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Tsaknakis K, Afifi FK, Lorenz HM, Hell AK. [Non-traumatic osteochondral lesions of the knee joint during growth : Juvenile osteochondritis dissecans (JOCD) of the knee]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:651-658. [PMID: 39196304 DOI: 10.1007/s00132-024-04552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Juvenile osteochondritis dissecans of the knee joint is the most common osteochondral lesion during growth, usually occurring between the 10th and 14th year of age. PATHOGENESIS Repetitive microtraumata lead to a subchondral osseus lesion, which is commonly located at the medial aspect of the femoral condyle. Sport activities are considered to be the main cause, although genetic and hereditary factors as well as vitamin D3 deficiency also play a role. Current classification systems distinguish between stable and unstable osteochondral lesions, which is decisive for further treatment. TREATMENT Stable lesions may heal through conservative treatment by avoiding weight bearing and sport. Unstable lesions, on the other hand, can lead to a complete defect of the joint surface with the formation of a free joint body. In such cases, various surgical techniques aim at reconstructing the surface of the joint, in order to reduce the risk of secondary arthritis.
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Affiliation(s)
- Konstantinos Tsaknakis
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Faik K Afifi
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Heiko M Lorenz
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Anna K Hell
- Kinderorthopädie, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
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Nguyen JC, Caine D. The Immature Pediatric Appendicular Skeleton. Semin Musculoskelet Radiol 2024; 28:361-374. [PMID: 39074720 DOI: 10.1055/s-0044-1786151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Growth and maturation occur in a predictable pattern throughout the body and within each individual bone. In the appendicular skeleton, endochondral ossification predominates in long bones and growth plates. The ends of these long bones are sites of relative weakness in the immature skeleton and prone to injury from acute insult and overuse. We present the normal histoanatomy and physiology of the growth plate complex, highlighting the unique contribution of each component and shared similarities between primary and secondary complexes. Components of the growth plate complex include the physis proper, subjacent vascularity within the growth cartilage, and the ossification front. The second section describes imaging considerations and features of normal and abnormal growth. Finally, we review the Salter-Harris classification for acute fractures and offer examples of characteristic overuse injury patterns involving the epiphyseal (proximal humerus and distal radius), apophyseal (medial epicondyle and tibial tubercle), and secondary growth plate complexes (medial femoral condyle and capitellar osteochondritis dissecans). This article provides a foundation and basic framework to better understand and anticipate potential complications and growth disturbances and to ensure optimal follow-up and early intervention when treatment can be less invasive.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dennis Caine
- Division of Education, Health and Behavior Studies, Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota
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Nguyen JC, Patel V, Kiani SN, Guzek R, Williams BA, Ganley TJ. Patellar osteochondritis dissecans: maturation-dependent patellofemoral joint characteristics. Pediatr Radiol 2024; 54:977-987. [PMID: 38573353 DOI: 10.1007/s00247-024-05914-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The likelihood of healing of osteochondritis dissecans decreases with skeletal maturity and there are theories that abnormal biomechanical forces contribute to the development and progression of these lesions. OBJECTIVE To characterize, according to regional skeletal maturity, the morphology and alignment indices of the patellofemoral joint on MRI in patients with patellar osteochondritis dissecans. MATERIALS AND METHODS MRI examinations of patients with patellar osteochondritis dissecans obtained between January 2008 and May 2023 were retrospectively reviewed to determine regional skeletal maturity, osteochondritis dissecans lesion size and location, patellar and trochlear morphology (Wiberg/Dejour classifications), and to calculate trochlear sulcus angles, trochlear depth index, lateral trochlear inclination, Insall-Salvati index, Caton-Deschamps index, patellar tendon-lateral trochlear ridge, and tibial tubercle-trochlear groove distances. Values were compared between skeletally immature and mature groups. RESULTS Sixty-eight children (22 girls, 46 boys, age: 14.0 ± 1.7 years) yielded 74 knees with patellar osteochondritis dissecans lesions, 14 (19%) of which were skeletally mature. The most common anatomic location was over the central patella [median ridge (34/74 - 46%) on the axial images and over the middle third (45/74 - 61%) on the sagittal images]. Overall, mean trochlear sulcus angle (high, 151 ± 11°), trochlear depth index (low, 2.8 ± 1.4 mm), and Insall-Salvati index (borderline, 1.3 ± 0.1) were abnormal for the entire sample. Skeletally mature knees were significantly more likely to have higher (more dysplastic) Dejour types when compared to skeletally immature knees (p < 0.01). Knees in the mature group, compared to immature, had significantly more abnormal mean lateral trochlear inclination (15 ± 8° vs. 19 ± 6°, p = 0.03) and patellar tendon-lateral trochlear ridge distance (5.55 ± 4.31 mm vs. 2.89 ± 4.69 mm, p = 0.04). Half of the knees had ≥ 4 abnormal features that predispose to patellofemoral maltracking; mature knees were significantly (p = 0.02) more likely to have a higher number of abnormal features (> 6 features, 7/14, 50.0%) versus immature knees (0-3 features, 33/60, 55.0%). CONCLUSION In children with patellar osteochondritis dissecans, abnormal patellofemoral morphology and alignment indices were common in all patients and more severe in mature knees.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Vandan Patel
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sara N Kiani
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ryan Guzek
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brendan A Williams
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Theodore J Ganley
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Patel V, Nguyen NP, Brown N, Mendenhall SD, Zoga AC, Nguyen JC. Return to Play in Youth Athletes: Role of the Radiologist with Focus on the Upper Extremity. Semin Musculoskelet Radiol 2024; 28:180-192. [PMID: 38484770 DOI: 10.1055/s-0043-1778029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Increase in youth sports participation, longer duration of play, and earlier starting points have increased the prevalence of acute and repetitive overuse musculoskeletal injuries. This rise in injury rates has led to increased efforts to better understand the susceptible sites of injury that are unique to the growing immature skeleton. Upper extremity injuries are currently the best studied, particularly those that occur among pediatric baseball players and gymnasts. The weak link in skeletally immature athletes is the growth plate complex that includes those injuries located at the epiphyseal and apophyseal primary physes and the peripherally located secondary physes. This article reviews the anatomy and function of these growth plate complexes, followed by a discussion of the pathophysiologic mechanisms, spectrum of imaging findings, and existing evidence-based guidelines for injury prevention and return to play.
