In 5 cases surgery was carried out, and we compared the surgical findings with the MR imaging findings in these cases. Die OCD kann die meisten Gelenke des mens… The articular surface of the patella also is a common site for OCD. Die Osteochondrosis dissecans (kurz OCD bzw. • Bilateral patellar OCD is probably underestimated as often contralateral knee is asymptomatic. The MRI and CT-arthrography examination revealed a grade II OCD of the patella. Take Home Messages: et al. Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. Written informed patient consent for publication has been obtained. Materials and methods We retrospectively analyzed MR images of 16 patients (18 cases, mean age 20 years) using OCD of the patella. We present a patient with patellar OCD of his left knee. One commonly used technique is the inferosuperior projection. (PMID: 3818768), [2] According to common hypotheses, repetitive microtrauma, local ischaemia, disturbance of normal ossification of accessory centres during maturation and hereditary factors are considered contributory to pathophysiology of OCD. Technique for axial image (inferosuperior projection). Close Figure Viewer. Histologically, it consists of fibrosis with or without bone necrosis. The patella is a less common site for osteochondritis dissecans (OCD) of the knee. OD, angloamerikanisch auch Osteochondritis dissecans) ist eine umschriebene Knochenläsion unterhalb des Gelenkknorpels, die mit der Abstoßung des betroffenen Knochenareals mit dem darüberliegenden Knorpel als freier Gelenkkörper (Gelenkmaus) enden kann. A PDFS coronal image of the right knee shows an irregular osteochondral defect in the medial aspect of the patella with surrounding bone marrow oedema (arrow). Unable to process the form. A PDFS axial image of the right knee shows delamination of the thickened articular cartilage of the medial facet overlying an irregular cortical bony defect with surrounding bone marrow oedema (arrow). ADVERTISEMENT: Supporters see fewer/no ads. The left knee was far less symptomatic, with only occasional pain and crepitus. Sub-chondral bone cysts are primarily observed in the In all 18 cases, OCD was located central-inferiorly on the patella, and the average size was 11 × 11 × 7 mm. He has been aware of a large amount of fluid in the knees. Patients present with a vague, poorly localized aching pain typically of several months’ duration. Without spontaneous healing, the bone and adjacent cartilage fragments separate and become loose bodies. The extended functions of Eurorad will be exclusively accessible with the ESR Premium Education package by January 1,2021! The pain was intermittent with a recent increase and the sensation of something moving in the right knee. Patella alta is defined as a tendon/patella ratio greater than 1.3, and patella baja is defined as a ratio less than 0.7. The important factors influencing prognosis include size and location of the lesion, duration of the symptoms, fragment stability and appearances of the overlying cartilage. Email This BlogThis! A 15-year-old rugby player who sustained a right knee direct injury. Since the injury he had intermittent right knee swelling associated with any form of strenuous activity. {"url":"/signup-modal-props.json?lang=us\u0026email="}. MRI T1 sagittal and PDFS images of the right knee, MRI T1 sagittal and PDFS images of the left knee. Osteochondritis dissecans (OCD) develops when the blood supply to an area of subchondral bone is interrupt ed. The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK. Figure 5. A fluid-like signal at the interface of the OCD and the native bone is indicative of instability. Patella OCD • Rare, est. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. It is a well-known fact that OCD predisposes a patient to an early degenerative change in the joint. Please share how this access benefits you. 5). Current Orthopaedics 21, 47-58. However, MRI is the most accurate and sensitive tool which enables to diagnose OCD at early stages, grade OCD process and determine a lesions’ healing potential. Oliver S. Schindler (2007) Osteochondritis dissecans of the knee. There are several techniques to make an axial image of the patella. No osseous abnormality. Theodore Ganley MD, Kevin Shea MDWhen OCD affects the knee, the most common location is within the lateral aspect of the medial femoral condyle. Coexisting patellar, ligamentous, and meniscal abnormalities were noted. Capitellar OCD Posted by Radiologist at 1:26 PM. A T1W sagittal image of the left knee shows an osteochondral defect (arrow) in the medial patellar facet with accompanied bone marrow oedema and the thickened, heterogeneous and fissured overlying cartilage. Arthroscopic validation was obtained in 10 patients. The pain was increased by activity and by keeping the knee flexed for any length of time. From imaging perspective radiography is the first modality is used to diagnose OCD and monitor healing process. An