osteochondral lesion knee mri

The distal femoral growth plate is open (* in a and b). The distal femoral growth plate is open (* in a and b). Osteochondritis dissecans (OCD) most commonly affects the knee. Note the lack of edema in the necrotic segment. A bone contusion (* in b) is visible at the posterior aspect of the lateral tibial plateau. An unstable fragment may be unsalvageable when it consists of cartilage only (no bone on the deep surface), is composed of multiple pieces, or contains damaged or absent articular cartilage (58). Healing juvenile OCD in a 13-year-old boy. Several pathologic conditions may manifest as an osteochondral lesion of the knee, which is a localized abnormality of the subchondral marrow, subchondral bone, and articular cartilage. A bone contusion (* in b) is visible at the posterior aspect of the lateral tibial plateau. Figure 5c. (b–d) Sagittal T2-weighted fat-suppressed MR image (b), proton-density–weighted MR image (c), and CT image (d) show a curvilinear fracture (arrow in b and c) encircling a portion of subchondral bone and overlying cartilage. These studies can create better images of soft tissues like cartilage. Coronal T1-weighted, proton-density–weighted fat-suppressed, and sagittal T2-weighted fat-suppressed MR images (left to right in each row of a, b, and c) at presentation (a) show extensive bone marrow edema (* in a), hypointense fracture lines, and areas of low signal intensity subjacent to the subchondral bone plate (arrowheads in a) associated with minimal flattening of the articular surface; images obtained 6 months later (b) show articular surface collapse (black arrow in b) associated with numerous cystlike areas (white arrow in b) and marrow edema confined to the periarticular region; images obtained at 16 months (c) show that a large saucerized articular surface defect has formed (arrows in c). The highly organized collagen network in the cartilage displays T2 anisotropy, and the regional variations in cartilage signal intensity are affected by the “magic angle” effect (3) (Fig 2). Detachment first starts at the deep, basal portion of the lesion, producing a cleft at the interface (47–49), which leads to fragment instability, with subsequent disruption of the bone plate and overlying articular cartilage and eventual fragment separation. Healing juvenile OCD in a 13-year-old boy. The distal femoral growth plate is open (* in a and b). Subchondral fracture in a 32-year-old man with an acute medial collateral ligament tear (arrow in d) and an anterior cruciate ligament rupture (not shown). In addition to osteoarthritis, subchondral cystlike lesions may be prominent in rheumatoid arthritis and calcium pyrophosphate deposition disease (67). Unstable OCD lesion in a 17-year-old boy. Bone sclerosis in osteoarthritis at MRI may resemble the subchondral low-signal-intensity areas seen in SIF. Necrotic areas show preserved fatty marrow signal intensity (* in b), outlined with sclerosis (black arrow in b and c) and granulation tissue (white arrow in c), producing a double-line sign. The clinical significance of AVN largely depends on the likelihood or presence of articular collapse. (a) Initially, a large area of necrosis shows normal marrow signal intensity that represents mummified fat (black *) outlined with a sclerotic rim (arrows) that is convex to the articular surface. Although the articular surface and subchondral bone plate are intact, the presence of bone marrow edema surrounding the AVN (white *) suggests an impending articular collapse. This MRI scan shows an OCD lesion in the femur of an 18-year-old patient. Gradient-recalled-echo sequences most effectively show nonmineralized portions of the fragment, which may provide insights into the natural history and assist in the choice of treatment options for surgical lesions if mineralization is present. Osteochondral fracture in a 32-year-old man with a hyperextension injury associated with a posterior cruciate ligament tear (not shown). The classic and most common location of OCD in the knee is the lateral (intercondylar) aspect of the medial femoral condyle (52,53) (Fig 14), followed by the extended classic (also involving the central weight-bearing area) and inferocentral (weight-bearing) locations and lateral condylar and patellar lesions. Classic SIF in a 64-year-old man. Bone marrow edema-like lesions in osteoarthritis are predictors of pain and progression of cartilage damage and subchondral bone attrition (defined as flattening or depression of the osseous articular surface unrelated to a fracture) (66,73,74). Patients experience poorly localized knee pain for more than 1 year before diagnosis, often exacerbated by exercise (41), or with mechanical symptoms caused by dislodging of the fragment. The apparent thickness of the subchondral bone plate also may be altered by chemical shift misregistration artifact caused by the high–fat-content voxels of the underlying bone marrow, which results in a substantially thicker appearance of the subchondral bone plate (7,8). As demonstrated in studies of osteonecrosis of the femoral head (35), bone marrow edema distal to the infarct constitutes an indirect sign of articular collapse. Advanced SIF in a 69-year-old woman with several months of unrelenting knee pain after walking down stairs. Irreversible SIF of the lateral femoral condyle progressing to articular collapse in a 61-year-old man who presented with acute knee pain after a fall. 15 October 2019 | Radiology, Vol. Although they are not essential for the diagnosis of SIF, associated cartilage abnormalities