Magnetic Resonance Imaging of Osteochondritis Dissecans

Ellermann, Jutta; Donald, Bryan; Rohr, Sara R.; Takahashi, Takashi; Tompkins, Marc; Nelson, Bradley J.; Crawford, Amanda M.; Rud, Christopher T.; Macalena, Jeffrey A.

doi:10.1016/j.acra.2016.01.015

Cited by 42 publications

(17 citation statements)

References 30 publications

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“…determined the agreement for the Dipaola/Nelson classification based on MRs of knee OCD. 32 The authors reported moderate agreement among two musculoskeletal-trained radiologists and one musculoskeletal radiology fellow, compared to slight agreement in our investigation concerning capitellar OCD. Higher reliability reported by the authors may be due to the fact that the Dipaola/Nelson classification was originally developed for knee and talar OCD.…”

Section: Discussionsupporting

confidence: 48%

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Interobserver reliability of the classification of capitellar osteochondritis dissecans using magnetic resonance imaging

et al. 2019

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Aim (1) To determine the interobserver reliability of magnetic resonance classifications and lesion instability criteria for capitellar osteochondritis dissecans lesions and (2) to assess differences in reliability between subgroups. Methods Magnetic resonance images of 20 patients with capitellar osteochondritis dissecans were reviewed by 33 observers, 18 orthopaedic surgeons and 15 musculoskeletal radiologists. Observers were asked to classify the osteochondritis dissecans according to classifications developed by Hepple, Dipaola/Nelson, Itsubo, as well as to apply the lesion instability criteria of DeSmet/Kijowski and Satake. Interobserver agreement was calculated using the multirater kappa (k) coefficient. Results Interobserver agreement ranged from slight to fair: Hepple (k = 0.23); Dipaola/Nelson (k = 0.19); Itsubo (k = 0.18); DeSmet/Kijowksi (k = 0.16); Satake (k = 0.12). When classifications/instability criteria were dichotomized into either a stable or unstable osteochondritis dissecans, there was more agreement for Hepple (k = 0.52; p = .002), Dipaola/Nelson (k = 0.38; p = .015), DeSmet/Kijowski (k = 0.42; p = .001) and Satake (k = 0.41; p < .001). Overall, agreement was not associated with the number of years in practice or the number of osteochondritis dissecans cases encountered per year (p > .05). Conclusion One should be cautious when assigning grades using magnetic resonance classifications for capitellar osteochondritis dissecans. When making treatment decisions, one should rather use relatively simple distinctions (e.g. stable versus unstable osteochondritis dissecans; lateral wall intact versus not intact), as these are more reliable.

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Section: Discussionsupporting

confidence: 48%

“…The interobserver reliability for existing classification systems was lower in our investigation compared to two previous studies. 7 , 32 Itsubo et al. reported an intraclass coefficient, of their own developed classification, that ranged from 0.82 to 0.88 (i.e.…”

Section: Discussionmentioning

confidence: 99%

Interobserver reliability of the classification of capitellar osteochondritis dissecans using magnetic resonance imaging

et al. 2019

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“… 9 This system divides OCLs on MRI into 4 categories: grade 1, thickening of the cartilage without disruption, including bone marrow edema or fluid at the bone-lesion interface; grade 2, cartilage breached and fluid at partial but not entire interface; grade 3, cartilage completely disrupted with fluid interface surrounding lesion; and grade 4, displaced fragment. 12 …”

Section: Methodsmentioning

confidence: 99%

Incidence of Coexisting Talar and Tibial Osteochondral Lesions Correlates With Patient Age and Lesion Location