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Affiliation(s)
- Vandan Patel
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Drexel University College of Medicine, Philadelphia, Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ngan P Nguyen
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Naomi Brown
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shaun D Mendenhall
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Jefferson, Philadelphia, Pennsylvania
| | - Jie C Nguyen
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Rupp MC, Hochberger F, Berthold DP, Muench LN, Imhoff AB, Siebenlist S, Willinger L. Tibiofemoral Subluxation on Radiograph as a Predictor of Location and Size of Osteochondritis Dissecans Lesions of the Knee. Orthop J Sports Med 2024; 12:23259671241232397. [PMID: 38455152 PMCID: PMC10919139 DOI: 10.1177/23259671241232397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 03/09/2024] Open
Abstract
Background Lower limb malalignment has been associated with osteochondritis dissecans (OCD). However, the location of the OCD lesion often is not concordant with the mechanical leg axis. Other potentially modifiable alignment parameters may influence the propensity for impingement of the femoral condyles. Purpose To assess differences in lower limb alignment (LLA) and relative tibiofemoral position between patients with medial (MFC-OCD) or lateral OCD (LFC-OCD) of the femoral condyle. Study Design Cohort study; Level of evidence, 3. Methods Patients ≤30 years old who were diagnosed with unicondylar OCD between January 2010 and January 2020 were eligible for this study. Included were 55 patients (age, 20.8 ± 4.5 years)-46 with MFC-OCD and 9 with LFC-OCD. Preoperative standing long-leg radiographs were studied to obtain primary outcomes-including LLA and mechanical alignment analyses-and secondary outcomes-including knee joint obliquity angle; rotation angle; medial, central (c-subluxation), and lateral subluxation (L-subluxation) of the tibia relative to the femur in the coronal plane; and tibiofemoral joint line center distance (TFJCD). Results With regard to primary outcomes, LLA was significantly different between MFC-OCD (1.7°± 3.1° varus) and LFC-OCD (2.7 ± 3.1° valgus) (P < .001), and 78% (36/46) of patients with MFC-OCD had varus alignment, whereas 78% (7/9) of patients with LFC-OCD had valgus alignment (P < 0.002). With regard to secondary outcomes, patients with MFC-OCD had a more medial tibial position in relation to the femur, with a significantly smaller rotation angle (5.6°± 2.4° vs 9.6°± 3.6°; P < .001), a smaller C-subluxation (7.2 ± 6.6 vs 14.9 ± 8.8 mm; P < .01), a smaller L-subluxation (2.3 ± 2.6 vs 4.4 ± 2.7 mm; P < .05), and reduced TFJCD (3.5 ± 1.7 vs 6.6 ± 1.8 mm; P < .001) compared with the LFC-OCD group. For patients with MFC-OCD, the size of the OCD was significantly correlated with C-subluxation (r = 0.412; P = .006). Conclusion LLA was significantly different according to OCD location. In patients with MFC-OCD, the tibia was subluxated medially, resulting in a change of joint geometry by approximation of the medial tibial eminence toward the medial femoral condyle, potentially causing excessive pressure overload and microtrauma of the cartilage. Interestingly, the extent of subluxation was correlated with OCD size.
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Affiliation(s)
| | - Felix Hochberger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Daniel P. Berthold
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU Munich), Munich, Germany
| | - Lukas N. Muench
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | | | - Lukas Willinger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
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Ishimatsu T, Yoshimura I, Kanazawa K, Hagio T, Minokawa S, Nagatomo M, Sugino Y, Yamamoto T. Ankle bone morphology affects the size of non-trauma related osteochondral lesions of the talus in skeletally immature children. J Orthop Sci 2024; 29:224-229. [PMID: 36462995 DOI: 10.1016/j.jos.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND This study aimed to elucidate the relationship between ankle morphology and the size of non-trauma related osteochondral lesions of the talus (OLT), because approximately half the OLT found in children is of unknown origin. METHODS 34 ankles in 30 skeletally immature children with OLTs who underwent preoperative magnetic resonance imaging (MRI) were evaluated. Parameters measured included area of the OLT, tibial axis-medial malleolus angle (TMM), malleolar width (MalW), and talar surface angle (TSA; defined as the angle between the line perpendicular to the mid-diaphysis of the tibia and the talar joint surface; medial inclination, positive). The ankles were divided into two groups: the trauma group had a history of injury and the idiopathic group had no history of injury. The correlation between lesion area and MRI parameters were evaluated in each group. RESULTS Thirteen ankles in 13 patients comprised the trauma group, while 21 ankles in 17 patients were in the idiopathic group. Of the 17 patients in the idiopathic group, four had bilateral OLT. In the trauma group, MalW was significantly correlated with the area (r = 0.827, P = 0.0001). In the idiopathic group, TMM and MalW were significantly correlated with the area (r = 0.608, P = 0.003 and r = 0.566, P = 0.008). TSA was positively correlated with area in the idiopathic group (r = 0.516, P = 0.017), but negatively correlated with area in the trauma group (r = -0.609, P = 0.027). The other parameters showed no significant correlation. CONCLUSIONS The size of non-trauma related OLTs may have been affected by an ankle morphology showing poor bone conformity, such as an open medial malleolus and inclined talar joint surface. In addition, the evaluation of the contralateral ankle joint may be crucial when patients with OLT have no specific history of trauma.
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Affiliation(s)
- Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Ichiro Yoshimura
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Kazuki Kanazawa
- Department of Orthopaedic Surgery, Fukuoka Seisyukai Hospital, 4-11-8 Choujyabarunishi, Kasuya-cho, Kasuya, Fukuoka 811-2316, Japan
| | - Tomonobu Hagio
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - So Minokawa
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyouin, Chikushino, Fukuoka 818-8502, Japan
| | - Masaya Nagatomo
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Yuki Sugino
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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Tariq SM, Patel V, Gendler L, Shah AS, Ganley TJ, Zoga AC, Nguyen JC. Pediatric thrower's elbow: maturation-dependent MRI findings in symptomatic baseball players. Pediatr Radiol 2024; 54:105-116. [PMID: 38015294 DOI: 10.1007/s00247-023-05817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Elbow pain is common among youth baseball players and elbow MRI is increasingly utilized to complement the clinical assessment. OBJECTIVE To characterize, according to skeletal maturity, findings on elbow MRI from symptomatic youth baseball players. MATERIALS AND METHODS This IRB-approved, HIPAA-compliant retrospective study included pediatric (<18 years of age) baseball players with elbow pain who underwent MRI examinations between 2010 and 2021. Two radiologists, blinded to the outcome, independently reviewed examinations to categorize skeletal maturity and to identify osseous and soft tissue findings with consensus used to resolve discrepancies. Findings were compared between skeletally immature and mature patients and logistic regression models identified predictors of surgery. RESULTS This study included 130 children (115 boys, 15 girls): 85 skeletally immature and 45 mature (12.8±2.3 and 16.2±1.0 years, respectively, p<0.01). Kappa coefficient for interobserver agreement on MRI findings ranged from 0.64 to 0.96. Skeletally immature children, when compared to mature children, were more likely to have elbow effusion (27%, 23/85 vs 9%, 4/45; p=0.03), medial epicondyle marrow edema (53%, 45/85 vs 16%, 7/45; p<0.01), avulsion fracture (19%, 16/85 vs 2%, 1/45; p=0.02), and juvenile osteochondritis dissecans (OCD, 22%, 19/85 vs 7%, 3/45; p=0.04), whereas skeletally mature children were more likely to have sublime tubercle marrow edema (49%, 22/45 vs 11%, 9/85; p<0.01) and triceps tendinosis (40%, 18/45 vs 20%, 17/85; p=0.03). Intra-articular body (OR=4.2, 95% CI 1.5-47.8, p=0.02) and osteochondritis dissecans (OR=3.7, 95% CI 1.1-11.9, p=0.03) were independent predictors for surgery. CONCLUSION Differential patterns of elbow MRI findings were observed among symptomatic pediatric baseball players based on regional skeletal maturity. Intra-articular body and osteochondritis dissecans were independent predictors of surgery.
