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. Special interest was placed on the assessment of fragment stability with radiological methods for staging … (, A 21-year-old man with an unstable adult OCD lesion of the lateral femoral condyle. Unable to process the form. 5 and 6 ), or was accompanied by multiple breaks in the subchondral bone plate. Osteochondritis dissecans (OCD) most commonly affects the knee. Check for errors and try again. In general, conventional radiographs are poor at establishing the stability and size of the lesion and are unable to assess the status of the overlying cartilage. 3 (March 1, 2003): 641-645. Boutin Robert D., Jennifer A. Januario, Arthur H. Newberg et al. The main quantitative sequences are T2 mapping and delayed gadolinium contrast-enhanced MRI of cartilage (dGEMRIC). Quantitative T2 mapping has been correlated with type II collagen matrix organization within normal hyaline articular cartilage. 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. CT arthrography consists of thin-slice CT evaluation following intra-articular administration of iodinated contrast. The itis suffix of osteochondritis denotes the previously understood cause of inflammation of the osteochondral joint surface. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. Imaging of the contralateral knee should be considered if symptoms warrant it. Clinical management of these lesions is based on whether or not the fragments are attached. The role of imaging in evaluating healing of the OCD and articular congruity after surgical and nonsurgical management is discussed. It should also provide valuable information about articular cartilage repair tissue after surgery. However, the clinical usefulness of these quantitative techniques remains uncertain. With radionuclide scanning, findings between stable and unstable fragments overlap. cartilage injury with associated subchondral fracture but without detachment; thin sclerotic margin Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. 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. The etymology of the term osteochondritis dissecans is worthy of discussion. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). 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. However, subsequent studies using the revised criteria of Kijowski and colleagues showed sensitivities and specificities approaching 100%. 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 … In addition, bone scintigraphy requires exposure to ionizing radiation, can be time consuming, and requires an intravenous injection. unstable on probing; fragment not dislocated; complete discontinuity of the "dead in situ" lesion; stage IV Cysts surrounding a juvenile OCD lesion indicated instability only if they were multiple or large (>5 mm) in size. Intermediate-weighted FSE imaging combines T2 weighting and relative fatty marrow signal preservation to generate images with bright joint fluid and subcortical bone marrow. Abstract. However, conventional CT is poor at assessing articular cartilage and other noncalcified aspects of a joint. MRI at 3.0 T has the potential advantage of imaging with higher spatial resolution at similar imaging acquisition times, compared with 1.5-T imaging. In comparison with radiography, scintigraphy has superior sensitivity to changes in the stability of OCD lesions. Osteochondritis dissecans typically affects the lateral surface of the medial femoral condyle in adolescent males. The skyline view allows for visualization of the femoral trochlea, an uncommon but problematic location for OCD lesions. Dissecans is derived from Latin and means to separate. The cause of this lesion remains elusive. 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. 20. 1 Bachmann G, Jurgensen I, Siaplaouras J. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Multiple studies have described the MRI findings in patients with stable and unstable OCD lesions. 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. The introduction of spiral CT has provided the additional ability to obtain thin, overlapping CT sections with excellent secondary sagittal and coronal reformations. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. 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. “MR Imaging Features of Osteochondritis Dissecans of the Femoral Sulcus.” Am. Conventional radiographs allow determination of the size and location of the lesion as well as assessment of the skeletal maturity of the patient. 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. 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 addition of fat saturation to FSE techniques can help in the evaluation of articular cartilage by optimizing the dynamic range of the images. 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. 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. Although not the focus of this discussion, other joints that can be affected include the ankle, elbow, hip, and wrist. Fluid-sensitive (T2) sequences should be obtained in all 3 standard planes. Intermediate-weighted and T2-weighted FSE acquisitions provide high-resolution, high-contrast imaging of articular cartilage in a short acquisition time. 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. In the talus, 96% of lateral lesions and 62% of … OCD usually causes pain during and after sports. The tunnel view provides improved visualization of the posterior aspect of the femoral condyle as it is brought into view with knee flexion ( Fig. 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. In addition, radiographs may not always show OCD lesions consistently or definitively. 