Theodore Ganley MD, Kevin Shea MDWhen OCD affects the knee, the most common location is within the lateral aspect of the medial femoral condyle. The patellar tendon and patellar lengths should be nearly equal. 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. It is a well-known fact that OCD predisposes a patient to an early degenerative change in the joint. (PMID: 17694305), [3] British Volume 69: 320–325. These are discussed in the general article on osteochondritis dissecans. 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. Unable to process the form. et al. The Journal of Bone and Joint Surgery. 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 most common joint to suffer from an OCD is the knee joint, involving the medial femoral condyle, with the patella being a rare location. Skeletal Radiology Volume 36, number 10, October 2007. 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. 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). 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). Downloaded 49,743 times Altmetric Score. Surgical treatment is reserved for patients who do not improve with conservative treatment or with a suspected unstable lesion. 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. In the talus, 96% of lateral lesions and 62% of … OCD Lesion: Diagnosis, Evaluation and Management - Geoffrey Van Thiel, MD (CSMS #45, 2018) Knee & Sports - Osteochondritis Dissecans Die OCD kann die meisten Gelenke des mens… A fluid-like signal at the interface of the OCD and the native bone is indicative of instability. [1] Since the injury he had intermittent right knee swelling associated with any form of strenuous activity. 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. 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. Patella OCD • Rare, est. Browse All Figures Return to Figure Change zoom level Zoom in Zoom out. 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. The diagonal length of the patella is also measured. Close Figure Viewer. The cartilage over a dorsal defect is usually, but not always, intact. An AP radiograph of the right knee demonstrates no osseous abnormality. Please share how this access benefits you. Osteochondritis dissecans (OCD) of the patella is generally unilateral and is usually seen in males between the ages of 15 and 20. The MRI and CT-arthrography examination revealed a grade II OCD of the patella. Sub-chondral bone cysts are primarily observed in the patella: ~7.5% (range 5-10%) typically inferomedial; patellofemoral groove (femoral trochlea): <1%; weight-bearing surface of the tibia: uncommon; Radiographic features. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Previous Figure Next Figure. • Presence of fluid-like signal at the interface of OCD and native bone is indicative of instability. (PMID: 3818768), [2] Normal menisci, collateral ligaments and cruciate ligaments. A PDFS 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. (2007) Magnetic resonance imaging in the evaluation of osteochondritis dissecans of the patella. OCD Lesions Of The Patella And Trochlea In Children The Harvard community has made this article openly available. ... subchondral cysts, or bone marrow edema was recorded. Osteochondritis dissecans typically affects the lateral surface of the medial femoral condyle in adolescent males. There are several techniques to make an axial image of the patella. Operative procedures include debridement, microfracture, osteochondral autografting and autologous chondrocyte implantation. The differential diagnosis includes: normal fusing apophysis: painless • Bilateral patellar OCD is probably underestimated as often contralateral knee is asymptomatic. Materials and methods We retrospectively analyzed MR images of 16 patients (18 cases, mean age 20 years) using OCD of the patella. 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 ]. SIF: subchondral insufficiency fracture. This ratio is accurate on MRI’s of younger children, while patellar … Osteochondritis Dissecans Repair. Alternatively, unstable OCD lesions may similarly present with pain, swelling, and mechanical symptoms. 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. From imaging perspective radiography is the first modality is used to diagnose OCD and monitor healing process. Your story matters Citation Kramer, Dennis E., Yi-Meng Yen, Michael Simoni, Patricia Miller, Lyle J. Micheli, Mininder S. Kocher, and Benton E. Heyworth. Caption . 5). 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. Fig. No osseous abnormality. 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. 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 extended functions of Eurorad will be exclusively accessible with the ESR Premium Education package by January 1,2021! In all 18 cases, OCD was located central-inferiorly on the patella, and the average size was 11 x 11 x 7 mm. Radiology 2000;215(3) ... OCD: osteochondritis dissecans. Email This BlogThis! Bipartite or multipartite patella is the presence of one or more accessory ossification centers near the patella. 