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Affiliation(s)
- Shahwar M Tariq
- Drexel University College of Medicine, Philadelphia, PA, USA
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Vandan Patel
- Drexel University College of Medicine, Philadelphia, PA, USA
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Liya Gendler
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Apurva S Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Theodore J Ganley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Jefferson, Philadelphia, PA, USA
| | - Jie C Nguyen
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Zbýň Š, Kajabi AW, Nouraee CM, Ludwig KD, Johnson CP, Tompkins MA, Nelson BJ, Zhang L, Moeller S, Marette S, Metzger GJ, Carlson CS, Ellermann JM. Evaluation of lesion and overlying articular cartilage in patients with juvenile osteochondritis dissecans of the knee using quantitative diffusion MRI. J Orthop Res 2023; 41:1449-1463. [PMID: 36484124 DOI: 10.1002/jor.25505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Current clinical MRI of patients with juvenile osteochondritis dissecans (JOCD) is limited by the low reproducibility of lesion instability evaluation and inability to predict which lesions will heal after nonoperative treatment and which will later require surgery. The aim of this study is to verify the ability of apparent diffusion coefficient (ADC) to detect differences in lesion microstructure between different JOCD stages, treatment groups, and healthy, unaffected contralateral knees. Pediatric patients with JOCD received quantitative diffusion MRI between January 2016 and September 2020 in this prospective research study. A disease stage (I-IV) and stability of each JOCD lesion was evaluated. ADCs were calculated in progeny lesion, interface, parent bone, cartilage overlying lesion, control bone, and control cartilage regions. ADC differences were evaluated using linear mixed models with Bonferroni correction. Evaluated were 30 patients (mean age, 13 years; 21 males), with 40 JOCD-affected and 12 healthy knees. Nine patients received surgical treatment after MRI. Negative Spearman rank correlations were found between ADCs and JOCD stage in the progeny lesion (ρ = -0.572; p < 0.001), interface (ρ = -0.324; p = 0.041), and parent bone (ρ = -0.610; p < 0.001), demonstrating the sensitivity of ADC to microstructural differences in lesions at different JOCD stages. We observed a significant increase in the interface ADCs (p = 0.007) between operative (mean [95% CI] = 1.79 [1.56-2.01] × 10-3 mm2 /s) and nonoperative group (1.27 [0.98-1.57] × 10-3 mm2 /s). Quantitative diffusion MRI detects microstructural differences in lesions at different stages of JOCD progression towards healing and reveals differences between patients assigned for operative versus nonoperative treatment.
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Affiliation(s)
- Štefan Zbýň
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abdul Wahed Kajabi
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cyrus M Nouraee
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kai D Ludwig
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Casey P Johnson
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Marc A Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
- TRIA Orthopedic Center, Minneapolis, Minnesota, USA
- Gillette Children's Specialty Healthcare, St. Paul, Minnesota, USA
| | - Bradley J Nelson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
- TRIA Orthopedic Center, Minneapolis, Minnesota, USA
| | - Lin Zhang
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Steen Moeller
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shelly Marette
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gregory J Metzger
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Jutta M Ellermann
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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Armstrong AR, Zbýň Š, Kajabi AW, Metzger GJ, Ellermann JM, Carlson CS, Tóth F. Naturally occurring osteochondrosis latens lesions identified by quantitative and morphological 10.5 T MRI in pigs. J Orthop Res 2023; 41:663-673. [PMID: 35716161 PMCID: PMC9759621 DOI: 10.1002/jor.25401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Juvenile osteochondritis dissecans (JOCD) is a pediatric orthopedic disorder that involves the articular-epiphyseal cartilage complex and underlying bone. Clinical disease is often characterized by the presence of radiographically apparent osteochondral flaps and fragments. The existence of early JOCD lesions (osteochondrosis latens [OCL] and osteochondrosis manifesta [OCM]) that precede the development of osteochondral flaps and fragments is also well recognized. However, identification of naturally occurring OCL lesions (confined to cartilage) using noninvasive imaging techniques has not yet been accomplished. We hypothesized that 10.5 T magnetic resonance imaging (MRI) can identify naturally occurring OCL lesions at predilection sites in intact joints of juvenile pigs. Unilateral elbows and knees (stifles) were harvested from three pigs aged 4, 8, and 12 weeks, and scanned in a 10.5 T MRI to obtain morphological 3D DESS images, and quantitative T2 and T1ρ relaxation time maps. Areas with increased T2 and T1ρ relaxation times in the articular-epiphyseal cartilage complex were identified in 1/3 distal femora and 3/3 distal humeri and were considered suspicious for OCL or OCM lesions. Histological assessment confirmed the presence of OCL or OCM lesions at each of these sites and failed to identify additional lesions. Histological findings included necrotic vascular profiles associated with areas of chondronecrosis either confined to the epiphyseal cartilage (OCL, 4- and 8-week-old specimens) or resulting in a delay in endochondral ossification (OCM, 12-week-old specimen). Future studies with clinical MR systems (≤7 T) are needed to determine whether these MRI methods are suitable for the in vivo diagnosis of early JOCD lesions in humans.
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Affiliation(s)
- Alexandra R. Armstrong
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Štefan Zbýň
- Center for Magnetic Resonance Research, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Abdul Wahed Kajabi
- Center for Magnetic Resonance Research, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Gregory J. Metzger
- Center for Magnetic Resonance Research, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Jutta M. Ellermann
- Center for Magnetic Resonance Research, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Cathy S. Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Ferenc Tóth
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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10
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Kajabi AW, Zbýň Š, Johnson CP, Tompkins MA, Nelson BJ, Takahashi T, Shea KG, Marette S, Carlson CS, Ellermann JM. Longitudinal 3T MRI T 2 * mapping of Juvenile osteochondritis dissecans (JOCD) lesions differentiates operative from non-operative patients-Pilot study. J Orthop Res 2023; 41:150-160. [PMID: 35430743 PMCID: PMC9573934 DOI: 10.1002/jor.25343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/21/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023]
Abstract
Juvenile osteochondritis dissecans (JOCD) is an orthopedic joint disorder of children and adolescents that can lead to premature osteoarthritis. Thirteen patients (mean age: 12.3 years, 4 females), 15 JOCD-affected and five contralateral healthy knees, that had a baseline and a follow-up magnetic resonance imaging (MRI) (mean interval of 8.9 months) and were treated nonoperatively during this interval were included. Retrospectively, patients were assigned to operative or nonoperative groups based on their electronic medical records. Volumetric mean T2 * values were calculated within regions of interest (progeny lesion, interface, parent bone) and region matched control bone in healthy contralateral knees and condyles. The normalized percentage difference of T2 * between baseline and follow up MRI in nonoperative patients significantly increased in progeny lesion (-47.8%, p < 0.001), parent bone (-13.9%, p < 0.001), and interface (-32.3%, p = 0.011), whereas the differences in operative patients were nonsignificant and below 11%. In nonoperative patients, the progeny lesion (p < 0.001) and interface T2 * values (p = 0.012) were significantly higher than control bone T2 * at baseline, but not at follow-up (p = 0.219, p = 1.000, respectively). In operative patients, the progeny lesion and interface T2 * values remained significantly elevated compared to the control bone both at baseline (p < 0.001, p < 0.001) and follow-up (p < 0.001, p < 0.001), respectively. Clinical Significance: Longitudinal T2 * mapping differentiated nonhealing from healing JOCD lesions following initial nonoperative treatment, which may assist in prognosis and improve the ability of surgeons to make recommendations regarding operative versus nonoperative treatment.
