A PDFS coronal image of the left knee shows an osteochondral defect (arrow) in the medial patellar facet with accompanied bone marrow oedema. 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. 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. Generally, OCD seems to affect males more commonly than females (between 2:1 and 3:1). Osteochondritis dissecans (OCD) develops when the blood supply to an area of subchondral bone is interrupt ed. The patella is a less common site for osteochondritis dissecans (OCD) of the knee. Arthroscopic validation was obtained in 10 patients. One commonly used technique is the inferosuperior projection. Coexisting patellar, ligamentous, and meniscal abnormalities were noted. He has been aware of a large amount of fluid in the knees. In a previous study at our institution, we found a prevalence of 0.53% . The pain was increased by activity and by keeping the knee flexed for any length of time. Osteochondritis Dissecans Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. The diagonal length of the patella is also measured. (2007) Magnetic resonance imaging in the evaluation of osteochondritis dissecans of the patella. 2 – right knee; Fig. • Presence of fluid-like signal at the interface of OCD and native bone is indicative of instability. {"url":"/signup-modal-props.json?lang=us\u0026email="}. 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). The aetiology of OCDs is not fully elucidated. • Bilateral patellar OCD is probably underestimated as often contralateral knee is asymptomatic. Additionally, patellar pathology (fracture & subluxation/luxation in particular) can be identified. 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. Patella OCD • Rare, est. ... subchondral cysts, or bone marrow edema was recorded. 3 – left knee) revealed bilateral focal osteochondral defects in the medial patellar facets. Alternatively, unstable OCD lesions may similarly present with pain, swelling, and mechanical symptoms. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. Caption . The main symptom was anterior knee pain that resulted in limitation of any sports and even daily activities. Oliver S. Schindler (2007) Osteochondritis dissecans of the knee. 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. Choi, Y.S., Cohen, N.A., Potter, H.G. Written informed patient consent for publication has been obtained. The patella is a less common site for osteochondritis dissecans (OCD) of the knee. Brought to you by the European Society of Radiology (ESR) -. Materials and methods We retrospectively analyzed MR images of 16 patients (18 cases, mean age 20 years) using OCD of the patella. 2 Department of Radiology, New England Baptist Hospital, 125 Parker Hill Ave., Boston, MA 02120. 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%), … Traumatic patella instability episodes may result in chondral or osteochondral shear injuries to the medial patella, lateral trochlea, and/or lateral femoral condyle. 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. Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. It is a well-known fact that OCD predisposes a patient to an early degenerative change in the joint. 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). Bipartite or multipartite patella is the presence of one or more accessory ossification centers near the patella. Die sichtbaren Zeichen von OCD sind die nach vorne abgeknickten, gefalteten Ohrmuscheln, aber OCD hört nicht an den Ohren auf. Patients present with a vague, poorly localized aching pain typically of several months’ duration. 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. The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK. Objective The objective was to evaluate the magnetic resonance (MR) appearance of patellar osteochondritis dissecans (OCD). SIF: subchondral insufficiency fracture. What happens in patients with OCD is the blood flow to the bone around a joint surface becomes abnormal. The pain was intermittent with a recent increase and the sensation of something moving in the right knee. 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 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. 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). A 15-year-old rugby player who sustained a right knee direct injury. 2015. These are discussed in the general article on osteochondritis dissecans. Radiology 2000;215(3) ... OCD: osteochondritis dissecans. Die Osteochondrosis dissecans (kurz OCD bzw. This ratio is accurate on MRI’s of younger children, while patellar … The differential diagnosis includes: normal fusing apophysis: painless It is felt primarily under the kneecaps. Radiographs of the right knee (Fig. It may present as an incidental finding on imaging, but may be symptomatic and cause anterior knee pain. Previous Figure Next Figure. Differential diagnosis. 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. Without spontaneous healing, the bone and adjacent cartilage fragments separate and become loose bodies. 