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. Characteristic radiographic findings include a well-circumscribed area of subchondral bone separated by a crescent-shaped radiolucent outline of the fragment. OCD lesions occur when an area of discrete articular surface begins to separate from the damaged underlying subchondral bone. Hence, although bone scintigraphy can serve to localize a lesion to a specific joint, it often offers little specificity in distinguishing OCD lesions from other joint abnormalities. FSE imaging also allows diagnostic evaluation of other intra-articular structures, including subchondral bone. However, given the young demographics of the typical OCD patient, the ionizing radiation associated with CT scanning has tempered widespread adoption. [1] OCD usually causes pain and swelling of the affected joint which catches and locks during movement. Bone scintigraphy also provides no anatomic information on articular surface deformity. 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. Symptoms include joint pain, stiffness, and even locking of the joint. MR imaging can detect the presence of OCD in the early stages when radiographs are normal or show only subtle changes. Emerging MRI sequences have shown great potential for the physiologic assessment of cartilage repair tissue. The role of the different imaging modalities has evolved with time. 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. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. 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. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. This test has more recently been shown to lack a satisfactory sensitivity and specificity, but can be used as a test after treatment to assess for clinical healing. 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 cause of this lesion remains elusive. 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. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. See osteochondritis dissecans article for a general discussion. 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. 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 weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. 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. (, A 12-year-old boy with ossification defect at the lateral femoral condyle. 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 techniques have been investigated as potential tools to characterize the histologic and biochemical composition and temporal maturation of repair tissue following osteochondral repair procedures. Franz Konig introduced the term osteochondritis dissecans in 1888, although it was originally described by Paget some years earlier. In contrast, true OCD lesions on MRI are seen as defects in the posterior femoral condyles with intercondylar extension and significant edema. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1995 ; 163:38-44[German]. Despite the popularity of these criteria, there is no apparent consensus in the literature regarding the most appropriate MRI criteria for defining OCD instability. 1 The first description of these lesions in the ankle was provided in 1922. Request PDF | Osteochondritis Dissecans of the Elbow | Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. Features are consistent with osteochondritis dissecans of the ankle joint. MR grading system of osteochondritis dissecans lesions: Comparison with arthroscopy ... (14 of 15), 100% (9 of 9), and 96% (23 of 24) in adult lesions. Osteochondritis dissecans (OCD) is characterized by separation of an osteochondral fragment from the articular surface. Prevalence of this condition ranges between 15 and 29 per 100,000, with an increased male predominance of 2:1. There are multiple existing and developing MRI pulse sequences that are valuable in assessment of osteochondral lesions. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondritis Dissecans 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. 2 ). This higher resolution may in turn improve diagnostic accuracy. Arthroscopic surgery is a procedure that is frequently used as a treatment to remove the loose cartilage and bone tissue from the joint. 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. The ultimate cause of OCD lesions is unknown at this time, but is likely multifactorial, with mechanical causal factors being most important. For example, OCD involving the trochlear sulcus is best evaluated on axial and sagittal images. Recently, Kijowski and colleagues proposed revised criteria for OCD instability based on skeletal maturity of the patient. 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). 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. Although the radiographic examination can establish the diagnosis of OCD correctly, it is not adequate for prognostic and therapeutic decisions. A Magnetic Resonance Imaging-Based Staging System for Osteochondritis Dissecans of the Elbow: A Validation Study Against the International Cartilage Repair Society Classification 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. 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. Initial radiographic evaluation of patients with suspected OCD should include anterior-posterior (AP), lateral, tunnel, and skyline views. 1. (, Large partially ossified osteochondral fragment. A 14-year-old male patient with an OCD lesion on the lateral femoral condyle. The knee is the most common location for OCD and the condition is bilateral in 15% to 30% of cases. 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. This condition has been seen with increased frequency as children of younger age are participating in more competitive sports. stable on probing; partial discontinuity of the lesion from the host bone; stage III. Materials and methods: This prospective study was approved by our institutional review board and all patients gave informed consent. Orthop J Sports Med 2018; 6:2325967118794620 [Google Scholar] Magnetic resonance imaging can accurately predict the presence and extent of chondral fragments, and it appears that a magnetic resonance staging classification has been developed that allows preoperative staging of lesions of the talus and the knee. 2018 Oct;9(4):346-362. doi: 10.1177/1947603517715736. 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. Of course distinguishing stage II from III can be difficult on MRI. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint Cartilage . Staging of osteochondritis dissecans in the knee and ankle joints with MR tomography: a comparison with conventional radiology and arthroscopy. 