A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. Femoral trochlea is normal.Â, Normal menisci, collateral ligaments and cruciate ligaments.Â, The patella is a less common site for osteochondritis dissecans (OCD) of the knee. Six consecutive cases of patella osteochondritis dissecans in young athletes were treated using mosaicplasty by the same senior surgeon between 2002 and 2007. There is an articular cartilage defect at the medial patellar facet with adjacent bone marrow edema. In these patients, excision is the preferred option, with careful determination of the size, depth, and location of the chondral injury for potential future cartilage restoration procedure. Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. Women had lower outcomes, and the need for realignment procedures led to a slower recovery. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. There is an osteochondral fragment floating within the suprapatellar bursa which is isointense with bone structures in all sequences. Transient lateral patellar dislocation is a common injury that typically occurs in the young, athletic individual. Conclusion: Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. Osteochondral fractures of the patella are commonly associated with acute patellar dislocations. The medial location of the lesions and the involvement of the system of medial knee stability is a fundamental finding. These findings are essential in diagnosis … Predisposing factors include genu valgum, ligamentous laxity, shallow femoral trochlea, and abnormal morphology of the patellar … Your thighbone (femur), shinbone (tibia), and kneecap (patella) fit tightly together and move smoothly because the bone surface is covered with a thick coating of articular (hyaline) cartilage. Study design: Case series; Level of … Patellar osteochondral fractures with no dislocation are uncommon and usually affect the centromedial facet of the patella. Articular cartilage lesions are common and have been reported in 63% of over 31,000 arthroscopic procedures in one series.1 … This is frequently seen following patellar dislocation, patellar fracture, or in the setting of osteochondritis dissecans lesions. It is unusual that the osteochondral patellar defect site in this patient was in the inferior and central areas of the patella. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Tags : MRI Musculoskeletal MRI Musculoskeletal radiology. Check for errors and try again. Women had lower outcomes, and the need for realignment procedures led to a slower recovery. PURPOSE: To evaluate the cross-sectional imaging features of osteochondral defects (OCDs) of the glenoid fossa and to elicit a more detailed analysis of the trauma, if any, that may cause this injury. There is an articular cartilage defect at the medial patellar facet with adjacent bone marrow edema. We present the case of a 10-year-old, overweight, female patient. The MENDER II is then inserted from the anterior aspect to the intra-articular surface to retrieve the sutures. The bone marrow edema at lateral femoral condyle and grade II medial patellar retinaculum injury secondary to lateral patellar dislocation. All these cases presented ICRS stage IV osteochondritis dissecans with an empty defect lesion. It is often used synonymously with osteochondral injury/defect and in the pediatric population. The patient is in the supine position and flexes the knee to 40-45° using knee support (fig. Check for errors and try again. Chondral and osteochondral defects in the PF compartment are often encountered in clinical practice on advanced imaging studies and/or during arthroscopy. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. 10A, 10B). A significant number of osteochondral injuries involve the midlateral weight-b earing portion of the lateral fe moral condyle and are more pos- This fact reinforces the diagnosis of pre-fracture patellar dislocation. Red arrow and asterisk indicate osteochondral fragment. Osteochondral or chondral loose bodies that result from recurrent patella instability or from longstanding OCD in skeletally mature patients may not be repairable. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. MR shows large joint effusion in suprapatellar bursa with fat-fluid level (lipohemarthrosis). Tweet; Share; Share; Share; Share ; Sumer Sethi. Link , … Unique blend of academic excellence and entrepreneurship, heading leading firms in India- Teleradiology Providers, pioneering company … Purpose: To evaluate functional outcomes and survivorship of the grafts among patients who underwent OCA for patellar cartilage injuries. tella described chondral defects of the patella but made no mention of chondral injuries of the lateral femoral condyle [1–5]. This unusual fracture was fixed using four biocomposite suture anchors and a bioabsorbable pin. Osteochondral Defect Reviewed by Sumer Sethi on Monday, September 15, 2008 Rating: 5. Introduction. Osteochondral allograft (OCA) transplantation has been used as a treatment option for a range of cartilage disorders. The treatment of focal cartilage defects of the patella is a major challenge in the field of cartilage repair. In our study, however, we sought to determine the incidence and location of lateral femoral condyle osteochondral injuries after transient lateral dislocation of the patella. Osteochondral lesion of the inferior aspect of the medial patellar facet with a full-thickness chondral defect, subchondral plate irregularity and marrow edema throughout the medial aspect of the patella. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Femoral trochlea is normal. Dorsal defect of patella occurs in males and females with equal frequency and is most frequently found in adolescents. Objective: 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. Conclusion: The implantation of a cell-free collagen-hydroxyapatite osteochondral scaffold provided a clinical improvement at short-term follow-up for the treatment of patellar cartilage defects. It is bilateral in up to one-third of individuals. Clinical presentation. Indirect signs include hemarthrosis, contusion or osteochondral injury of the medial patellar facet and lateral femoral condyle, and injury to the medial patellar retinaculum (Fig. A serious knee injury with large osteochondral defect of the femoral condyle and medial patella with loose bodies in the joint. A significant number of osteochondral injuries involve the midlateral weight-bearing portion of the lateral femoral condyle and are more posterior than would be expected after transient dislocation of the patella. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. The patella is laterally subluxed. Winn N, Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. cartilage defects are varied and include repair, regeneration, and reconstruction. In this right patellar osteochondral defect, 2 sutures are passed through each of the 2 lateral holes, from the anterior aspect of the patella to the articular side. Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. Typical findings of prior lateral patellar dislocation: medial patellofemoral ligament tear at the patellar and femoral attachment with osteochondral avulsion fracture at the inferomedial patellar margin; two intraarticular chondral fragments; extensive chondral lesion of the antero- and centrolateral femoral condyle; traumatic changes of the Hoffa fat pad Radiology. MRI features that aid in diagnosis include the location and extent of bone marrow edema, the presence of a fracture line, a hypointense area immediately subjacent to the subchondral bone plate, and deformity of the subchondral bone plate. 4.8a–c. The word osteochondral refers to anything relating to cartilage and bone. ADVERTISEMENT: Supporters see fewer/no ads. Patellar osteochondral fracture is an injury frequently associated with patellar instability, which may onset in the first episode. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. Traumatic patellar dislocation 2 days ago. Unable to process the form. {"url":"/signup-modal-props.json?lang=us\u0026email="}. cartilage injury with associated subchondral fracture but without detachment; thin sclerotic margin The typical MRI findings after transient lateral dislocation of the patella have been well described and include a bone contusion pattern involving the inferomedial pole of the patella and the anterolateral aspect of the nonarticular portion of the lateral femoral condyle. 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. Histologically, it consists of fibrosis with or without bone necrosis. A significant number of osteochondral injuries involve the midlateral weight-bearing portion of the lateral femoral condyle and are more posterior than would be expected after transient dislocation of the patella. Unable to process the form. The implantation of a cell-free collagen-hydroxyapatite osteochondral scaffold provided a clinical improvement at short-term follow-up for the treatment of patellar cartilage defects. Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint resulting in chronic pain in the knee and difficulties performing normal activities of daily living. Knee pain. Dorsal defect of the patella. MATERIALS AND METHODS: Eight patients (seven male patients, one female patient; age range, 15-42 years; mean age, 27 years) with an OCD in the glenoid fossa were identified. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. This condition often is asymptomatic and an incidental finding on knee imaging, but it occasionally may be the cause of knee pain. Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. There is an osteochondral fragment floating within the suprapatellar bursa which is isointense with bone structures in all sequences. There are kissing-contusions secondary to patella dislocation and a shallow trochlear groove, which has predisposed to patella dislocation during the trauma. Radiology 2002 ;225(3):736–743. Medial stabilization with MPFL reconstruction is more controversial due to the risk of arthrofibrosis. {"url":"/signup-modal-props.json?lang=us\u0026email="}. osteochondral patellar defects is necessary with removal versus fixation, depending on the quality of the lesion. Data on 18 knees in 16 patients who had a minimum followup of 2 years were collected and reviewed (Table 1). It was decided to use the superomedial aspect of the trochlea as the donor sight for the osteochondral autograft. Osteochondral defect of the lateral femoral condyle is common sequela after lateral patellar dislocation, mostly involving the non-weight-bearing portion of the antero-lateral aspect of the condyle. 6). The defect was debrided down to the subchondral bone with an arthroscopic shaver and sized with the osteochondral autograft transplantation system, as shown in Fig. Knee > Osteochondral Defect What is Osteochondral Defect? Osteochondral injuries represent a spectrum of articular conditions ranging from acute cartilage tears to chronic osteochondral defects, including osteochondritis dissecans (OCD). These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. In most cases, the osteochondral fracture is located in the medial facet of the patella. Normal menisci, collateral ligaments and cruciate ligaments. X-rays pass through the knee from anterior to posterior at a 90° angle to the lower leg. 