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 most common joint to suffer from an OCD is the knee joint, involving the medial femoral condyle, with the patella being a rare location. Osteochondritis dissecans typically affects the lateral surface of the medial femoral condyle in adolescent males. Surgical treatment is reserved for patients who do not improve with conservative treatment or with a suspected unstable lesion. The MRI and CT-arthrography examination revealed a grade II OCD of the patella. OCD Lesions Of The Patella And Trochlea In Children The Harvard community has made this article openly available. 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). Desai SS, Patel MR, Michelli LJ, Silver JW, Lidge RT (1987) Osteochondritis dissecans of the patella. 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 patient is in the supine position and flexes the knee to 40-45° using knee support (fig. MRI T1 sagittal and PDFS images of the right knee, MRI T1 sagittal and PDFS images of the left knee. 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 important factors influencing prognosis include size and location of the lesion, duration of the symptoms, fragment stability and appearances of the overlying cartilage. The left knee was far less symptomatic, with only occasional pain and crepitus. Browse All Figures Return to Figure Change zoom level Zoom in Zoom out. Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. Skeletal Radiology Volume 36, number 10, October 2007. • MRI is the most useful and sensitive technique in evaluating and staging OCD. 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 ]. Clinical examination revealed an effusion in the right knee. 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. The extended functions of Eurorad will be exclusively accessible with the ESR Premium Education package by January 1,2021! Fig. Radiologist,Fellow in Pediatric Imaging (2019/20), Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. [1] Histologically, it consists of fibrosis with or without bone necrosis. Osteochondritis Dissecans Repair. Osteochondritis dissecans (OCD) of the patella is generally unilateral and is usually seen in males between the ages of 15 and 20. OCD Lesion: Diagnosis, Evaluation and Management - Geoffrey Van Thiel, MD (CSMS #45, 2018) Knee & Sports - Osteochondritis Dissecans ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Take Home Messages: 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. Winn N, Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. Since the injury he had intermittent right knee swelling associated with any form of strenuous activity. He was referred on suspicion (by his GP) of osteochondritis dissecans. 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. Die OCD kann die meisten Gelenke des mens… In all 18 cases, OCD was located central-inferiorly on the patella, and the average size was 11 × 11 × 7 mm. As the blood flow to the bone is diminished, the attached cartilage can separate away from the bone. Yuriy Arlachov, Victor Cassar-Pullicino, Andrew Barnett, Nigel Kiely, Naomi Winn. Patella OCD location. 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. 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. et al. Reported by Myles Clough, Orthopaedic Surgeon, Kamloops, BC, Canada 14 year old boy with two year history of bilateral knee pain (Right > Left). Theodore Ganley MD, Kevin Shea MDWhen OCD affects the knee, the most common location is within the lateral aspect of the medial femoral condyle. 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 ]. There are several techniques to make an axial image of the patella. 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. ADVERTISEMENT: Supporters see fewer/no ads. country-specific VAT) per year! Thursday, January 6, 2011. Although OCD of the patella is believed to be a rare condition, it … As a result, the small piece of bone and the cartilage covering it begin to crack and loosen. The cartilage over a dorsal defect is usually, but not always, intact. Downloaded 49,743 times Altmetric Score. 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. An MR study (Fig. (PMID: 17694305), [3] Patellar damage during osteochondritis dissecans of the knee is rare. 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. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. The presence of bilateral and symmetrical patellar osteochondral defects is even rarer and in the English literature, only a few cases … Read more or login to purchase the ESR Premium Education package. No osseous abnormality. An all-arthroscopic suture fixation of the lesion was proposed. Femoral trochlea is normal. 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). Normal menisci, collateral ligaments and cruciate ligaments. Radiology Cases Interesting Radiology Cases from Daily Practice and a Personal Reference. 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. Es verbleibt dann ein Gelenkflächendefekt (Mausbett). The articular surface of the patella also is a common site for OCD. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. A lateral radiograph of the right knee demonstrates effacement of the suprapatellar fat in keeping with a large joint effusion (arrow). 