Irwin

Shimozono

Yasui

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:The incidence of coexisting osteochondral lesions (OCLs) of the tibia and talus has been negatively correlated with successful clinical outcomes, yet these lesions have not been extensively characterized.Purpose:To determine the incidence of coexisting tibial and talar OCLs, assess the morphologic characteristics of these lesions, and evaluate whether these characteristics are predictive of outcome.Study Design:Case series; Level of evidence, 4.Methods:A total of 83 patients who underwent surgery for a talar OCL were evaluated for coexisting OCLs of the distal tibia with preoperative magnetic resonance images. Size, location, containment, International Cartilage Repair Society (ICRS) grade, patient age, and patient sex were analyzed for predictors of coexisting lesions or patient outcome. The talar and tibial surfaces were each divided into 9 zones, with 1 corresponding to the most anteromedial region and proceeding laterally and then posteriorly. The Foot and Ankle Outcome Score (FAOS) was evaluated pre- and postoperatively.Results:Twenty-six patients (31%) had coexisting tibial and talar OCLs, with 9 (35%) identified as kissing lesions. Age correlated with coexisting lesion incidence, as older patients were more likely to have a coexisting tibial OCL (P = .038). More than half of talar OCLs were found in zone 4 (61%), whereas the majority of tibial OCLs were located in zones 2, 4, and 5 (19% each). Patients with coexisting lesions were more likely to have a lateral talar OCL (P = .028), while those without a coexisting tibial lesion were more likely to have a talar OCL in zone 4 (P = .016). There was no difference in FAOS result or lesion size between patients with and without coexisting OCLs, but patients with coexisting lesions were more likely to have an ICRS grade 4 talar OCL (P = .034). For patients with coexisting lesions, kissing lesions were more likely to be located in zone 6 (P = .043). There was no difference in OCL size or containment between kissing and nonkissing coexisting OCLs.Conclusion:The incidence of coexisting talar and tibial OCLs may be more prevalent than what previous reports have suggested, with older patients being more likely to present with this pathology. The location of a talar OCL correlates with the incidence of a coexisting tibial OCL.

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“…Commonly found in the knee, plain radiographs are used reliably for diagnosis, staging [ 2 ], and management. Advanced imaging, such as MRI, is often used in conjunction with radiographs and physical exam for staging and surgical planning though inconsistencies in protocols and findings limit its clinical utility [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Sustained Results in Long-Term Follow-Up of Autologous Chondrocyte Implantation (ACI) for Distal Femur Juvenile Osteochondritis Dissecans (JOCD)

Beck

Sugimoto

Micheli

2018

Advances in Orthopedics

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Introduction Concern regarding ability of autologous chondrocyte implantation (ACI) to correct for the bone and cartilage pathology of knee juvenile osteochondritis dissecans (JOCD) exists. The purpose of this study was to determine long-term, patient-based outcomes of ACI treatment of JOCD in young patients. Authors hypothesized long-term outcomes are comparable to reported mid-term outcomes. Methods A single institution, longitudinal cohort study design combining medical record review and outcome surveys was used. Inclusion criteria included isolated JOCD diagnosis, failed primary healing of operatively treated JOCD, ACI surgery > 5 years ago, and ≤20 years of age at time of ACI. Results 10/26 eligible patients (38.5%) participated (M: F = 5:5, age at ACI: 18.3 ± 2.5 y, current age: 30.8 ± 5.1 y, and current BMI: 24.6 ± 2.1). Follow-up was 12.0 ± 4.5 y. Lesion size at ACI was 9.1 ± 1.9 cm2. Femoral condyle location was medial = 6 and lateral = 4. All required treatment at some point for knee symptoms after ACI. During the past one year, four patients required treatment. Patient reported outcome scores at 12 years following ACI were IKDC score: 73.0 ± 3.6, KOOS scores including pain [88.7 ± 2.3], symptoms [78.2 ± 4.6], activity of daily living [94.7 ± 1.9], function, sports, and recreational activities [73.0 ± 5.3], and quality of life [57.5 ± 5.8], and Modified Cincinnati Knee Rating score was 77.9 ± 4.1. A moderate to good relationship was found between KOOS symptoms and BMI and lesion size. Function, sports, and recreational activities of the KOOS were greater in participants who had ≤1 lesion prior to ACI procedures (p = 0.044). Conclusion This study of ACI treatment of knee JOCD patients confirms sustained, long-term results. Number of lesions prior to ACI procedure influenced status of function, sports, and recreational activities.

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Magnetic Resonance Imaging of Osteochondritis Dissecans

Cited by 42 publications

References 30 publications

Interobserver reliability of the classification of capitellar osteochondritis dissecans using magnetic resonance imaging

Interobserver reliability of the classification of capitellar osteochondritis dissecans using magnetic resonance imaging

Incidence of Coexisting Talar and Tibial Osteochondral Lesions Correlates With Patient Age and Lesion Location

Sustained Results in Long-Term Follow-Up of Autologous Chondrocyte Implantation (ACI) for Distal Femur Juvenile Osteochondritis Dissecans (JOCD)

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