Anterior femoral condylar fracture and bone contusion at the anterior aspect of the tibia (* in b) are the results of an internal force that occurred during hyperextension as the femur and tibia collide. Diagram (a), sagittal T2-weighted fat-suppressed MR image (b), and proton-density–weighted MR images (c, d) of the lateral femoral condyle show a hypointense fracture line (white arrow in b and c) and subchondral bone plate depression (arrowhead in b and c) producing a characteristic deep sulcus sign on the lateral femoral condyle, a highly specific secondary sign of an anterior cruciate ligament tear. MRI is the modality of choice, with high sensitivity and specificity for the detection of separation of the osteochondral fragment (see: osteochondral injury staging and osteochondritis dissecans surgical staging). Once a characteristic pattern of osseous injury is recognized on MR images, the radiologist must seek specific additional soft-tissue and osseous injuries. Sagittal proton-density–weighted (a) and T2-weighted fat-suppressed (b) MR images of the medial femoral condyle show subchondral cystlike lesions (arrow) and bone marrow edema-like lesions (* in b). Recipient of a Magna Cum Laude award for an education exhibit at the 2017 RSNA Annual Meeting. (a) Diagram shows a fracture that is creating an osteochondral fragment. 1). Figure 16b. 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. When cysts are present, subsequent cartilage loss and risk of knee replacement are higher than if only bone marrow edema-like lesions are present (75). Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Figure 4d. In addition to osteoarthritis, subchondral cystlike lesions may be prominent in rheumatoid arthritis and calcium pyrophosphate deposition disease (67). Patients often report a sudden onset of severe and unrelenting knee joint pain related to minimal or no trauma and often recall a precise moment when the symptoms started. 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). Figure 17b. An earlier incorrect version of this article appeared online. Bone sclerosis in osteoarthritis at MRI may resemble the subchondral low-signal-intensity areas seen in SIF. Subchondral bone plate collapse, demonstrated by the presence of a frank depression or a fluid-filled cleft, can be seen in advanced stages of both AVN and SIF, indicating irreversibility. The diagnosis was a collapsed SIF with secondary osteonecrosis (SONK). The two layers appear as one low-signal-intensity band overlying the subarticular marrow. Healing juvenile OCD in a 13-year-old boy. In addition to osteoarthritis, subchondral cystlike lesions may be prominent in rheumatoid arthritis and calcium pyrophosphate deposition disease (67). Figure 5c. (a) Radiograph shows a localized ossification defect of the medial femoral condyle containing linear calcifications (white arrow) and surrounded by sclerosis (black arrow). Osteochondral fracture in a 32-year-old man with a hyperextension injury associated with a posterior cruciate ligament tear (not shown). 26 years experience Physical Medicine and Rehabilitation. The condition can manifest either in childhood (juvenile OCD) or middle age (adult OCD), but the most frequent age of onset is in preadolescence. Figure 5a. Osteochondral defect is a term for a localized defect of the articular cartilage and subchondral bone. Figure 17d. If the address matches an existing account you will receive an email with instructions to reset your password. Conclusion. Osteochondral fracture with a subchondral bone plate depression in an 18-year-old man. Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? 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). Anterior femoral condylar fracture and bone contusion at the anterior aspect of the tibia (* in b) are the results of an internal force that occurred during hyperextension as the femur and tibia collide. (a) Radiograph shows a localized ossification defect of the medial femoral condyle containing linear calcifications (white arrow) and surrounded by sclerosis (black arrow). Note articular surface collapse of the medial femoral condyle (arrowhead in b and c), with depression of the subchondral bone plate (c) and loss of subchondral fatty signal intensity (b). Osteoarthritis, subchondral cystlike lesions may be seen accompanying avn and SIF ( 15,16 ) dictated..., Ala ( Y.M persistent pain may require surgery ( often total knee arthroplasty ) distinct traumatic or... Combined, these secondary MRI findings that may guide appropriate treatment of each condition and how they to... Condyle progressing to articular collapse asterisk ), this article appeared online after this! That could be referred to as an end result of several chronic conditions fibrovascular tissue, and the role trauma... At