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Haug LP, Sill AP, Shrestha R, Patel KA, Kile TA, Fox MG. Osteochondral Lesions of the Ankle and Foot. Semin Musculoskelet Radiol 2023; 27:269-282. [PMID: 37230127 DOI: 10.1055/s-0043-1766110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Osteochondral lesions (OCLs) in the ankle are more common than OCLs of the foot, but both share a similar imaging appearance. Knowledge of the various imaging modalities, as well as available surgical techniques, is important for radiologists. We discuss radiographs, ultrasonography, computed tomography, single-photon emission computed tomography/computed tomography, and magnetic resonance imaging to evaluate OCLs. In addition, various surgical techniques used to treat OCLs-debridement, retrograde drilling, microfracture, micronized cartilage-augmented microfracture, autografts, and allografts-are described with an emphasis on postoperative appearance following these techniques.
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Affiliation(s)
- Logan P Haug
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Andrew P Sill
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | | | - Karan A Patel
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona
| | - Todd A Kile
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona
| | - Michael G Fox
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
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2
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Chahla J, Williams BT, Yanke AB, Farr J. The Large Focal Isolated Chondral Lesion. J Knee Surg 2023; 36:368-381. [PMID: 34507359 DOI: 10.1055/s-0041-1735278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Focal chondral defects (FCDs) of the knee can be a debilitating condition that can clinically translate into pain and dysfunction in young patients with high activity demands. Both the understanding of the etiology of FCDs and the surgical management of these chondral defects has exponentially grown in recent years. This is reflected by the number of surgical procedures performed for FCDs, which is now approximately 200,000 annually. This fact is also apparent in the wide variety of available surgical approaches to FCDs. Although simple arthroscopic debridement or microfracture are usually the first line of treatment for smaller lesions, chondral lesions that involve a larger area or depth require restorative procedures such as osteochondral allograft transplantation or other cell-based techniques. Given the prevalence of FCDs and the increased attention on treating these lesions, a comprehensive understanding of management from diagnosis to rehabilitation is imperative for the treating surgeon. This narrative review aims to describe current concepts in the treatment of large FCDs through providing an algorithmic approach to selecting interventions to address these lesions as well as the reported outcomes in the literature.
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Affiliation(s)
- Jorge Chahla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brady T Williams
- Department of Orthopedic Surgery, University of Colorado, Aurora, Colorado
| | - Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jack Farr
- Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana
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Arthroscopic defect size measurement in osteochondral lesions of the talus underestimates the exact defect size and size measurement with arthro-MRI (MR-A) and high-resolution flat-panel CT-arthro imaging (FPCT-A). Knee Surg Sports Traumatol Arthrosc 2023; 31:716-723. [PMID: 36441219 DOI: 10.1007/s00167-022-07241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The size of osteochondral lesions of the talus (OLTs) is highly relevant for their treatment. In addition to intraoperative measurement of defect size, preoperative planning by means of magnetic resonance imaging (MRI) or computed tomography (CT) is crucial. METHODS Four defects of different sizes and depths were created on the talar joint surface in 14 cadaver feet. All defects were evaluated, both arthroscopically and via arthrotomy with a probe. Arthro-MRI (MR-A) and high-resolution flat-panel CT arthro scans (FPCT-A) were acquired. Length, width, and depth were measured for every defect and the defect volume was calculated. To determine the exact defect size, each talar defect was filled with plastic pellets to form a cast and the casts were scanned using FPCT to create a 3D multiplanar reconstruction data set. Finally, the surgically measured values were compared with the radiological values and the exact defect size. RESULTS Overall, the surgically measured values (both arthroscopic and open) underestimated the exact defect size (p < 0.05). Arthroscopically determined defect length and width showed the largest deviation (p < 0.05) and underestimated the size in comparison with MR-A and FPCT-A. The FPCT-A measurements demonstrated higher correlation with both the arthroscopic and open surgical measurements than did the MR-A measurements (p < 0.05). CONCLUSION The exact defect size is underestimated on intraoperative measurement, in both arthroscopic and open approaches. Arthroscopic defect size measurement underestimates defect size in comparison with MR-A and FPCT-A. FPCT-A was shown to be a reliable imaging technique that allows free image reconstruction in every plane and could be considered as the new reference standard for preoperative evaluation of defect size in OLT.