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. 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. The lesion size and the thickness of the sclerotic margin as measured on plain radiographs were good parameters for predicting loosening. If the lesion is unstable, mechanical symptoms may be present. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement. Early presentation of OCD often consists of vague pain in and around the knee. Ossification variability is typically seen as irregularity in the farposterior condyles without intercondylar extension, and without associated edema ( Fig. 180, no. Hereditary, traumatic, and vascular causes have been proposed, with conflicting evidence supporting each. 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. 4 ). 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. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. In these sequences, cartilage abnormalities are seen as morphologic abnormalities of contour. The De Smet criteria initially revealed a sensitivity and specificity of 92% and 90% respectively for differentiating unstable lesions from stable lesions. 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. This process results in an arthrogramlike effect and highlights the usually low-intermediate signal cartilage. Comparison of combined 3D GRE and routine MRI and arthroscopic results in staging of osteochondritis dissecans lesions for reader 2. On evaluation of the knee, the clinician may notice atrophy of the quadriceps and pain with range of motion. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 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. CT offers excellent anatomic delineation of mineralized/ossified structures within the knee joint. 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 Discrepancies include underestimation of fragment size, or fragments that appear radiographically separated can be covered by normal cartilage at surgery, and vice versa ( Fig. 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. Osteochondritis dissecans has been shown to heal with protective weight bearing alone, if there is no loose body in the joint. 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. Less common locations include the lateral femoral condyle (15%), patella (5%), and femoral trochlea (1%). There are 4 widely used MRI criteria for OCD instability that were described by De Smet and colleagues ( Fig. 7 ). J. Roentgenol. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The widespread difference of opinion may relate to a lack of distinction between the juvenile and adult forms OCD and the potentially different imaging features of stability/instability seen between juvenile and adult forms of the disease. 1 ). The classic location for OCD in the knee is the posterolateral aspect of the medial femoral condyle (69%). The impending separation of the osteochondral fragment is in keeping of grade III lesion. 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. Practice Essentials. The Wilson test is a special provocative test that has been described with attempts to impinge the tibial spine on the OCD lesion. This evolution has resulted in a resurgence of CT arthrography for the assessment of intra-articular lesions, including OCD lesions. 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. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. The pain is worse with activity and can be associated with an antalgic, externally rotated gait. 3 ). The cause of osteochondritis dissecans is often unknown. 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. Osteochondritis dissecans is best diagnosed with imaging studies. Imaging and Staging. Direct MR arthrography also provides advantages of distention, increased intra-articular pressure from the fluid volume, and increased signal/noise ratio on T1-weighted imaging. partial discontinuity of the lesion from the host bone, complete discontinuity of the "dead in situ" lesion. 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. 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. Although many researchers have attempted to determine the cause of OCD, there remains considerable debate and no clear consensus. MR imaging is useful in diagnosing and staging osteochondral lesions. MRI has been shown to be diagnostically valuable in the differentiation of variations in ossification from true OCD lesions. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Knee (, A 15-year-old boy with an unstable juvenile OCD lesion of medial femoral condyle. (, 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. Osteochondritis dissecans (OCD or OD) is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. CONCLUSION. Osteochondritis dissecans can be classified at surgery into 4 stages: Classification according to International Cartilage Repair Society. 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. The MRI-based staging system corresponded well with the ICRS classification, providing an accurate preoperative assessment of OCD lesions of the elbow, even with minimal subchondral bone information. {"url":"/signup-modal-props.json?lang=us\u0026email="}. 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. As such, conventional CT is limited in providing diagnostic information regarding OCD lesion stability or healing potential. 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A 14-year-old male patient with an unstable juvenile OCD lesion of medial femoral condyle often caused discrepancies. A 15-year-old boy with ossification defect at the lateral femoral condyle in adolescent males this prospective study was approved our... The role of the knee and ankle joints with MR tomography: a comparison conventional... Diagnosis of OCD in the articular cartilage ; MRI findings in patients with suspected OCD should include anterior-posterior AP. With conflicting evidence supporting each with type II collagen matrix organization within normal hyaline articular cartilage repair tissue OCD.