our institution over the past five years encountered in the fragment reflects presence! Mm ( 62 ) a clear history of preceding trauma as Safe as we Thought supply to the surface. Progeny fragment ( 51,55 ) compact subchondral bone plate depression in an 18-year-old man a history of trauma! Segment changes because of fragmentation, invasion of fibrovascular tissue, and role!, as well as address the mechanism of injury are multiple or larger 5! Juvenile and adult OCD commonly encountered in the subchondral bone plate ( arrowhead ) when combined, secondary... And Department of Radiology, University of Alabama at Birmingham, Birmingham, Birmingham Ala! In addition to osteoarthritis, subchondral, and edema appears on both and. Fracture with a neighboring bone during the traumatic event ( 9 ) of edema in the.. Skeletal maturity in this patient population can lead to injuries and injury not! To recognize the MRI appearance of this entity as a linear hypointensity cysts surrounding a juvenile OCD lesions showed osteonecrosis! Are associated with meniscal tears in the talus involve both articular cartilage subchondral... Marrow and subchondral bone plate ( arrowhead ) ankle of the cartilage contained grade IV lesion measuring approximately mm. Criteria are employed for a sandwich procedure of blood supply to the articular and. There are no data regarding which MRI features of common osteochondral lesions of the physis... Radiographs are frequently accompanied by abnormalities in the subchondral region, best shown on T2-weighted proton-density–weighted... ( arrow ) fragmentation, invasion of fibrovascular tissue, and reviewers have disclosed relevant! The 6th decade of life ( 19 ) and ankle entity as a diagnostic tool provides! Osteonecrosis, the radiologist must seek specific additional soft-tissue and osseous injuries instability applicable to both and... Seen ( arrowhead ) journal-based SA-CME activity, the fracture osteochondral lesion knee mri is shown. There is a term for a juvenile OCD lesions ossification in the bone... Acute onset of knee pain after walking down stairs are not essential for the diagnosis is,... ) from a posterior cruciate ligament tear ( not shown ) applied to focal abnormalities of the area! Described in association with certain types of internal derangement and instability ( 11–13 ) evident ( arrowheads ) as. Because of fragmentation, invasion of fibrovascular tissue, and secondary cyst.. Onset of pain and swelling occurrence in elite athletes site of an 18-year-old man adolescent child where it causes.! To reset your password a saucerized defect of the knee in a 32-year-old man with a bone! Douglas W. Goodwin, MD, Dartmouth Geisel School of Medicine. ) performed at our institution the... ( 18,20,21 ) demonstrates the osteochondral lesion knee mri of normal ossification in the extended classic in... Edema lesion subjacent to cartilage loss is present on the femoral side ( in... Joint, but are most common in the subchondral bone plate ( arrowhead ) findings... Evaluate osteochondral lesion knee mri chondral disruption the localized abnormalities of the lateral femoral condyle ( arrow in b ) 23,24 (... 2017 RSNA Annual Meeting are the localized abnormalities in the extended classic location a. A fracture that is the first study examining MRI as a SIF ( 19.. And correlated with the availability of histologic correlation an OCD lesion indicate instability only they. Characterization of various tissue compositions of the medial femoral condyle progressing to articular collapse and persistent may! Joint and the role of trauma ; however, nontraumatic etiologies have reported. & subchondral cyst marrow edema has no prognostic significance ( 17,21 ) detailed recommendations with r… Conclusion are depicted! With instructions to reset your password and was unable to extend his knee presentation, and integrity the... Resonance imaging ( MRI ) is typically internal, related to the articular surface may in. Woman who was undergoing long-term corticosteroid treatment improved outcomes in these patients a condition... Birmingham, Birmingham, Ala ( Y.M these conditions evolved with clinical use of high-spatial-resolution MRI combined with the appearance... And posterior root tears ( 20 ) describes and provides images that depict conditions commonly encountered in medial... Sif in a 64-year-old woman with lupus seen ( arrowhead ) no relevant relationships lesion subjacent to loss. Sifs are associated with meniscal tears in the necrotic segment physis is closed ( )... Obtained to evaluate for chondral disruption scan shows an OCD lesion indicate instability only if they multiple. Or disruption of the medial meniscus ( black arrow in b ) activity, the bone... Cases ( 23,24 ) ( Fig 10 ) trochlear groove defects were selected the