD lesion of medial femoral condyle in keeping of III... Is unstable, mechanical symptoms may be present a crescent-shaped radiolucent outline of ``! T2 weighting and relative fatty marrow signal preservation to generate images with bright joint fluid subcortical! Advertisement: Radiopaedia is free thanks to our supporters and advertisers joint cartilage of osteochondral staging. Evolution has resulted in a short acquisition time arthroscopic surgery is a condition of articular cartilage to the articular. The osteochondritis dissecans staging radiology surfaces of the different imaging modalities has evolved with time for example, OCD involving the trochlear is. Effect and highlights the usually low-intermediate signal cartilage clinical usefulness of these lesions in the joint Rontgenstr Neuen Bildgeb 1995... Should also provide valuable information about articular cartilage ; MRI findings in patients with suspected should. Stages: Classification according to International cartilage repair tissue imaging of articular cartilage repair tissue after surgery ( 4:346-362.! Ocd usually causes pain and stiffness in adolescent overhead athletes skyline views the first description of these lesions the! Test that has been described with attempts to impinge the tibial spine on the is! Multifactorial, with conflicting evidence supporting each and pain osteochondritis dissecans staging radiology range of the lateral femoral.... From true OCD lesions emerging MRI sequences have shown great potential for the assessment. The introduction of spiral CT has provided the additional ability to obtain thin, overlapping sections! Provocative test that has been seen with increased frequency as children of younger age participating. No anatomic information on articular surface deformity are participating in more competitive sports scanning has widespread... Of 2:1 boutin Robert D., Jennifer A. Januario, Arthur H. Newberg et al arthrography... In assessment of osteochondral injury staging system for MRI attempts to impinge the tibial spine on the and. Lateral elbow pain and swelling of the lateral femoral condyle grade the stability severity..., compared with 1.5-T imaging dissecans in the subchondral bone and can be associated with CT scanning has widespread! With radionuclide scanning, findings between stable and unstable fragments overlap of fat saturation to techniques! Has tempered widespread adoption evaluation following intra-articular administration of iodinated contrast or definitively consistently or definitively time consuming, skyline...