Semin Musculoskelet Radiol 2014; 18(05): 505-512
DOI: 10.1055/s-0034-1389268
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Osteochondral Lesions in Pediatric and Adolescent Patients

Shahnaz Ghahremani
1   Pediatric Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
,
Rachel Griggs
1   Pediatric Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
,
Theodore Hall
1   Pediatric Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
,
Kambiz Motamedi
2   Musculoskeletal Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
,
M. Ines Boechat
1   Pediatric Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
› Author Affiliations
Further Information

Publication History

Publication Date:
28 October 2014 (online)

Abstract

Osteochondral lesions are acquired, potentially reversible injuries of the subchondral bone with or without associated articular cartilage involvement. Injury results in delamination and potential sequestration of the affected bone. Although an association with mechanical and traumatic factors has been established, the etiology remains poorly understood. These lesions commonly occur in the knee; articular surfaces of the elbow, ankle, hip, and shoulder are also affected. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. Prognosis of these lesions depends on stability, location, and size of the lesion.

Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Many of these lesions are first diagnosed by plain film. MRI adds value by identifying unstable lesions that require surgical intervention. This review focuses on the clinical and imaging features of osteochondral lesions of the knee, elbow, and ankle. Imaging criteria for staging and management are also reviewed.

 
  • References

  • 1 Kocher MS, Tucker R, Ganley TJ, Flynn JM. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 2006; 34 (7) 1181-1191
  • 2 Hefti F, Beguiristain J, Krauspe R , et al. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B 1999; 8 (4) 231-245
  • 3 Edmonds EW, Polousky J. A review of knowledge in osteochondritis dissecans: 123 years of minimal evolution from König to the ROCK study group. Clin Orthop Relat Res 2013; 471 (4) 1118-1126
  • 4 Helms C, Major N, Anderson M, Kaplan P, Dussault R. Musculoskeletal Imaging. 2nd ed. Philadelphia, PA: Saunders Elsevier; 2009: 168-170
  • 5 Gebarski K, Hernandez RJ. Stage-I osteochondritis dissecans versus normal variants of ossification in the knee in children. Pediatr Radiol 2005; 35 (9) 880-886
  • 6 Orth RC. The pediatric knee. Pediatr Radiol 2013; 43 (Suppl. 01) S90-S98
  • 7 Bancroft LW, Pettis C, Wasyliw C, Varich L. Osteochondral lesions of the elbow. Semin Musculoskelet Radiol 2013; 17 (5) 446-454
  • 8 Bae S, Lee HK, Lee K , et al. Comparison of arthroscopic and magnetic resonance imaging findings in osteochondral lesions of the talus. Foot Ankle Int 2012; 33 (12) 1058-1062
  • 9 Bowen RE, Otsuka NY, Yoon ST, Lang P. Osteochondral lesions of the capitellum in pediatric patients: role of magnetic resonance imaging. J Pediatr Orthop 2001; 21 (3) 298-301
  • 10 McKay S, Chen C, Rosenfeld S. Orthopedic perspective on selected pediatric and adolescent knee conditions. Pediatr Radiol 2013; 43 (Suppl. 01) S99-S106
  • 11 Chen CH, Liu YS, Chou PH, Hsieh CC, Wang CK. MR grading system of osteochondritis dissecans lesions: comparison with arthroscopy. Eur J Radiol 2013; 82 (3) 518-525
  • 12 Heywood CS, Benke MT, Brindle K, Fine KM. Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans. Arthroscopy 2011; 27 (2) 194-199
  • 13 Nelson DW, DiPaola J, Colville M, Schmidgall J. Osteochondritis dissecans of the talus and knee: prospective comparison of MR and arthroscopic classifications. J Comput Assist Tomogr 1990; 14 (5) 804-808
  • 14 Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 1959; 41-A: 988-1020
  • 15 Strouse PJ. MRI of the knee: key points in the pediatric population. Pediatr Radiol 2010; 40 (4) 447-452
  • 16 Zellner B, May MM. Elbow injuries in the young athlete—an orthopedic perspective. Pediatr Radiol 2013; 43 (Suppl. 01) S129-S134
  • 17 Tis JE, Edmonds EW, Bastrom T, Chambers HG. Short-term results of arthroscopic treatment of osteochondritis dissecans in skeletally immature patients. J Pediatr Orthop 2012; 32 (3) 226-231
  • 18 Marshall KW, Marshall DL, Busch MT, Williams JP. Osteochondral lesions of the humeral trochlea in the young athlete. Skeletal Radiol 2009; 38 (5) 479-491
  • 19 Pruthi S, Parnell SE, Thapa MM. Pseudointercondylar notch sign: manifestation of osteochondritis dissecans of the trochlea. Pediatr Radiol 2009; 39 (2) 180-183
  • 20 De Smet AA, Fisher DR, Burnstein MI, Graf BK, Lange RH. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. AJR Am J Roentgenol 1990; 154 (3) 555-558
  • 21 O'Farrell TA, Costello BG. Osteochondritis dissecans of the talus. The late results of surgical treatment. J Bone Joint Surg Br 1982; 64 (4) 494-497
  • 22 Hughes JA, Cook JV, Churchill MA, Warren ME. Juvenile osteochondritis dissecans: a 5-year review of the natural history using clinical and MRI evaluation. Pediatr Radiol 2003; 33 (6) 410-417
  • 23 Tabaddor RR, Banffy MB, Andersen JS , et al. Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop 2010; 30 (1) 14-20
  • 24 Gudas R, Simonaityte R, Cekanauskas E, Tamosiūnas R. A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop 2009; 29 (7) 741-748
  • 25 Chang E, Lenczner E. Osteochondritis dissecans of the talar dome treated with an osteochondral autograft. Can J Surg 2000; 43 (3) 217-221