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4
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Tudisco C, Bernardi G, Manisera MT, De Maio F, Gorgolini G, Farsetti P. An update on osteochondritis dissecans of the knee. Orthop Rev (Pavia) 2022; 14:38829. [PMID: 36540072 PMCID: PMC9760694 DOI: 10.52965/001c.38829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Osteochondritis dissecans of the knee (OCD) is a multifactorial pathology in where repetitive microtrauma plays a central role in the etiopathogenesis. Knee MRI is indicated in young, active patients who have knee pain and/or effusion, to make an early diagnosis and decide about treatment, according essentially to the MRI stability signs. The choice of treatment should be also tailored, based on the patient's skeletal maturity, as well as the size and location of the lesion. Conservative treatment with restricting sports activities is the first line treatment and often sufficient to ensure healing in patients with open physes. Surgical treatment depends on the persistence of symptoms after 6 months of conservative treatment and/or based on the development of signs of instability of the lesion. Stable lesions with intact articular cartilage may be treated by drilling of the subchondral bone aiming to stimulate vascular ingrowth and subchondral bone healing. Every attempt should be made to retain the osteochondral fragment when possible. Instable lesions should be fixed or "replaced" with salvage procedures to prevent the onset of early osteoarthritis in this young population. Furthers studies are needed to improve the knowledge and optimizing non-operative and surgical treatment and to develop noninvasive diagnostic tools to predict with more accuracy the fragment's stability.
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Affiliation(s)
- Cosimo Tudisco
- Unicamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Gabriele Bernardi
- Department of Orthopaedics and TraumatologyNuova Itor Clinic, Rome, Italy
| | - Maria Teresa Manisera
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and TraumatologyUniversity of Rome “Tor Vergata”, Italy
| | - Fernando De Maio
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and TraumatologyUniversity of Rome “Tor Vergata”, Italy
| | - Giulio Gorgolini
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and TraumatologyUniversity of Rome “Tor Vergata”, Italy
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and TraumatologyUniversity of Rome “Tor Vergata”, Italy
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5
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Chau MM, Tompkins MA. Osteochondritis Dissecans of the Knee in Young Athletes. Clin Sports Med 2022; 41:579-594. [DOI: 10.1016/j.csm.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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6
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Andriolo L, Solaro L, Altamura SA, Carey JL, Zaffagnini S, Filardo G. Classification Systems for Knee Osteochondritis Dissecans: A Systematic Review. Cartilage 2022; 13:19476035221121789. [PMID: 36117427 PMCID: PMC9634996 DOI: 10.1177/19476035221121789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Aim of this systematic review was to describe all classification systems for knee osteochondritis dissecans (OCD) lesions, evaluating their accuracy and reliability, as well as their use in the literature on knee OCD. DESIGN A systematic review of the literature was performed in July 2021 on PubMed, WebOfScience, and Cochrane Collaboration (library) to describe all published classification systems for knee OCD lesions and quantify the use of these classifications in the literature. RESULTS Out of 1,664 records, 30 studies on 33 OCD classifications systems were identified, describing 11 radiographic, 13 MRI, and 9 arthroscopic classifications. The search included 193 clinical studies applying at least one OCD classification, for a total of 7,299 knee OCD cases. Radiographic classifications were applied to 35.8%, MRI to 35.2%, and arthroscopic classifications to 64.2% of the included studies. Among these, in the last two decades, the International Cartilage Repair Society's (ICRS) arthroscopic classification was the most described approach in studies on knee OCD. Overall, there is a lack of data on accuracy and reliability of the available systems. CONCLUSIONS Several classifications are available, with ICRS being the most used system over the time period studied. Arthroscopy allows to confirm lesion stability, but noninvasive imaging approaches are the first line to guide patient management. Among these, radiographic classifications are still widely used, despite being partially superseded by MRI, because of its capability to detect the earliest disease stages and to distinguish stable from unstable lesions, and thus to define the most suitable conservative or surgical approach to manage patients affected by knee OCD. LEVEL OF EVIDENCE Systematic review, level IV.
