Open reduction internal fixation of chondral defects should be attempted when a large chondral fragment with bone is present. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. Bildgebendes Verfahren der Wahl ist die MRT-Untersuchung, da sich selbst größere osteochondrale Fragmente der konventionellen Röntgenbildgebung entziehen können. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. 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. Link , … There is an articular cartilage defect at the medial patellar facet with adjacent bone marrow edema. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. 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. There is an articular cartilage defect at the medial patellar facet with adjacent bone marrow edema. Chondral and osteochondral defects in the PF compartment are often encountered in clinical practice on advanced imaging studies and/or during arthroscopy. Radiology 2002 ;225(3):736–743. The word osteochondral refers to anything relating to cartilage and bone. About Dr. Sumer Sethi Number of Entries : 35. 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 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. A serious knee injury with large osteochondral defect of the femoral condyle and medial patella with loose bodies in the joint. Unable to process the form. Normal menisci, collateral ligaments and cruciate ligaments. 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 Tweet; Share; Share; Share; Share ; Sumer Sethi. MR shows large joint effusion in suprapatellar bursa with fat-fluid level (lipohemarthrosis). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The average age at diagnosis was 20.5 ± 9.2 years old. 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. Check for errors and try again. Two donor plugs were harvested from this region, measuring 10 × 14 mm and 6 × 14 mm, respectively. The treatment of focal cartilage defects of the patella is a major challenge in the field of cartilage repair. Medial stabilization with MPFL reconstruction is more controversial due to the risk of arthrofibrosis. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. 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. 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. 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 {"url":"/signup-modal-props.json?lang=us\u0026email="}. Acute patellar dislocation (APD) is associated with a spectrum of soft tissue and osteochondral injuries. Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. 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. Patellar osteochondral fractures with no dislocation are uncommon and usually affect the centromedial facet of the patella. 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. X-rays pass through the knee from anterior to posterior at a 90° angle to the lower leg. Tags : MRI Musculoskeletal MRI Musculoskeletal radiology. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. This condition often is asymptomatic and an incidental finding on knee imaging, but it occasionally may be the cause of knee pain. 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. 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. {"url":"/signup-modal-props.json?lang=us\u0026email="}. One commonly used technique is the axial projection. Purpose: To evaluate functional outcomes and survivorship of the grafts among patients who underwent OCA for patellar cartilage injuries. This fact reinforces the diagnosis of pre-fracture patellar dislocation. 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. 10A, 10B). 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. It is unusual that the osteochondral patellar defect site in this patient was in the inferior and central areas of the patella. This unusual fracture was fixed using four biocomposite suture anchors and a bioabsorbable pin. 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. 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. 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. In most cases, the osteochondral fracture is located in the medial facet of the patella. A significant number of osteochondral injuries involve the midlateral weight-b earing portion of the lateral fe moral condyle and are more pos- Six consecutive cases of patella osteochondritis dissecans in young athletes were treated using mosaicplasty by the same senior surgeon between 2002 and 2007. Osteochondral injuries represent a spectrum of articular conditions ranging from acute cartilage tears to chronic osteochondral defects, including osteochondritis dissecans (OCD). Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. This injury pattern can be explained by the mechanism of injury. It was decided to use the superomedial aspect of the trochlea as the donor sight for the osteochondral autograft. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Check for errors and try again. The MENDER II is then inserted from the anterior aspect to the intra-articular surface to retrieve the sutures. Unique blend of academic excellence and entrepreneurship, heading leading firms in India- Teleradiology Providers, pioneering company … 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 … This is frequently seen following patellar dislocation, patellar fracture, or in the setting of osteochondritis dissecans lesions. Conclusion: Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. 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. 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. There are kissing-contusions secondary to patella dislocation and a shallow trochlear groove, which has predisposed to patella dislocation during the trauma. 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. Women had lower outcomes, and the need for realignment procedures led to a slower recovery. Radiology. Introduction. 1 The knee joint is perhaps one of the busiest joints in the body as it bears most of the body weight when standing. Dorsal defect of patella occurs in males and females with equal frequency and is most frequently found in adolescents. 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. Osteochondral defects of the latera l femoral condyle are a common se- quela after transient lateral patellar dislocation. Akute osteochondrale Läsionen des Kniegelenks sind Verletzungen, welche häufig im Rahmen von Patellaluxationen auftreten. It is used primarily to identify a free body or osteochondral defect (see Pathology section). 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. It is often used synonymously with osteochondral injury/defect and in the pediatric population. Dorsal defect of the patella. The patella is laterally subluxed. 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. We present the case of a 10-year-old, overweight, female patient. Osteochondral defects of the lateral femoral condyle are a common sequela after transient lateral patellar dislocation. Red arrow and asterisk indicate osteochondral fragment. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Femoral trochlea is normal. The patella is laterally subluxed. cartilage defects are varied and include repair, regeneration, and reconstruction. 4.8a–c. These findings are essential in diagnosis … The bone marrow edema at lateral femoral condyle and grade II medial patellar retinaculum injury secondary to lateral patellar dislocation. 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. 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. 6). 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. cartilage injury with associated subchondral fracture but without detachment; thin sclerotic margin Winn N, Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. 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. Radiographic features Knee > Osteochondral Defect What is Osteochondral Defect? Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. Clinical presentation. 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. osteochondral patellar defects is necessary with removal versus fixation, depending on the quality of the lesion. There is an osteochondral fragment floating within the suprapatellar bursa which is isointense with bone structures in all sequences. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. Articular cartilage lesions are common and have been reported in 63% of over 31,000 arthroscopic procedures in one series.1 … 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. The patient is in the supine position and flexes the knee to 40-45° using knee support (fig. Osteochondral allograft (OCA) transplantation has been used as a treatment option for a range of cartilage disorders. All these cases presented ICRS stage IV osteochondritis dissecans with an empty defect lesion. Histologically, it consists of fibrosis with or without bone necrosis. Osteochondral Defect Reviewed by Sumer Sethi on Monday, September 15, 2008 Rating: 5. Patellar chondral fractures without dislocation or patella fracture are rare. Data on 18 knees in 16 patients who had a minimum followup of 2 years were collected and reviewed (Table 1). There is an osteochondral fragment floating within the suprapatellar bursa which is isointense with bone structures in all sequences. Study design: Case series; Level of … 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. 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. tella described chondral defects of the patella but made no mention of chondral injuries of the lateral femoral condyle [1–5]. Transient lateral patellar dislocation is a common injury that typically occurs in the young, athletic individual. 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]. Predisposing factors include genu valgum, ligamentous laxity, shallow femoral trochlea, and abnormal morphology of the patellar … There are various techniques to make a tunnel image. Knee pain. Osteochondral or chondral loose bodies that result from recurrent patella instability or from longstanding OCD in skeletally mature patients may not be repairable. It is bilateral in up to one-third of individuals. The medial location of the lesions and the involvement of the system of medial knee stability is a fundamental finding. 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. Osteochondral fractures of the patella are commonly associated with acute patellar dislocations. Osteochondral lesions / defects (OCD) are a common pathology of subchondral bone and overlying cartilage in children and adolescents. Patellar osteochondral fracture is an injury frequently associated with patellar instability, which may onset in the first episode. Unable to process the form. 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. Women had lower outcomes, and the need for realignment procedures led to a slower recovery. 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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