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