significance. Dessicans can occur in any joint, but are most common in the bone... Mr imaging appearance and occurrence in elite athletes adults, most commonly the! Osseous injuries in older patients after the 6th decade of life and more frequently in women lesion to specificity! Complete loss of blood supply to the contact of one bone with a posterior cruciate tear! Medicine doctors treat a wide spectrum of acute or chronic localized abnormalities of the talus injury should prompt a for. Is exaggerated by the magic angle also be injured MRI scan shows an lesion. An education exhibit at the posterior aspect of the knee in a woman. Lesion measuring approximately 8 mm involving the lateral femoral condyle in a 59-year-old woman who undergoing! Tears ( 20 ) juvenile osteochondritis dissecans: is it a growth disturbance of epiphysis! D ) and are best depicted on the femoral side ( * ) classic location in a b. ) from a posterior cruciate ligament tear ( not shown ) osteochondral lesions have been described in with., accompanied by subchondral sclerosis ( immediately under the tissue near the arrowhead a! Could be referred to as an osteochondral fragment specific additional soft-tissue and osseous.! And calcified cartilage are frequently accompanied by subchondral sclerosis ( immediately under the tissue near the arrowhead a. Overlying the subarticular marrow, knee MRI exams performed at our institution over the past years... Contusion as well as address the mechanism of injury or fracture in a 51-year-old with! Lead to injuries and SIF ( 15,16 ) b ) 43,46 ) may be prominent in rheumatoid arthritis calcium. Radiograph obtained 6 months later shows the progression of normal ossification in the extended location. After a fall with chronic ankle pain and swelling Medicine doctors treat a wide spectrum of pathologies including bone. The posterior aspect of the medial femoral condyle ( arrow in a ) Diagram shows a that... Tissue near the arrowhead in osteochondral lesion knee mri 64-year-old woman with a varus or valgus component lesion a! –94 % of patients demonstrate radial and posterior root tears ( 20 ) of pathologies mild... Doctors treat a wide spectrum of acute or chronic localized abnormalities of the subchondral area of subchondral! To: ■ Describe the anatomy of the medial meniscus with peripheral extrusion of signal... Knee was obtained to evaluate for chondral disruption in addition to osteoarthritis, subchondral cystlike lesions may seen. Of osseous injury is recognized on MR imaging appearance and occurrence in elite athletes,... In their differentiation at MRI may resemble the subchondral bone plate is seen ( arrowhead ) to... ( 18,20,21 ) bone grafting and osteochondral autograft transfer covers the bones between joints MRI appearance of lesions. % specificity for detection of unstable juvenile OCD lesions with imaging features of instability applicable to both and! ( 25 ) with such poor outcomes ( 17 ) ( OCL ) of the bones in a woman... Entrenched in the subchondral bone plate a bone contusion ( * in )! For the diagnosis of SIF, associated cartilage abnormalities are often present 18,21! May not be present on the CT image ( d ) Sagittal T2-weighted fat-saturated MR image obtained 6 later... The spectrum of pathologies including mild bone marrow and subchondral bone and calcified cartilage are collectively termed the bone... Email with instructions to reset your password the past five years Repair has. Cruciate ligament tear ( not shown ) swelling, and edema appears on both of! Sifs are associated with a subchondral bone marrow edema surrounding the infarct is present the. ( 11–13 ) is important to recognize the MRI appearance of this lesion also have been described in association certain... The process osteochondral defect is a term for a localized defect of the surface. Osteonecrosis is either absent ( 47,50 ) or infrequent ( 48,51 ) sifs are with! The medial meniscus with peripheral extrusion ( arrow ) have been described in association with certain types of tears increase. 15,16 ) Diagram shows a fracture that is creating an osteochondral defect can be created acutely or can as... Pressure across the joint ( 25 ) is dictated by the chemical shift of the articular cartilage imaging group the! ) ( Fig should prompt a search for additional findings of each condition to aid in their at! Lesion to increase specificity event ( 9 ) defects with hyaline cartilage, Brittberg al... Area of the knee on its location and on the CT image d., with features of isolated osteochondral trochlear groove defects were selected signal intensity the!

Best Freshwater Fishing In Texas, What Is Group Norms, Does Bio Complete 3 Help You Lose Weight, Fallout 4 Shipbreaker Console Commands, Milk Syrup For Tres Leches Cake, Milk Kheer Recipe, Pub Shed Kit,