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Affiliation(s)
- Luca Andriolo
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Solaro
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Luca Solaro, Clinica Ortopedica e
Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1/10, 40136
Bologna, Italy.
| | | | - James L. Carey
- Penn Center for Advanced Cartilage
Repair and Osteochondritis Dissecans Treatment, Hospital of the University of
Pennsylvania, Philadelphia, PA, USA,Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research
(ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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7
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Komnos G, Iosifidis M, Papageorgiou F, Melas I, Metaxiotis D, Hantes M. Juvenile Osteochondritis Dissecans of the Knee Joint: Midterm Clinical and MRI Outcomes of Arthroscopic Retrograde Drilling and Internal Fixation with Bioabsorbable Pins. Cartilage 2021; 13:1228S-1236S. [PMID: 33899529 PMCID: PMC8808801 DOI: 10.1177/19476035211003325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to assess the clinical and radiographic outcomes of juvenile patients who suffered from stage II or III osteochondritis dissecans (OCD) of the knee and underwent arthroscopic retrograde drilling and internal fixation with bioabsorbable pins. DESIGN Medical and radiological records from patients aged 11 to 16 years, who underwent arthroscopic treatment for OCD lesions of the knee in 2 tertiary hospitals, were retrospectively reviewed. The procedure was indicated by persistent pain and by magnetic resonance imaging (MRI). All patients underwent retrograde drilling and arthroscopic fixation of the lesion with bioabsorbable pins. MRI was conducted at least 1 year postoperative in all patients to evaluate healing. Functional outcomes were evaluated through the Visual Analogue Scale (VAS) for pain, Lysholm, and IKDC (International Knee Documentation Committee) scores. RESULTS A total of 40 patients, with an average age of 13.1 years (range = 11-16 years) and an average follow-up of 6.6 years (range = 3-13 years) were reviewed. MRI findings confirmed the healing of the lesion in 36 out of the 40 (90%) patients. In particular, the healing rate was 95% (20/21) and 84% (16/19) for stage II and stage III, respectively. Lysholm, IKDC, and VAS scores revealed a statistically significant improvement (P < 0.05) at final follow-up in comparison to preoperative status. No infection, knee stiffness, or other complication was recorded. CONCLUSIONS Retrograde drilling combined with internal fixation with bioabsorbable pins, of stages II and III OCD lesions of the knee provides good to excellent outcomes to juvenile patients, with a high healing rate.
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Affiliation(s)
| | - Michael Iosifidis
- Geniko Nosokomeio Thessalonikis
Papageorgiou, Thessaloniki, Central Macedonia, Greece
| | | | | | - Dimitrios Metaxiotis
- Geniko Nosokomeio Thessalonikis
Papageorgiou, Thessaloniki, Central Macedonia, Greece
| | - Michael Hantes
- General University Hospital of Larissa,
Larisa, Greece,Michael Hantes, General University Hospital
of Larissa, Mezourlo Area, Larissa 41110, Greece.
