Skip to main content
Erschienen in: Pediatric Radiology 9/2005

01.09.2005 | Original Article

Stage-I osteochondritis dissecans versus normal variants of ossification in the knee in children

verfasst von: Kathleen Gebarski, Ramiro J. Hernandez

Erschienen in: Pediatric Radiology | Ausgabe 9/2005

Einloggen, um Zugang zu erhalten

Abstract

Background: Juvenile osteochondritis dissecans (OCD) has a better prognosis than the adult type. Objective: We postulated that the excellent prognosis of juvenile OCD could be explained, at least in part, by the erroneous diagnosis of some developmental variants of ossification as stage-I OCD. Materials and methods: Knee MRIs of 38 children, ages 7.5–17.7 years (mean and median age 13 years), were retrospectively reviewed to look for features that might separate normal variants of ossification from stage-I OCD. These included age, gender, site, configuration of the lesion, residual cartilaginous model and presence of edema. Results: Twenty-three patients (32 condyles) had ossification defects with intact articular cartilage suggestive of stage-I lesions. No stage-II lesions were seen in the posterior femoral condyles. Accessory ossification centers were seen in 11/16 posterior condyles and 3/16 central condyles. Spiculation of existing ossification was seen in 12/16 posterior condylar lesions and 1/16 central condyles. There was a predominance of accessory ossifications and spiculations in the patients with 10% or greater residual cartilaginous model. No edema signal greater than diaphyseal red-marrow signal was seen in the posterior condyles. Clinical follow-up ranged from 0.5 to 38 months, with clinical improvement in 22 out of 23 patients. Conclusion: Inclusion of normal variants in the stage-I OCD category might explain, in part, the marked difference in published outcome between the juvenile and adult forms of OCD. Ossification defects in the posterior femoral condyles with intact overlying articular cartilage, accessory ossification centers, spiculation, residual cartilaginous model, and lack of bone-marrow edema are features of developmental variants rather than OCD.
Literatur
1.
Zurück zum Zitat Bradley J, Dandy DJ (1989) Osteochondritis dissecans and other lesions of the femoral condyles. J Bone Joint Surg Br 71:518–522PubMed Bradley J, Dandy DJ (1989) Osteochondritis dissecans and other lesions of the femoral condyles. J Bone Joint Surg Br 71:518–522PubMed
2.
Zurück zum Zitat Schenck RC Jr, Goodnight JM (1996) Current concept review—osteochondritis dissecans. J Bone Joint Surg Am 78:439–456PubMed Schenck RC Jr, Goodnight JM (1996) Current concept review—osteochondritis dissecans. J Bone Joint Surg Am 78:439–456PubMed
3.
Zurück zum Zitat Yoshida S, Ikata T, Takai H, et al (1998) Osteochondritis dissecans of the femoral condyle in the growth stage. Clin Orthop 346:162–170PubMed Yoshida S, Ikata T, Takai H, et al (1998) Osteochondritis dissecans of the femoral condyle in the growth stage. Clin Orthop 346:162–170PubMed
4.
Zurück zum Zitat Bohndorf K (1998) Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification. Eur Radiol 8:103–112 Bohndorf K (1998) Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification. Eur Radiol 8:103–112
5.
Zurück zum Zitat Cahill BR, Phillips MR, Navarro R (1989) The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy. Am J Sports Med 17:601–606PubMed Cahill BR, Phillips MR, Navarro R (1989) The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy. Am J Sports Med 17:601–606PubMed
6.
Zurück zum Zitat Harding WG III (1977) Diagnosis of osteochondritis dissecans of the femoral condyles. Clin Orthop 123:25–26PubMed Harding WG III (1977) Diagnosis of osteochondritis dissecans of the femoral condyles. Clin Orthop 123:25–26PubMed
7.
Zurück zum Zitat Hughston JC, Hergenroeder PT, Courtenay BG (1984) Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 66:1340–1348PubMed Hughston JC, Hergenroeder PT, Courtenay BG (1984) Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 66:1340–1348PubMed
8.
Zurück zum Zitat Pyle SI, Hoerr NL (1969) A radiographic standard of reference for the growing knee. Thomas, Springfield, pp 43–111 Pyle SI, Hoerr NL (1969) A radiographic standard of reference for the growing knee. Thomas, Springfield, pp 43–111
9.
Zurück zum Zitat Ribbing S (1955) The hereditary multiple epiphyseal disturbance and its consequences for the aetiogenesis of local malacias, particularly the osteochondrosis dissecans. Acta Orthoped Scand 24:286–299 Ribbing S (1955) The hereditary multiple epiphyseal disturbance and its consequences for the aetiogenesis of local malacias, particularly the osteochondrosis dissecans. Acta Orthoped Scand 24:286–299
10.
