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Osteochondritis Dissecans Workup

  • Author: Grant Cooper, MD; Chief Editor: Thomas M DeBerardino, MD  more...
 
Updated: Apr 13, 2016
 

Approach Considerations

No laboratory studies are indicated in the workup of osetochondritis dissecans (OCD). Imaging studies, typically beginning with plain radiographs and often progressing to magnetic resonance imaging (MRI) scans, are used to confirm the diagnosis and guide treatment. Computed tomography (CT) scanning may be helpful in preoperative planning and in guiding treatment when MRI is not available or is contraindicated.Some authors advocate the use of arthroscopy as a diagnostic tool in addition to MRI prior to invasive procedures.

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Imaging Studies

Imaging techniques used in the evaluation of osteochondritis dissecans (OCD) include the following:

  • Plain radiography
  • Scintigraphy
  • Magnetic resonance imaging (MRI)
  • Ultrasound

Radiography

Radiographic evaluation is an appropriate first-line investigation for OCD.[7] When detectable, an osteochondral lesion appears as lucency in the articular epiphysis. However, patients with very early lesions may have normal radiographic findings. In OCD in the knee, a notch or tunnel posteroanterior radiograph is the best way to visualize a lesion in the medial femoral condyle. Lateral and anteroposterior radiographs are also helpful in identifying OCD on the condyles.

See the images below.

Osteochondritis dissecans. Anteroposterior radiogr Osteochondritis dissecans. Anteroposterior radiograph showing lucency in the medial femoral condyle.
Osteochondritis dissecans. Tunnel-view radiograph Osteochondritis dissecans. Tunnel-view radiograph showing an osteochondral lesion of the medial femoral condyle.

Scintigraphy

Technetium bone scintigraphy is an important tool for evaluating OCD. The degree of osseous uptake is an important indicator of potential healing of the osteochondral fragment. The greater the uptake, the higher the apparent osteoblastic activity and the greater the likelihood for healing with conservative, as opposed to surgical, management. Some authors advocate the use of serial technetium imaging to stratify patient prognosis and guide treatment. Technetium imaging may also reveal occult bilateral involvement.

Magnetic resonance imaging

MRI is useful in the evaluation of patients with OCD (see the images below). It permits visualization of loose bodies and the degree of displacement. Lesions that appear normal on standard radiographs may be detected using MRI. MRI also permits determination of the fluid interfaces and the integrity of the articular surfaces. MRI is useful in preoperative planning to determine whether the fragment is detached and if so, to what degree. Intra-articular injection of gadolinium may be considered because it increases the sensitivity and specificity of MRI findings.[8, 9, 7, 10]

Osteochondritis dissecans. Sagittal view of an ost Osteochondritis dissecans. Sagittal view of an osteochondral lesion in the medial femoral condyle.
Osteochondritis dissecans. MRI sagittal view of an Osteochondritis dissecans. MRI sagittal view of an osteochondral defect in the medial femoral condyle.
Osteochondritis dissecans. MRI coronal view of an Osteochondritis dissecans. MRI coronal view of an osteochondral defect in the medial femoral condyle.

Kijowski et al retrospectively compared the sensitivity and specificity of previously described MRI criteria for the detection of instability in patients with juvenile or adult OCD of the knee, with arthroscopic findings as the reference standard. Separately, previously described MR imaging criteria for detection of OCD instability were 0-88% sensitive and 21-100% specific for juvenile OCD lesions and 27-54% sensitive and 100% specific for adult OCD lesions. When used together, the criteria were 100% sensitive and 11% specific for instability in juvenile OCD lesions and 100% sensitive and 100% specific for instability in adult OCD lesions. The authors concluded from their findings that previously described MR imaging criteria for OCD instability have high specificity for adult but not juvenile lesions of the knee.[11]

Ultrasound

Sonography has been used to evaluate OCD of the knee and humeral capitellum. The advantages of sonography are lower cost than MRI and CT scanning, and dynamic scanning with motion of the affected joint. When performed by an experienced practitioner, ultrasonography may be an appropriate examination for evaluation of the humeral capitellum.

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Contributor Information and Disclosures
Author

Grant Cooper, MD Co-Founder, Co-Director, Princeton Spine and Joint Center

Grant Cooper, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Russell Warren, MD Professor of Surgery, Professor, Division of Orthopedic Surgery, Weill Medical College of Cornell University

Russell Warren, MD is a member of the following medical societies: American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Thomas M DeBerardino, MD Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; Ivy Sports Medicine; MTF; Aesculap; The Foundry, Cotera; ABMT<br/>Received research grant from: Histogenics; Cotera; Arthrex.

Additional Contributors

Robert D Bronstein, MD Associate Professor, Department of Orthopedics, Division of Athletic Medicine, University of Rochester School of Medicine

Robert D Bronstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Medical Society of the State of New York

Disclosure: Nothing to disclose.

References
  1. Schenck RC, Goodnight JM. Osteochondritis dissecans. J Bone Joint Surg Am. 1996 Mar. 78(3):439-56. [Medline].

  2. Wiesler E, Poehling GG. Osteochondritis dissecans of the capitellum. Tech Shoulder Elbow Surg. 2001. 2:131-8.

  3. Petrie PW. Aetiology of osteochondritis dissecans. Failure to establish a familial background. J Bone Joint Surg Br. 1977 Aug. 59(3):366-7. [Medline].

