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. 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