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Affiliation(s)
- Abdul Wahed Kajabi
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Štefan Zbýň
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Casey P. Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Marc A. Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Bradley J. Nelson
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Takashi Takahashi
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | | | - Shelly Marette
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Cathy S. Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Jutta M. Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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11
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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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12
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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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13
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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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14
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Zbýň Š, Santiago C, Johnson CP, Ludwig KD, Zhang L, Marette S, Tompkins MA, Nelson BJ, Takahashi T, Metzger GJ, Carlson CS, Ellermann JM. Compositional evaluation of lesion and parent bone in patients with juvenile osteochondritis dissecans of the knee using T 2 * mapping. J Orthop Res 2022; 40:1632-1644. [PMID: 34637164 PMCID: PMC9001743 DOI: 10.1002/jor.25187] [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] [Received: 03/19/2021] [Revised: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
Juvenile osteochondritis dissecans (JOCD) lesions contain cartilaginous, fibrous and osseous tissues which are difficult to distinguish with clinical, morphological magnetic resonance imaging (MRI). Quantitative T2 * mapping has earlier been used to evaluate microstructure and composition of all aforementioned tissues as well as bone mineral density. However, the ability of T2 * mapping to detect changes in tissue composition between different JOCD lesion regions, different disease stages, and between stable and unstable lesions has not been demonstrated. This study analyzed morphological and T2 * MRI data from 25 patients (median age, 12.1 years) with 34 JOCD-affected and 13 healthy knees. Each lesion was assigned a stage reflecting the natural history of JOCD, with stages I and IV representing early and healed lesion, respectively. T2 * values were evaluated within the progeny lesion, interface and parent bone of each lesion and in the control bone region. T2 * was negatively correlated with JOCD stage in progeny lesion (ρ = -0.871; p < 0.001) and interface regions (ρ = -0.649; p < 0.001). Stage IV progeny showed significantly lower T2 * than control bone (p = 0.028). T2 * was significantly lower in parent bone than in control bone of patients with stable lesions (p = 0.009), but not in patients with unstable lesions (p = 0.14). Clinical significance: T2 * mapping enables differentiation between different stages of JOCD and quantitative measurement of the ossification degree in progeny lesion and interface. The observed T2 * decrease in healed and stable lesions may indicate increased bone density as a result of the active repair process. T2 * mapping provides quantitative information about JOCD lesion composition.
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Affiliation(s)
- Štefan Zbýň
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cassiano Santiago
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Casey P. Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA,Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Kai D. Ludwig
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lin Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shelly Marette
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc A. Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA,TRIA Orthopedic Center, Minneapolis, Minnesota, USA,Gillette Children’s Specialty Healthcare, St. Paul, Minnesota, USA
| | - Bradley J. Nelson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA,TRIA Orthopedic Center, Minneapolis, Minnesota, USA
| | - Takashi Takahashi
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gregory J. Metzger
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cathy S. Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Jutta M. Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA,Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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15
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Ochi J, Nozaki T, Nimura A, Yamaguchi T, Kitamura N. Subchondral insufficiency fracture of the knee: review of current concepts and radiological differential diagnoses. Jpn J Radiol 2021; 40:443-457. [PMID: 34843043 PMCID: PMC9068663 DOI: 10.1007/s11604-021-01224-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/19/2021] [Indexed: 12/27/2022]
Abstract
Subchondral insufficiency fracture of the knee (SIFK) is a common cause of knee joint pain in older adults. SIFK is a type of stress fracture that occurs when repetitive and excessive stress is applied to the subchondral bone. If the fracture does not heal, the lesion develops into osteonecrosis and results in osteochondral collapse, requiring surgical management. Because of these clinical features, SIFK was initially termed "spontaneous osteonecrosis of the knee (SONK)" in the pre-MRI era. SONK is now categorized as an advanced SIFK lesion in the spectrum of this disease, and some authors believe the term "SONK" is a misnomer. MRI plays a significant role in the early diagnosis of SIFK. A subchondral T2 hypointense line of the affected condyle with extended bone marrow edema-like signal intensity are characteristic findings on MRI. The large lesion size and the presence of osteochondral collapse on imaging are associated with an increased risk of osteoarthritis. However, bone marrow edema-like signal intensity and osteochondral collapse alone are not specific to SIFK, and other osteochondral lesions, including avascular necrosis, osteochondral dissecans, and osteoarthritis should be considered. Chondral lesions and meniscal abnormalities, including posterior root tears, are also found in many patients with SIFK, and they are considered to be related to the development of SIFK. We review the clinical and imaging findings, including the anatomy and terminology history of SIFK, as well as its differential diagnoses. Radiologists should be familiar with these imaging features and clinical presentations for appropriate management.
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Affiliation(s)
- Junko Ochi
- Department of Diagnostic Radiology, Suita Tokushukai Hospital, 21-1, Senriokanishi, Suita-shi, Osaka, 565-0814, Japan.
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takehiko Yamaguchi
- Department of Pathology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
| | - Nobuto Kitamura
- Department of Orthopaedic Surgery, St Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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16
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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: 45] [Impact Index Per Article: 15.0] [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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17
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Sports-Related Injuries of the Pediatric Musculoskeleton. ACTA ACUST UNITED AC 2021. [DOI: 10.1007/978-3-030-71281-5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
AbstractWorldwide, more than 50 million children and adolescents participate in organized athletic programs annually. Despite the numerous health and well-being benefits, this widespread involvement also leads to acute and overuse injuries that account for millions of medical visits each year. Musculoskeletal injury in childhood may lead to growth disturbance and lifelong disability. Imaging plays a critical role in the diagnosis and management of these injuries. While radiography is sufficient for most long bone fractures, MRI is often necessary for optimal evaluation of injuries involving the radiolucent growth mechanism and articular structures. The following review will discuss the imaging features associated with many sports-related injuries unique to the pediatric musculoskeleton, specifically the lower extremity.