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8
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Osteochondral lesions of the talar dome: an up-to-date approach to multimodality imaging and surgical techniques. Skeletal Radiol 2021; 50:2151-2168. [PMID: 34129065 DOI: 10.1007/s00256-021-03823-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 02/02/2023]
Abstract
Osteochondral lesions (OCLs) of the talar dome consist of a multifactorial pathology of the articular cartilage and subchondral bone and can result in persistent ankle pain and osteoarthritis (OA). Along with a physical examination and clinical history, an imaging evaluation plays a pivotal role in the diagnosis of these lesions and is fundamental for making treatment decisions and determining prognosis by providing information regarding the size, location, and cartilage and subchondral bone statuses as well as associated lesions and degenerative changes. Multiple surgical techniques for OCLs of the talar dome have been developed in recent decades, including cartilage repair, regeneration, and replacement strategies, and radiologists should be acquainted with their specific expected and abnormal postoperative imaging findings to better monitor the results and predict poor outcomes. The present article proposes a thorough review of the ankle joint anatomy and biomechanics, physiopathology, diagnosis, and treatment of OCLs of the talar dome, highlighting the radiological approach and imaging findings in both pre- and postoperative scenarios.
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9
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Shah AJ, Patel D. Imaging update on cartilage. J Clin Orthop Trauma 2021; 22:101610. [PMID: 34722147 PMCID: PMC8531853 DOI: 10.1016/j.jcot.2021.101610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022] Open
Abstract
In this update article, we present a review of the literature regarding the physiology of the articular cartilage, role of MR imaging in cartilage assessment, MRI sequences and protocols for cartilage imaging, brief overview of classifications and nomenclature for chondral and osteochondral lesions, MR imaging following cartilage repair and degenerative osteoarthritis.
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Affiliation(s)
- Ankur J. Shah
- Consultant Radiologist at Sadbhav Imaging Centre and Gujarat Imaging Centre, Ahmedabad, 380009, India
| | - Drushi Patel
- Consultant Radiologist, Gujarat Imaging Centre, Ahmedabad, 380009, India
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10
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Chau MM, Klimstra MA, Wise KL, Ellermann JM, Tóth F, Carlson CS, Nelson BJ, Tompkins MA. Osteochondritis Dissecans: Current Understanding of Epidemiology, Etiology, Management, and Outcomes. J Bone Joint Surg Am 2021; 103:1132-1151. [PMID: 34109940 PMCID: PMC8272630 DOI: 10.2106/jbjs.20.01399] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis. ➤ While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition. ➤ Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging. ➤ Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have had failure of conservative management or have unstable lesions. ➤ Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value.
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Affiliation(s)
- Michael M Chau
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Mikhail A Klimstra
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Kelsey L Wise
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Jutta M Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ferenc Tóth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Bradley J Nelson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- TRIA Orthopedic Center, Bloomington, Minnesota
| | - Marc A Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- TRIA Orthopedic Center, Bloomington, Minnesota
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11
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Leary E, Stoker AM, Cook JL. Classification, Categorization, and Algorithms for Articular Cartilage Defects. J Knee Surg 2020; 33:1069-1077. [PMID: 32663886 DOI: 10.1055/s-0040-1713778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is a critical unmet need in the clinical implementation of valid preventative and therapeutic strategies for patients with articular cartilage pathology based on the significant gap in understanding of the relationships between diagnostic data, disease progression, patient-related variables, and symptoms. In this article, the current state of classification and categorization for articular cartilage pathology is discussed with particular focus on machine learning methods and the authors propose a bedside-bench-bedside approach with highly quantitative techniques as a solution to these hurdles. Leveraging computational learning with available data toward articular cartilage pathology patient phenotyping holds promise for clinical research and will likely be an important tool to identify translational solutions into evidence-based clinical applications to benefit patients. Recommendations for successful implementation of these approaches include using standardized definitions of articular cartilage, to include characterization of depth, size, location, and number; using measurements that minimize subjectivity or validated patient-reported outcome measures; considering not just the articular cartilage pathology but the whole joint, and the patient perception and perspective. Application of this approach through a multistep process by a multidisciplinary team of clinicians and scientists holds promise for validating disease mechanism-based phenotypes toward clinically relevant understanding of articular cartilage pathology for evidence-based application to orthopaedic practice.
