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Chondral and Osteochondral Injury, Ankle
Julia R. Crim, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Osteochondral lesion (OCL): Umbrella term for focal injury of articular cartilage and underlying bone
                • Preferred term, does not indicate chronicity or stage
              • Osteochondral injury: Term used for acute/subacute lesions
              • Osteochondritis dissecans: Chronic OCL
              • Multiple staging systems used
              • Berndt and Harty staging system most widely accepted staging system
                • Stage 1: Subchondral bone bruise, injury to overlying cartilage
                • Stage 2: Crescentic fracture line, stable or partly detached
                • Stage 3: Detached osteochondral fragment, in situ
                • Stage 4: Detached osteochondral fragment, displaced from donor site
                • Stage 5 (later addition to classification, some classify this as 2A): Cystic degeneration of osteochondral fragment
              • Most important features to orthopedic surgeon are lesion size and stability

            IMAGING

            • General Features

              • Radiographic Findings

                • MR Findings

                  • CT Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Natural History & Prognosis

                            • Treatment

                              Selected References

                              1. Kirschke JS et al: Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. Biomed Res Int. 2016:3594253, 2016
                              2. Hembree WC et al: Magnetic resonance imaging features of osteochondral lesions of the talus. Foot Ankle Int. 33(7):591-7, 2012
                              3. Naran KN et al: Osteochondral lesions about the ankle. Radiol Clin North Am. 46(6):995-1002, v, 2008
                              4. De Smet AA et al: Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. AJR Am J Roentgenol. 154(3):555-8, 1990
                              5. Berndt AL et al: Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 41-A:988-1020, 1959
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Top Differential Diagnoses

                                    • Pathology

                                      • Clinical Issues

                                        TERMINOLOGY

                                        • Definitions

                                          • Osteochondral lesion (OCL): Umbrella term for focal injury of articular cartilage and underlying bone
                                            • Preferred term, does not indicate chronicity or stage
                                          • Osteochondral injury: Term used for acute/subacute lesions
                                          • Osteochondritis dissecans: Chronic OCL
                                          • Multiple staging systems used
                                          • Berndt and Harty staging system most widely accepted staging system
                                            • Stage 1: Subchondral bone bruise, injury to overlying cartilage
                                            • Stage 2: Crescentic fracture line, stable or partly detached
                                            • Stage 3: Detached osteochondral fragment, in situ
                                            • Stage 4: Detached osteochondral fragment, displaced from donor site
                                            • Stage 5 (later addition to classification, some classify this as 2A): Cystic degeneration of osteochondral fragment
                                          • Most important features to orthopedic surgeon are lesion size and stability

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • MR Findings

                                              • CT Findings

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          Selected References

                                                          1. Kirschke JS et al: Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. Biomed Res Int. 2016:3594253, 2016
                                                          2. Hembree WC et al: Magnetic resonance imaging features of osteochondral lesions of the talus. Foot Ankle Int. 33(7):591-7, 2012
                                                          3. Naran KN et al: Osteochondral lesions about the ankle. Radiol Clin North Am. 46(6):995-1002, v, 2008
                                                          4. De Smet AA et al: Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. AJR Am J Roentgenol. 154(3):555-8, 1990
                                                          5. Berndt AL et al: Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 41-A:988-1020, 1959