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18
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Editorial Comment: Meniscal Root Tears-Something Else to Worry About in Adolescents. AJR Am J Roentgenol 2021; 217:995. [PMID: 33728977 DOI: 10.2214/ajr.21.25844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Hinkle A, Dickason CQ, Jinguji T, Shenoi S, Thapa M, Saper MG, Bompadre V, Schmale GA. Prevalence and Severity of Juvenile Osteochondritis Dissecans in Patients With Juvenile Idiopathic Arthritis. Orthop J Sports Med 2021; 9:2325967120984139. [PMID: 33718500 PMCID: PMC7917878 DOI: 10.1177/2325967120984139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic
arthritides presenting in patients aged ≤16 years, with a prevalence of 16
to 150 per 100,000. Juvenile osteochondritis dissecans (OCD) is an
idiopathic disease of articular cartilage and subchondral bone, has an onset
age of 10 to 16 years, and often affects the knee, with a prevalence of 2 to
18 per 100,000. Currently, there are few studies that have evaluated the
relationship between JIA and OCD. Hypothesis: OCD is more prevalent in children with JIA, and when diagnosed in such
patients, OCD often presents at an advanced state. Study Design: Case series; Level of evidence, 4. Methods: The medical records of patients with diagnoses of both JIA and OCD treated
between January 2008 and March 2019 at a single children’s hospital were
retrospectively reviewed. Associations between timing of diagnoses, number
and types of corticosteroid treatments, category of arthritis, timing of
diagnoses, and lesion stability were examined with Spearman correlation
coefficients. Results: A total of 2021 patients with JIA were identified, 20 of whom (19 female, 1
male) had OCD of the knee and/or talus for a prevalence of 1 in 100 or 1000
in 100,000, or approximately 50 to 500 times that of the general population.
These 20 patients had a total of 28 OCD lesions: 43% (9 femur, 3 talus) were
radiographically stable over time, 50% (10 femur, 2 patella, 2 talus) were
unstable at initial diagnosis, and 7% (2 femur) were initially stable but
progressed to unstable lesions despite drilling. Twelve patients (60%)
underwent surgery: 4 (20%) with stable femoral lesions for persistent
symptoms despite prolonged nonoperative treatment and 8 (40%) for treatment
of their unstable lesions (femoral and patellar). Within our study design,
we could identify no significant associations between lesion stability and
timing of diagnoses, number of joint injections, or limb deformities, nor
were there associations between timing of JIA and OCD diagnoses and category
of arthritis. Conclusion: In our population of patients with JIA, OCD lesions were found to be 50 to
500 times more prevalent when compared with published rates in the general
population and often presented at an advanced state, with instability or
delayed healing requiring surgery for stabilization or resolution of
symptoms.
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Affiliation(s)
- Andrew Hinkle
- Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Celeste Quitiquit Dickason
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | - Thomas Jinguji
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | - Susan Shenoi
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | - Mahesh Thapa
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael G Saper
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Gregory A Schmale
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
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20
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Ludwig KD, Johnson CP, Zbýň Š, Nowacki A, Marette S, Takahashi T, Macalena JA, Nelson BJ, Tompkins MA, Carlson CS, Ellermann JM. MRI evaluation of articular cartilage in patients with juvenile osteochondritis dissecans (JOCD) using T2∗ mapping at 3T. Osteoarthritis Cartilage 2020; 28:1235-1244. [PMID: 32278071 PMCID: PMC8576840 DOI: 10.1016/j.joca.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Evaluate articular cartilage by magnetic resonance imaging (MRI) T2∗ mapping within the distal femur and proximal tibia in adolescents with juvenile osteochondritis dissecans (JOCD). DESIGN JOCD imaging studies acquired between August 2011 and February 2019 with clinical and T2∗ mapping MRI knee images were retrospectively collected and analyzed for 31 participants (9F/22M, 15.0 ± 3.8 years old) with JOCD lesions in the medial femoral condyle (MFC). In total, N = 32 knees with JOCD lesions and N = 14 control knees were assessed. Mean T2∗ values in four articular cartilage regions-of-interest (MFC, lateral femoral condyle (LFC), medial tibia (MT), and lateral tibia (LT)) and lesion volume were measured and analyzed using Wilcoxon-rank-sum tests and Spearman correlation coefficients (R). RESULTS Mean ± standard error T2∗ differences observed between the lesion-sided MFC and the LFC in JOCD-affected knees (28.5 ± 0.9 95% confidence interval [26.8, 30.3] vs 26.3 ± 0.7 [24.8, 27.7] ms, P = 0.088) and between the affected- and control-knee MFC (28.5 ± 0.9 [26.8, 30.3] vs 28.5 ± 0.6 [27.1, 29.9] ms, P = 0.719) were nonsignificant. T2∗ was significantly increased in the lesion-sided MT vs the LT for the JOCD-affected knees (21.5 ± 0.7 [20.1, 22.9] vs 18.0 ± 0.7 [16.5, 19.5] ms, P = 0.002), but this same difference was also observed between the MT and LT in control knees (21.0 ± 0.6 [19.7, 22.3] vs 18.1 ± 1.1 [15.8, 20.4] ms, P = 0.037). There was no significant T2∗ difference between the affected- and control-knee MT (21.5 ± 0.7 [20.1, 22.9] vs 21.0 ± 0.6 [19.7, 22.3] ms, P = 0.905). T2∗ within the lesion-sided MFC was not correlated with patient age (R = 0.20, P = 0.28) or lesion volume (R = 0.06, P = 0.75). T2∗ values were slightly increased near lesions in later-stage JOCD subjects but without statistical significance. CONCLUSIONS T2∗ relaxations times were not significantly different from control sites in the articular cartilage overlying JOCD lesions in the MFC or adjacent MT cartilage in early-stage JOCD.
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Affiliation(s)
- Kai D. Ludwig
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Corresponding Author Info: Jutta M. Ellermann, MD, PhD, Center for Magnetic Resonance Research, 2021 6th St SE, Minneapolis, Minnesota, USA 53705-2275. Telephone: 612-626-2001.
| | - Casey P. Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Štefan Zbýň
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Amanda Nowacki
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Shelly Marette
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Takashi Takahashi
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey A. Macalena
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Bradley J. Nelson
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
- TRIA Orthopaedic Center, Minneapolis, MN, USA
| | - Marc A. Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
- TRIA Orthopaedic Center, Minneapolis, MN, USA
| | - Cathy S. Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Jutta M. Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Patel M, Francavilla ML, Lawrence JTR, Barrera CA, Nguyen MK, Longoria C, Nguyen JC. Osteochondral lesion of the talus in children: Are there MRI findings of instability? Skeletal Radiol 2020; 49:1305-1311. [PMID: 32306071 DOI: 10.1007/s00256-020-03436-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association between skeletal maturity and lesion stability. MATERIALS AND METHOD This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March 1, 2011, and May 31, 2018. Blinded to the clinical outcome, 2 radiologists retrospectively assessed each MRI study for the presence or absence of various features on the articular side, along the interface, and on the subchondral side of each lesion. Regional skeletal maturity was recorded. Lesion stability was classified using clinical and surgical findings. Mann-Whitney U, Chi-square, Fisher's exact, and Cochran-Armitage tests were used to compare demographic and MRI findings between children with stable and unstable lesions. RESULTS Of the 48 ankles identified, 36 were stable (12.7 + 3.9 years) and 12 were unstable (14.2 + 1.6 years) lesions. None of the lesions presented as a detached fragment. Skeletal immaturity (p = 0.01) was significantly more common in stable than unstable lesions. No other MRI features were found to be significantly different between stable and unstable lesions, which included the presence of an effusion (p = 0.27), intra-articular body (p = 0.25), cartilage changes (p = 0.19), subchondral disruption (p = 0.51), T2-weighted signal intensity rim (p = 0.16), cysts (p = 0.48), marginal sclerosis (p = 0.70), and perilesional marrow edema (p = 0.17). CONCLUSION Results from our study suggest that previously published OCD criteria using conventional MRI are not sufficient for predicting stability of OLT in children. Regional skeletal maturity and older age were more predictive of unstable lesions.