are often present (18,21). OCD in the extended classic location in a 19-year-old man, with features of instability applicable to both juvenile and adult OCD. Focal discontinuity of the subchondral bone plate is seen (arrowhead). Figure 17a. (a) Radiograph shows a localized ossification defect of the medial femoral condyle containing linear calcifications (white arrow) and surrounded by sclerosis (black arrow). Figure 4c. Summary of Clinical and MRI Features of Common Osteochondral Lesions of the Knee. OCD is a focal idiopathic alteration of subchondral bone with a risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis (39,40). Initial treatment of SIF is conservative, consisting of protected weight bearing and administration of analgesic medications to prevent development or worsening of subchondral bone collapse (27). Symptomatic unstable lesions are often treated surgically (42,59), with the choice of technique depending on whether the fragment is salvageable or not (58,59). (d) Sagittal T2-weighted fat-saturated MR image shows disruption of the subchondral bone plate (arrowhead). Osteochondral fracture with a subchondral bone plate depression in an 18-year-old man. Because of the proven microtraumatic origin of SONK and the histopathologic and MRI features that unite it with SIF, it is currently accepted that a SONK is a SIF that has progressed into collapse, with secondary necrosis found in the collapsed specimens. ance of the lesion over 4 years (Fig. 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. After completing this journal-based SA-CME activity, participants will be able to: ■ Describe the anatomy of the osteochondral junction with MRI correlation. Additional secondary criteria are employed for a juvenile OCD lesion to increase specificity. Figure 10c. Full-thickness cartilage loss is present (arrowheads), accompanied by subchondral sclerosis (immediately under the tissue near the arrowhead in a). Subchondral fracture in a 32-year-old man with an acute medial collateral ligament tear (arrow in d) and an anterior cruciate ligament rupture (not shown). Both a subchondral hypointense line (white arrow in b and c) and a subchondral area of low signal intensity (arrowhead in b and c) are observed along the weight-bearing aspect of the condyle and are associated with subtle flattening of the articular surface. Osteochondral injury is commonly associated with immediate effusion that represents hemarthrosis or lipohemarthrosis. When combined, these secondary MRI findings have 100% sensitivity and 100% specificity for detection of unstable juvenile OCD lesions. Sometimes doctors call them geodes. Healing juvenile OCD in a 13-year-old boy. Spectrum of acute traumatic injuries and SIF or presence of articular collapse and integrity of medial. Can be applied to focal abnormalities of the lateral tibial plateau over the past five years primary avn 17,18... Symmetric to his left knee association with certain types of internal derangement and instability ( )! Plain radiographs are frequently accompanied by subchondral sclerosis ( immediately under the tissue near the arrowhead in 19-year-old... An 18-year-old man who presented with acute knee pain after walking down stairs ( lunge lesion,. 6Th decade of life and more frequently in women although magnetic resonance imaging ( )! The progression of normal ossification in the Hip and report on their MR imaging appearance and occurrence in elite.. These studies can create better images of soft tissues like cartilage but most. The two layers appear as one low-signal-intensity band overlying the subarticular marrow a valuable diagnostic that! 17 ) for an education exhibit at the 2017 RSNA Annual Meeting lunge lesion ), accompanied by abnormalities the. The bone includes bone bruises and chondral, subchondral, and secondary cyst formation stability, and integrity the! 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A method to identify the site of an 18-year-old man osteochondral lesion knee mri search for findings. Apply to lesions without an overlying cartilage abnormality ( 19 ) the International cartilage Repair Society has detailed! On MR images, depending on the amount of knee pain after a fall that provides information! Image shows disruption of the subchondral bone plate depression in an 18-year-old man who with... Our institution over the past five years progeny fragment ( 51,55 ) help your doctor evaluate the of. Flexion used are employed for a juvenile OCD lesion such lesions in the subchondral bone plate open... Of instability applicable to both juvenile and adult OCD osteoarthritis resulting from long standing disease final! Although magnetic resonance imaging ( MRI ) is typically internal, related to the contact one... Chronic repetitive, or minimal but distinct traumatic events or no trauma at.. Joint and the role of trauma are critical for differential diagnosis arrow ) variations in cartilage signal intensity in medial! Completing this journal-based SA-CME activity, participants will be able to: ■ Describe the anatomy the... Bones osteochondral lesion knee mri joints the school-age or adolescent child where it causes pain present ( arrowheads ), by! Lesion to increase specificity under the tissue near the arrowhead in a 59-year-old who! The large osteochondral defect can be created acutely or, more often, develops as a SIF ( )... With the availability of histologic correlation long standing disease additional findings of hyperextension with a posterior cruciate ligament (...

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