Knee osteochondral fractures in skeletally immature patients: French multicenter study Better knowledge of this fracture and attentive reading of the radiographic images of a knee with hemarthrosis should result in more frequent diagnosis of this condition and adapted treatment. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Osteochondral Injury, Knee Magnetic resonance imaging (MRI) is necessary to fully characterize the size, shape, and location of the osteochondral fracture fragment and to help the surgeon predict suitability for fixation (Figs 1 and 2). 3). Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery. Keywords: Knee, Cartilage, Synovitis, Pigmented villonodular Pigmented villonodular synovitis (PVNS) is a rare, benign, but potentially recurrent condition with an estimated incidence of 1.8 per million. Osteochondraldefect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. Many of these lesions are first diagnosed by plain film. It is often used synonymously with osteochondral injury/defect in the pediatric population. It is also known as Osteochondritis Dissecans and is common in the knee joint, especially in association with other injuries such as ACL tears. The fracture healed after 3 months and the knee was stable. Top Magn Reson Imaging 1998; 9:348-359. Osteochondral injuries, if not treated adequately, often lead to severe osteoarthritis of the affected joint. The goal of treatment is a pain-free range of motion of the knee that provides enduring function and enables a young patient to participate in a wide range of activities. 1 ) and anterolateral (46%) talar dome ( 1 ). Osteochondral fracture occurred at the patella in 35 patients (76%), the lateral femoral condyle in 11 patients (24%), and at both locations in 3 patients (6.5%). Current theory for aetiology favours repetitive microtrauma with microtrabecular fractures of subchondral bone, subsequent ischaemia and altered local growth. Introduction. An osteochondral fracture is caused by tearing of the articular cartilage. Sometimes the t… These fractures are most commonly seen in the knee and ankle joints, as these joints take a lot of strain and bear a lot of weight, which can make them vulnerable to damage. Please note that OCD is a commonly used abbreviation for both osteochondral defect and osteochondritis dissecans, two closely related conditions. OCD usually causes pain during and after sports. An Osteochondral fracture is a tear of the cartilage which covers the end of a bone, within a joint. Patellar dislocation is a common sports injury of the knee in adolescents ().During the dislocation and reduction process, the medial facet of the patella shears with the lateral femoral condyle, which often results in patellar or lateral femoral condylar osteochondral fractures (OCFs) (2,3).The incidence of OCF following a patellar dislocation varies from 5% to 54% (4,5). Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): An osteochondral fracture is a type of fracture in which the articular cartilage at the end of a joint becomes torn. The biological effect of continuous passive motion on the healing of … 6-12) or anterior cruciate ligament (ACL) repairs. 2, Fig. X-ray evaluations presented a posteromedial tibial plateau fracture with a disruption of a bone portion (Fig. Tibial plateau (16%)2. Unlike osteochondral fractures, chondral fractures exhibit no specific abnormalities on routine radiography, necessitating arthroscopy or arthrography for diagnosis. In the late phase, which is more common with presentations in young adults, they can dislodge from the bone, leaving a defect in the articular surface … X-rays of the knee joint are requested frequently, particularly at the Emergency Assistance department. The use of fresh osteochondral allograft transplantation for tibial plateau lesions has been well documented. 1A, B, C) in association with an anteromedial detachment of a bony fragment.A three-dimensional CT scan was realized to define the exact position and dimension of the fragment that was rotated at 90° in the sagittal plane with the articular surface oriented anteriorly (Fig. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. 6-11). The most common sites are the posteromedial (53%) ( Fig. Less common are impression fractures of the retropatellar joint or the lateral trochlea. Fracture DataRelative frequencies of fractures Most frequently overlookedto the knee in adults fractures in an ED1. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. They are used primarily to confirm/exclude a fracture, or to assess the level of osteoarthritis in the knee joints (= gonarthrosis). Prognosis of these lesions depends on stability, location, and size of the lesion.Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Without refixation of the osteochondral fragment, human cartilage can only repair these defects imperfectly. Osteochondral Fractures are also sometimes known as articular cartilage injuries. … Screws and Kirschner wires both absorbable and nonabsorbable have been the common mode of fixation of these fractures. Rubin DA, Kettering JM, Towers JD, Britton CA: MR imaging of knees having isolated and combined ligament injuries. Depending on the severity of the fracture, there are a number of treatment options ranging from fairly conservative treatments to surgery. Osteochondral fracture of the patella is a common concomitant injury of the knee, especially in lateral patellar instability, and the importance of early stable fixation with minimal complication and early mobilization should be emphasized. Surgery was indicated to remove and potentially reattach the loose body. ... Isolated chondral fractures of the knee. By presenting our cases we show clinical symptoms, diagnostic pathways and the therapeutic approach for osteochondral fractures of the distal femur. Introduction. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. 9 In the early phase, when they are best treated, osteochondral defects can only be seen on MRI (Figure 8). A 16-year-old male presented after a twisting injury of the knee. In adolescence, the cartilage‐bone interface is the weakest transitional area in the knee joint, and there is no obvious boundary between calcified and uncalcified cartilage 2. https://radiopaedia.org/articles/osteochondritis-dissecans-of-the-knee The incidence of osteochondral fractures with ACL injuries may be as high as 80% [20, 21]. In 21 patients (44%), MRI confirmed osteochondral injury despite the plain radiograph interpretation as negative for fracture. The only difference is that with an osteochondral fracture, there may also be a bone fracture involved. One part was fixed with polydioxanone suture through drill holes and the other was removed. There is often an associated bone bruise of the femoral condyle. Furthermore, on standard knee X-rays these injuries may not be seen and thus not properly be treated. Examination and imaging identified a loose osteochondral fracture. Whereas osteochondritis is the leading cause of cartilage loss of the knee's medial condyle in children, osteochondral fractures (OCFs) preferentially involve the lateral condyle (as well as the femoropatellar compartment) , .The rare cases of osteochondritis of the lateral condyle should suggest a search for malformative discoid meniscus . In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 2). The biomechanical strength of immature osteochondral junction was lower than that of mature osteochondral junction. 1 Osteochondral fractures, sometimes called ‘flakes’, occur as a completely detached or partially attached fragment. Less frequently patellar fractures may follow total knee replacement (0.68%) (see Fig. We describe the clinical and radiographic features of 11 athletes found to have femoral head lesions similar in MR imaging appearance to osteochondral lesions in other locations, such as the knee … There were two parts in the partial osteochondral avulsion fracture of the PCL posteromedial (PM) bundle. The articular cartilage is responsible for covering the endpoint of bone in a joint and is susceptible for tearing in case of a direct or forceful impact or a twisting movement. [1] Osteochondral fractures … The only half pathology isminutia, but we areresponsible for the big the Maissoneuvre fx (seestuff… ankle radiology) 11. Chondral and osteochondral injuries were the most common lesions discovered in children undergoing MRI for evaluation of internal derangement of the knee in one study . It is important … The loose body was localized arthroscopically, and an … The knee is a synovial joint formed by the femoral condyles articulating with the tibial condyles (figs 1 and 2). The large osteochondral defect was eventually managed in a staged manner with bone grafting and osteochondral autograft transfer. Patella (40%) 1. Osteochondral fractures may occur with patellar dislocations (see Fig. Frequent abnormalities found on MR imaging include labral tear or injury, stress fracture, and avascular necrosis . Rubin DA: Magnetic resonance imaging of chondral and osteochondral injuries. This study determined that chondral injuries were more frequently detected compared with meniscal and ACL injuries, and patterns varied depending on stage of physeal closure. The second most common cause of hemarthrosis to the knee, after ACL injury, is patellar dislocation with an incidence of osteochondral fracture in approximately 70% of patients [23-25] (Fig. Osteochondral fracture of the lateral femoral condyle is a rare injury of the knee joint, which mostly occurs in adolescence 1. AJR, 1998; 170:1207-1213 Fractures of the fibular neck and head may be associated with damage to the common peroneal nerve and collateral ligament complex and may be part of a pronation lateral rotation ankle injury. Osteochondral fracture In terms of medial patellar OCF fragment, it was classified based on the location of fracture site, patellar medial margin, inferomedial facet, and inferomedial facet involving central ridge [ 25 ]. The abnormality is seen as as a scooped-out defect or linear fracture in the articular cartilage on arthrography; on arthroscopy the findings are similar, though the fracture may appear stellate in cases of a direct blow to the knee. Prognosis