Imaging of osteochondritis dissecans

Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. The cause of this lesion remains elusive. With the vague clinical symptoms and signs of OCD, imaging plays a vital role in making the diagnosis and helping with the prognosis of OCD lesions. This article reviews current imaging modalities for the assessment of OCD including conventional radiography, nuclear medicine, computed tomography (CT), CT arthrography, magnetic resonance (MR) and MR arthrography. The role of imaging in evaluating healing of the OCD and articular congruity after surgical and nonsurgical management is discussed.     

Navigierte retrograde Anbohrung bei Osteochondrosis dissecans (OCD) des Talus

Objective

Subchondral decompression and revascularization in Osteochondrosis dissecans (OCD) of the talus with cartilage preservation.

Indications

Symptomatic talar OCD stage I and II, i.e., cartilage intact or almost intact.

Contraindications

Talar OCD stage III and IV, i.e., cartilage not intact.

Surgical technique

Diagnostic ankle arthroscopy. Insertion of dynamic reference base (DRB) in the talar neck through a stab incision. After 3D image acquisition and planning of the drilling, navigated drilling with a 5?mm drill. Insertion of a 1?mm titanium wire into the canal and 3D image acquisition for evaluation of the canal. Autologous cancellous bone transplantation into the canal. Arthroscopic evaluation.

Postoperative management

For 6?weeks, 15?kg partial weight bearing without immobilization. After 6?weeks full weight bearing.

Results

A total of 52?patients with symptomatic talar OCD stage I and II were included in a clinical follow-up study. Time needed for preparation, including the placement of the DRB, scanning time, and preparation of the trajectories was 7?min 32?s (4?C30?min). In 50?cases (96%), the drilling was judged with 3D imaging to be correct. In the remaining 2?cases (4%), the drilling ended in the caudal portion of the lesion. A perforation of the cartilage was not registered arthroscopically. Follow-up after 12?months (range 6?C36?months) was possible in 48?patients (92%). Three patients (6%) had been converted to bone cartilage transplantation (OATS) due to recurrent symptoms. These patients were excluded from follow-up. The follow-up scores were Visual Analogue Scale Foot and Ankle (mean 93?points [range 86?C100?points]) and the SF 36 (standardized to 100 point maximum, 90?points [range 79?C100?points]).     

Dynamic bone scintigraphy in osteochondritis dissecans

Summary We report a retrospective study of eighteen patients with pain in the knee or ankle, eleven of whom had osteochondritis dissecans. In these patients the bone-flow time-activity curves were observed after an intravenous injection of a bolus of 99mTc MDP. The curves varied according to the severity of the clinical signs and symptoms. The diagnosis rate was 29% with static scintigraphy and this improved to 57% when dynamic flow studies were used. A positive pattern in the dynamic study together with radiographs and static scintigraphs raised the diagnosis rate to 100%; the sensitivity was 90%. These preliminary results show that dynamic bone scintigraphy holds promise as a technique for identification and management of this condition.

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Résumé Etude rétrospective de dix-huit malades présentant des douleurs du genou ou de la cheville, dont onze étaient porteurs d'une ostéochondrite disséquante. Chez ces malades on a établi, après injection intra-veineuse d'un bolus de Tc99m, des courbes d'activité du flux sanguin en fonction du temps. Celles-ci varient selon l'importance de la symptomatologie. Le taux de diagnostic était de 29% avec la scintigraphie statique et il a atteint 57% lorsqu'on a eu recours à l'étude dynamique. Une réponse positive à l'épreuve dynamique associée à des arguments radiologiques et scintigraphiques statiques élève à 100% le taux de diagnostic; la sensibilité est de 90%. Ces résultats préliminaires permettent de penser que la scintigraphie dynamique est une technique valable pour le diagnostic et le traitement de l'ostéochondrite.

     

Diagnosis and treatment of osteochondritis dissecans

This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of osteochondritis dissecans of the knee. None of the 16 recommendations made by the work group is graded as strong; most are graded inconclusive; two are graded weak; and four are consensus statements. Both of the weak recommendations are related to imaging evaluation. For patients with knee symptoms, radiographs of the joint may be obtained to identify the lesion. For patients with radiographically apparent lesions, MRI may be used to further characterize the osteochondritis dissecans lesion or identify other knee pathology.     

Natural course of osteochondritis dissecans in children

Results are reported from an absence of physiotherapic, orthopaedic, or surgical treatment in 31 cases of osteochondritis dissecans in 24 children. The mean age at diagnosis was 11 years and 4 months, and all the children were suffering from pain for an average of 3 months. None of these children were treated, except for instructions to discontinue involvement in sports activities until their pain had disappeared. In all cases pain disappeared, and these children have all returned to their former activities. According to x-ray findings, 30 lesions disappeared totally, although there was one case of a loose body. As a result, absence of treatment is recommended for osteochondritis dissecans in children.     

幼年型剥脱性骨软骨炎研究进展

幼年型剥脱性骨软骨炎（JOCD）好发于男性,创伤、血供障碍及关节周围结构异常等均可能是重要致病因素。发病早期缺乏典型临床表现,易被漏诊。MRI是首选检查方法,可定位、定性地诊断并有助于分型。对于稳定型JOCD患者,保守治疗是最佳选择;对不稳定型或经保守治疗效果较差者,可采用剥离软骨片固定、软骨下骨钻孔、自体骨软骨移植及自体软骨细胞移植等手术治疗。JOCD不同于成年型剥脱性骨软骨炎,治疗方法差别明显。损伤时间和损伤部位、程度、范围等均对预后产生重要影响,早期诊断是获得良好预后的重要条件。     

Injuries to the talus-neck fractures and osteochondral lesions (osteochondritis dissecans)

The authors discuss pathology to the talus, as determined radiographically. They review pertinent anatomy, including blood supply to this bone. Fractures are categorized, with a review of clinical management.     

