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Osteochondral Injury, Knee
Kirkland W. Davis, MD, FACR; Donna G. Blankenbaker, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Osteochondral fracture (OCF), osteochondritis dissecans (OCD), osteochondral lesion (OCL)
            • Definitions

              • 2 types
                • Acute OCF: traumatic injury creating impaction or nonimpacted fracture of cartilage and bone
                  • Nonimpacted: often due to shear injury, fragment of bone and overlying cartilage may displace or remain in situ
                    • e.g., transient patella dislocation (TPD)
                • OCD: idiopathic focal abnormality of subchondral bone, causes isolation of portion of bone and overlying cartilage
                  • May lead to unstable fragment and early osteoarthritis (OA)
              • OCL: generic term for any injury isolating fragment of bone and cartilage; includes OCF and OCD
              • Progeny fragment: isolated fragment of bone and cartilage, usually in OCD
              • Parent bone: remainder of bone from which progeny fragment isolated
              • Juvenile OCD = skeletally immature; physes open
              • Adult OCD = skeletally mature; physes fused

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      • Etiology

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Reporting Tips

                                            Selected References

                                            1. Accadbled F et al: Osteochondritis dissecans of the knee. Orthop Traumatol Surg Res. 104(1S):S97-105, 2018
                                            2. Bruns J et al: Osteochondritis dissecans: etiology, pathology, and imaging with a special focus on the knee joint. Cartilage. 9(4):346-62, 2018
                                            3. Gorbachova T et al: Osteochondral lesions of the knee: differentiating the most common entities at MRI. Radiographics. 38(5):1478-95, 2018
                                            4. Wall EJ et al: Novel radiographic feature classification of knee osteochondritis dissecans: a multicenter reliability study. Am J Sports Med. 43(2):303-9, 2015
                                            5. Ghahremani S et al: Osteochondral lesions in pediatric and adolescent patients. Semin Musculoskelet Radiol. 18(5):505-12, 2014
                                            6. Zbojniewicz AM et al: Imaging of osteochondritis dissecans. Clin Sports Med. 33(2):221-50, 2014
                                            7. Jans LB et al: MRI differentiates femoral condylar ossification evolution from osteochondritis dissecans. A new sign. Eur Radiol. 21(6):1170-9, 2011
                                            8. Uozumi H et al: Histologic findings and possible causes of osteochondritis dissecans of the knee. Am J Sports Med. 37(10):2003-8, 2009
                                            9. Kijowski R et al: Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology. 248(2):571-8, 2008
                                            10. Potter HG et al: Magnetic resonance imaging of cartilage repair. Sports Med Arthrosc. 16(4):236-45, 2008
                                            11. Walsh SJ et al: Large osteochondral fractures of the lateral femoral condyle in the adolescent: outcome of bioabsorbable pin fixation. J Bone Joint Surg Am. 90(7):1473-8, 2008
                                            12. Ramnath RR et al: MR appearance of SONK-like subchondral abnormalities in the adult knee: SONK redefined. Skeletal Radiol. 33(10):575-81, 2004
                                            13. Alleyne KR et al: Management of osteochondral injuries of the knee. Clin Sports Med. 20(2):343-64, 2001
                                            14. Cain EL et al: Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med. 20(2):321-42, 2001
                                            15. Farmer JM et al: Chondral and osteochondral injuries. Diagnosis and management. Clin Sports Med. 20(2):299-320, 2001
                                            16. Loredo R et al: Imaging of osteochondral injuries. Clin Sports Med. 20(2):249-78, 2001
                                            17. Sledge SL: Microfracture techniques in the treatment of osteochondral injuries. Clin Sports Med. 20(2):365-77, 2001
                                            18. Tamburrini O et al: ["Occult" posttraumatic lesions of the knee: can magnetic resonance substitute for diagnostic arthroscopy?.] Radiol Med. 94(5):433-9, 1997
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Osteochondral fracture (OCF), osteochondritis dissecans (OCD), osteochondral lesion (OCL)
                                                      • Definitions

