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. 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. However, given the young demographics of the typical OCD patient, the ionizing radiation associated with CT scanning has tempered widespread adoption. Unable to process the form. 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 Wilson test is a special provocative test that has been described with attempts to impinge the tibial spine on the OCD lesion. It should also provide valuable information about articular cartilage repair tissue after surgery. 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. Bone scintigraphy also provides no anatomic information on articular surface deformity. 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. 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. CONCLUSION. In contrast, true OCD lesions on MRI are seen as defects in the posterior femoral condyles with intercondylar extension and significant edema. This process results in an arthrogramlike effect and highlights the usually low-intermediate signal cartilage. Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. Practice Essentials. 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. CT offers excellent anatomic delineation of mineralized/ossified structures within the knee joint. This higher resolution may in turn improve diagnostic accuracy. 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. 1 ). Abstract. 3 ). 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. Osteochondritis dissecans typically affects the lateral surface of the medial femoral condyle in adolescent males. 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. Boutin Robert D., Jennifer A. Januario, Arthur H. Newberg et al. 1 The first description of these lesions in the ankle was provided in 1922. 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. 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. 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. 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. In these sequences, cartilage abnormalities are seen as morphologic abnormalities of contour. See osteochondritis dissecans article for a general discussion. Conventional radiographs allow determination of the size and location of the lesion as well as assessment of the skeletal maturity of the patient. The addition of fat saturation to FSE techniques can help in the evaluation of articular cartilage by optimizing the dynamic range of the images. MR imaging can detect the presence of OCD in the early stages when radiographs are normal or show only subtle changes. 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. 4 ). 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 Sho Kohyama, MD , Takeshi Ogawa, MD, PhD , Naotaka Mamizuka, MD, PhD , Yuki Hara, MD, PhD , and Masashi Yamazaki, MD, PhD 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. Initial radiographic evaluation of patients with suspected OCD should include anterior-posterior (AP), lateral, tunnel, and skyline views. 2 ). partial discontinuity of the lesion from the host bone, complete discontinuity of the "dead in situ" lesion. 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. 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 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. The main quantitative sequences are T2 mapping and delayed gadolinium contrast-enhanced MRI of cartilage (dGEMRIC). 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 in which cracks form in the articular cartilage and the underlying subchondral bone. This condition has been seen with increased frequency as children of younger age are participating in more competitive sports. The cause of this lesion remains elusive. 1 Bachmann G, Jurgensen I, Siaplaouras J. 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. However, conventional CT is poor at assessing articular cartilage and other noncalcified aspects of a joint. OCD lesions occur when an area of discrete articular surface begins to separate from the damaged underlying subchondral bone. 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). As such, conventional CT is limited in providing diagnostic information regarding OCD lesion stability or healing potential. In the talus, 96% of lateral lesions and 62% of … The lesion size and the thickness of the sclerotic margin as measured on plain radiographs were good parameters for predicting loosening. Less common locations include the lateral femoral condyle (15%), patella (5%), and femoral trochlea (1%). (, Large partially ossified osteochondral fragment. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. MR imaging is useful in diagnosing and staging osteochondral lesions. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Check for errors and try again. 5 and 6 ), or was accompanied by multiple breaks in the subchondral bone plate. Franz Konig introduced the term osteochondritis dissecans in 1888, although it was originally described by Paget some years earlier. Dissecans is derived from Latin and means to separate. [1] OCD usually causes pain and swelling of the affected joint which catches and locks during movement. 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. There are multiple existing and developing MRI pulse sequences that are valuable in assessment of osteochondral lesions. 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. Cysts surrounding a juvenile OCD lesion indicated instability only if they were multiple or large (>5 mm) in size. The introduction of spiral CT has provided the additional ability to obtain thin, overlapping CT sections with excellent secondary sagittal and coronal reformations. In comparison with radiography, scintigraphy has superior sensitivity to changes in the stability of OCD lesions. Imaging and Staging. (, A 21-year-old man with an unstable adult OCD lesion of the lateral femoral condyle. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. Or not the Focus of this condition ranges between 15 and 29 per 100,000 with! On evaluation of articular cartilage for reader 2 between 15 and 29 per 100,000, with evidence... 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