Juvenile versus Adult Osteochondritis Dissecans of the Knee: Appropriate MR Imaging Criteria for Instability

Kijowski, Richard; Blankenbaker, Donna G.; Shinki, Kazuhiko; Fine, Jason P.; Graf, Ben K.; Smet, Arthur A. De

doi:10.1148/radiol.2482071234

Cited by 189 publications

(162 citation statements)

References 38 publications

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“…Another study [63] suggested that if the criteria for instability included both the high T2 signal separating the lesion and a breach of the articular cartilage on T1-weighted images, then the accuracy in predicting instability shifted from 45% to 85%. Recently, Kijowski et al [36] examined the sensitivity and specificity of the criteria of De Smet et al [16] for predicting arthroscopic instability (frank evidence of cartilage disruption or motion of the overlaying cartilage at the OCD) and applied them to adult OCD and to juvenile OCD. They reported that when all four criteria were applied together, there was 100% sensitivity and 100% specificity for instability in adult OCD and 100% sensitivity but only 11% specificity for instability in childhood OCD lesions.…”

Section: Imagingmentioning

confidence: 99%

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

Edmonds

Polousky

2013

Clinical Orthopaedics &Amp; Related Research

203

212

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Background Osteochondritis dissecans (OCD) was first described to provide an explanation for the nontraumatic development of loose bodies within a joint. Despite many reports on the subject, there remains no clear understanding of the etiology, natural history, or treatment. Questions/purposes This review was undertaken to delineate (1) the etiology of OCD; (2) the presentation and locations; (3) the most appropriate imaging modalities; and (4) the most effective treatment strategies. Methods We reviewed the English literature using a database compiled from a Medline search for ''osteochondritis dissecans''. We identified 1716 publications, 1246 of which were in English. After exclusions, we reviewed 748 articles and of these cited 85. The observations of each study were then synthesized into this report. Results There appears to be no consensus concerning the etiology of OCD lesions. The presentations and locations are variable, but the knee, ankle, and elbow are most commonly involved. Although plain film assessment is important in OCD, there appears to be a trend toward the use of MRI, but the preferred sequences are in evolution. We found no consensus on the treatment of these lesions, related in part to the lack of agreement of methods for assessing outcomes. Conclusions Despite more than a century of study, we have made little advancement in our understanding of OCD. A study group has been formed to address this issue and actively seeks to answer these unknown issues regarding OCD.

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Section: Imagingmentioning

confidence: 99%

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

Edmonds

Polousky

2013

Clinical Orthopaedics &Amp; Related Research

203

212

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“…Signs on fat-suppressed MR images that suggest instability include: a fragment outlined by fluid; an articular fracture passing through the subchondral bone plate; a focal osteochondral defect filled with joint fluid, and a 5-mm or larger cyst deep to the lesion. The criteria above have high specificity for lesions in adults, but not in juveniles [48].…”

Section: Intraarticular Injuriesmentioning

confidence: 99%

Sport injuries in the paediatric and adolescent patient: a growing problem

et al. 2009

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With an increasing number of paediatric and adolescent athletes presenting with injuries due to overuse, a greater demand is put on clinicians and radiologists to assess the specific type of injury. Repetitive forces applied to the immature skeleton cause a different type of injury than those seen in adults due to the differences in vulnerability of the musculoskeletal system, especially at the site of the growth cartilage. Intrinsic and extrinsic risk factors all play a role in the development of overuse injuries. MRI plays a key role in imaging overuse injuries due to its high potential for depicting cartilaginous and softtissue structures. Sport-specific biomechanics are described, since this knowledge is essential for adequate MRI assessment. An overview of several sport-related injuries is presented, based on anatomical location.

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“…Other signs of an unstable OCL are focal cartilage defects or defects in the subchondral bony end plate, the presence of subchondral cysts or an empty bony defect zone filled with fluid [25,29]. However, mechanical stability assessment alone, based on MRI findings, has also been critically discussed [41], and one study of the knee demonstrated no relationship between the size and localization of an OCL and its stability [42]. The aforementioned signs of instability of an OCL apply to adults and adolescents with closed epiphyseal plates [25,43].…”

Section: Classification Of Osteochondral Lesionsmentioning

confidence: 99%

“…The aforementioned signs of instability of an OCL apply to adults and adolescents with closed epiphyseal plates [25,43]. In adolescents with open epiphyseal plates and children a signal-poor border (possibly as an expression of sclerosis) around the osteochondral lesion was described as a sign of instability in addition to the fluid border around the OCL fragment or (multiple) defects in the subchondral bony end plate [42,43]. In contrast, cysts in association with an osteochondral lesion are not signs of instability in juvenile patients [25,42], as shown in (▶ Fig.…”

Section: Classification Of Osteochondral Lesionsmentioning

confidence: 99%

Modern Cartilage Imaging of the Ankle

Weber

Wünnemann

Jungmann

et al. 2017

Fortschr Röntgenstr

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ABSTR AC TBackground Talar osteochondral lesions are an important risk factor for the development of talar osteoarthritis. Furthermore, osteochondral lesions might explain persistent ankle pain. Early diagnosis of accompanying chondral defects is important to establish the optimal therapy strategy and thereby delaying or preventing the onset of osteoarthritis. The purpose of this review is to explain modern cartilage imaging with emphasis of MR imaging as well as the discussion of more sophisticated imaging studies like CT-arthrography or functional MR imaging.Methods Pubmed literature search concerning: osteochondral lesions, cartilage damage, ankle joint, talus, 2 D MR imaging, 3 D MR imaging, cartilage MR imaging, CT-arthrography, cartilage repair, microfracture, OATS, MACT.Results and Conclusion Dedicated MR imaging protocols to delineate talar cartilage and the appearance of acute and chronic osteochondral lesions were discussed. Recent developments of MR imaging, such as isotropic 3 D imaging that has a higher signal-to noise ratio when compared to 2 D imaging, and specialized imaging methods such as CT-arthrography as well as functional MR imaging were introduced. Several classifications schemes and imaging findings of osteochondral lesions that influence the conservative or surgical therapy strategy were discussed. MRI enables after surgery the noninvasive assessment of the repair tissue and the success of implantation. Key points▪ Modern MRI allows for highly resolved visualization of the articular cartilage of the ankle joint and of subchondral pathologies. ▪ Recent advances in MRI include 3 D isotropic ankle joint imaging, which deliver higher signal-to-noise ratios of the cartilage and less partial volume artifacts when compared with standard 2 D sequences. ▪ In case of osteochondral lesions MRI is beneficial for assessing the stability of the osteochondral fragment and for this discontinuity of the cartilage layer is an important factor. ▪ CT-arthrography can be used in case of contraindications of MRI and in unclear MRI findings as further diagnostic approach. Citation Format

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Juvenile versus Adult Osteochondritis Dissecans of the Knee: Appropriate MR Imaging Criteria for Instability

Abstract: Previously described MR imaging criteria for OCD instability have high specificity for adult but not juvenile lesions of the knee.

Cited by 189 publications

References 38 publications

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

Sport injuries in the paediatric and adolescent patient: a growing problem

Modern Cartilage Imaging of the Ankle

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