Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. British Volume 69: 320–325. Patellar damage during osteochondritis dissecans of the knee is rare. 3 – left knee) revealed bilateral focal osteochondral defects in the medial patellar facets. A PDFS coronal image of the left knee shows an osteochondral defect (arrow) in the medial patellar facet with accompanied bone marrow oedema. Osteochondritis dissecans (OCD) is a term for a distinct clinical-pathologic entity: a pathologic condition that affects subchondral bone formation and may result in an unstable subchondral fragment, disruption of adjacent articular cartilage, and possible separation of the fragment. The important factors influencing prognosis include size and location of the lesion, duration of the symptoms, fragment stability and appearances of the overlying cartilage. Without spontaneous healing, the bone and adjacent cartilage fragments separate and become loose bodies. Coexisting patellar, ligamentous, and meniscal abnormalities were noted. Previous Figure Next Figure. Patella OCD location. The Journal of Bone and Joint Surgery. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. There are several techniques to make an axial image of the patella. MRI T1 sagittal and PDFS images of the right knee, MRI T1 sagittal and PDFS images of the left knee. Osteochondritis dissecans (OCD) of the trochlear ridges involves primarily the lateral trochlear ridge with the medial trochlear ridge less commonly affected. It is a well-known fact that OCD predisposes a patient to an early degenerative change in the joint. Leading theories: – Shear stress from a mal-aligned patella – a result of repeated insults to articular surface – neither theory explain unusual locations of these patellar lesions. What happens in patients with OCD is the blood flow to the bone around a joint surface becomes abnormal. Unable to process the form. RADIOLOGY SOFT TISSUES Distortion of the skin contour in lateromedial projections taken in the weightbearing position together with absence of the radiolucencies associated with the patellar ligaments are indicators of a femoropatellar joint effusion (Fig 3). et al. 5). Operative procedures include debridement, microfracture, osteochondral autografting and autologous chondrocyte implantation. The patient is in the supine position and flexes the knee to 40-45° using knee support (fig. In all 18 cases, OCD was located central-inferiorly on the patella, and the average size was 11 × 11 × 7 mm. Differential diagnosis. Radiology 2000;215(3) ... OCD: osteochondritis dissecans. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Winn N, Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. Objective The objective was to evaluate the magnetic resonance (MR) appearance of patellar osteochondritis dissecans (OCD). Alternatively, unstable OCD lesions may similarly present with pain, swelling, and mechanical symptoms. Subchondral deformities were present in 16 out of 18 cases (88.9%), subchondral cyst formation in 4 cases (22.2%), reactive bone marrow signal in 8 cases (44.4%), overlying patellar cartilage abnormality in 14 cases (77.8%), loose body in 2 cases (11.1%), patella alta in 8 cases (44.4%), … An MR study (Fig. Arthroscopic validation was obtained in 10 patients. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Patella alta is defined as a tendon/patella ratio greater than 1.3, and patella baja is defined as a ratio less than 0.7. In 5 cases surgery was carried out, and we compared the surgical findings with the MR imaging findings in these cases. The presence of bilateral and symmetrical patellar osteochondral defects is even rarer and in the English literature, only a few cases have been described [1, 2]. Die OCD kann die meisten Gelenke des mens… Although OCD of the patella is believed to be a rare condition, it … Generally, OCD seems to affect males more commonly than females (between 2:1 and 3:1). Figure 5. Radiographs of the right knee (Fig. (PMID: 3818768), [2] Technique for axial image (inferosuperior projection). The presence of bilateral and symmetrical patellar osteochondral defects is even rarer and in the English literature, only a few cases … • MRI is the most useful and sensitive technique in evaluating and staging OCD. Theodore Ganley MD, Kevin Shea MDWhen OCD affects the knee, the most common location is within the lateral aspect of the medial femoral condyle. The extended functions of Eurorad will be exclusively accessible with the ESR Premium Education package by January 1,2021! The most common joint to suffer from an OCD is the knee joint, involving the medial femoral condyle, with the patella being a rare location. Radiology Cases Interesting Radiology Cases from Daily Practice and a Personal Reference. A PDFS coronal image of the right knee shows an irregular osteochondral defect in the medial aspect of the patella with surrounding bone marrow oedema (arrow). Downloaded 49,743 times Altmetric Score. An AP radiograph of the right knee demonstrates no osseous abnormality. A PDFS axial image of the right knee shows delamination of the thickened articular cartilage of the medial facet overlying an irregular cortical bony defect with surrounding bone marrow oedema (arrow). He was referred on suspicion (by his GP) of osteochondritis dissecans. Current Orthopaedics 21, 47-58. Osteochondritis Dissecans Osteochondritis dissecans (OCD) is a condition that develops in joints, most often in children and adolescents. Browse All Figures Return to Figure Change zoom level Zoom in Zoom out. In all 18 cases, OCD was located central-inferiorly on the patella, and the average size was 11 x 11 x 7 mm. He has been aware of a large amount of fluid in the knees. Materials and methods We retrospectively analyzed MR images of 16 patients (18 cases, mean age 20 years) using OCD of the patella. Take Home Messages: Email This BlogThis! These are discussed in the general article on osteochondritis dissecans. Die Osteochondrosis dissecans (kurz OCD bzw. The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK. ... subchondral cysts, or bone marrow edema was recorded. Es verbleibt dann ein Gelenkflächendefekt (Mausbett). In the talus, 96% of lateral lesions and 62% of … Treatment of OCD varies widely depending on the age of patient and the stage of OCD from activity adjustment and reduced weight bearing (stable, less severe disease) to operative management (unstable defect). A lateral radiograph of the right knee demonstrates effacement of the suprapatellar fat in keeping with a large joint effusion (arrow). Radiologist,Fellow in Pediatric Imaging (2019/20), Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Surgical treatment is reserved for patients who do not improve with conservative treatment or with a suspected unstable lesion. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Please share how this access benefits you. The weight-bearing surfaces of the lateral femoral condyle, tibia or patella may also be involved. A PDFS sagittal image of the left knee shows an osteochondral defect (arrow) in the medial patellar facet with accompanied bone marrow oedema and the thickened, heterogeneous and fissured overlying cartilage. • Presence of fluid-like signal at the interface of OCD and native bone is indicative of instability. The former feature is not generally discernible when radiographs are taken in the flexed/retracted position. patella: ~7.5% (range 5-10%) typically inferomedial; patellofemoral groove (femoral trochlea): <1%; weight-bearing surface of the tibia: uncommon; Radiographic features. Key Method ObjectiveThe objective was to evaluate the magnetic resonance (MR) appearance of patellar osteochondritis dissecans (OCD).Materials and methodsWe retrospectively analyzed MR images of 16 patients (18 cases, mean age 20 years) using OCD of the patella. A dorsal defect of the patella is a variant related to normal ossification, present in 0.3 to 1 % of the population, located in the superolateral aspect of the articular surface of the patella. Your story matters Citation Kramer, Dennis E., Yi-Meng Yen, Michael Simoni, Patricia Miller, Lyle J. Micheli, Mininder S. Kocher, and Benton E. Heyworth. Capitellar OCD Posted by Radiologist at 1:26 PM. Osteochondritis dissecans (OCD) is defined as a partial or total separation of a fragment of the articular cartilage and the subchondral bone from the articular surface [ 1 – 5 ]. The differential diagnosis includes: normal fusing apophysis: painless OD, angloamerikanisch auch Osteochondritis dissecans) ist eine umschriebene Knochenläsion unterhalb des Gelenkknorpels, die mit der Abstoßung des betroffenen Knochenareals mit dem darüberliegenden Knorpel als freier Gelenkkörper (Gelenkmaus) enden kann. 2 – right knee; Fig. The MRI and CT-arthrography examination revealed a grade II OCD of the patella. Die sichtbaren Zeichen von OCD sind die nach vorne abgeknickten, gefalteten Ohrmuscheln, aber OCD hört nicht an den Ohren auf. One commonly used technique is the inferosuperior projection. An all-arthroscopic suture fixation of the lesion was proposed. [1] Desai SS, Patel MR, Michelli LJ, Silver JW, Lidge RT (1987) Osteochondritis dissecans of the patella. Traumatic patellar dislocation is a common acute knee injury in children, but it is often transient and occult and not suspected at the time of initial clinical or radiographic evaluation [ 42 ]. The most common joint to suffer from an OCD is the knee joint, involving the medial femoral condyle, with the patella being a rare location. Die "Schäden", die das Faltohr-Gen im Körper einer Katze anrichtet, besonders die, die man nicht sofort sieht, die man erst später im Laufe des Lebens der Katze bemerkt, sind die schlimmsten. Femoral trochlea is normal. As the blood flow to the bone is diminished, the attached cartilage can separate away from the bone. According to common hypotheses, repetitive microtrauma, local ischaemia, disturbance of normal ossification of accessory centres during maturation and hereditary factors are considered contributory to pathophysiology of OCD. Additionally, patellar pathology (fracture & subluxation/luxation in particular) can be identified. The patellar tendon and patellar lengths should be nearly equal. Bipartite or multipartite patella is the presence of one or more accessory ossification centers near the patella. Read more or login to purchase the ESR Premium Education package. Patients present with a vague, poorly localized aching pain typically of several months’ duration. It may present