In addition to the well-described osteochondral injuries of the lower pole of the patella, there have been a few reports in the literature regarding femoral condyle osteochondral injuries [6-10]. "i am 16 y/o and i had been having pain in my knee(for 4-5 years).my report says osteochondral defect with a loose body. 26. That said, there were still six chondral defects confirmed by the arthroscopist, making this an important injury to be aware of. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. Many classification schemes have been proposed for the characterization of osteochondral injuries of the ankle and knee on the basis of findings on MR imaging or arthroscopy, with the thought that the long-term outcomes of the various types of lesions may differ [5, 6, 13, 14]. The chondral injury is consistently located at the posterior margin of the nonarticular marrow edema (Figs. Findings suggestive of a prior transient lateral patellar dislocation included mention of marrow edema involving both the anterolateral femoral condyle and the inferomedial patella or mention in the report of transient dislocation of the patella. Of the two lesions not identified at the time of arthroscopy, one was observed on a high-field-strength system and the other on a low-field-strength system. If only those patients with injuries isolated to the lateral trochlear groove are included, the incidence in our series is 12%, which is more in line with the 5% incidence reported by Elias et al. This proved to be a highly predictable pattern of injury and was observed in each of the 10 cases. Two donor plugs were harvested from this region, measuring 10 × 14 mm and 6 × 14 mm, respectively. Edema is present in the bed of the defect (asterisk). The osteochondral defects were full-thickness (grade 4) chondral defects with exposure of the subchondral bone in seven (70%) of 10 patients and full-thickness chondral defects with underlying cortical abnormalities (grade 5) in three (30%) of 10 patients. In addition, two of the patients have not undergone follow-up surgery. 2A, 2B, 2C, 3A, 3B, and 3C). It was decided to use the superomedial aspect of the trochlea as the donor sight for the osteochondral autograft. 2 – right knee; Fig. She first started noticing the pain while running track, which she has stopped due to the degree of pain. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. An osteochondral lesion is seen at the posterior weightbearing surface of the medial femoral condyle. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Autologous osteochondral graft provides good or excellent results in 85% of patients with focal contained chondral and osteochondral defects of the knee. Answered by Dr. Veena Govila: Loose body is common: Talk to your dr. As loose body is very common. The injury usually occurs with the femur internally rotated on a fixed tibia and with the knee in a slightly flexed position. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. Chondral defects located posterior to the anterior margin of the anterior horn of the lateral meniscus were designated as involving the weight-bearing aspect of the lateral femoral condyle. to detect the most effective treatment option for primary talar osteochondral defects in adults. 5-10% of people > 40 years old have high grade chondral lesions; location. [7], who evaluated the knee using MRI. Osteochondral defect is a term for a localized defect of the articular cartilage and subchondral bone. The nonarticular marrow edema involving the lateral femoral condyle is always centered anterior to the chondral defect of the lateral femoral condyle, which suggests that the knee is likely more extended as the second stage of injury begins. osteochondral lesions (OCLs) of the talus. She obtained radiographs (not shown) which showed an osteochondral defect. Another limitation of this study is that MRI examinations were performed on different scanners, which could affect the ability to detect chondral abnormalities. Fresh frozen osteochondral allograft may be a better choice for massive chondral and osteochondral defect. The patella then proceeds to bounce back into its normal position within the trochlear groove. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of spatial resolution hampers accurate assessment of thin articular cartilage. MRI of Spinal Bone Marrow: Part 2, T1-Weighted Imaging-Based Differential Diagnosis, Pictorial Essay. Osteochondritis dissecans (OCD) is the end result of the aseptic separation of an osteochondral fragment with the gradual fragmentation of the articular surface and results in an osteochondral defect.It is often associated with intraarticular loose bodies. C. Autologous chondrocyte implantation, osteochondral autografting, and osteochondral allografting are considered investigational for any location other than the knee (only weight-bearing surface of the medial or lateral femoral condyle or the trochlea) or the talus. An MR study (Fig. The osteochondral defects involved the articular surface of the trochlear groove in three (30%) of the 10 patients (Figs. It is during this stage of injury that the patella strikes against the nonarticular surface of the anterior aspect of the lateral femoral condyle as it attempts to reduce, thus giving rise to the classic bone contusion pattern. Osteochondral Defects of the Knee. Treatment of osteochondral defects in the knee with MaioRegen Mr Andrew Edwards. The operative reports were reviewed after MR image analysis was completed, and surgical findings were compared with the MRI results. At the time of this study, eight (80%) of the 10 patients with osteochondral injuries of the lateral femoral condyle identified on MRI had undergone follow-up arthroscopic surgery. Address correspondence to T. G. Sanders ([email protected]). CONCLUSION. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. The average size of the defects was 1.2 cm in the anteroposterior diameter and 1.0 cm in the transverse diameter. The patient underwent stem cell transplantation of the left knee. Chondral defects are almost always diagnosed after a magnetic resonance imaging (MRI) scan. More recently, there has been brief mention in both the radiology and orthopedic literature of osteochondral injuries involving not only the patellar articular surface but also the articular surface of the lateral femoral condyle [6-10]. [6]. OSTEOCHONDRAL INJURY . Each of the original interpretations was performed by one of four experienced, fellowship-trained musculoskeletal radiologists. AP, lateral, and Merchant view radiographs of the left knee demonstrate an osteochondral lesion … This configuration allows for a potential shearing injury to involve the articular surface of either the patella or the femoral condyle during the first stage of dislocation. References : 1. After the injury, the patient usually seeks medical attention because of persistent pain and swelling, which is typically located along the medial joint line, and the patient occasionally complains of a locking or catching sensation. Osteochondral lesions have been reported in the talus and knee and have a characteristic ap-pearance on MR imaging [2]. Answered by Dr. Veena Govila: Loose body is common: Talk to your dr. As loose body is very common. Subchondral marrow edema was present underlying the chondral defects in 10 (100%) patients. Transient lateral patellar dislocation is a common injury that typically occurs in the young, athletic individual. Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint resulting in chronic pain in the knee and difficulties performing normal activities of daily living. In each case, the subchondral marrow edema was centered anterior to the chondral defect, with the chondral defect located along the posterior margin of the subchondral edema (Figs. Femoroacetabular Impingement: Radiographic Diagnosis—What the Radiologist Should Know, Review. In each case, the chondral defect was located at the posterior margin of the bone contusion. asymptomatic vs. localized knee pain; may complain of effusion, motion deficits, mechanical symptoms (e.g., catching, instability) Physical exam. Other symptoms of osteochondral defect knee pain include: Swelling and inflammation; Warmth and redness over the area of the knee joint; Increased body temperature or fever as a result of the body’s attempt to fight infection of the area. incidence. As a result, orthopedic research has concentrated on the development of alternative strategies. • To discuss concomitant MR findings. A total of 25 patients (male:female ratio, 9:16; age range, 10-31 years; mean age, 17 years) were found to have MRI evidence of prior transient dislocation of the patella. Material and Methods: We retrospectively evaluated MR imaging findings of all knee MRI exams performed at our institution over the past five years. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. Consequently, our objective was to determine the incidence of lateral femoral condyle osteochondral injuries and to better define the locations and patterns of chondral injury involving the lateral femoral condyle after transient dislocation of the patella based on MRI and follow-up arthroscopy. In adults, the MR imaging criteria of a high-signal-intensity rim surrounding an OCD lesion on T2-weighted images, cysts surrounding an OCD lesion, a high T2 signal intensity fracture line extending through the articular cartilage overlying an OCD lesion, and a fluid-filled osteochondral defect have high sensitivity and specificity for instability. Aim of this study is to evaluate the clinical and MRI outcome after the implantation of a nanostructured biomimetic three-phasic collagen–hydroxyapatite construct for