  4. Enneking, WF. Clinical Musculoskeletal Pathology. Ed. 3. Gainesville, Florida: University of Florida Press; 1990. 166.

  5. Rogers WM, Gladstone H. Vascular foramina and arterial supply of the distal end of the femur. J Bone Joint Surg Am. 1950 Oct. 32(A:4):867-74. [Medline].

  6. Chiroff RT, Cooke CP. Osteochondritis dissecans: a histologic and microradiographic analysis of surgically excised lesions. J Trauma. 1975 Aug. 15(8):689-96. [Medline].

  7. Lunden JB, Legrand AB. Osteochondritis dissecans of the humeral head. J Orthop Sports Phys Ther. 2012. 42(10):886. [Medline].

  8. Choi YS, Cohen NA, Potter HG, Mintz DN. Magnetic resonance imaging in the evaluation of osteochondritis dissecans of the patella. Skeletal Radiol. 2007 Oct. 36(10):929-35. [Medline].

  9. Brunton LM, Anderson MW, Pannunzio ME, Khanna AJ, Chhabra AB. Magnetic resonance imaging of the elbow: update on current techniques and indications. J Hand Surg [Am]. 2006 Jul-Aug. 31(6):1001-11. [Medline].

  10. Wulf CA, Stone RM, Giveans MR, Lervick GN. Magnetic Resonance Imaging After Arthroscopic Microfracture of Capitellar Osteochondritis Dissecans. Am J Sports Med. 2012 Sep 26. [Medline].

  11. Kijowski R, Blankenbaker DG, Shinki K, Fine JP, Graf BK, De Smet AA. Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology. 2008 Aug. 248(2):571-8. [Medline].

  12. Weiss JM, Nikizad H, Shea KG, Gyurdzhyan S, Jacobs JC, Cannamela PC, et al. The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents. Orthop J Sports Med. 2016 Mar. 4 (3):2325967116635515. [Medline]. [Full Text].

  13. Michael JW, Wurth A, Eysel P, König DP. Long-term results after operative treatment of osteochondritis dissecans of the knee joint-30 year results. Int Orthop. 2008 Apr. 32(2):217-21. [Medline].

  14. Smith MV, Bedi A, Chen NC. Surgical treatment for osteochondritis dissecans of the capitellum. Sports Health. 2012 Sep. 4(5):425-32. [Medline]. [Full Text].

  15. Barrett I, King AH, Riester S, van Wijnen A, Levy BA, Stuart MJ, et al. Internal Fixation of Unstable Osteochondritis Dissecans in the Skeletally Mature Knee with Metal Screws. Cartilage. 2016 Apr. 7 (2):157-62. [Medline].

  16. Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. Surgical technique. J Bone Joint Surg Am. 2008 Mar. 90 Suppl 2:47-62. [Medline].

  17. Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am. 2007 Jun. 89(6):1205-14. [Medline].

  18. Bentley G, Biant LC, Carrington RW, et al. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003 Mar. 85(2):223-30. [Medline].

  19. Peterson L, Minas T, Brittberg M, Lindahl A. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am. 2003. 85-A Suppl 2:17-24. [Medline].

  20. Koulalis D, Schultz W, Heyden M. Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. Clin Orthop. 2002 Feb. 186-92. [Medline].

  21. Pascual-Garrido C, Friel NA, Kirk SS, McNickle AG, Bach BR Jr, Bush-Joseph CA, et al. Midterm results of surgical treatment for adult osteochondritis dissecans of the knee. Am J Sports Med. 2009 Nov. 37 Suppl 1:125S-30S. [Medline].

  22. Adachi N, Deie M, Nakamae A, Ishikawa M, Motoyama M, Ochi M. Functional and radiographic outcome of stable juvenile osteochondritis dissecans of the knee treated with retroarticular drilling without bone grafting. Arthroscopy. 2009 Feb. 25(2):145-52. [Medline].

  23. Tabaddor RR, Banffy MB, Andersen JS, McFeely E, Ogunwole O, Micheli LJ, et al. Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop. 2010 Jan-Feb. 30(1):14-20. [Medline].

  24. Lyon R, Nissen C, Liu XC, Curtin B. Can Fresh Osteochondral Allografts Restore Function in Juveniles With Osteochondritis Dissecans of the Knee?. Clin Orthop Relat Res. 2012 Sep 13. [Medline].

  25. Weckström M, Parviainen M, Kiuru MJ, Mattila VM, Pihlajamäki HK. Comparison of bioabsorbable pins and nails in the fixation of adult osteochondritis dissecans fragments of the knee: an outcome of 30 knees. Am J Sports Med. 2007 Sep. 35(9):1467-76. [Medline].

 
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Osteochondritis dissecans. Sagittal view of an osteochondral lesion in the medial femoral condyle.
Osteochondritis dissecans. MRI sagittal view of an osteochondral defect in the medial femoral condyle.
Osteochondritis dissecans. MRI coronal view of an osteochondral defect in the medial femoral condyle.
Osteochondritis dissecans. Anteroposterior radiograph showing lucency in the medial femoral condyle.
Osteochondritis dissecans. Tunnel-view radiograph showing an osteochondral lesion of the medial femoral condyle.
Osteochondritis dissecans. Postoperative MRI coronal view showing pinning of the osteochondral defect.
Osteochondritis dissecans. Postoperative MRI coronal view showing pinning of the osteochondral defect.
Osteochondritis dissecans. Postoperative MRI sagittal view showing pinning of the osteochondral defect.
 
 
 
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