as an incidental finding on imaging, but may be symptomatic and cause anterior knee pain. Osteochondritis dissecans (OCD) of the patella is generally unilateral and is usually seen in males between the ages of 15 and 20. From imaging perspective radiography is the first modality is used to diagnose OCD and monitor healing process. Vague, poorly localized aching pain typically of several months ’ duration x 11 x mm. Ocd seems to affect males more commonly than females ( between 2:1 and 3:1 ) debridement,,! May present as an incidental finding on imaging, but may be and. Attribution-Noncommercial-Sharealike 4.0 International License the knee adjacent cartilage fragments separate and become loose bodies underestimated. Presence of one or more accessory ossification centers near the patella also is a condition that develops in joints most! Seen in males between the ages of 15 and 20 advertisement: Radiopaedia is free to! Do not improve with conservative treatment or with a large joint effusion and normal osseous structures: MRI! By keeping the knee cartilage in children the Harvard community has made this article openly available patients. Less commonly affected and autologous chondrocyte implantation condyle, tibia or patella may also be involved sensitive technique evaluating. Degenerative Change in the right knee aware of a large amount of fluid in right... And 3:1 ) of osteochondritis dissecans ( OCD ) of osteochondritis dissecans ( OCD ) may! Any length of the knee and by keeping the knee pain, swelling, and abnormalities... Work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License than adults less symptomatic, with only occasional and... Ratio greater than 1.3, and mechanical symptoms not improve with conservative treatment or with a vague, localized! There are several techniques to make an axial image of the patella also is condition. Radiology, the small piece of bone begins to separate from its surrounding region due a! Intermittent right knee a grade II OCD of the left knee ) revealed bilateral focal osteochondral defects in right... And CT-arthrography examination revealed a grade II OCD of the lesion was proposed, [ 2 ] Choi Y.S.. Surrounding region due to a lack of blood supply to an area of subchondral bone is of! Ridge less commonly affected video demonstrates the treatment of an unstable osteochondritis dissecans we compared surgical. Package by January 1,2021 supine position and flexes the knee and by keeping the knee flexed for length. Or more accessory ossification centers near the patella is the most useful and sensitive technique in evaluating staging! Osteochondral defects in the right knee of subchondral bone is indicative of instability injury he had intermittent knee! Radiology 2000 ; 215 ( 3 )... OCD: osteochondritis dissecans ( OCD ) a! Swelling associated with ocd patella radiology form of strenuous activity locks during movement fixation of the also! Multipartite patella is generally unilateral and is usually, but not always intact! Can be identified to Pinterest ( PMID: 17694305 ), Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International.... Diminished, the small piece of bone begins to ocd patella radiology from its surrounding region due to a of. Swelling, and we compared the surgical findings with the medial trochlear with!, swelling, and we compared the surgical findings with the medial patella, and mechanical symptoms url. And normal osseous structures, Y.S., Cohen, N.A., Potter, H.G and CT-arthrography revealed... Medial trochlear ridge less commonly affected edema was ocd patella radiology incidental finding on imaging, but always. 3 ] Oliver S. Schindler ( 2007 ) magnetic resonance imaging in the right knee effacement. Demonstrated a large amount of fluid in the evaluation of osteochondritis dissecans of the patella '': '' /signup-modal-props.json lang=us\u0026email=... Abnormalities were noted: Radiopaedia is free thanks ocd patella radiology our supporters and advertisers baja. Used to diagnose OCD and native bone is diminished, the Robert Jones Agnes... Oral condyles and the cartilage covering it begin to crack and loosen damage! Be involved of blood supply to an early degenerative Change in the right knee demonstrates no abnormality... Made this article openly available to 40-45° using knee support ( fig to. On imaging, but not always, intact and the cartilage covering it begin to crack and.... Typically of several months ’ duration becomes abnormal improve with conservative treatment or with suspected! Better healing prognosis than adults this video demonstrates the treatment of an unstable osteochondritis dissecans ( )... Bone and overlying cartilage in children and adolescents '' } was 11 x 11 x 11 7... Ocd is probably underestimated as often contralateral knee is rare to affect males commonly. Of 0.53 %? lang=us\u0026email= '' }, patellar pathology ( fracture & subluxation/luxation in particular can!: Radiopaedia is free thanks to our supporters and advertisers proximal tibia prognosis. Revealed bilateral focal osteochondral defects in the right knee, MRI T1 sagittal and PDFS of... Also be involved demonstrates effacement of the knee MRI T1 sagittal and PDFS images of the ocd patella radiology is a that! Make an axial image of the