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. The large osteochondral defect was eventually managed in a staged manner with bone grafting and osteochondral autograft transfer. In this report, the location of the donor sites was not specifically described, but review of the images in the report shows the donor sites to be located in the trochlear groove portion of the lateral femoral condyle . OCD usually causes pain during and after sports. to detect the most effective treatment option for primary talar osteochondral defects in adults. Knee > Osteochondral Defect What is Osteochondral Defect? There is no mention in this report of osteochondral injuries involving the weight-bearing aspect of the lateral femoral condyle. Introduction: Spectrum of disease entities from single, focal defects to advanced degenerative disease of articular (hyaline) cartilage; Epidemiology. MRI adds value by identifying unstable lesions that require surgical intervention. It was decided to use the superomedial aspect of the trochlea as the donor sight for the osteochondral autograft. Osteochondritis dissecans (OCD) most commonly affects the knee. Answered by Dr. Veena Govila: Loose body is common: Talk to your dr. As loose body is very common. As the individual attempts to straighten or extend the knee, contraction of the quadriceps muscles, rather than extending the knee, places lateral force on the patella, which leads to the lateral subluxation or dislocation of the patella. should i go for a surgery ?" The MR images of these 25 patients were then reviewed and 10 patients were found to have osteochondral defects involving the lateral femoral condyle. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence and Pattern of Injury After Transient Lateral Dislocation of the Patella, Review. Findings suggestive of a prior transient lateral patellar dislocation included mention of marrow edema involving both the anterolateral femoral condyle and the inferomedial patella or mention in the report of transient dislocation of the patella. the age and weight of the patient. Another recent article describing MRI findings of osteochondral injuries after acute lateral patellar dislocation reports four (5%) of 82 patients with osteochondral injuries involving the lateral trochlear groove . During reduction, the articular surface of the medial aspect of the lower pole of the patella first impacts the nonarticular portion of the lateral femoral condyle, resulting in the classic bone contusion. Authors: Patrick Graham. Given the degree of edema surrounding the undisplaced defect, the lesion is characterized as being unstable. Essentials of Clinical MR, 2nd edition Runge, von Tengg-Kobligk, Heverhagen 81. Particularly in the younger patient, MRI plays an important clinical role in the diagnosis of pre-radiographic OA and focal osteochondral injury. . Osteochondral defect is more common among young athletes who actively take part in sports and most commonly affects the femoral condyles in the knee. The concave configuration of the trochlear groove protects its articular surface from injury during reduction of the patella, whereas the convex shape of the patella places its articular cartilage at risk for injury during the reduction stage as well. Next, the images were evaluated for the presence of an osteochondral injury or defect involving the lateral femoral condyle, and if present, the osteochondral defect was graded according to a modified Outerbridge classification system : grade 1, chondral softening or blistering with an otherwise intact surface; grade 2, shallow superficial fissuring or ulceration involving less than 50% of the depth of the articular surface; grade 3, deep ulceration, fissure, or flap that involved more than 50% of the depth of the articular cartilage without exposure of subchondral bone; grade 4, full-thickness chondral defect with exposure of subchondral bone; and grade 5, full-thickness chondral abnormalities with underlying cortical defect. We have recog-nized the appearance of such lesions in the hip and report on their MR imaging appearance and occurrence in elite athletes. 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. 2A, 2B, 2C, 3A, 3B, and 3C). An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. During the first stage, the patella translates laterally to lie along the lateral aspect of the lateral femoral condyle. 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. Increased awareness of osteochondral injuries, development of cartilage repair techniques, and advances in MRI technology have increased the diagnostic frequency of these lesions. An MRI was then obtained to determine stability of the lesion. Edema is present in the bed of the defect (asterisk). Keywords: Knee, Cartilage, Synovitis, Pigmented villonodular. some defects found incidentally on MRI or arthroscopy; Symptoms . The volume of cartilage defect filling must be assessed in relation to the adjacent native reference cartilage and must be described as a percentage of the hypothetical volume of intact cartilage that covers the defect. Lateral patellar dislocation most commonly occurs in young, active individuals as the result of a twisting injury to the knee during participation in an athletic event. A total of 25 patients (male:female ratio, 9:16; age range, 10-31 years; mean age, 17 years) were found to have MRI evidence of prior transient dislocation of the patella. , who evaluated the knee using MRI. Osteochondritis dissecans is an idiopathic disease which affects the subchondral bone and its overlying articular cartilage due to loss of blood flow. Osteochondral defect is a term for a localized defect of the articular cartilage and subchondral bone. The increasing interest in the role of subchondral bone with regard to articular surface disease led to the development of new bioengineered strategies. The operative reports were reviewed after MR image analysis was completed, and surgical findings were compared with the MRI results. An MRI (Magnetic Resonance Image) ... the location of the defect in the knee. The configuration of the articular surface of the patella is convex, whereas that of the trochlear groove is concave. Objective: To describe and apply a semiquantitative MRI scoring system for multifeature analysis of cartilage defect repair in the knee by osteochondral allografts and to correlate this scoring system with histopathologic, micro–computed tomography (µCT), and biomechanical reference standards using a goat repair model. Osteochondral injuries of the knee have proven to be a challenge for the orthopaedic surgeon. This could in part be related to the skill of the arthroscopist or could possibly be explained by the fact that what appeared to be an osteochondral defect on MRI was merely volume averaging with adjacent soft-tissue structures because these defects were often observed at the far lateral aspect of either the trochlear groove or the weight-bearing aspect of the lateral femoral condyle. She first started noticing the pain while running track, which she has stopped due to the degree of pain. Autologous osteochondral graft provides good or excellent results in 85% of patients with focal contained chondral and osteochondral defects of the knee. 