the treatment of chondral and osteochondral defects of the knee … A 38-year-old female patient was referred with a five-year history of bilateral knee pain. Treatment of Knee Osteochondral Defects with Mosaicoplasty Technique Mohsen Fawzy Omar, MD1, Mohammed a Gheith, MD2 1Lecturer of Orthopedic Surgery, Zagazig University, Egypt 2Assistant professor, Orthopedic Surgery, Zagazig University, Egypt 1yousufmmkh@gmail.com 2ymkhairy@medicine.zu.edu.eg Abstract Background: Due to the avascular nature of the articular … The use of low-field-strength magnets may have actually resulted in underdetection of these lesions. In two (20%) of the 10 patients, the osteochondral defects involved the articular surface of both the trochlear groove and the midlateral weight-bearing portion of the lateral femoral condyle. Pigmented villonodular synovitis (PVNS) is a rare, benign, but potentially recurrent condition with an estimated incidence of 1.8 per million. Review of the 25 cases in our series shows a 40% incidence of osteochondral injury involving the lateral femoral condyle after transient dislocation of the patella, which is similar to, but slightly higher than, the arthroscopically detected incidence of 31% recently reported by Nomura et al. It is also possible that a chondral defect was present but not considered by the surgeon to be significant enough to warrant treatment or mention in the operative report. In some cases, both an MRI and CT are needed to diagnose an osteochondral lesion. Osteochondral defects located anterior to the anterior margin of the anterior horn of the lateral meniscus were designated as involving the articular surface of the trochlear groove. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. osteochondral defects (lunge lesion), as well as address the mechanism of injury. An X-ray may be ordered, but a cartilage tear is difficult to see on an X-ray, so a magnetic resonance imaging (MRI) or computed tomography (CT) scan may be required. Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. Of the 25 patients for whom there was MRI evidence of prior transient dislocation of the patella, 10 (40%) were found to have chondral defects involving the articular surface of the lateral femoral condyle. A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). 1991; 178:271-276. The defect measured 2.88 cm 2 after debridement. Essentials of Clinical MR, 2nd edition Runge, von Tengg-Kobligk, Heverhagen 81. These MRI examinations were performed at six different outpatient imaging facilities. Zhenyu Cai, Zhao Wei, Mei Wu, Saeed Jerban, Hyungseok Jang, Shaolin Li, Xuchun Yuan, Ya-Jun Ma, Knee osteochondral junction imaging using a fast 3D T1-weighted ultrashort echo time cones sequence at 3T, Magnetic Resonance Imaging, 10.1016/j.mri.2020.08.003, 73, (76-83), (2020). ... Osteochondral Autograft Resurfacing. Anatomy Each knee has two femoral condyles, the medial femoral condyle on the inside of the knee and the lateral femoral condyle on the outside of the knee. By Val M. Runge, MD. Osteochondral defect is more common among young athletes who actively take part in sports and most commonly affects the femoral condyles in the knee. 9 In the early phase, when they are best treated, osteochondral defects can only be seen on MRI (Figure 8). The typical MRI findings after transient lateral dislocation of the patella have been well described and include a bone contusion pattern involving the inferomedial pole of the patella and the anterolateral aspect of the nonarticular portion of the lateral femoral condyle. Another recent report in the orthopedic literature describes osteochondral lesions of the lateral femoral condyle in 12 (31%) of 39 consecutive patients who underwent arthroscopy after transient dislocation of the patella [9]. Discussion . Early reports of MRI findings after transient dislocation of the patella described chondral defects of the patella but made no mention of chondral injuries of the lateral femoral condyle [1-5]. Your thighbone (femur), shinbone (tibia), and kneecap (patella) fit tightly together and move smoothly because the bone surface is covered with a thick coating of articular (hyaline) cartilage. In two of the patients, the surgeon reported no evidence of femoral chondral injury. cartilage injury with associated subchondral fracture but without detachment OBJECTIVE. An MRI (Magnetic Resonance Image) ... the location of the defect in the knee. These osteochondral injuries typically involve the inferomedial pole, the median eminence of the patella [5], or both and can result either from a shearing injury at the time of dislocation or reduction or from an impaction injury as the patella strikes the nonarticular surface of the anterolateral femoral condyle. A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). METHODS: A literature... Read Summary Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. High-grade osteochondral injuries involving the patella or the lateral femoral condyle are often treated with abrasion chondroplasty or autologous chondrocyte transplantation, and treatment of these lesions has been shown to improve functional outcome in adolescent athletes [14]. This report does not attempt to determine the frequency of this injury but simply describes the arthroscopic findings in seven patients [8]. Authors: Patrick Graham. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. This could in part be related to the skill of the arthroscopist or could possibly be explained by the fact that what appeared to be an osteochondral defect on MRI was merely volume averaging with adjacent soft-tissue structures because these defects were often observed at the far lateral aspect of either the trochlear groove or the weight-bearing aspect of the lateral femoral condyle. 1A, 1B, 1C, 2A, 2B, and 2C). The typical bone bruise pattern involving the anterolateral femoral condyle and inferomedial patella after transient lateral dislocation of the patella is a well-described MRI finding. The medial constraint of the patella that prevents lateral subluxation, the medial patellofemoral ligament (MFPL), is torn. They are not possible to be detected by way of physical examination, but sometimes the clinical history can point towards a chondral defect being the cause of the pain. Diagnosis: IOsteochondral defect (unstable). 4A and 4B). Results. MRI shows an osteochondral loose body and unstable osteochondritis dessicans lesion on the medial femoral condyle with underlying signal intensity (Figure 2). Australian Medicare Benefits Schedule criteria for knee magnetic resonance imaging 18: ... subsequent ischaemia and altered local growth. During reduction, the articular surface of the medial aspect of the lower pole of the patella first impacts the nonarticular portion of the lateral femoral condyle, resulting in the classic bone contusion. There is no mention in this report of osteochondral injuries involving the weight-bearing aspect of the lateral femoral condyle. Particularly in the younger patient, MRI plays an important clinical role in the diagnosis of pre-radiographic OA and focal osteochondral injury. Multiple surgical options are now available for repairing osteochondral lesions, and this fact, combined with the fact that the majority of patients experiencing transient dislocation of the patella are young, increases the importance of accurately identifying these lesions [8, 12, 13]. The defect was debrided down to the subchondral bone with an arthroscopic shaver and sized with the osteochondral autograft transplantation system, as shown in Fig. 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. The word osteochondral refers to anything relating to cartilage and bone. See osteochondritis dissecans article for a general discussion. Arthroscopy confirmed the presence of chondral defects of the lateral femoral condyle in six (75%) of the eight cases. There is growing recognition that focal osteochondral injury represents a substantial risk factor for the development of OA ( Fig. To describe and apply a semiquantitative MRI scoring system for multifeature analysis of cartilage defect repair in the knee by osteochondral allografts and to correlate this scoring system with histopathologic, micro–computed tomography (µCT), and biomechanical reference standards using a goat repair model. Chondral defects are almost always diagnosed after a magnetic resonance imaging (MRI) scan. Figure 1. Address correspondence to T. G. Sanders ([email protected]). A significant number of osteochondral injuries involve the midlateral weight-bearing portion of the lateral femoral condyle and are more posterior than would be expected after transient dislocation of the patella. MR is an important tool for the follow-up of patients that underwent to different kind of surgical treatments with particular regards … Magnetic resonance imaging (MRI) is widely used for diagnosing osteochondral lesions in the talus. Knee MRI – Axial cut showing the osteochondral defect of the patella. inspection. This study determined that chondral injuries were more frequently detected compared with meniscal and ACL injuries, and patterns varied depending on stage of physeal closure. Next, the size (using electronic calipers) and location of the lateral femoral condyle defect were recorded. Bone Marrow Edema Patterns in the Ankle and Hindfoot: Distinguishing MRI Features, Review. the patient's future goals and activity level. Potential soft-tissue injuries include a partial- or full-thickness tear of the medial soft-tissue restraints, including the medial patellofemoral ligament and medial retinaculum [7, 11, 12]. It is known from long-term followup studies, such as those conducted by Linden, 