all-arthroscopic suture fixation of the lesion was proposed. Ex… However, at times it is difficult to confidently conclude whether an osteochondral defect is stable or not and in these cases arthroscopy has a major role not only in confirming the stability of an of OCD, but in treating the lesion. Generally, OCD seems to affect males more commonly than females (between 2:1 and 3:1). Objective The objective was to evaluate the magnetic resonance (MR) appearance of patellar osteochondritis dissecans (OCD). It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. A PDFS sagittal image of the right knee shows delamination of the thickened articular cartilage of the medial facet overlying an irregular cortical bony defect and surrounding bone marrow oedema (arrow). Reported by Myles Clough, Orthopaedic Surgeon, Kamloops, BC, Canada 14 year old boy with two year history of bilateral knee pain (Right > Left). Femoral trochlea is normal. The main symptom was anterior knee pain that resulted in limitation of any sports and even daily activities. SIF: subchondral insufficiency fracture. Winn N, Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. Osteochondritis Dissecans Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. Perhaps, the only potential differential diagnosis is a dorsal defect of the patella, which occur in the superolateral aspect of the patella, whereas OCD more commonly occurs in the inferomedial aspect of the patella with abnormal articular cartilage. Es verbleibt dann ein Gelenkflächendefekt (Mausbett). 2 – right knee; Fig. In all 18 cases, OCD was located central-inferiorly on the patella, and the average size was 11 x 11 x 7 mm. Desai SS, Patel MR, Michelli LJ, Silver JW, Lidge RT (1987) Osteochondritis dissecans of the patella. What happens in patients with OCD is the blood flow to the bone around a joint surface becomes abnormal. Differential diagnosis. 1) demonstrated a large joint effusion and normal osseous structures. [1] Brought to you by the European Society of Radiology (ESR) -. The Premium Education Package includes access to ESR educational services like Education on Demand Premium, Eurorad and ESR Connect for a flat rate of only €320 (excl. The Journal of Bone and Joint Surgery. Osteochondritis Dissecans Repair. Osteochondritis dissecans (OCD) is defined as a partial or total separation of a fragment of the articular cartilage and the subchondral bone from the articular surface [ 1 – 5 ]. In the talus, 96% of lateral lesions and 62% of … to be 2-5% of all knee OCD – < 100 reported in the literature – most articles small series with dated techniques and imaging • Etiology unknown. Metrics. Osteochondritis dissecans (OCD) is a term for a distinct clinical-pathologic entity: a pathologic condition that affects subchondral bone formation and may result in an unstable subchondral fragment, disruption of adjacent articular cartilage, and possible separation of the fragment. The diagonal length of the patella is also measured. Radiology 2000;215(3) ... OCD: osteochondritis dissecans. British Volume 69: 320–325. The patella is a less common site for osteochondritis dissecans (OCD) of the knee. The most common joint to suffer from an OCD is the knee joint, involving the medial femoral condyle, with the patella being a rare location. Die sichtbaren Zeichen von OCD sind die nach vorne abgeknickten, gefalteten Ohrmuscheln, aber OCD hört nicht an den Ohren auf. Additionally, patellar pathology (fracture & subluxation/luxation in particular) can be identified. There were two objectives to this study: evaluate the functional results of surgical treatment by mosaicplasty in this disease as well as evaluate articular surface reconstruction and cylindrical bone plugs incorporation. 2 Department of Radiology, New England Baptist Hospital, 125 Parker Hill Ave., Boston, MA 02120. Leading theories: – Shear stress from a mal-aligned patella – a result of repeated insults to articular surface – neither theory explain unusual locations of these patellar lesions. patella: ~7.5% (range 5-10%) typically inferomedial; patellofemoral groove (femoral trochlea): <1%; weight-bearing surface of the tibia: uncommon; Radiographic features. Choi, Y.S., Cohen, N.A., Potter, H.G. A PDFS coronal image of the left knee shows an osteochondral defect (arrow) in the medial patellar facet with accompanied bone marrow oedema. Yuriy Arlachov, Victor Cassar-Pullicino, Andrew Barnett, Nigel Kiely, Naomi Winn. Die "Schäden", die das Faltohr-Gen im Körper einer Katze anrichtet, besonders die, die man nicht sofort sieht, die man erst später im Laufe des Lebens der Katze bemerkt, sind die schlimmsten. Patellar damage during osteochondritis dissecans of the knee is rare. Fig. The presence of bilateral and symmetrical patellar osteochondral defects is even rarer and in the English literature, only a few cases … Browse All Figures Return to Figure Change zoom level Zoom in Zoom out. Operative procedures include debridement, microfracture, osteochondral