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Affiliation(s)
- Emily Leary
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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12
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Glaser C, Heuck A, Horng A. Update: Klinische Knorpelbildgebung – Teil 2. Radiologe 2019; 59:700-709. [DOI: 10.1007/s00117-019-0554-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Chan C, Richmond C, Shea KG, Frick SL. Management of Osteochondritis Dissecans of the Femoral Condyle. JBJS Rev 2018; 6:e5. [DOI: 10.2106/jbjs.rvw.17.00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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14
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Gonzalez-Herranz P, Rodriguez M, de la Fuente C. Femoral osteochondritis of the knee: prognostic value of the mechanical axis. J Child Orthop 2017; 11:1-5. [PMID: 28439302 PMCID: PMC5382330 DOI: 10.1302/1863-2548-11-160173] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Femoral osteochondritis dissecans (OCD) is a disorder of unknown aetiology and variable prognosis that causes knee pain. In this paper, the authors study the impact of lower limb malalignment on the development and prognosis of OCD. METHODS After anteroposterior (AP) and lateral radiograph and MRI of the knee, 53 cases of OCD were diagnosed. All patients were studied by standing full-length AP radiograph of the lower extremities in order to analyse the relationship between the femorotibial and mechanical axis and the location and stability of the osteochondritis. RESULTS The OCD lesion was located in the medial condyle (zone 2) in 75.5% of cases (40 cases). The lateral condyle was affected in 24.5% of cases (zone 4 in nine cases and zone 5 in four cases). The femorotibial angle (anatomical axis) was normally aligned in 68% of cases. A valgus deformity was observed in 9.5% of cases and a varus deformity in 22.5%. The mechanical axis of the limb appeared normal in only 32% of cases, with medial deviation in 53%, and lateral deviation in 15% of cases. When the OCD lesion was located in the medial condyle (40 cases), the mechanical axis also crossed the knee through the medial zone in 28 cases. When the OCD lesion was located in the lateral condyle (13 cases), the mechanical axis crossed the knee through zones 1 or 2 in four cases. In stable OCD, the mechanical axis and location of the lesion coincided in 19 of 36 cases (52%), compared with 16 of 17 cases (94%) in unstable OCD. CONCLUSIONS There is a high correlation between OCD location and lower limb mechanical axis deviation. The convergence of the mechanical axis with the location of the OCD lesion may be considered an associated factor in fragment instability. This convergence is more common in unstable OCD.
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Affiliation(s)
- P. Gonzalez-Herranz
- Hospital Materno Infantil, Teresa Herrera, Complejo, Hospitalario Universitario A Coruña, Spain,Correspondence should be sent to: Pedro Gonzalez-Herranz, Rua Manzaneda 12, 15173-Oleiros-La Coruña, Spain.
| | - M.L. Rodriguez
- Hospital Materno Infantil, Teresa Herrera, Complejo, Hospitalario Universitario A Coruña, Spain
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15
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Abstract
The subchondral zone plays an important role in both the structural and biochemical maintenance of articular cartilage. Knowledge of the structure, function, and pathophysiology of the normal subchondral bone/articular surface interface is essential for an understanding of the pathogenesis of many of the disease entities that we will review in this chapter.
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Shaikh HH, Vícha J, Proček T, Pavlata J, Kučera T. Osteochondritis Dissecans of the Knee in Children and Adolescents: Our Experience with Transchondral Drilling. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016; 58:98-103. [PMID: 26686950 DOI: 10.14712/18059694.2015.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Osteochondritis dissecans(OCD) of the knee is identified with increasing frequency in the adolescent patient. Left untreated, OCD can cause significant impairment and restriction in physical activity and development of osteoarthritis at an early age. The diagnosis of lesions of OCD can be confirmed on plain radiographs. MRI has emerged as the gold standard to evaluate the stability of the lesion and the integrity of the overlying articular cartilage. Treatment of OCD lesions depend on the stability of the lesion. Stable lesions can be treated conservatively by physical activity modification and immobilization. Unstable lesions and stable lesions not responding to conservative measures should be treated surgically. Surgical options range from arthroscopic drilling, either transarticular or extra-articular drilling for stable lesions or salvage procedures such as autologous chondrocyte transplantation (ACT), mosaicplasty to restore joint and cartilage congruency.