Management of loose osteochondritis dissecans in an adolescent

Osteochondritis dissecans (OCD) of the knee joint affects subchondral bone first, and then it involves the articular cartilage. It can cause pain, effusion and loose body formation. Nonoperative treatment is for the stable lesion, but if the lesion is unstable and symptomatic, then operative management is needed. Short term goal of the treatment is pain relief, and the long-term goal is the prevention of early arthritis. Surgical treatment includes removal of loose body, microfractures, osteochondral autograft and allograft transplantation, autologous chondrocyte implantation (ACI), arthroscopic removal of the loose body and internal fixation of the fragment using k wire or screw. We successfully managed an adolescent with a loose OCD fragment with an arthroscopic evaluation, removal of the loose body and refixation of the loose fragment to the parent location, using three bio screws.     

踝关节镜下治疗距骨剥脱性骨软骨炎

目的探讨踝关节镜技术在距骨剥脱性骨软骨炎治疗中的应用及效果。方法对17例距骨剥脱性骨软骨炎患者施行踝关节镜手术,在关节镜下对损伤关节面清创、搔刮及钻孔。结果随访14．54个月。踝关节Kofoed评分由术前平均56．5分提高至89．4分,17例中优6例,良8例,可2例,差1例,优良率为82．4％。结论踝关节镜下手术治疗距骨剥脱性骨软骨炎,疗效确切,具有创伤小、并发症少、恢复快等优点。     

Bilateral osteochondritis dissecans of the carpal scaphoid

Summary The results of an anatomical and radiological study of one unusual case of bilateral osteochondritis dissecans of the carpal scaphoid are reported.On both sides, histological examination of the excised surgical specimen showed previous remodelling of the bone and marrow which had been followed by further aseptic necrosis. On the painful left side the sequestrum itself was fractured and appeared to be involved in a localised cystic remodelling reaction.The observations are discussed as an example of the histological changes in aseptic bone necrosis as well as an unusual type of pathology affecting the carpal scaphoid.

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Résumé L'auteur présente les résultats d'une étude anatomique et radiologique d'un cas inhabituel d'ostéochondrite disséquante bilatérale du scaphoïde carpien.Des deux côtés, l'examen histologique du fragment excisé montre une réorganisation préalable de l'os et de la moelle osseuse qui a été suivie d'une nécrose aseptique. Du côté gauche douloureux, le séquestre lui-même est fracturé et paraît être impliqué dans une réaction de réorganisation localisée de type kystique.Ces observations sont discutées en tant qu'exemple des changements histologiques lors d'une nécrose osseuse aseptique et en tant que lésion inhabituelle du scaphoïde carpien.

     

Familial osteochondritis dissecans of the knee.

The autosomal dominant pattern of osteochondritis dissecans and association with mild dwarfism were observed during a study of 4 generations of one family. Twelve of 31 family members had proven osteochondritis dissecans and 8 others appeared to have or (now deceased) have had it; 10 of these 20 patients were of short stature (less than 5%). At the onset, children under 11 years of age had bilateral irregularities of ossification. Three of the 11 adolescents (13-19 years) had osteochondritis dissecans with development of the condition from irregularities of ossification that could be traced in the roentgenograph of one. Two of the 3 surviving adults now in their sixth or seventh decade have osteoarthritis (one moderate, one severe). The younger adults, now in the 20's and 40's, have minimal knee sysmptoms.     

Histological and cell biological characterization of dissected cartilage fragments in human osteochondritis dissecans of the femoral condyle

Introduction: Osteochondritis dissecans (OCD) within the weight-bearing femoral condyle carries a high risk of osteoarthritis. The definitive pathogenetic cause is unclear. Therefore biochemical and cellular features of OCD were analyzed and compared to macroscopically normal cartilage of the same joint surface. Materials and methods: Dissected fragments from 14 patients and biopsies of normal cartilage from the intercondylar notch as controls were harvested at arthroscopy. Staining with safranin O to monitor proteoglycan content, alkaline phosphatase activity, and immunohistochemistry with mouse monoclonal antibodies to collagen types I, II, and X. Chondrocytes were isolated for RT-PCR to detect GAPDH, collagen types I, II, X, aggrecan, TGF-β, BMP-7, bFGF, VEGF and IL-1. Results: The dissected cartilage displayed significant variability. Apart from normal cartilage matrix components also atypical molecules such as collagen type X and alkaline phosphatase were detected at the tidemark but also across the entire dissecate, suggesting chondrocyte hypertrophy. Extended fibrous degeneration associated with collagen type I deposition was observed at the surface and may indicate chondrocyte dedifferentiation. Viable cells could be extracted from OCD and notch. Both expressed similar mRNA levels for matrix molecules, growth factors, and interleukin-1 (IL-1), however significantly more Col X mRNA was detected in dissecates. Conclusion: Histology suggests focal alteration of cartilage matrix originating from the basis of the joint cartilage, potentially the mineralized layer or subchondral bone. The molecular analysis indicates a disorganization of cartilage homeostasis across the joint accompanied by embryogenetic processes. The surprisingly high viability and quality of the extracted cells suggests a still preserved intrinsic repair capacity of those vital dissecates.