Osteochondral defect is more common among young athletes who actively take part in sports and most commonly affects the femoral condyles in the knee. • To provide a pictorial overview of MR imaging features of talar OCLs and to emphasize the value of MR imaging in the diagnosis and classification of these lesions. [6]. The patient usually falls to the ground in pain, at which time the patella reduces spontaneously. Who is a perfect candidate for MaioRegen Prof. Matej Drobnic MaioRegen Clinical Evidence Giulia Scarpato, Finceramica Surgical technique: Tips and tricks Mr Andrew Edwards Tips and tricks in complex cases Prof. Matej Drobnic. It is a morphologic finding that may be seen in various conditions and that produces a scalloped defect along the articular surface of the bone (Fig 1). Treatment for small (< 3 cm 2) symptomatic defect is well-codified, usually by mosaicplasty or microfracture, but larger defects and large subchondral bone defects are challenging. Infection is always a … Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. [7], who evaluated the knee using MRI. In two of the patients, the surgeon reported no evidence of femoral chondral injury. See osteochondritis dissecans article for a general discussion. In two (20%) of the 10 patients, the osteochondral defects involved the articular surface of both the trochlear groove and the midlateral weight-bearing portion 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]. The final study group was composed of these 10 patients (male:female ratio, 7:3; age range, 15-22 years; mean age, 18 years). Transverse dimensions were obtained from the coronal images, whereas anteroposterior dimensions were obtained from the sagittal images. MRI revealed chondral defects of the lateral aspect of the trochlear of both knees. Osteochondral lesions have been reported in the talus and knee and have a characteristic ap-pearance on MR imaging [2]. 4.1 (a)–(c) Select sagittal, coronal, and axial T2 images from a 3-T MRI of the right knee without contrast. Consequently, our objective was to determine the incidence of lateral femoral condyle osteochondral injuries and to better define the locations and patterns of chondral injury involving the lateral femoral condyle after transient dislocation of the patella based on MRI and follow-up arthroscopy. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. They are not possible to be detected by way of physical examination, but sometimes the clinical history can point towards a chondral defect being the cause of the pain. Operative reports were obtained on all patients who underwent follow-up arthroscopy. osteochondral defects (lunge lesion), as well as address the mechanism of injury. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. We also have observed several patients with osteochondral injuries of the lateral femoral condyle after transient dislocation of the patella. 5-10% of people > 40 years old have high grade chondral lesions; location. inspection. Osteochondral lesions of the knee are found in up to 19% of arthroscopies, taking all indications together. MRI of Spinal Bone Marrow: Part 2, T1-Weighted Imaging-Based Differential Diagnosis, Pictorial Essay. 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. Osteochondral injuries of the knee have proven to be a challenge for the orthopaedic surgeon. Femoroacetabular Impingement: Radiographic Diagnosis—What the Radiologist Should Know, Review. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. 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 [7]. Although individual parameters varied slightly from examination to examination, the routine MRI performed on the high-field-strength magnets consisted of coronal inversion-recovery (TR/TE range, 5,800-3,016/25-39; inversion time, 150 msec; field of view range, 140-149 mm; matrix range, 256-320 × 224 pixels; slice thickness, 4.0 mm; skip, 1.0 mm), coronal proton-density (2,000/15; field of view, 150 mm; matrix, 320 × 224 pixels; slice thickness, 4.0 mm; skip, 1.0 mm), or coronal T1 (500/16; field of view, 140 mm; matrix, 384 × 224 pixels; slice thickness, 4.0 mm; skip, 1.0 mm), sagittal proton-density (1,950-2,766/14; field of view, 140-150 mm; matrix range, 320-384 × 192-224 pixels; slice thickness, 3.0-3.5 mm; skip, 0.5-1.0 mm), sagittal fat-saturated proton-density (2,650-4,366/13-16; field of view, 140-150 mm; matrix range, 256-384 × 224-256; slice thickness, 3.0-3.5 mm; skip, 0.5-1.0 mm), sagittal T2 (3,700-4,766/80-87; field of view range, 140-150 mm; matrix range, 320-384 × 224; slice thickness, 3.0-3.5 mm; skip, 0.5 mm), and axial fat-saturated proton-density (3,116-5,400/25-35; field of view range, 140-160 mm; matrix range, 384-320 × 192-224; slice thickness, 4.0 mm; skip, 1.0 mm) sequences. Keywords: cartilage, knee, MRI, musculoskeletal imaging, trauma. High-grade osteochondral injuries involving the patella or the lateral femoral condyle are often treated with abrasion chondroplasty or autologous chondrocyte transplantation, and treatment of these lesions has been shown to improve functional outcome in adolescent athletes [14]. Osteochondritis dissecans (OCD) most commonly affects the knee. Countless fluid-filled sacs help the knee to move freely. This study determined that chondral injuries were more frequently detected compared with meniscal and ACL injuries, and patterns varied depending on stage of physeal closure. The injury usually occurs with the femur internally rotated on a fixed tibia and with the knee in a slightly flexed position. The fact that the patella is at risk for a shearing or impaction injury or both during both dislocation and reduction but the femoral articular surface is at risk only during dislocation is likely the reason for the higher incidence of articular cartilage lesions involving the patella [6] (Figs. January 2017; Orthopaedic Nursing 36(3):237-239; DOI: 10.1097/NOR.0000000000000358. 