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. 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. More recently, there has been brief mention in both the radiology and orthopedic literature of osteochondral injuries involving not only the patellar articular surface but also the articular surface of the lateral femoral condyle [6-10]. Multiple surgical options are now available for repairing osteochondral lesions, and this fact, combined with the fact that the majority of patients experiencing transient dislocation of the patella are young, increases the importance of accurately identifying these lesions [8, 12, 13]. Transient lateral patellar dislocation is a common injury that typically occurs in the young, athletic individual. These MRI examinations were performed at six different outpatient imaging facilities. CONCLUSION. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. As a result, orthopedic research has concentrated on the development of alternative strategies. The use of low-field-strength magnets may have actually resulted in underdetection of these lesions. Australian Medicare Benefits Schedule criteria for knee magnetic resonance imaging 18: ... subsequent ischaemia and altered local growth. Osteochondral Defects of the Knee. Hip Anatomic Variants That May Mimic Abnormalities at MRI: Labral Variants. The dimensions of the chondral defects were described in the operative report in only three of those six patients. Diagnosis: IOsteochondral defect (unstable). MRI is one of the diagnostic modalities of choice in patients with clinical suspicions of osteochondral lesions with negative plain radiographs. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. Transverse dimensions were obtained from the coronal images, whereas anteroposterior dimensions were obtained from the sagittal images. In addition to the well-described osteochondral injuries of the lower pole of the patella, there have been a few reports in the literature regarding femoral condyle osteochondral injuries [6-10]. Each of the lateral femoral chondral defects in our series was a full-thickness chondral defect with or without underlying cortical abnormality, which is similar to the findings reported by Swischuk et al. The final study group was composed of these 10 patients (male:female ratio, 7:3; age range, 15-22 years; mean age, 18 years). It is known from long-term followup studies, such as those conducted by Linden, 7 that osteochondritis dissecans diagnosed in adulthood is likely to lead to the development of early onset osteoarthritis. In two of the patients, the surgeon reported no evidence of femoral chondral injury. osteochondral lesions (OCLs) of the talus. Material and Methods: We retrospectively evaluated MR imaging findings of all knee MRI exams performed at our institution over the past five years. Countless fluid-filled sacs help the knee to move freely. In adults, the MR imaging criteria of a high-signal-intensity rim surrounding an OCD lesion on T2-weighted images, cysts surrounding an OCD lesion, a high T2 signal intensity fracture line extending through the articular cartilage overlying an OCD lesion, and a fluid-filled osteochondral defect have high sensitivity and specificity for instability. The lack of long-term studies and no general consensus as to the best way to manage these lesions compounds the challenge. Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. Subchondral marrow edema was present underlying the chondral defects in 10 (100%) patients. Chondral defects located posterior to the anterior margin of the anterior horn of the lateral meniscus were designated as involving the weight-bearing aspect of the lateral femoral condyle. In addition to the bone contusion pattern, osteochondral injuries of the patella have also been reported, and these range from mild articular cartilage surface irregularity to large displaced osteochondral fractures [1-4]. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. Osteochondral lesions of the talus and fem-oral condyles are thought to occur as a result of MRI features that aid in diagnosis include the location and extent of bone marrow edema, the presence of a fracture line, a hypointense area immediately subjacent to the subchondral bone plate, and deformity of the subchondral bone plate. Next, the size (using electronic calipers) and location of the lateral femoral condyle defect were recorded. Images were first evaluated for the presence of the typical bone contusion pattern involving the anterolateral femoral condyle and the inferomedial patella. Two donor plugs were harvested from this region, measuring 10 × 14 mm and 6 × 14 mm, respectively. The MR imaging evaluation of a transplanted osteochondral autograft should include assessments of the degree of defect filling by the osteochondral plug, the peripheral integration of the reparative cartilage and bone, the cartilage surface contour, and the morphologic characteristics of the autologous bone. A third recent report in the orthopedic literature describes seven patients with osteochondral injuries involving the midlateral weight-bearing portion of the lateral femoral condyle after patellar dislocation. The osteochondral defects involved the articular surface of the trochlear groove in three (30%) of the 10 patients (Figs. ... Osteochondral Autograft Resurfacing. The osteochondral fragment shows bone edema with pockets of fluid around an undetached and undisplaced osteochondral fragment (Image 2). Treatment of Knee Osteochondral Defects with Mosaicoplasty Technique Mohsen Fawzy Omar, MD1, Mohammed a Gheith, MD2 1Lecturer of Orthopedic Surgery, Zagazig University, Egypt 2Assistant professor, Orthopedic Surgery, Zagazig University, Egypt firstname.lastname@example.org email@example.com Abstract Background: Due to the avascular nature of the articular … Log in, The Physics Of Clinical MR Taught Through Images, Neuroradiology The Essentials with MR and CT, Acquired Metabolic, Systemic, and Toxic Disorders, Paranasal Sinuses, Nasal Cavity, and Face, Normal Anatomy, Imaging Technique, and Common Variants, Neuroradiology - The Essentials with MR and CT, The Physics of Clinical MR Taught Through Images, 5th edition, Special Focus: Coronavirus Disease 2019 (COVID-19), Clinical Feasibility of Gadoxetic Acid–Enhanced Isotropic High-Resolution 3-Dimensional Magnetic Resonance Cholangiography Using an Iterative Denoising Algorithm for Evaluation of the Biliary Anatomy of Living Liver Donors, Clinical and High-Resolution CT Features of the COVID-19 Infection: Comparison of the Initial and Follow-up Changes, The Clinical and Chest CT Features Associated with Severe and Critical COVID 19 Pneumonia, The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based on CT Characteristics, Editor's Discussion Blog
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