The Clinical Utility and Diagnostic Performance of MRI for Identification and Classification of Knee Osteochondritis Dissecans

Quatman, Carmen E.; Quatman‐Yates, Catherine; Schmitt, Laura C.; Paterno, Mark V.

doi:10.2106/jbjs.k.00275

Cited by 38 publications

(23 citation statements)

References 36 publications

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“…MRI was then used either to identify or confirm the findings. MRI may also help to evaluate the stability of the lesion and thus give information for follow-up and treatment [11,12]. It is possible that the routine use of MRI makes the prevalence of asymptomatic OCD higher [12].…”

Section: Discussionmentioning

confidence: 99%

Osteochondral lesions in children with juvenile idiopathic arthritis

et al. 2013

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BackgroundJoint pain and swelling are typical symptoms in children with juvenile idiopathic arthritis (JIA) and these are often related to inflammation of the joint. Juvenile osteochondritis dissecans (JOCD), that is separation of a bone-cartilage segment from the articular surface, can manifest with similar symptoms.FindingsWe studied thirteen cases of osteochondritis dissecans lesions (OCD) in children with JIA. There were nine girls and four boys with a mean age of 6.5 (2–12) years at the time of diagnosis of JIA. Mean time between diagnosis of JIA and manifestation of OCD was 5.5 (1–11) years. Indications for MRI were the presence of pain or discomfort in the joint, despite otherwise effective treatment, with no evidence from ultrasound examination of any obvious signs of active inflammation. The most common location of osteochondral lesion was the knee, although the ankle joint was affected in one case. Five patients had lesions in both knees. Operative treatment was needed in eight cases (joints).ConclusionsPain, and minor dysfunction of the joint are common complaints of children suffering from JIA. Earlier research has discounted the possibility of children who were not athletes presenting with this condition. However, this study demonstrates that these lesions also seem to be relatively common in patients with JIA. When there is no sign of inflammation, the possibility of OCD must therefore be considered in these children.

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Section: Discussionmentioning

confidence: 99%

Osteochondral lesions in children with juvenile idiopathic arthritis

et al. 2013

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“…A systematic review found that the overall sensitivity and specificity of MRI for identifying OCD in the knee compared with arthroscopy is between 78%–91% and 95%–97.9%, respectively 8. MRI can be used to classify OCD into different stages of progression.…”

Section: Discussionmentioning

confidence: 99%

An uncommon chronic osteochondral defect in the lateral tibial plateau detected after a separate injury

Leung¹,

2018

BMJ Case Reports

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Osteochondral defects (OCD) are rare conditions that usually present in young adolescents. The causes include trauma, inflammation, ischaemia, genetics and changes at secondary ossification centres. The case report presents a 27-year-old man with chronic intermittent left knee pain for about 3 years. He typically develops the symptom after prolonged standing or when rising from a prolonged seated position. An initial MRI scan in 2014 did not identify and report an OCD that was present in his left lateral tibial plateau. It was only after an accidental tibial fracture injury this year that the defect was incidentally detected on a scan. OCD can be staged based on MRI and/or arthroscopic findings. The treatment can be either non-operative or operative, but this largely depends on the age of the patient, the severity of symptoms and the staging of the defect.

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“…The overall sensitivity of MRI for identifying lesions compared with arthroscopy was reported to be between 78% and 91%, and the specificity ranged between 95% and 97.9%. 3 Features of a stable, low-grade lesion on MRI include poor definition of the fragment, a low fragment rim signal, absence of articular cartilage breach, and/or softening and thickening of articular cartilage. 4 These lesions are not as readily discernible on arthroscopy because they lack the definable characteristics of an unstable, high-grade lesion, such as an identifiable fragment, articular cartilage flap, or loose body.…”

Section: Discussionmentioning

confidence: 99%

The Golf Ball Sign: Arthroscopic Localization of an Osteochondritis Dissecans Lesion of the Knee

Piposar

Sutton

2014

Arthroscopy Techniques

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We report on the arthroscopic treatment of a 12-year-old boy diagnosed with an osteochondral defect of the medial femoral condyle. He underwent arthroscopic fixation of the defect, and during the surgery, a blunt trocar was used to localize the lesion. The trocar created a transient dimpling effect on the cartilage overlying the osteochondral defect that resembled the surface of a golf ball. This "golf ball sign" then served as a visual guide during placement of a chondral dart. When present, it is believed that this sign can benefit arthroscopists by helping to improve intraoperative localization of an osteochondral defect.O steochondritis dissecans (OCD) of the knee is an acquired, idiopathic disease that affects the subchondral bone of the femur. The specific etiology remains unknown, but delamination and sequestration of the bone can result depending on the extent of the OCD lesion.1 The impact this has on the overlying cartilage can range from softening of the articular cartilage to development of an osteochondral flap and/or loose body formation. Depending on the size, location, and extent of articular cartilage involvement, the OCD lesion can cause significant discomfort and morbidity.Treatment options vary but can involve conservative, restricted weight-bearing options; operative fixation of a stable or unstable lesion; and/or loose body removal. Operative intervention is usually performed arthroscopically. A magnetic resonance imaging (MRI) study is often obtained beforehand during the clinical workup of the patient. The MRI study helps to determine the location of the lesion, which is verified by arthroscopic visualization of the defect. In early stages of the lesion, articular cartilage becomes soft and ballotable before developing overt fibrillations, fissures, or exposed bone.This particular case involves a 12-year-old boy with an OCD lesion who underwent operative fixation of his type IV lesion. We report about a technique used during the procedure, in which a blunt trocar was used to delineate the borders of the OCD lesion, which would later serve as a guide during the placement of our fixation. Surgical TechniqueThe patient was a 12-year-old boy who sustained a recent fall from standing that caused him to have continued left knee pain and swelling. He was unable to play his usual sports because of pain, clicking, and catching of the left knee. Radiographs obtained at the time of presentation showed an osteochondral defect involving the lateral aspect of the left medial femoral condyle. The plan for the patient was to restrict him from any sports, and he was to avoid any impact activities (running, jumping, and so on) for the next month until an MRI study was obtained. At his followup visit 5 weeks later, the MRI study showed a 10-mm oval lesion at the previously defined location, as well as the presence of subchondral cysts and fluid between the fragment and underlying bone (Fig 1). The articular cartilage remained free from any defects, and there was no evidence of a loose body within ...

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The Clinical Utility and Diagnostic Performance of MRI for Identification and Classification of Knee Osteochondritis Dissecans

Cited by 38 publications

References 36 publications

Osteochondral lesions in children with juvenile idiopathic arthritis

Osteochondral lesions in children with juvenile idiopathic arthritis

An uncommon chronic osteochondral defect in the lateral tibial plateau detected after a separate injury

The Golf Ball Sign: Arthroscopic Localization of an Osteochondritis Dissecans Lesion of the Knee

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