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Affiliation(s)
- Maya Patel
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Michael L Francavilla
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - J Todd R Lawrence
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Michael K Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | | | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Andriolo L, Crawford DC, Reale D, Zaffagnini S, Candrian C, Cavicchioli A, Filardo G. Osteochondritis Dissecans of the Knee: Etiology and Pathogenetic Mechanisms. A Systematic Review. Cartilage 2020; 11:273-290. [PMID: 29998741 PMCID: PMC7298596 DOI: 10.1177/1947603518786557] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The purpose of this manuscript is to analyze the evidence regarding etiopathogenesis of knee osteochondritis dissecans (OCD) lesions through a systematic review, so to summate the current understanding of the origin and progression of this pathologic articular processes. DESIGN A systematic review of the literature was performed on the PubMed and Cochrane databases on October 2017 by 2 independent authors and included all levels of evidence. This included all English language literature, pertaining specifically to etiopathology of knee OCD with exclusions for review articles and expert opinion. Of 965 identified records, 154 full-text articles were assessed for eligibility and 86 studies met the inclusion criteria. RESULTS According to these studies, the etiology of OCD can be of a biological or mechanical origin: 40 articles proposed a biological hypothesis, including genetic causes (27), ossification center deficit (12), and endocrine disorders (9); conversely, 52 articles supported a mechanical hypothesis, including injury/overuse (18), tibial spine impingement (5), discoid meniscus (16), and biomechanical alterations (20) as the cause of the onset of OCD. The pathogenic processes were investigated by 36 of these articles, with a focus on subchondral bone fracture and ischemia as the ultimate events leading to OCD. CONCLUSIONS Biological and mechanical factors are found to result in subchondral bone remodeling alterations, acting independently or more likely synergically in the progression of knee OCD. The former includes genetic causes, deficit of ossification centers and endocrine disorders; the latter, tibial spine impingement, discoid meniscus, and biomechanical alterations, together with injuries and overuse. The resultant subchondral bone ischemia and/or fracturing appears to determine the onset and progression of OCD. LEVEL OF EVIDENCE Systematic review of level II-IV studies, level IV.
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Affiliation(s)
- Luca Andriolo
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Dennis C. Crawford
- Department of Orthopaedics &
Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Davide Reale
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy,Davide Reale, II Orthopaedic and
Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano,1/10, 40136
Bologna, Italy.
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy
| | | | - Alessia Cavicchioli
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Giuseppe Filardo
- II Orthopaedic and Traumatologic Clinic,
Rizzoli Orthopaedic Institute, Bologna, Italy
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23
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Li X, Johnson CP, Ellermann J. Measuring Knee Bone Marrow Perfusion Using Arterial Spin Labeling at 3 T. Sci Rep 2020; 10:5260. [PMID: 32210271 PMCID: PMC7093505 DOI: 10.1038/s41598-020-62110-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
Bone perfusion is an essential physiological measure reflecting vasculature status and tissue viability of the skeletal system. Arterial spin labeling (ASL), as a non-invasive and non-contrast enhanced perfusion imaging method, is an attractive approach for human research studies. To evaluate the feasibility of ASL perfusion imaging of knee bone marrow in the distal femoral condyle at a 3 T MRI scanner, a study was performed with eight healthy volunteers (three males and five females, 26 ± 2 years old) and two patients (male, 15 and 11 years old) with diagnosed stage II juvenile osteochondritis dissecans (JOCD). ASL imaging utilized a flow-sensitive alternating inversion recovery method for labeling and a single-shot fast spin echo sequence for image readout. In addition to quantitative knee bone marrow ASL imaging, studies were also performed to evaluate the effects of prolonged post-bolus delay and varied labeling size. ASL imaging was successfully performed with all volunteers. Despite the benefits of hyper-intensive signal suppression within bone marrow, the use of a prolonged post-bolus delay caused excessive perfusion signal decay, resulting in low perfusion signal-to-noise ratio (SNR) and poor image quality. Bone marrow perfusion signal changed with the labeling size, suggesting that the measured bone marrow perfusion signal is flow-associated. The means and standard deviations of bone marrow blood flow, spatial SNR, and temporal SNR from the quantitative perfusion study were 38.3 ± 5.2 mL/100 g/min, 3.31 ± 0.48, and 1.33 ± 0.31, respectively. The imaging results from JOCD patients demonstrated the potential of ASL imaging to detect disease-associated bone marrow perfusion changes. This study demonstrates that it is feasible to perform ASL imaging of knee bone marrow in the distal femoral condyle at 3 T.
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Affiliation(s)
- Xiufeng Li
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA.
| | - Casey P Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
- Veterinary Clinical Sciences Department, University of Minnesota, Saint Paul, MN, USA
| | - Jutta Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
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Ellermann JM, Ludwig KD, Nissi MJ, Johnson CP, Strupp JP, Wang L, Zbýň Š, Tóth F, Arendt E, Tompkins M, Shea K, Carlson CS. Three-Dimensional Quantitative Magnetic Resonance Imaging of Epiphyseal Cartilage Vascularity Using Vessel Image Features: New Insights into Juvenile Osteochondritis Dissecans. JB JS Open Access 2019; 4:JBJSOA-D-19-00031. [PMID: 32043049 PMCID: PMC6959910 DOI: 10.2106/jbjs.oa.19.00031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We introduce a quantitative measure of epiphyseal cartilage vascularity and examine vessel networks during human skeletal maturation. Understanding early morphological changes in the distal femoral condyle is expected to provide information on the pathogenesis of developmental diseases such as juvenile osteochondritis dissecans. Methods Twenty-two cadaveric knees from donors ranging from 1 month to 10 years of age were included in the study. Images of bone, cartilage, and vascularity were acquired simultaneously with a 3-dimensional gradient-recalled-echo magnetic resonance imaging (MRI) sequence. The secondary ossification center volume and total epiphysis cartilage volume ratio and articular-epiphyseal cartilage complex and epiphyseal cartilage widths were measured. Epiphyseal cartilage vascularity was visualized for 9 data sets with quantitative susceptibility mapping and vessel filtering, resulting in 3-dimensional data to inform vessel network segmentation and to calculate vascular density. Results Three distinct, non-anastomosing vascular networks (2 peripheral and 1 central) supply the distal femoral epiphyseal cartilage. The central network begins regression as early as 3 months and is absent by 4 years. From 1 month to 3 years, the ratio of central to peripheral vascular area density decreased from 1.0 to 0.5, and the ratio of central to peripheral vascular skeletal density decreased from 0.9 to 0.6. A narrow, peripheral vascular rim was present at 8 years but had disappeared by 10 years. The secondary ossification center progressively acquires the shape of the articular-epiphyseal cartilage complex by 8 years of age, and the central areas of the medial and lateral femoral condyles are the last to ossify. Conclusions Using cadaveric pediatric knees, we provide quantitative, 3-dimensional measures of epiphyseal cartilage vascular regression during skeletal development using vessel image features. Central areas with both early vascular regression and delayed ossification correspond to predilection sites of juvenile osteochondritis dissecans in this limited case series. Our findings highlight specific vascular vulnerabilities that may lead to improved understanding of the pathogenesis and better-informed clinical management decisions in developmental skeletal diseases. Clinical Relevance This paradigm shift in understanding of juvenile osteochondritis dissecans etiology and disease progression may critically impact future patient management. Our findings highlight specific vascular vulnerabilities during skeletal maturation in a group of active young patients seen primarily by orthopaedic surgeons and sports medicine professionals.