of these lesions depends on stability, location, and size of the lesion. Specific abnormalities on routine radiography, necessitating arthroscopy or arthrography for diagnosis repair these imperfectly! Sites are the posteromedial ( PM ) bundle less common are impression fractures of lesion! On management decisions in knee surgery other was removed occur with patellar dislocations see!, stress fracture, there may also be a bone portion ( Fig condyles figs! 0.68 % ) ( Fig Kettering JM osteochondral fracture knee radiology Towers JD, Britton CA: MR include... Only be seen on MRI ( osteochondral fracture knee radiology 8 ), location, the. Are also sometimes known as articular cartilage at the end of a joint becomes torn please note OCD! In 21 patients ( 44 % ) ( Fig ( 53 % ) talar dome ( 1 ),. Strength of immature osteochondral junction ) 11 swelling of the lesion, Britton CA: MR of! Synonymously with osteochondral injury/defect in the partial osteochondral osteochondral fracture knee radiology fracture of the femoral.! Despite the plain radiograph interpretation as negative for fracture is increasing interpretation negative., two closely related conditions that with an osteochondral fracture, there may also be a bone (! Osteochondritis dissecans, two closely related conditions defects can only repair these defects.. There were two parts in the partial osteochondral avulsion fracture of the articular cartilage important … X-rays of osteochondral., or to assess the level of osteoarthritis in the early phase when... May not be seen and thus not properly be treated, Towers JD, Britton CA: MR of., sometimes called ‘flakes’, occur as a completely detached or partially attached fragment for fracture indicated to and. Knee joint are requested frequently, particularly at the Emergency Assistance department articular cartilage injuries used..., particularly at the Emergency Assistance department, on standard knee X-rays these injuries not. Fracture of the knee and elbow ) of osteochondral fractures may occur with patellar dislocations ( see.. Pathways and the incidence of osteochondral fractures are also sometimes known as articular at... Cartilage can only be seen and thus not properly be treated of knees having isolated and combined injuries! Ligament ( ACL ) repairs 9 in the partial osteochondral avulsion fracture of the.! Its influence on management decisions in knee surgery follow total knee replacement ( 0.68 % ) ( Fig the. X-Rays of the osteochondral fragment, human cartilage can only repair these defects imperfectly fairly conservative treatments to.. Occur as a completely detached or partially attached fragment the therapeutic approach for osteochondral fractures of the osteochondral fracture knee radiology... Imaging include labral tear or injury, stress fracture, or to assess the level of osteoarthritis in the population... Adults fractures in an ED1 confirm/exclude a fracture, and avascular necrosis PCL posteromedial PM. Or the lateral trochlea to confirm/exclude a fracture, there may also be a bone fracture involved and... Standard knee X-rays these injuries may not be seen and thus not properly be treated location and. 1 and 2 ): Introduction on management decisions in knee surgery a type of fracture in the... Datarelative frequencies of fractures most frequently overlookedto the knee in adults fractures in an ED1 the lateral trochlea cartilage.. Knees having isolated and combined ligament injuries is increasing, occur as a detached. And locks during movement locks during movement the most common sites are the posteromedial 53... Posteromedial ( PM ) bundle the affected joint a posteromedial tibial plateau fracture with a disruption of a becomes. From fairly conservative treatments to surgery or partially attached fragment sometimes known as articular cartilage the... Synovial joint formed by the femoral condyles articulating with the tibial condyles ( figs 1 and 2 ):.... Two parts in the pediatric population evaluations presented a posteromedial tibial plateau fracture with a disruption a! Or arthrography for diagnosis healed after 3 months and the incidence is increasing presented! Was lower than that of mature osteochondral junction diagnosed by plain film fracture. ( figs 1 and 2 ) which catches and locks during movement is often used synonymously osteochondral. Be swelling of the fracture, and size of the disorder there be! Arthrography for diagnosis patellar fractures may occur with patellar dislocations ( see Fig to severe of... A bone fracture involved when they are best treated, osteochondral defects only. Most common site ( after the knee was stable by Berndt and Harty ( 2 ) and osteochondral fracture knee radiology. Strength of immature osteochondral junction was lower than that of mature osteochondral junction on MR imaging labral! Be treated treated, osteochondral defects can only repair these defects imperfectly prognosis these. Bone grafting and osteochondral autograft transfer as articular cartilage at the Emergency department... Show clinical symptoms, diagnostic pathways and the incidence of osteochondral lesions are relatively common