7 that osteochondritis dissecans diagnosed in adulthood is likely to lead to the development of early onset osteoarthritis. OCD usually causes pain during and after sports. Transverse dimensions were obtained from the coronal images, whereas anteroposterior dimensions were obtained from the sagittal images. Hemarthrosis is common and loose intraarticular bodies are occasionally present [1-3]. A magnetic resonance imaging (MRI) scan of the knee is performed at six months to assess the cartilage repair and subchondral bone. 4.8a–c. Examinations at three of the centers were obtained using high-field-strength (1.5 T) magnets, and examinations at the other three centers were obtained using low-field-strength (0.2 T) magnets. The large osteochondral defect was eventually managed in a staged manner with bone grafting and osteochondral autograft transfer. The purpose of this study was to directly compare the MRI with the arthroscopic findings. A third recent report in the orthopedic literature describes seven patients with osteochondral injuries involving the midlateral weight-bearing portion of the lateral femoral condyle after patellar dislocation. It is likely therefore that the lateral femoral condyle osteochondral injuries result from a shearing force that occurs during the first stage of injury. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence and Pattern of Injury After Transient Lateral Dislocation of the Patella, Review. "i am 16 y/o and i had been having pain in my knee(for 4-5 years).my report says osteochondral defect with a loose body. Chondral and osteochondral injuries were the most common lesions discovered in children undergoing MRI for evaluation of internal derangement of the knee in one study . The increasing interest in the role of subchondral bone with regard to articular surface disease led to the development of new bioengineered strategies. It is often used synonymously with osteochondral injury/defect and in the pediatric population. chronic ACL tear. The Rotator Interval: A Review of Anatomy, Function, and Normal and Abnormal MRI Appearance, Review. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. At six months postoperatively she reported that her symptoms had greatly improved and her symptoms were minimal. Next, the images were evaluated for the presence of an osteochondral injury or defect involving the lateral femoral condyle, and if present, the osteochondral defect was graded according to a modified Outerbridge classification system [5]: grade 1, chondral softening or blistering with an otherwise intact surface; grade 2, shallow superficial fissuring or ulceration involving less than 50% of the depth of the articular surface; grade 3, deep ulceration, fissure, or flap that involved more than 50% of the depth of the articular cartilage without exposure of subchondral bone; grade 4, full-thickness chondral defect with exposure of subchondral bone; and grade 5, full-thickness chondral abnormalities with underlying cortical defect. Articular cartilage lesions are common and have been reported in 63% of over 31,000 arthroscopic procedures in one series.1 Although 20% have been… The concave configuration of the trochlear groove protects its articular surface from injury during reduction of the patella, whereas the convex shape of the patella places its articular cartilage at risk for injury during the reduction stage as well. Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. Osteochondral lesions of the knee are found in up to 19% of arthroscopies, taking all indications together. Another recent article describing MRI findings of osteochondral injuries after acute lateral patellar dislocation reports four (5%) of 82 patients with osteochondral injuries involving the lateral trochlear groove [7]. The patient usually falls to the ground in pain, at which time the patella reduces spontaneously. These dislocations are often transient, and as a result, the patient and clinician may be unaware of the true nature of the injury. If the MRI demonstrates good graft integration then the patient is permitted to resume full activity. 3-2 ).Particularly in the younger patient, MRI plays an important clinical role in the diagnosis of pre-radiographic OA and focal osteochondral injury. In some cases, both an MRI and surgical findings or an underlying disorder of the lateral femoral marrow! And with the MRI with the knee joint is perhaps one of the was... These MRI examinations were performed at six different outpatient imaging facilities bone marrow: 2. Take Part in sports and most commonly affects the knee osteochondral lesions of the typical contusion. Best way to manage these lesions compounds the challenge outpatient imaging facilities rare,,! Chronic conditions ( Figs G. Sanders ( [ email protected ] ) to... 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