Zurück zum Zitat Sontag LW, Pyle SI (1941) Variations in the calcification pattern in epiphyses. AJR 45:50–54 Sontag LW, Pyle SI (1941) Variations in the calcification pattern in epiphyses. AJR 45:50–54
11.
Zurück zum Zitat Caffey J, Madell SH, Royer C, et al (1958) Ossification of the distal femoral epiphysis. J Bone Joint Surg Am 40:647–654PubMed Caffey J, Madell SH, Royer C, et al (1958) Ossification of the distal femoral epiphysis. J Bone Joint Surg Am 40:647–654PubMed
12.
Zurück zum Zitat Federico DJ, Lynch JK, Jokl P (1990) Osteochondritis dissecans of the knee: a historical review of etiology and treatment. Arthroscopy 6:190–197PubMed Federico DJ, Lynch JK, Jokl P (1990) Osteochondritis dissecans of the knee: a historical review of etiology and treatment. Arthroscopy 6:190–197PubMed
13.
Zurück zum Zitat Nelson DW, DiPaola J, Colville M, et al (1990) Osteochondritis dissecans of the talus and knee: prospective comparison of MR and arthroscopic classifications. J Comput Assist Tomogr 14:804–808PubMed Nelson DW, DiPaola J, Colville M, et al (1990) Osteochondritis dissecans of the talus and knee: prospective comparison of MR and arthroscopic classifications. J Comput Assist Tomogr 14:804–808PubMed
14.
Zurück zum Zitat Dipaola JD, Nelson DW, Colville MR (1991) Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 7:101–104PubMed Dipaola JD, Nelson DW, Colville MR (1991) Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 7:101–104PubMed
15.
Zurück zum Zitat De Smet AA, Ilahi OA, Graf BK (1996) Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol 25:159–163CrossRefPubMed De Smet AA, Ilahi OA, Graf BK (1996) Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol 25:159–163CrossRefPubMed
16.
Zurück zum Zitat De Smet AA, Fisher DR, Graf BK, et al (1990) Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. AJR 155:549–553PubMed De Smet AA, Fisher DR, Graf BK, et al (1990) Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. AJR 155:549–553PubMed
17.
Zurück zum Zitat O’Connor MA, Palaniappan M, Khan N, et al (2002) Osteochondritis dissecans of the knee in children: a comparison of MRI and arthroscopic findings. J Bone Joint Surg Br 84B:258–262CrossRefPubMed O’Connor MA, Palaniappan M, Khan N, et al (2002) Osteochondritis dissecans of the knee in children: a comparison of MRI and arthroscopic findings. J Bone Joint Surg Br 84B:258–262CrossRefPubMed
18.
Zurück zum Zitat Löfgren L (1953) Spontaneous healing of osteochondritis dissecans in children and adolescents. Acta Chir Scand CVI:460–478 Löfgren L (1953) Spontaneous healing of osteochondritis dissecans in children and adolescents. Acta Chir Scand CVI:460–478
19.
Zurück zum Zitat Green WT, Banks HH (1953) Osteochondritis dissecans in children. J Bone Joint Surg Am 35:26–47PubMed Green WT, Banks HH (1953) Osteochondritis dissecans in children. J Bone Joint Surg Am 35:26–47PubMed
20.
Zurück zum Zitat Green JP (1966) Osteochondritis dissecans of the knee. J Bone Joint Surg Br 48:82–91PubMed Green JP (1966) Osteochondritis dissecans of the knee. J Bone Joint Surg Br 48:82–91PubMed
21.
Zurück zum Zitat Mubarak SJ, Carroll NC (1981) Juvenile osteochondritis dissecans of the knee: etiology. Clin Orthop 157:200–211PubMed Mubarak SJ, Carroll NC (1981) Juvenile osteochondritis dissecans of the knee: etiology. Clin Orthop 157:200–211PubMed
22.
Zurück zum Zitat Langer F, Percy EC (1971) Osteochondritis dissecans and anomalous centers of ossification: a review of 80 lesions in 61 patients. Can J Surg 14:208–215PubMed Langer F, Percy EC (1971) Osteochondritis dissecans and anomalous centers of ossification: a review of 80 lesions in 61 patients. Can J Surg 14:208–215PubMed
23.
Zurück zum Zitat Linden B (1977) Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 59:769–776PubMed Linden B (1977) Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 59:769–776PubMed
24.
Zurück zum Zitat Nawata K, Teshima R, Morio Y, et al (1999) Anomalies of ossification in the posterolateral femoral condyle: assessment by MRI. Pediatr Radiol 29:781–784CrossRefPubMed Nawata K, Teshima R, Morio Y, et al (1999) Anomalies of ossification in the posterolateral femoral condyle: assessment by MRI. Pediatr Radiol 29:781–784CrossRefPubMed
25.
Zurück zum Zitat Outerbridge RE (1981) Osteochondritis dissecans of the posterior femoral condyle. Clin Orthop 175:121–129 Outerbridge RE (1981) Osteochondritis dissecans of the posterior femoral condyle. Clin Orthop 175:121–129
Metadaten
Titel
Stage-I osteochondritis dissecans versus normal variants of ossification in the knee in children
verfasst von
Kathleen Gebarski
Ramiro J. Hernandez
Publikationsdatum
01.09.2005
Erschienen in
Pediatric Radiology / Ausgabe 9/2005
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-005-1507-6

Weitere Artikel der Ausgabe 9/2005

Pediatric Radiology 9/2005 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.