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Affiliation(s)
- Jutta M Ellermann
- Center for Magnetic Resonance Research (CMRR) (J.M.E., K.D.L., M.J.N., C.P.J., J.P.S., L.W., and S.Z.), Department of Radiology, and Department of Orthopaedic Surgery (E.A. and M.T.), Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Kai D Ludwig
- Center for Magnetic Resonance Research (CMRR) (J.M.E., K.D.L., M.J.N., C.P.J., J.P.S., L.W., and S.Z.), Department of Radiology, and Department of Orthopaedic Surgery (E.A. and M.T.), Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Mikko J Nissi
- Center for Magnetic Resonance Research (CMRR) (J.M.E., K.D.L., M.J.N., C.P.J., J.P.S., L.W., and S.Z.), Department of Radiology, and Department of Orthopaedic Surgery (E.A. and M.T.), Medical School, University of Minnesota, Minneapolis, Minnesota.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Casey P Johnson
- Center for Magnetic Resonance Research (CMRR) (J.M.E., K.D.L., M.J.N., C.P.J., J.P.S., L.W., and S.Z.), Department of Radiology, and Department of Orthopaedic Surgery (E.A. and M.T.), Medical School, University of Minnesota, Minneapolis, Minnesota.,Departments of Veterinary Population Medicine (F.T.) and Veterinary Clinical Sciences (C.P.J.,C.S.C.), College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - John P Strupp
- Center for Magnetic Resonance Research (CMRR) (J.M.E., K.D.L., M.J.N., C.P.J., J.P.S., L.W., and S.Z.), Department of Radiology, and Department of Orthopaedic Surgery (E.A. and M.T.), Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Luning Wang
- Center for Magnetic Resonance Research (CMRR) (J.M.E., K.D.L., M.J.N., C.P.J., J.P.S., L.W., and S.Z.), Department of Radiology, and Department of Orthopaedic Surgery (E.A. and M.T.), Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Štefan Zbýň
- Center for Magnetic Resonance Research (CMRR) (J.M.E., K.D.L., M.J.N., C.P.J., J.P.S., L.W., and S.Z.), Department of Radiology, and Department of Orthopaedic Surgery (E.A. and M.T.), Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Ferenc Tóth
- Departments of Veterinary Population Medicine (F.T.) and Veterinary Clinical Sciences (C.P.J.,C.S.C.), College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Elizabeth Arendt
- Center for Magnetic Resonance Research (CMRR) (J.M.E., K.D.L., M.J.N., C.P.J., J.P.S., L.W., and S.Z.), Department of Radiology, and Department of Orthopaedic Surgery (E.A. and M.T.), Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Marc Tompkins
- Center for Magnetic Resonance Research (CMRR) (J.M.E., K.D.L., M.J.N., C.P.J., J.P.S., L.W., and S.Z.), Department of Radiology, and Department of Orthopaedic Surgery (E.A. and M.T.), Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Kevin Shea
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Cathy S Carlson
- Departments of Veterinary Population Medicine (F.T.) and Veterinary Clinical Sciences (C.P.J.,C.S.C.), College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
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25
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Tóth F, Johnson CP, Mills B, Nissi MJ, Nykänen O, Ellermann J, Ludwig KD, Tompkins M, Carlson CS. Evaluation of the Suitability of Miniature Pigs as an Animal Model of Juvenile Osteochondritis Dissecans. J Orthop Res 2019; 37:2130-2137. [PMID: 31115932 PMCID: PMC6739150 DOI: 10.1002/jor.24353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/14/2019] [Indexed: 02/04/2023]
Abstract
Juvenile osteochondritis dissecans (JOCD) is a developmental disease characterized by formation of intra-articular (osteo)chondral flaps or fragments. Evidence-based treatment guidelines for JOCD are currently lacking. An animal model would facilitate study of JOCD and evaluation of diagnostic and treatment approaches. The purpose of this study was to assess the suitability of miniature pigs as a model of JOCD at the distal femur. First, stifle (knee) joints harvested from three juvenile miniature pigs underwent magnetic resonance imaging (MRI) to establish the vascular architecture of the distal femoral epiphyseal cartilage. Second, vessels supplying the axial or abaxial aspects of the medial femoral condyle were surgically interrupted in four additional juvenile miniature pigs, and the developing epiphyseal cartilage lesions were monitored using three consecutive MRI examinations over nine weeks. The miniature pigs were then euthanized, and their distal femora were harvested for histological evaluation. Vascular architecture of the distal femoral epiphyseal cartilage in the miniature pigs was found to be nearly identical to that of juvenile human subjects, characterized by separate vascular beds supplying the axial and abaxial aspects of the condyles. Surgical interruption of the vascular supply to the abaxial aspect of the medial femoral condyle resulted in ischemic cartilage necrosis (a precursor lesion of JOCD) in 75% (3/4) of the miniature pigs. Cartilage lesions were identified during the first MRI performed 3 weeks post-operatively. No clinically apparent JOCD-like lesions developed. In conclusion, miniature pigs are suitable for modeling JOCD precursor lesions. Further investigation of the model is warranted to assess induction of clinically apparent JOCD lesions. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2130-2137, 2019.