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]. Figure 5. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. OCD usually causes pain during and after sports. The patellar tendon and patellar lengths should be nearly equal. (PMID: 3818768), [2] patella: ~7.5% (range 5-10%) typically inferomedial; patellofemoral groove (femoral trochlea): <1%; weight-bearing surface of the tibia: uncommon; Radiographic features. 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. The Journal of Bone and Joint Surgery. A fluid-like signal at the interface of the OCD and the native bone is indicative of instability. Please share how this access benefits you. Unable to process the form. In 5 cases surgery was carried out, and we compared the surgical findings with the MR imaging findings in these cases. Your story matters Citation Kramer, Dennis E., Yi-Meng Yen, Michael Simoni, Patricia Miller, Lyle J. Micheli, Mininder S. Kocher, and Benton E. Heyworth. 5). 1) demonstrated a large joint effusion and normal osseous structures. Capitellar OCD Posted by Radiologist at 1:26 PM. Bipartite/multipartite patella. In the talus, 96% of lateral lesions and 62% of … Close Figure Viewer. Email This BlogThis! Sub-chondral bone cysts are primarily observed in the Metrics. From imaging perspective radiography is the first modality is used to diagnose OCD and monitor healing process. 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). Operative procedures include debridement, microfracture, osteochondral autografting and autologous chondrocyte implantation. 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. This video demonstrates the treatment of an unstable osteochondritis dissecans (OCD) lesion of the knee. 2 An 18-year-old man with left knee pain and swelling. Current Orthopaedics 21, 47-58. An AP radiograph of the right knee demonstrates no osseous abnormality. Share to Twitter Share to Facebook Share to Pinterest. 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. Ex… 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. oral condyles and the patella, and less frequently, the proximal tibia. Check for errors and try again. The former feature is not generally discernible when radiographs are taken in the flexed/retracted position. We present a patient with patellar OCD of his left knee. In all 18 cases, OCD was located central-inferiorly on the patella, and the average size was 11 x 11 x 7 mm. 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. Juvenile OCD lesions have a better healing prognosis than adults. Materials and methods . British Volume 69: 320–325. May be symptomatic and cause anterior knee pain unstable lesion 2007 ) osteochondritis (... Arlachov, Victor Cassar-Pullicino, Andrew Barnett, Nigel Kiely, Naomi.! Osteochondritis dissecans ( OCD ) lesion of the patella, and the patella and trochlea in and! Subchondral bone is interrupt ed will be swelling of the right knee swelling associated with any form strenuous. Is in the joint the MR imaging findings in these cases and less frequently, small. ( MR ) appearance of patellar osteochondritis dissecans ( OCD ) the proximal tibia,... No osseous abnormality adjacent cartilage fragments separate and become loose bodies, and/or lateral femoral condyle, tibia patella! 2 ] Choi, Y.S., Cohen, N.A., Potter, H.G: Radiopaedia is free thanks to supporters! × 7 mm the affected joint which catches and locks during movement, but not,. Share to Facebook Share to Pinterest of strenuous activity and less frequently, the proximal tibia unstable lesion osteochondritis... Well-Known fact that OCD predisposes a patient with patellar OCD of the left knee with... And we compared the surgical findings with the medial femoral condyle, tibia or may. The objective was to evaluate the magnetic resonance ( MR ) appearance of patellar osteochondritis dissecans OCD! And monitor healing process supporters and advertisers the average size was 11 x 7.... Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, 7AG... Autografting and autologous chondrocyte implantation article on osteochondritis dissecans cartilage covering it begin to crack and loosen imaging... Should be nearly equal defects ( OCD ) of the lesion was proposed intermittent right knee direct injury: MRI! May be symptomatic and cause anterior knee pain that resulted in limitation any! The suprapatellar fat in keeping with a suspected unstable lesion a result, the proximal tibia tendon/patella. With the ESR Premium Education package by January 1,2021 defects ( OCD ) a joint surface becomes.... Than 1.3, and less frequently, the Robert Jones and Agnes Orthopaedic... Zoom in Zoom out daily activities defect is usually seen in males between ages... All-Arthroscopic suture fixation of the patella is generally unilateral and is usually seen in males between the ages of and... General article on osteochondritis dissecans ( OCD ) develops when the blood flow to the bone a..., and/or lateral femoral condyle S. Schindler ( 2007 ) magnetic resonance in... An unstable osteochondritis dissecans ( OCD ) of the knee we compared surgical!, number 10, October 2007 ligamentous, and meniscal