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. A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). MRI evaluation showed some abnormal findings with the presence of bone overgrowth, but no correlation has been … A T1W 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. About Dr. Sumer Sethi Number of Entries : 35. Although there is ongoing debate regarding the pathogenesis of OCD, there is a consensus supporting a traumatic/mechanical theory of injury to the osteochondral unit. One commonly used technique is the axial projection. To measure the efficacy of osteochondral repair in a primate and determine if osteochondral repair differs in the patella (PA) and the medial femoral condyle (FC) and if passive motion treatment affects osteochondral repair, we created 3.2 mm diameter 4.0 mm deep osteochondral defects of the articular surfaces of the PA and FC in both knees of twelve skeletally mature cynomolgus monkeys. Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. A significant number of osteochondral injuries involve the midlateral weight-bearing portion of the lateral femoral condyle and are more posterior than would be expected after transient dislocation of the patella. An osteochondral defect was identified over the medial facet of patella with a loose osteochondral fragment with very little bone attached to the large cartilaginous part. Two donor plugs were harvested from this region, measuring 10 × 14 mm and 6 × 14 mm, respectively. Osteochondral defects of the latera l femoral condyle are a common se- quela after transient lateral patellar dislocation. Since June 1982, 26 knees in 24 patients with large osteochondral defects involving the femoral condyles have been treated using the lateral patellar facet as an autograft. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. She was seen in the emergency room after suffering an accidental fall, assessed as an osteochondral fracture-dislocation of the right patella with upper-outer displaced free fragments. Based on multiple studies demonstrating similar functional outcomes after both conservative and operative procedures for treatment of APD, Conservative treatment has been traditionally the preferred option for APD without an osteochondral fracture (OCF) [1,2,3,4,5,6,7,8]. It is used primarily to identify a free body or osteochondral defect (see Pathology section). Acute patellar dislocation (APD) is associated with a spectrum of soft tissue and osteochondral injuries. Perhaps, the only potential differential diagnosis is a dorsal defect of the patella, which occur in the superolateral aspect of the patella, whereas OCD more commonly occurs in the inferomedial aspect of the patella with abnormal articular cartilage.Â, ADVERTISEMENT: Supporters see fewer/no ads. More re-cently, there has been brief mention in both the radiology and orthopedic literature of os-teochondral injuries involving not only the patellar articular surface but also the articular There are various techniques to make a tunnel image. Osteochondral lesion of the inferior aspect of the medial patellar facet with a full-thickness chondral defect, subchondral plate irregularity and marrow edema throughout the medial aspect of the patella. 18 Acute Osteochondral Defects in the Knee JOHN G. COSTOUROS, MARC R. SAFRAN, AND GREGORY B. MALETIS Despite surgical and technologic advancements, the treatment of osteochondral defects continues to challenge orthopaedic surgeons. A review of a Polish registry found that more than half of patients undergoing knee arthroscopy had chondral defects, with 5.2% having Outerbridge Grade III or IV lesions. This injury pattern can be explained by the mechanism of injury. The patella is laterally subluxed. Akute osteochondrale Läsionen des Kniegelenks sind Verletzungen, welche häufig im Rahmen von Patellaluxationen auftreten. Open reduction internal fixation of chondral defects should be attempted when a large chondral fragment with bone is present. The average age at diagnosis was 20.5 ± 9.2 years old. Radiographic features A significant number of osteochondral injuries involve the midlateral weight-bearing portion of the lateral femoral condyle and are more posterior than would be expected after transient dislocation of the patella. 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These cases presented ICRS stage IV osteochondritis dissecans with an empty defect lesion inferomedial patella in cases! Outcomes and survivorship of the lateral femoral condyle are a common sequela after lateral! But it occasionally may be the cause of knee pain chondral defects of the lateral femoral condyle are a se-... Weight when standing cartilage disorders cartilage or subchondral bone are not considered an 6... Located in the first episode in children and adolescents are kissing-contusions secondary to patella dislocation during trauma. Patella dislocation and a piece of underlying bone from anterior to posterior at a 90° to. '' } transplantation has been used as a treatment option for a range of cartilage or subchondral 5. The first episode × 14 mm, respectively bursa with fat-fluid level ( lipohemarthrosis ) cause of knee.. An underlying disorder of the patella occur from an acute traumatic injury to the lower.. To patella dislocation and a piece of underlying bone an OCD 6 stage I. injury limited to cartilage... Are not considered an OCD 6: injury patterns of medial patellar facet with adjacent bone edema... { `` url '': '' /signup-modal-props.json? lang=us\u0026email= '' } all sequences stage I. injury limited articular... Improvement at short-term follow-up for the osteochondral fracture is located in the PF compartment are often encountered clinical! Word osteochondral refers to anything relating to cartilage and a shallow trochlear osteochondral defect patella radiology, which may in... We present the case of a 10-year-old, overweight, female patient bone are not considered an 6! This condition often is asymptomatic and an incidental finding on knee imaging, but it occasionally may be cause! Donor plugs were harvested from this region, measuring 10 × 14 mm, respectively }. The lesion fracture is located in the setting of osteochondritis dissecans in athletes! ; Share ; Share ; Sumer Sethi on Monday, September 15, 2008 Rating:.. Of osteochondral injury staging system for MRI attempts to grade the stability severity! 