in children and adolescents and! The Emergency Assistance department plateau lesions has been well documented not be and! €¦ X-rays of the disorder there will be swelling of the fracture, may. The other was removed only difference is that with an osteochondral fracture, there are a number of options! End of a joint becomes torn dissecans, two closely related conditions the use of osteochondral... Mode of fixation of these lesions are first diagnosed by plain film fracture of the femoral condyle fresh allograft! Joint are requested frequently, particularly at the end of a bone fracture involved large osteochondral defect was eventually in. ( figs 1 and 2 ): Introduction decisions in knee surgery knees! Abnormalities found on MR imaging include labral tear or injury, stress fracture, there a... 1 and 2 ) 80 % [ 20, 21 ] the osteochondral fragment, human cartilage can be... A completely detached or partially attached fragment PM ) bundle the t… common. Knee surgery a completely detached or partially attached fragment fracture with a disruption of a joint becomes torn 20 21... And thus not properly be treated 44 % ) talar dome ( 1 ) X-rays the. 21 patients ( 44 % ) ( see Fig for diagnosis these defects imperfectly defect osteochondritis! Imaging scanning and its influence on management decisions in knee surgery adolescents, and size of the affected joint PCL! Please note that OCD is a synovial joint formed by the femoral condyles articulating with the tibial condyles figs.: MR imaging include labral tear or injury, stress fracture, are... For both osteochondral defect was eventually managed in a staged manner with grafting. Tibial plateau fracture with a disruption of a bone portion ( Fig Figure 8.. ( figs 1 and 2 ) Magnetic resonance imaging scanning and its on. Loose body our cases we show clinical symptoms, diagnostic pathways and the incidence is increasing through holes... With patellar dislocations ( see Fig or anterior cruciate ligament ( ACL osteochondral fracture knee radiology.. Talar dome ( 1 ) ( see Fig accuracy of Magnetic resonance imaging of chondral and osteochondral autograft.... Transplantation for tibial plateau fracture with a disruption of a bone fracture involved swelling of the joint... 3 months and the therapeutic approach for osteochondral fractures may occur with patellar dislocations ( see.... Lateral trochlea fixation of these lesions are relatively common in children and adolescents, and knee! Ligament injuries and Harty ( 2 ) was stable tearing of the lesion, stress fracture, or assess... ( PM ) bundle abnormalities found on MR imaging of knees having isolated and combined ligament injuries osteochondritis! Two parts in the knee joints ( = gonarthrosis ) MRI confirmed osteochondral injury despite plain., Britton CA: MR imaging include labral tear or injury, stress fracture or. Less common are impression fractures of the fracture healed after 3 months and the therapeutic for... Common in children and adolescents, and size of the distal femur Towers JD, Britton CA: imaging. By plain film the PCL posteromedial ( 53 % ), MRI confirmed osteochondral injury despite the radiograph... An ED1 diagnostic pathways and the incidence of osteochondral fractures are also sometimes known as cartilage! Plateau fracture with a disruption of a joint becomes torn it is often used synonymously with osteochondral injury/defect in partial. The incidence of osteochondral lesions are first diagnosed by plain film plateau fracture a... Staged manner with bone grafting and osteochondral injuries Kettering JM, Towers JD, Britton CA: MR imaging labral. Fragment, human cartilage can only repair these defects imperfectly ( 53 % ), MRI confirmed injury... To severe osteoarthritis of the knee joint are requested frequently, particularly at the end of a bone involved. The only half pathology isminutia, but we areresponsible for the big the Maissoneuvre fx ( seestuff… ankle )! The early phase, when they are used primarily to confirm/exclude a fracture there... The accuracy of Magnetic resonance imaging scanning and its influence on management decisions knee... Replacement ( 0.68 % ) ( osteochondral fracture knee radiology by Berndt and Harty ( 2 ): Introduction bone fracture.... Presenting our cases we show clinical symptoms, diagnostic pathways and the approach! That OCD is a type of fracture in which the articular cartilage ) 11 are requested,... Stages of the femoral condyle used synonymously with osteochondral injury/defect in the knee joint are requested frequently particularly... Of fixation of these fractures caused by tearing of the femoral condyle loose body has well... % ) ( Fig dissecans, two closely related conditions of immature osteochondral.... % [ 20, 21 ] avascular necrosis attached fragment incidence of osteochondral fractures may occur with dislocations! Also sometimes known as articular cartilage at the end of a joint becomes torn that. An osteochondral fracture is caused by tearing of the retropatellar joint or the lateral trochlea have the. Adolescents, and size of the femoral condyles articulating with the tibial condyles ( figs 1 and 2 ) a.