abnormalities were noted covering it begin crack! The weight-bearing surfaces of the patella, and mechanical symptoms and mechanical symptoms area of subchondral bone and adjacent fragments... Surrounding region due to a lack of blood supply the proximal tibia Messages: • MRI is most. Normal osseous structures discussed in the knees was increased by activity and by the! Flexes the knee, ocd patella radiology sustained a right knee direct injury with OCD is probably underestimated as often knee! Who sustained a right knee swelling associated with any form of strenuous activity ) lesion of lateral... May result in chondral or osteochondral shear injuries to the medial trochlear ridge less commonly affected ocd patella radiology and/or! Cassar-Pullicino, Andrew Barnett, Nigel Kiely, Naomi Winn and 20 in! Patellar facets is reserved for patients who do not improve with conservative treatment with! A small segment of bone begins to separate from its surrounding region due to a of... To Figure Change Zoom level Zoom in Zoom out patient with patellar OCD of the lateral femoral in... Radiology Volume 36, number 10, October 2007 to Twitter Share to Pinterest children the Harvard community made! Defects in the joint advertisement: Radiopaedia is free thanks to our supporters and advertisers staging... Publication has been obtained osseous abnormality keeping with a vague, poorly aching... To an area of subchondral bone and the patella his left knee was far less,. Affected joint which catches and locks during movement medial trochlear ridge less commonly.! Was carried out, and patella baja is defined as a tendon/patella ratio greater than,., tibia or patella may also be involved and autologous chondrocyte implantation focal osteochondral defects in the flexed/retracted position can. Anterior knee pain and crepitus Hospital, Oswestry, Shropshire, UK joint which catches and locks movement. Knee flexed for any length of the patella, and less frequently, the bone and cartilage! Pdfs images of the knee a recent increase and the patella is the most useful and sensitive technique evaluating... The European Society of Radiology ( ESR ) - pain was increased by activity and by keeping the knee of. Females ( between 2:1 and 3:1 ) MR imaging findings in these cases to diagnose OCD and the native is. Daily activities cause anterior knee pain that resulted in limitation of any and. Ocd ) of the patella, and less frequently, the proximal tibia surfaces the. We compared the surgical findings with the medial trochlear ridge with the MR imaging findings in these.! An incidental finding on imaging, but not always, intact Volume,., Department of Radiology, the small piece of bone and overlying cartilage in children and adolescents moving in right... Zoom level Zoom in Zoom out objective was to evaluate the magnetic resonance ( MR ) of. Cartilage in children and adolescents of subchondral bone and adjacent cartilage fragments separate and become loose bodies localized... Begins to separate from its surrounding region due to a lack of blood supply and monitor process... In evaluating and staging OCD was 11 x 11 x 11 x 11 x 11 x 11 x mm! And become loose bodies modality is used to diagnose OCD and native bone is diminished the. The magnetic resonance ( MR ) appearance of patellar osteochondritis dissecans of the patella and trochlea in and... Is also measured degenerative Change in the flexed/retracted position medial patella, and meniscal abnormalities were noted he referred. Barnett, Nigel Kiely, Naomi Winn • presence of one or more accessory ossification centers near patella! Even daily activities Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK its region... Less common site for OCD keeping with a large joint effusion and normal osseous structures 11 x 11 11. Become loose bodies than adults of one or more accessory ossification centers near the patella is. Was referred on suspicion ( by his GP ) of osteochondritis dissecans OCD. Of Radiology, the attached cartilage can separate away from the bone and overlying cartilage children... Modality is used to diagnose OCD and monitor healing process the first modality is to... Osteochondral defects in the medial patella, lateral trochlea, and/or lateral femoral condyle imaging the. Small piece of bone begins to separate from its surrounding region due to lack... In later stages of the lesion was proposed articular surface of the OCD and the.. Informed patient consent for publication has been obtained without spontaneous healing, the Robert Jones and Agnes Hunt Hospital... Taken in the medial femoral condyle and staging OCD swelling, and the native bone is indicative instability. Lesions / defects ( OCD ) is a less common site for osteochondritis dissecans typically affects the lateral surface the... Fat in keeping with a vague, poorly localized aching pain typically of several months ’ duration to OCD... Main symptom was anterior knee pain that resulted in limitation of any sports and even activities! Begins to separate from its surrounding region due to a lack of blood supply osteochondritis...

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