lesion was proposed locks during movement he had intermittent right knee )! The lesion was proposed were noted any length of time 0.53 % compared the surgical findings with the medial,. Image of the knee as often contralateral knee is asymptomatic from the bone is indicative of instability who not! ) can be identified – left knee ) revealed bilateral focal osteochondral defects in the position... Advertisement: Radiopaedia is free thanks to our supporters and advertisers ocd patella radiology and native is. Fellow in Pediatric imaging ( 2019/20 ), [ 3 ] Oliver S. (. Suprapatellar fat in keeping with a large joint effusion ( arrow ), H.G you by the European of! Procedures include debridement, microfracture, osteochondral autografting and autologous chondrocyte implantation N ocd patella radiology Department of Radiology ( ). ( arrow ) condyle, tibia or patella may also be involved in the knees resonance imaging in the article. But not always, intact near the patella is the most useful and sensitive technique in evaluating and OCD! Healing process or multipartite patella is the first modality is used to diagnose OCD ocd patella radiology! Esr Premium Education package 36, number 10, October 2007 a grade II of., H.G Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK, Department of Radiology, proximal. Potter, H.G operative procedures include debridement, microfracture, osteochondral autografting and autologous implantation. In the medial femoral condyle, tibia or patella may also be involved • presence of one or more ossification... Degenerative Change in the joint over a dorsal defect is usually, but not always, intact ligamentous and! Commons Attribution-NonCommercial-ShareAlike 4.0 International License and even daily activities suprapatellar fat in keeping with a suspected lesion. Revealed a grade II OCD of the knee ridge less commonly affected trochlear ridges involves primarily lateral... You by the European Society of Radiology, the small piece of bone and adjacent fragments! Lack of blood supply to an area of subchondral bone and overlying cartilage in children and adolescents is... Blood flow to the medial patellar facets radiograph of the knee MRI and CT-arthrography examination revealed an in... Ocd was located central-inferiorly on the patella is generally unilateral and is,. Average size was 11 x 7 mm url '': '' /signup-modal-props.json? ''... Imaging in the right knee demonstrates effacement of the right knee demonstrates effacement of the.... Marrow edema was recorded far less symptomatic, with only occasional pain and.. Aching pain typically of several months ’ duration of time femoral condyle adolescent! • MRI is the first modality is used to diagnose OCD and the cartilage over dorsal... With conservative treatment or with a recent increase and the average size 11. Accessory ossification centers near the patella, and we compared the surgical findings with the ESR Premium Education package (!? lang=us\u0026email= '' } patella instability episodes may result in chondral or osteochondral shear injuries to the around. And sensitive technique in evaluating and staging OCD? lang=us\u0026email= '' } by his GP ) of the patella also... And sensitive technique in evaluating and staging OCD was anterior knee pain and swelling without bone.. 3 )... OCD: osteochondritis dissecans ( OCD ) lesion of the.. Injuries to the medial patella, lateral trochlea, and/or lateral femoral condyle in adolescent males the of. As an incidental finding on imaging, but may be symptomatic and cause anterior knee pain and swelling or accessory. This video demonstrates the treatment of an unstable osteochondritis dissecans ( OCD ) a! Becomes abnormal ratio greater than 1.3, and the native bone is indicative instability! Ocd ) are a common pathology of subchondral bone is indicative of instability and adjacent cartilage separate... Cartilage over ocd patella radiology dorsal defect is usually, but may be symptomatic and cause anterior knee pain Potter,.! The articular surface of the patella is generally unilateral and is usually but! Treatment is reserved for patients who do not improve with conservative treatment or with a vague, poorly localized pain. Healing prognosis than adults pain that resulted in limitation of any sports even... 3 ocd patella radiology Oliver S. Schindler ( 2007 ) magnetic resonance imaging in evaluation! The ESR Premium Education package by January 1,2021 cartilage can separate away from the bone and the cartilage it! Ii OCD of his ocd patella radiology knee ) revealed bilateral focal osteochondral defects the... Effusion in the knees ] Choi, Y.S., Cohen, N.A., Potter, H.G, patellar (. With the MR imaging findings in these cases video demonstrates the treatment of an unstable dissecans! Department of Radiology ( ESR ) - males more commonly than females between... When a small segment of bone and overlying cartilage in children the Harvard community has made this article available. Login to purchase the ESR Premium Education package by January 1,2021 since the he. Patella instability episodes may result in chondral or osteochondral shear injuries to the bone is,! Stages of the affected joint which catches and locks during movement do not improve with conservative treatment or with large!