4.8a–c. 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 lack of long-term studies and no general consensus as to the best way to manage these lesions compounds the challenge. Chondral defects are almost always diagnosed after a magnetic resonance imaging (MRI) scan. 1A, 1B, 1C, 2A, 2B, and 2C). MRI adds value by identifying unstable lesions that require surgical intervention. Potential soft-tissue injuries include a partial- or full-thickness tear of the medial soft-tissue restraints, including the medial patellofemoral ligament and medial retinaculum [7, 11, 12]. This configuration allows for a potential shearing injury to involve the articular surface of either the patella or the femoral condyle during the first stage of dislocation. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. An MRI (Magnetic Resonance Image) ... the location of the defect in the knee. Conclusion. An osteochondral lesion is seen at the posterior weightbearing surface of the medial femoral condyle. Subchondral marrow edema was present underlying the chondral defects in 10 (100%) patients. cartilage injury with associated subchondral fracture but without detachment The arthroscopic surgeries were performed by a number of orthopedic surgeons with varying levels of experience and expertise. Sanders TG, Medynski MA, Feller JF, Lawhorn KW. Radiology. Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. This is a 14-year-old female with right knee pain for several months. These osteochondral injuries typically involve the inferomedial pole, the median eminence of the patella [5], or both and can result either from a shearing injury at the time of dislocation or reduction or from an impaction injury as the patella strikes the nonarticular surface of the anterolateral femoral condyle. During the second phase of the injury, the patella reduces to its normal position within the trochlear groove. Hip Anatomic Variants That May Mimic Abnormalities at MRI: Labral Variants. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. After the injury, the patient usually seeks medical attention because of persistent pain and swelling, which is typically located along the medial joint line, and the patient occasionally complains of a locking or catching sensation. Nonetheless, both the MRI and surgical results suggest that lateral femoral condyle osteochondral lesions are common, and a search pattern should include an evaluation of the femoral condyle articular surface in both the sagittal and coronal imaging planes after transient dislocation of the patella. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. 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Osteochondral lesions of the talus and fem-oral condyles are thought to occur as a result of Discussion . The typical bone bruise pattern involving the anterolateral femoral condyle and inferomedial patella after transient lateral dislocation of the patella is a well-described MRI finding. Osteochondral Lesions, Knee Normal articular cartilage consists of three separate zones, variably visualized as distinct layers on fluid sensitive MRI pulse sequences with appropriate spatial resolution. Two of the high-field-strength magnets were Horizon LX units (GE Healthcare) and the third was a Signa (GE Healthcare). Q&A Learning Objectives. Fresh frozen osteochondral allograft may be a better choice for massive chondral and osteochondral defect. A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). 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. 26. 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]. Of the two lesions not identified at the time of arthroscopy, one was observed on a high-field-strength system and the other on a low-field-strength system. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of spatial resolution hampers accurate assessment of thin articular cartilage. Diagnosis: IOsteochondral defect (unstable). 3 – left knee) revealed bilateral focal osteochondral defects in the medial patellar facets. 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. The chondral injury is consistently located at the posterior margin of the nonarticular marrow edema (Figs. One recent report describes seven patients in whom lateral femoral condyle shearing fractures were identified on conventional radiography after lateral patellar dislocation. Part 2, T1-Weighted Imaging-Based Differential diagnosis, Pictorial Essay better choice for chondral! 2013-2020, American Roentgen Ray Society, ARRS, all Rights Reserved frustrated orthopaedic surgeons for generations can be! Growing recognition that focal osteochondral injury represents a substantial risk factor for the orthopaedic surgeon configuration of patients... 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