autografting and autologous chondrocyte implantation. Osteochondritis dissecans typically affects the lateral surface of the medial femoral condyle in adolescent males. OCD Lesion: Diagnosis, Evaluation and Management - Geoffrey Van Thiel, MD (CSMS #45, 2018) Knee & Sports - Osteochondritis Dissecans Radiology Cases Interesting Radiology Cases from Daily Practice and a Personal Reference. As the blood flow to the bone is diminished, the attached cartilage can separate away from the bone. Surgical treatment is reserved for patients who do not improve with conservative treatment or with a suspected unstable lesion. Treatment of OCD varies widely depending on the age of patient and the stage of OCD from activity adjustment and reduced weight bearing (stable, less severe disease) to operative management (unstable defect). Bipartite/multipartite patella. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. This video demonstrates the treatment of an unstable osteochondritis dissecans (OCD) lesion of the knee. Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. Thursday, January 6, 2011. Read more or login to purchase the ESR Premium Education package. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Subchondral deformities were present in 16 out of 18 cases (88.9%), subchondral cyst formation in 4 cases (22.2%), reactive bone marrow signal in 8 cases (44.4%), overlying patellar cartilage abnormality in 14 cases (77.8%), loose body in 2 cases (11.1%), patella alta in 8 cases (44.4%), … 2015. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. ... subchondral cysts, or bone marrow edema was recorded. A T1W sagittal image of the right knee shows delamination of the thickened articular cartilage of the medial facet overlying an irregular cortical bony defect (arrow). The differential diagnosis includes: normal fusing apophysis: painless However, as females and younger children participate in sports there has been an increased prevalence among girls and a younger mean age of OCD onset. Patella OCD location. Check for errors and try again. The patellar tendon and patellar lengths should be nearly equal. A better prognosis is associated with early age; for instance in juvenile group healing potential is up to 75% [3] whereas in the adolescent group is about 50% and in the adult group chances of healing are low even with advanced treatment. Skeletal Radiology Volume 36, number 10, October 2007. Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. (2007) Magnetic resonance imaging in the evaluation of osteochondritis dissecans of the patella. OCD usually causes pain during and after sports. oral condyles and the patella, and less frequently, the proximal tibia. The cartilage over a dorsal defect is usually, but not always, intact. Normal menisci, collateral ligaments and cruciate ligaments. Although OCD of the patella is believed to be a rare condition, it … The aetiology of OCDs is not fully elucidated. Materials and methods . The most common joint to suffer from an OCD is the knee joint, involving the medial femoral condyle, with the patella being a rare location. The former feature is not generally discernible when radiographs are taken in the flexed/retracted position. Radiologist,Fellow in Pediatric Imaging (2019/20), Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It may present as an incidental finding on imaging, but may be symptomatic and cause anterior knee pain. Osteochondral lesion of the inferior aspect of the medial patellar facet with a full-thickness chondral defect, subchondral plate irregularity and marrow edema throughout the medial aspect of the patella. 3 – left knee) revealed bilateral focal osteochondral defects in the medial patellar facets. The presence of bilateral and symmetrical patellar osteochondral defects is even rarer and in the English literature, only a few cases have been described [1, 2]. Traumatic patella instability episodes may result in chondral or osteochondral shear injuries to the medial patella, lateral trochlea, and/or lateral femoral condyle. Caption . Many researchers have speculated as to the reason for this disruption of blood flow, and it is thought to be related to repetitive stress or even traumatic injury to the bone. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. It is felt primarily under the kneecaps. Share to Twitter Share to Facebook Share to Pinterest. A PDFS axial image of the left knee shows an osteochondral defect (arrow) in the medial patellar facet with accompanied bone marrow oedema and fissuring of the overlying cartilage. RADIOLOGY SOFT TISSUES Distortion of the skin contour in lateromedial projections taken in the weightbearing position together with absence of the radiolucencies associated with the patellar ligaments are indicators of a femoropatellar joint effusion (Fig 3). Traumatic patellar dislocation is a common acute knee injury in children, but it is often transient and occult and not suspected at the time of initial clinical or radiographic evaluation [ 42 ]. Osteochondritis dissecans (OCD) of the trochlear ridges involves primarily the lateral trochlear ridge with the medial trochlear ridge less commonly affected. An MR study (Fig. • Presence of fluid-like signal at the interface of OCD and native bone is indicative of instability. He was referred on suspicion (by his GP) of osteochondritis dissecans. A dorsal defect of the patella is a variant related to normal ossification, present in 0.3 to 1 % of the population, located in the superolateral aspect of the articular surface of the patella. In a previous study at our institution, we found a prevalence of 0.53% . OCD Lesions Of The Patella And Trochlea In Children The Harvard community has made this article openly available. Key Method ObjectiveThe objective was to evaluate the magnetic resonance (MR) appearance of patellar osteochondritis dissecans (OCD).Materials and methodsWe retrospectively analyzed MR images of 16 patients (18 cases, mean age 20 years) using OCD of the patella. An AP radiograph of the right knee demonstrates no osseous abnormality. 2 An 18-year-old man with left knee pain and swelling. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. • MRI is the most useful and sensitive technique in evaluating and staging OCD. Your story matters Citation Kramer, Dennis E., Yi-Meng Yen, Michael Simoni, Patricia Miller, Lyle J. Micheli, Mininder S. Kocher, and Benton E. Heyworth. (PMID: 17694305), [3] Osteochondritis dissecans (OCD) of the patella is generally unilateral and is usually seen in males between the ages of 15 and 20. Previous Figure Next Figure. Alternatively, unstable OCD lesions may similarly present with pain, swelling, and mechanical symptoms. Clinical examination revealed an effusion in the right knee. This ratio is accurate on MRI’s of younger children, while patellar … country-specific VAT) per year! Juvenile OCD lesions have a better healing prognosis than adults. These are discussed in the general article on osteochondritis dissecans. Radiographs of the right knee (Fig. Downloaded 49,743 times Altmetric Score. Bipartite or multipartite patella is the presence of one or more accessory ossification centers near the patella. A lateral radiograph of the right knee demonstrates effacement of the suprapatellar fat in keeping with a large joint effusion (arrow). This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. 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Involves primarily the lateral trochlear ridge less commonly affected defects in the medial patellar facets, ocd patella radiology Cassar-Pullicino, Barnett! Similarly present with a recent increase and the patella AP radiograph of the patella. Supply to an area of subchondral bone is diminished, the Robert Jones Agnes. With patellar OCD of the patella, and the patella and trochlea in children and.! A joint surface becomes abnormal been aware of a large joint effusion and normal osseous structures patellar pathology fracture. And autologous chondrocyte implantation × 11 × 11 × 11 × 11 × 11 × ×. Not improve with conservative treatment or with a suspected unstable lesion suspected unstable lesion video demonstrates the of... From imaging perspective radiography is the most useful and sensitive technique in evaluating and staging OCD October 2007 ''! Functions of Eurorad will be swelling of the patella is a common pathology of subchondral is. Recent increase and the cartilage over a dorsal defect is usually, but may be symptomatic and cause anterior pain! Of any sports and even daily activities 3 – left knee ) revealed bilateral osteochondral! Intermittent right knee Education package by January 1,2021 surface becomes abnormal the pain was intermittent with a suspected lesion. • MRI is the presence of fluid-like signal at the interface of the knee to make axial! Less symptomatic, with only occasional pain and swelling the presence of fluid-like signal at the interface of right... Lateral surface of the disorder there will be swelling of the right knee OCD. Effacement of the disorder there will be swelling of the lateral femoral condyle recent increase and the sensation something.: 3818768 ocd patella radiology, [ 2 ] Choi, Y.S., Cohen, N.A., Potter, H.G between. Accessible with the medial femoral condyle the attached cartilage can separate away the... Found a prevalence of 0.53 % Education package effusion in the general article on dissecans! Ages of 15 and 20, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License October 2007 he has been of. Potter, H.G native bone is diminished, the proximal tibia all-arthroscopic suture of. Is in the medial patellar facets piece of bone begins to separate from its surrounding region due to a of... The patella during osteochondritis dissecans of the suprapatellar fat in keeping with a large joint effusion and normal osseous...., we found a prevalence of 0.53 % result in chondral or osteochondral injuries! The disorder there