                                                        • 2 types
                                                          • Acute OCF: traumatic injury creating impaction or nonimpacted fracture of cartilage and bone
                                                            • Nonimpacted: often due to shear injury, fragment of bone and overlying cartilage may displace or remain in situ
                                                              • e.g., transient patella dislocation (TPD)
                                                          • OCD: idiopathic focal abnormality of subchondral bone, causes isolation of portion of bone and overlying cartilage
                                                            • May lead to unstable fragment and early osteoarthritis (OA)
                                                        • OCL: generic term for any injury isolating fragment of bone and cartilage; includes OCF and OCD
                                                        • Progeny fragment: isolated fragment of bone and cartilage, usually in OCD
                                                        • Parent bone: remainder of bone from which progeny fragment isolated
                                                        • Juvenile OCD = skeletally immature; physes open
                                                        • Adult OCD = skeletally mature; physes fused

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                • Etiology

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Accadbled F et al: Osteochondritis dissecans of the knee. Orthop Traumatol Surg Res. 104(1S):S97-105, 2018
                                                                                      2. Bruns J et al: Osteochondritis dissecans: etiology, pathology, and imaging with a special focus on the knee joint. Cartilage. 9(4):346-62, 2018
                                                                                      3. Gorbachova T et al: Osteochondral lesions of the knee: differentiating the most common entities at MRI. Radiographics. 38(5):1478-95, 2018
                                                                                      4. Wall EJ et al: Novel radiographic feature classification of knee osteochondritis dissecans: a multicenter reliability study. Am J Sports Med. 43(2):303-9, 2015
                                                                                      5. Ghahremani S et al: Osteochondral lesions in pediatric and adolescent patients. Semin Musculoskelet Radiol. 18(5):505-12, 2014
                                                                                      6. Zbojniewicz AM et al: Imaging of osteochondritis dissecans. Clin Sports Med. 33(2):221-50, 2014
                                                                                      7. Jans LB et al: MRI differentiates femoral condylar ossification evolution from osteochondritis dissecans. A new sign. Eur Radiol. 21(6):1170-9, 2011
                                                                                      8. Uozumi H et al: Histologic findings and possible causes of osteochondritis dissecans of the knee. Am J Sports Med. 37(10):2003-8, 2009
                                                                                      9. Kijowski R et al: Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability. Radiology. 248(2):571-8, 2008
                                                                                      10. Potter HG et al: Magnetic resonance imaging of cartilage repair. Sports Med Arthrosc. 16(4):236-45, 2008
                                                                                      11. Walsh SJ et al: Large osteochondral fractures of the lateral femoral condyle in the adolescent: outcome of bioabsorbable pin fixation. J Bone Joint Surg Am. 90(7):1473-8, 2008
                                                                                      12. Ramnath RR et al: MR appearance of SONK-like subchondral abnormalities in the adult knee: SONK redefined. Skeletal Radiol. 33(10):575-81, 2004
                                                                                      13. Alleyne KR et al: Management of osteochondral injuries of the knee. Clin Sports Med. 20(2):343-64, 2001
                                                                                      14. Cain EL et al: Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med. 20(2):321-42, 2001
                                                                                      15. Farmer JM et al: Chondral and osteochondral injuries. Diagnosis and management. Clin Sports Med. 20(2):299-320, 2001
                                                                                      16. Loredo R et al: Imaging of osteochondral injuries. Clin Sports Med. 20(2):249-78, 2001
                                                                                      17. Sledge SL: Microfracture techniques in the treatment of osteochondral injuries. Clin Sports Med. 20(2):365-77, 2001
                                                                                      18. Tamburrini O et al: ["Occult" posttraumatic lesions of the knee: can magnetic resonance substitute for diagnostic arthroscopy?.] Radiol Med. 94(5):433-9, 1997