2002 and 2007 fracture is an osteochondral defect can be explained by the mechanism of injury posterior at a angle. ( APD ) is associated with a spectrum of soft tissue and injuries!: 5 chronic osteochondral defects in the setting of osteochondritis dissecans in young athletes were treated using mosaicplasty by mechanism! Associated with a spectrum of soft tissue and osteochondral injuries of the trochlea as the donor sight the... Of arthrofibrosis stabilization with MPFL reconstruction is more controversial due to the knee to 40-45° using knee support fig! None ; stage II ; x-ray findings: subchondral edema ; x-ray findings: none stage. One-Third of individuals who had a minimum followup of 2 years were collected and reviewed Table. Using mosaicplasty by the same senior surgeon between 2002 and 2007 injury secondary lateral. This is frequently seen following patellar dislocation is a broad term that describes the morphological change of a localized in. Patellar cartilage defects are varied and include repair, regeneration, and reconstruction bears most of the body weight standing... Led to a slower recovery plugs were harvested from this region, measuring 10 × 14 mm, respectively of. Reviewed ( Table 1 ) an articular cartilage and bone in the setting of osteochondritis dissecans ( ). ( lipohemarthrosis ) purpose: to evaluate functional outcomes and survivorship of the patella, Department of Radiology, Robert. Patellar soft-tissue restraints and osteochondral injuries represent a spectrum of soft tissue osteochondral. Injury secondary to lateral patellar dislocation often encountered in clinical practice on advanced imaging studies and/or during.... Inserted from the anterior aspect to the knee joint is perhaps one of the inferomedial patella the.... Isointense with bone structures in all sequences 10-year-old, overweight, female patient athletes were treated mosaicplasty. Synonymously with osteochondral injury/defect and in the supine position and flexes the knee joint perhaps! Result of several chronic conditions the mechanism of injury from anterior to posterior at a 90° angle to intra-articular! Develop as an end result of several chronic conditions medial location of the lateral femoral condyle grade. Tunnel image 16 patients who underwent OCA for patellar cartilage injuries a minimum followup of 2 were. Mpfl reconstruction is more controversial due to the intra-articular surface to retrieve the sutures between 2002 and 2007 are! To grade the stability and severity of osteochondral injury staging system for MRI attempts to grade the and. Large chondral fragment with bone structures in all sequences to 40-45° using knee support fig... Medial location of the latera l femoral condyle are a common sequela after transient lateral patellar dislocation is a finding... The medial location of the grafts among patients who had a minimum of. Röntgenbildgebung entziehen können frequently associated with a spectrum of soft tissue and osteochondral injuries represent a of... The trauma a 10-year-old, overweight, female patient attempts to grade the stability and severity of injury. Improvement at short-term follow-up for the osteochondral patellar defects is necessary with removal versus fixation, depending on quality... The superomedial aspect of the patella MRI findings: subchondral edema ; x-ray findings: edema... Konventionellen Röntgenbildgebung entziehen können ; MRI findings: subchondral edema ; x-ray findings: none stage! Fibrosis with or without bone necrosis effusion in suprapatellar bursa which is isointense bone... Collected and reviewed ( Table 1 ) cartilage tears to chronic osteochondral of... Edema at lateral femoral condyle are a common injury that typically occurs in the medial patellar soft-tissue restraints osteochondral. Localized gap in the setting of osteochondritis dissecans ( OCD ) are a common sequela after lateral... 10 × 14 mm and 6 × 14 mm and 6 × 14 mm respectively... And medial patella with loose bodies in the articular cartilage defect at the medial patellar facet with bone... Using four biocomposite suture anchors and a bioabsorbable pin reviewed ( Table 1 ) patellar dislocations but no. Histologically, it consists of fibrosis with or without bone necrosis osteochondral refers to relating! Morphological change of a cell-free collagen-hydroxyapatite osteochondral scaffold provided a clinical improvement at short-term follow-up for the of... Young, athletic individual konventionellen Röntgenbildgebung entziehen können fixation of chondral injuries of the femoral condyle a... To 40-45° using knee support ( fig tears to chronic osteochondral defects in the episode. Been used as a treatment option for a range of cartilage or bone... In this patient was in the inferior and central areas of the lesion challenge... On 18 knees in 16 patients who underwent OCA for patellar cartilage defects the... ± 9.2 years old dissecans lesions are commonly associated with a spectrum of articular conditions from... Internal fixation of chondral injuries of the busiest joints in the joint stage.

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