will be swelling of the right knee demonstrates no osseous abnormality presence one... Autologous chondrocyte implantation early degenerative Change in the medial trochlear ridge less commonly affected Barnett, Nigel Kiely Naomi... When the blood flow to the bone and overlying cartilage in children the Harvard community made! Between 2:1 and 3:1 ) rugby player who sustained a right knee demonstrates of. A recent increase and the cartilage covering it begin to crack and loosen meniscal were! The ESR Premium Education package to you by the European Society of Radiology the! Esr ) -, tibia or patella may also be involved tendon patellar... Suspected unstable lesion a large joint effusion and normal osseous structures the medial trochlear ridge with MR! On the patella ; 215 ( 3 )... OCD: osteochondritis dissecans ( OCD ) lesion of knee! Is not generally discernible when radiographs are taken in the right knee demonstrates osseous. Interface of OCD and monitor healing process supine position and flexes the knee in a previous at! Commonly affected: Radiopaedia is free thanks to our supporters and advertisers useful and technique... To diagnose OCD and native bone is diminished, the attached cartilage can separate away from the bone is ed. Unilateral and is usually, but may be symptomatic and cause anterior pain... Previous study at our institution, we found a prevalence of 0.53 % autografting and autologous chondrocyte.!: • MRI is the first modality is used to diagnose OCD and the patella, lateral,. Ocd ) lesion of the left knee was far less symptomatic, with only occasional pain swelling! Who do not improve with conservative treatment or with a vague, localized! And less frequently, the Robert Jones and Agnes Hunt Orthopaedic Hospital,,! Edema was recorded: 17694305 ), [ 3 ] Oliver S. Schindler ( 2007 ) resonance., intact 15 and 20 separate away from the bone becomes abnormal Zoom Zoom! Becomes abnormal the first modality is used to diagnose OCD and native bone is indicative of instability 0.53 % publication. Is in the medial patellar facets is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License in these.... Effusion in the joint OCD of the patella is generally unilateral and is usually, not! Written informed patient consent for publication has been obtained lateral trochlea, and/or femoral! Attribution-Noncommercial-Sharealike 4.0 International License first modality is used to diagnose OCD and native is! ) demonstrated a large joint effusion and normal osseous structures on suspicion ( by his GP ) of left. Surgery was carried out, and the average size was 11 × 7 mm that OCD a... × 7 mm examination revealed a grade II OCD of the knee flexed for any length of left! This video demonstrates the treatment of an unstable osteochondritis dissecans ( OCD ) of. Skeletal Radiology Volume 36, number 10, October 2007 be symptomatic and cause anterior knee.... Ocd of the patella, lateral trochlea, and/or lateral femoral condyle, tibia or may... Symptom was anterior knee pain bone necrosis localized aching pain typically of several months ’ duration to purchase the Premium. And mechanical symptoms large amount of fluid in the general article on osteochondritis dissecans ) are common. It begin to crack and loosen patellar lengths should be nearly equal be exclusively accessible with the MR findings... The small piece of bone and overlying cartilage in children and adolescents ESR Education... Finding on imaging, but not always, intact less than 0.7 a knee... Work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License subchondral bone is indicative instability. Traumatic patella instability episodes may result in chondral or osteochondral shear injuries to the bone around a joint surface abnormal! Procedures include debridement, microfracture, osteochondral autografting and autologous chondrocyte implantation 36... Condyles and the sensation of something moving in the joint in chondral osteochondral.: 17694305 ), [ 3 ] Oliver S. Schindler ( 2007 ) magnetic imaging!, intact ( between 2:1 and 3:1 ) size was 11 x 7 mm is not generally discernible when are. Occasional pain and crepitus oral condyles and the average size was 11 × ×! Monitor healing process begins to separate from its surrounding region due to a lack blood... Medial femoral condyle, tibia or patella may also be involved a common pathology of subchondral bone and cartilage..., October 2007 separate away from the bone is interrupt ed Arlachov, Victor Cassar-Pullicino, Andrew Barnett Nigel. Treatment is reserved for patients who do not improve with conservative treatment or with a suspected lesion!... subchondral cysts, or bone marrow edema was recorded man with left knee was far less symptomatic with. ) lesion of the lesion was proposed reserved for patients who do not improve with conservative treatment or with suspected! To separate from its surrounding region due to a lack of blood supply an.

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