OBJECTIVE. It is a morphologic finding that may be seen in various conditions and that produces a scalloped defect along the articular surface of the bone (Fig 1). Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. Knee > Osteochondral Defect What is Osteochondral Defect? 5-10% of people > 40 years old have high grade chondral lesions; location. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. Answered by Dr. Veena Govila: Loose body is common: Talk to your dr. As loose body is very common. METHODS: A literature... Read Summary OSTEOCHONDRAL INJURY . [7], who evaluated the knee using MRI. 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. 2A, 2B, 2C, 3A, 3B, and 3C). to detect the most effective treatment option for primary talar osteochondral defects in adults. The injury usually occurs with the femur internally rotated on a fixed tibia and with the knee in a slightly flexed position. 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. Chondral defects are almost always diagnosed after a magnetic resonance imaging (MRI) scan. PEARL: In this case, the patient has a large effusion and loose body on the outpatient MRI. Bone Marrow Edema Patterns in the Ankle and Hindfoot: Distinguishing MRI Features, Review. 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. It was decided to use the superomedial aspect of the trochlea as the donor sight for the osteochondral autograft. Chondral defects overlapping the anterior margin of the anterior horn of the lateral meniscus were considered to be involving both chondral surfaces. Answered by Dr. Veena Govila: Loose body is common: Talk to your dr. As loose body is very common. 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. Infection is always a … An MRI was then obtained to determine stability of the lesion. The MR images of these 25 patients were then reviewed and 10 patients were found to have osteochondral defects involving the lateral femoral condyle. some defects found incidentally on MRI or arthroscopy; Symptoms . Images were first evaluated for the presence of the typical bone contusion pattern involving the anterolateral femoral condyle and the inferomedial patella. Chondral defects are almost always diagnosed after a magnetic resonance imaging (MRI) scan. If the MRI demonstrates good graft integration then the patient is permitted to resume full activity. The patella then proceeds to bounce back into its normal position within the trochlear groove. The osteochondral defects involved the articular surface of the trochlear groove in three (30%) of the 10 patients (Figs. 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. OCD usually causes pain during and after sports. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence and Pattern of Injury After Transient Lateral Dislocation of the Patella ... Keywords: cartilage, knee, MRI, musculoskeletal imaging, trauma. 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. 3. Minced articular cartilage to repair osteochondral defects of the ankle or knee. The precise location of the osteochondral defect is thus dependent on the degree of flexion of the knee at the time of dislocation. What is your management in the ED? Although osteochondral defects of the patella are usually best appreciated in the axial imaging plane, the lateral femoral condyle osteochondral injuries in this series were best depicted in either the coronal or the sagittal imaging plane. Transient dislocation of the patella occurs in two separate stages. 20 patients with imaging features of isolated osteochondral trochlear groove defects were selected. Particularly in the younger patient, MRI plays an important clinical role in the diagnosis of pre-radiographic OA and focal osteochondral injury. The word osteochondral refers to anything relating to cartilage and bone. Knee MRI – Axial cut showing the osteochondral defect of the patella. 1A, 1B, and 1C), whereas in five (50%) of the 10 patients, the chondral defects were isolated to the midlateral weight-bearing portion of the lateral femoral condyle (Figs. Transient lateral patellar dislocation is a common injury that typically occurs in the young, athletic individual. Tunnel or notch view X-ray of the right knee from a patient with osteochondritis dissecans—cystic changes and irregular border are indicated by arrows on the medial side compared to the lateral side Osteochondritis dissecans differs from "wear and tear" degenerative arthritis, which is primarily an articular surface problem. 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. 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. "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. • To provide a pictorial overview of MR imaging features of talar OCLs and to emphasize the value of MR imaging in the diagnosis and classification of these lesions. 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]. Two of the high-field-strength magnets were Horizon LX units (GE Healthcare) and the third was a Signa (GE Healthcare). There is no mention in this report of osteochondral injuries involving the weight-bearing aspect of the lateral femoral condyle. Increased awareness of osteochondral injuries, development of cartilage repair techniques, and advances in MRI technology have increased the diagnostic frequency of these lesions. The 25 cases were retrospectively reviewed in consensus by two musculoskeletal radiologists who had 7 and 18 years, respectively, of clinical experience in musculoskeletal radiology. 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. asymptomatic vs. localized knee pain; may complain of effusion, motion deficits, mechanical symptoms (e.g., catching, instability) Physical exam. • To discuss concomitant MR findings. Given the degree of edema surrounding the undisplaced defect, the lesion is characterized as being unstable. 4.8a–c. 3 – left knee) revealed bilateral focal osteochondral defects in the medial patellar facets. The medial constraint of the patella that prevents lateral subluxation, the medial patellofemoral ligament (MFPL), is torn. MRI revealed chondral defects of the lateral aspect of the trochlear of both knees. cartilage injury with associated subchondral fracture but without detachment Osteochondral lesions of the talus and fem-oral condyles are thought to occur as a result of Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. The location of the lateral femoral condyle osteochondral injury was observed to maintain a constant relationship with regard to the location of the lateral femoral condyle bone contusion. A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. 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. 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. The clinical history and physical findings may be inadequate to establish the exact nature of the injury, and as a result MRI can play a key role both in establishing the correct diagnosis and in delineating the extent of osseous and soft-tissue injury essential for directing appropriate surgical management [1]. 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