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Affiliation(s)
- Ferenc Tóth
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN
| | - Casey P. Johnson
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Benigno Mills
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN
| | - Mikko J. Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Olli Nykänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Jutta Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Kai D. Ludwig
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Marc Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN
| | - Cathy S. Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN
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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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Tóth F, Tompkins MA, Shea KG, Ellermann JM, Carlson CS. Identification of Areas of Epiphyseal Cartilage Necrosis at Predilection Sites of Juvenile Osteochondritis Dissecans in Pediatric Cadavers. J Bone Joint Surg Am 2018; 100:2132-2139. [PMID: 30562294 PMCID: PMC6738538 DOI: 10.2106/jbjs.18.00464] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The pathogenesis of human juvenile osteochondritis dissecans (JOCD) remains poorly understood, with multiple factors implicated, including ischemia, repetitive trauma, and genetic predisposition. Similarities in the predilection site and the diagnostic and clinical features of JOCD to the well-characterized veterinary counterpart, osteochondrosis dissecans, suggest that, similar to the animal disease, the pathogenesis JOCD may also be initiated in the first few years of life, when disruption of blood supply to the epiphyseal growth cartilage leads to failure of endochondral ossification. To gather data in support of the hypothesis that JOCD and osteochondrosis dissecans have a shared pathogenesis, biopsy specimens obtained from predilection sites of JOCD in juvenile human cadavers were histologically examined to determine whether they contained lesions similar to those found in animals diagnosed with subclinical osteochondrosis dissecans. METHODS In this descriptive laboratory study, 59 biopsy specimens (6 mm in diameter) were harvested from the central aspect (i.e., the notch side) of the femoral condyles of 26 human cadavers (1 month to 11 years old). Specimens were histologically evaluated for the presence of areas of cartilage necrosis and the morphology of cartilage canal blood vessels. RESULTS Locally extensive areas of necrotic epiphyseal cartilage were identified in 4 specimens obtained from 3 donors (ages 2 to 4 years). Areas of cartilage necrosis accompanied by focal failure of endochondral ossification or surrounded by subchondral bone were identified in biopsy specimens from 4 donors (ages 4 to 9 years). CONCLUSIONS The identification of epiphyseal cartilage necrosis identical to that described in animals with subclinical osteochondrosis, found in biopsy specimens obtained from femoral predilection sites of JOCD in pediatric cadavers, suggests a shared pathogenesis of JOCD in humans and osteochondrosis dissecans in animals. CLINICAL RELEVANCE These findings imply that the pathogenesis of human JOCD likely starts 5 to 10 years prior to the development of clinical symptoms. Enhanced understanding of the temporal features of JOCD pathogenesis provides an opportunity for earlier diagnosis and treatment, likely resulting in improved outcomes for this condition in the future.
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Affiliation(s)
- Ferenc Tóth
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota
| | - Marc A Tompkins
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
- TRIA Orthopedic Center, Minneapolis, Minnesota
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Jutta M Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota
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Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. Radiographics 2018; 38:1478-1495. [PMID: 30118392 DOI: 10.1148/rg.2018180044] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Several pathologic conditions may manifest as an osteochondral lesion of the knee that consists of a localized abnormality involving subchondral marrow, subchondral bone, and articular cartilage. Although understanding of these conditions has evolved substantially with the use of high-spatial-resolution MRI and histologic correlation, it is impeded by inconsistent terminology and ambiguous abbreviations. Common entities include acute traumatic osteochondral injuries, subchondral insufficiency fracture, so-called spontaneous osteonecrosis of the knee, avascular necrosis, osteochondritis dissecans, and localized osteochondral abnormalities in osteoarthritis. Patient demographics, the clinical presentation, and the role of trauma are critical for differential diagnosis. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. 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. These findings are essential in diagnosis of acute traumatic injuries, subchondral insufficiency fracture, and its potentially irreversible form, spontaneous osteonecrosis of the knee. If the lesion consists of a subchondral region demarcated from the surrounding bone, the demarcation should be examined for completeness and the presence of a "double-line sign" that is seen in avascular necrosis or findings of instability, which are important for proper evaluation of osteochondritis dissecans. Subchondral bone plate collapse, demonstrated by the presence of a depression or a fluid-filled cleft, can be seen in advanced stages of both avascular necrosis and subchondral insufficiency fracture, indicating irreversibility. Once the diagnosis is established, it is important to report pertinent MRI findings that may guide treatment of each condition. ©RSNA, 2018 An earlier incorrect version of this article appeared online. This article was corrected on August 23, 2018.
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Affiliation(s)
- Tetyana Gorbachova
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
| | - Yulia Melenevsky
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
| | - Micah Cohen
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
| | - Brett W Cerniglia
- From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141 (T.G, M.C., B.W.C.) and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (Y.M.)
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29
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Nguyen JC, Liu F, Blankenbaker DG, Woo KM, Kijowski R. Juvenile Osteochondritis Dissecans: Cartilage T2 Mapping of Stable Medial Femoral Condyle Lesions. Radiology 2018; 288:536-543. [PMID: 29762089 DOI: 10.1148/radiol.2018171995] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To determine whether a T2 mapping sequence could depict early changes in the composition and microstructure of cartilage overlying stable lesions of the medial femoral condyle in patients with juvenile osteochondritis dissecans (JOCD). Materials and Methods This retrospective study analyzed a sagittal T2 mapping sequence performed between September 1, 2015, and March 31, 2017, on 16 patients (10 boys and six girls; median age, 11.5 years) with 18 stable medial femoral condyle JOCD lesions and 18 age-, sex-, and skeletal maturation-matched control participants (11 boys and seven girls; median age, 11.5 years). Cartilage T2 values were quantitatively measured within regions of interest placed around the cartilage within and overlying the JOCD lesion in patients with JOCD and around the cartilage on the weight-bearing medial femoral condyle in patients with JOCD and controls. Wilcoxon signed rank and Wilcoxon rank sum tests were used to compare T2 values. Results T2 values were significantly higher (P < .001) for cartilage within the JOCD lesion than for cartilage overlying the JOCD lesion in patients with JOCD. However, there were no significant differences in T2 values between cartilage overlying the JOCD lesion and cartilage on the weight-bearing medial femoral condyle in patients with JOCD (P = .67) or in T2 values of the cartilage on the weight-bearing medial femoral condyle between patients with JOCD and controls (P = .30). Conclusion There were no significant quantifiable differences in T2 values of cartilage overlying stable JOCD lesions and normal cartilage on the medial femoral condyle, suggesting no substantial changes in cartilage composition and microstructure.
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Affiliation(s)
- Jie C Nguyen
- From the Department of Radiology (J.C.N., F.L., D.G.B., R.W.K.) and Department of Biostatistics and Medical Informatics (K.M.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Fang Liu
- From the Department of Radiology (J.C.N., F.L., D.G.B., R.W.K.) and Department of Biostatistics and Medical Informatics (K.M.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Donna G Blankenbaker
- From the Department of Radiology (J.C.N., F.L., D.G.B., R.W.K.) and Department of Biostatistics and Medical Informatics (K.M.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Kaitlin M Woo
- From the Department of Radiology (J.C.N., F.L., D.G.B., R.W.K.) and Department of Biostatistics and Medical Informatics (K.M.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Richard Kijowski
- From the Department of Radiology (J.C.N., F.L., D.G.B., R.W.K.) and Department of Biostatistics and Medical Informatics (K.M.W.), University of Wisconsin School of Medicine and Public Health, Madison, Wis
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30
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Osteochondritis dissecans of the knee. Orthop Traumatol Surg Res 2018; 104:S97-S105. [PMID: 29197636 DOI: 10.1016/j.otsr.2017.02.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/20/2017] [Accepted: 02/28/2017] [Indexed: 02/02/2023]
Abstract
Osteochondritis dissecans (OCD) of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. The diagnosis is usually made during adolescence. Mechanical factors play a major role in the pathophysiology of OCD. When the radiographic diagnosis is made early in a patient with open physes, healing can often be obtained simply by restricting sports activities. The degree of lesion instability can be assessed by magnetic resonance imaging. When the lesion remains unstable and the pain persists despite a period of rest, surgery is indicated. Arthroscopic exploration is always the first step. Drilling of the lesion produces excellent outcomes if the lesion is stable. Unstable lesions require fixation and, in some cases, bone grafting. Defects must be filled, depending on their surface area. Although many surgical techniques are available, the therapeutic indications are now standardized.
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