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%), … It is felt primarily under the kneecaps. Share to Twitter Share to Facebook Share to Pinterest. In 5 cases surgery was carried out, and we compared the surgical findings with the MR imaging findings in these cases. Thursday, January 6, 2011. Check for errors and try again. Bipartite/multipartite patella. Traumatic patella instability episodes may result in chondral or osteochondral shear injuries to the medial patella, lateral trochlea, and/or lateral femoral condyle. Die sichtbaren Zeichen von OCD sind die nach vorne abgeknickten, gefalteten Ohrmuscheln, aber OCD hört nicht an den Ohren auf. Brought to you by the European Society of Radiology (ESR) -. Without spontaneous healing, the bone and adjacent cartilage fragments separate and become loose bodies. Metrics. Radiographs of the right knee (Fig. OCD usually causes pain during and after sports. Read more or login to purchase the ESR Premium Education package. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. Arthroscopic validation was obtained in 10 patients. The left knee was far less symptomatic, with only occasional pain and crepitus. The patella is a less common site for osteochondritis dissecans (OCD) of the knee. Patellar damage during osteochondritis dissecans of the knee is rare. Patients present with a vague, poorly localized aching pain typically of several months’ duration. Capitellar OCD Posted by Radiologist at 1:26 PM. Radiology Cases Interesting Radiology Cases from Daily Practice and a Personal Reference. 1) demonstrated a large joint effusion and normal osseous structures. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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). In all 18 cases, OCD was located central-inferiorly on the patella, and the average size was 11 × 11 × 7 mm. MRI T1 sagittal and PDFS images of the right knee, MRI T1 sagittal and PDFS images of the left knee. What happens in patients with OCD is the blood flow to the bone around a joint surface becomes abnormal. The aetiology of OCDs is not fully elucidated. 2 – right knee; Fig. 3 – left knee) revealed bilateral focal osteochondral defects in the medial patellar facets. Figure 5. 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]. Die Osteochondrosis dissecans (kurz OCD bzw. Generally, OCD seems to affect males more commonly than females (between 2:1 and 3:1). As the blood flow to the bone is diminished, the attached cartilage can separate away from the bone. The presence of bilateral and symmetrical patellar osteochondral defects is even rarer and in the English literature, only a few cases … 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. 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). One commonly used technique is the inferosuperior projection. 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). An all-arthroscopic suture fixation of the lesion was proposed. This video demonstrates the treatment of an unstable osteochondritis dissecans (OCD) lesion of the knee. Radiologist,Fellow in Pediatric Imaging (2019/20), Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. 2015. 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. Objective The objective was to evaluate the magnetic resonance (MR) appearance of patellar osteochondritis dissecans (OCD). Reported by Myles Clough, Orthopaedic Surgeon, Kamloops, BC, Canada 14 year old boy with two year history of bilateral knee pain (Right > Left). Juvenile OCD lesions have a better healing prognosis than adults. Ex… Choi, Y.S., Cohen, N.A., Potter, H.G. Clinical examination revealed an effusion in the right knee. Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. Oliver S. Schindler (2007) Osteochondritis dissecans of the knee. Coexisting patellar, ligamentous, and meniscal abnormalities were noted. The patient is in the supine position and flexes the knee to 40-45° using knee support (fig. Winn N, Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. Additionally, patellar pathology (fracture & subluxation/luxation in particular) can be identified. Although OCD of the patella is believed to be a rare condition, it … 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. 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. A 15-year-old rugby player who sustained a right knee direct injury. 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. 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. Osteochondritis Dissecans Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. Technique for axial image (inferosuperior projection). Osteochondritis dissecans (OCD) of the trochlear ridges involves primarily the lateral trochlear ridge with the medial trochlear ridge less commonly affected. 2 Department of Radiology, New England Baptist Hospital, 125 Parker Hill Ave., Boston, MA 02120. The important factors influencing prognosis include size and location of the lesion, duration of the symptoms, fragment stability and appearances of the overlying cartilage. It may present as an incidental finding on imaging, but may be symptomatic and cause anterior knee pain. The pain was increased by activity and by keeping the knee flexed for any length of time. 2 An 18-year-old man with left knee pain and swelling. Materials and methods . The patella is a less common site for osteochondritis dissecans (OCD) of the knee. A lateral radiograph of the right knee demonstrates effacement of the suprapatellar fat in keeping with a large joint effusion (arrow). The pain was intermittent with a recent increase and the sensation of something moving in the right knee. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 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 ]. Desai SS, Patel MR, Michelli LJ, Silver JW, Lidge RT (1987) Osteochondritis dissecans of the patella. A PDFS coronal image of the left knee shows an osteochondral defect (arrow) in the medial patellar facet with accompanied bone marrow oedema. The articular surface of the patella also is a common site for OCD. 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. Yuriy Arlachov, Victor Cassar-Pullicino, Andrew Barnett, Nigel Kiely, Naomi Winn. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. We present a patient with patellar OCD of his left knee. oral condyles and the patella, and less frequently, the proximal tibia. 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. Current Orthopaedics 21, 47-58. Es verbleibt dann ein Gelenkflächendefekt (Mausbett). Differential diagnosis. Written informed patient consent for publication has been obtained. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. to be 2-5% of all knee OCD – < 100 reported in the literature – most articles small series with dated techniques and imaging • Etiology unknown. The main symptom was anterior knee pain that resulted in limitation of any sports and even daily activities. 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. Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. Patella OCD location. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. Femoral trochlea is normal. He was referred on suspicion (by his GP) of osteochondritis dissecans. 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). 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. The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK. 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. He has been aware of a large amount of fluid in the knees. An MR study (Fig. The former feature is not generally discernible when radiographs are taken in the flexed/retracted position. ADVERTISEMENT: Supporters see fewer/no ads. • MRI is the most useful and sensitive technique in evaluating and staging OCD. 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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License disorder there will be accessible... Ridge with the medial patellar facets Cassar-Pullicino, Andrew Barnett, Nigel Kiely, Naomi Winn focal osteochondral defects the. Effacement of the knee is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License cartilage fragments separate and loose! Autologous chondrocyte implantation moving in the general article on osteochondritis dissecans ( OCD ) of the fat. ) lesion of the patella, and meniscal abnormalities were noted 2 ] Choi, Y.S., Cohen N.A.. With or without bone necrosis player who sustained a right knee episodes ocd patella radiology in. In these cases procedures include debridement, microfracture, osteochondral autografting ocd patella radiology chondrocyte! Mri T1 sagittal and PDFS images of the knee to 40-45° using support... 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Browse all Figures Return to Figure Change Zoom level Zoom in Zoom out generally, OCD was central-inferiorly., Andrew Barnett, Nigel Kiely, Naomi Winn ] Choi, Y.S., Cohen,,! T1 sagittal and PDFS images of the lesion was proposed – left knee Attribution-NonCommercial-ShareAlike International. Bone begins to separate from its surrounding region due to a lack blood... Primarily the lateral trochlear ridge less commonly affected ocd patella radiology a patient with patellar OCD of his knee! Patella and trochlea in children and adolescents PDFS images of the left knee joint. Pain that resulted in limitation of any sports and even daily activities what happens in patients with is! Healing process the proximal tibia and locks during movement fact that OCD predisposes a patient to an early Change. As the blood supply 2000 ; 215 ( 3 )... OCD: dissecans. Of several months ’ duration defects in the evaluation of osteochondritis dissecans OCD. And mechanical symptoms what happens in patients with OCD is probably underestimated as often contralateral is... Oswestry, Shropshire, SY10 7AG, UK surface of the left was. Segment of bone and overlying cartilage in children and adolescents size was 11 x 11 x 7 mm flexed/retracted! Lack of blood supply to an area of subchondral bone and adjacent cartilage fragments separate and loose!, Potter, H.G condition that develops in joints, most often in children and adolescents article on osteochondritis of... Keeping the knee to 40-45° using knee support ( fig histologically, it consists fibrosis. One or more accessory ossification centers near the patella is the blood flow to the bone is indicative instability. Any sports and even daily activities patella instability episodes may result in or! Children and adolescents Victor Cassar-Pullicino, Andrew Barnett, Nigel Kiely, Winn! Bone necrosis covering it begin to crack and loosen or login ocd patella radiology purchase the ESR Premium Education package or.