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Affiliation(s)
- Hasour Hassan Shaikh
- Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Czech Republic: Department of Orthopedic Surgery.
| | - Jan Vícha
- Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Czech Republic: Department of Orthopedic Surgery
| | - Tomáš Proček
- Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Czech Republic: Department of Orthopedic Surgery
| | - Jaroslav Pavlata
- Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Czech Republic: Department of Orthopedic Surgery
| | - Tomáš Kučera
- Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Czech Republic: Department of Orthopedic Surgery
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Abstract
PURPOSE OF REVIEW Juvenile osteochondritis dissecans (JOCD) knee lesions are common abnormalities in adolescents and children, and have higher rates of spontaneous healing with nonoperative management compared to adult osteochondritis dissecans (OCD) lesions. Multiple classification and assessment systems have been established in order to help clinicians determine which lesions are amenable to nonoperative management. However, these assessments often use adult OCD classification systems of lesion stability, which have poor reliability in JOCD lesions. The purpose of this review is to assess these various classification systems proposed for JOCD lesions. RECENT FINDINGS Although arthroscopy remains the gold standard for the definitive assessment of lesion stability, recent evidence suggests that MRI characteristics indicative of instability in adult OCD lesions are not applicable in determining JOCD lesion instability. In addition, the correlation between arthroscopic and MRI indications of instability is highly varied in these younger patients. SUMMARY In order for the pediatric orthopedic surgeon to more accurately predict treatment outcomes in patients with JOCD knee lesions, further investigation into the radiographic characteristics specific to JOCD lesion instability and healing is warranted.
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18
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Quatman CE, Quatman-Yates CC, Schmitt LC, Paterno MV. The clinical utility and diagnostic performance of MRI for identification and classification of knee osteochondritis dissecans. J Bone Joint Surg Am 2012; 94:1036-44. [PMID: 22637210 PMCID: PMC3364031 DOI: 10.2106/jbjs.k.00275] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is a common clinical tool used to diagnose and monitor the progression and/or healing of osteochondritis dissecans of the knee. The purpose of this study was to systematically review the literature relative to the following questions: (1) Is MRI a valid, sensitive, specific, accurate, and reliable imaging modality to identify knee osteochondritis dissecans compared with arthroscopy? (2) Is MRI a sensitive tool that can be utilized to characterize lesion severity and stability of osteochondritis dissecans fragments in the knee? METHODS A systematic search was performed in December 2010 with use of PubMed MEDLINE (from 1966), CINAHL (from 1982), SPORTDiscus (from 1985), Scopus (from 1996), and EMBASE (from 1974) databases. RESULTS Seven studies, four Level-II and three Level-III investigations, met the specified inclusion criteria. No randomized controlled studies were identified. Because of inconsistencies between imaging techniques and methodological shortcomings of many of the studies, a meta-analysis was not performed. CONCLUSIONS The limited available evidence, methodological inconsistencies in imaging techniques, and lack of standardized grading criteria used in current studies prevent clear conclusions regarding the diagnostic and specific staging equivalency of MRI with arthroscopy. However, available evidence supports the use of MRI to detect the stability or instability of the lesion. Given the benefits of the use of MRI as a noninvasive tool to diagnose, predict lesion progression, and assess clinical outcomes of treatment, there is a pressing need for high-level, systematic, sound, and thorough studies related to the clinical utility of MRI for assessing osteochondritis dissecans of the knee.
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Affiliation(s)
- Carmen E. Quatman
- Department of Orthopaedic Surgery (C.E.Q.), Sports Health and Performance Institute (C.E.Q. and L.S.), and Division of Physical Therapy, School of Health and Rehabilitation Services (L.S.), Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221. E-mail address for C.E. Quatman:
| | - Catherine C. Quatman-Yates
- Human Performance Laboratory at the Sports Medicine Biodynamics Center (C.C.Q.-Y. and M.P.), Department of Pediatrics (M.P.), and Division of Occupational Therapy and Physical Therapy (C.C.Q.-Y. and M.P.), Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229
| | - Laura C. Schmitt
- Department of Orthopaedic Surgery (C.E.Q.), Sports Health and Performance Institute (C.E.Q. and L.S.), and Division of Physical Therapy, School of Health and Rehabilitation Services (L.S.), Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221. E-mail address for C.E. Quatman:
| | - Mark V. Paterno
- Human Performance Laboratory at the Sports Medicine Biodynamics Center (C.C.Q.-Y. and M.P.), Department of Pediatrics (M.P.), and Division of Occupational Therapy and Physical Therapy (C.C.Q.-Y. and M.P.), Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229
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Abstract
BACKGROUND Recent data suggest magnetic resonance imaging (MRI) is the best method to analyze the status of the cartilage and subchondral bone in patients with juvenile osteochondritis dissecans (JOCD). METHODS MRI analysis of 122 knees and 132 JOCD lesions in 109 patients who underwent arthroscopic treatment for osteochondritis dissecans lesions of the knee between March 2003 and January 2011. RESULTS Agreement between MRI and arthroscopic grading was 62.1%. MRI sensitivity was 92% and specificity was 55%. Positive predictive value of MRI was 33% and negative predictive value of MRI was 97%. In a multivariable logistic regression model, the odds of a unstable lesion on the lateral femoral condyle nonweight-bearing location were 15.7 times greater than the odds of an unstable lesion on the medial femoral condyle weight-bearing area (95% confidence interval: 2.6-95.7, P=0.003.) The odds of the lateral femoral condyle weight-bearing lesion having an unstable grade were also greater than for a medial femoral condyle weight-bearing lesion, but the results were not statistically significant (odds ratio, 1.70, P=0.349). CONCLUSIONS A high T2 signal retrograde to the lesion may commonly appear with an early, stable arthroscopic grade lesion. MRI continues to be reliably sensitive to JOCD lesions and a good predictor of low-grade, stable lesions. However, MRI predictability of high-grade, unstable JOCD lesions is less reliable. Lesions in atypical locations, such as the nonweight-bearing surface of the lateral femoral condyle, more commonly present as higher, arthroscopic grade lesions. LEVEL OF EVIDENCE Level IV, retrospective case series.
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20
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Abstract
Talar dome chondral and osteochondral lesions are a common cause of ankle pain and subjective instability. The goal of imaging these lesions is primarily their detection, demonstration of their position and extent, including status of the chondral surface, demonstration of any associated chondral delamination, assessment of the integrity of the subchondral plate, and assessment of the cancellous subchondral bone for bone marrow edema like signal, sclerosis, cystic change, and for the presence of an unstable osteochondral fragment. Although plain radiography, computerized tomography, and bone scan may be helpful in the detection and characterization of these lesions, magnetic resonance imaging is the only imaging modality that will provide a comprehensive assessment of all these issues. Technical aspects of plain radiography, computerized tomography, and magnetic resonance imaging are discussed, and imaging findings are presented.
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Multiple osteochondritis dissecans lesions within the knee of an immature gymnast on growth hormone supplementation. CURRENT ORTHOPAEDIC PRACTICE 2008. [DOI: 10.1097/bco.0b013e328313a94b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sexton AT, Labib SA. Osteochondral lesions of the talus: current opinions on diagnosis and management. ACTA ACUST UNITED AC 2007. [DOI: 10.1097/bco.0b013e3280895b22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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