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Semin Musculoskelet Radiol 2018; 22(01): 057-065
DOI: 10.1055/s-0037-1608006
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pediatric Osteochondral Lesions

Selwan B. Abdullah
1   Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
,
Ramesh S. Iyer
2   Department of Radiology, Seattle Children's Hospital, Seattle, Washington
,
Narendra S. Shet
3   Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2018 (online)

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Abstract

Osteochondral lesions are common in children and may arise from a variety of etiologies. Although they most frequently occur in the knee, other joints may be involved including the ankle and elbow. We describe the typical imaging appearance of osteochondral lesions with a focus on radiographs and magnetic resonance imaging. Assessment of the stability of these lesions is of paramount importance in directing management. As such, we describe staging schemes as well as imaging features differentiating stable from unstable lesions. Finally, we briefly discuss management strategies as they correlate to imaging findings.

Keywords

pediatric - bone lesions - osteochondral lesions - magnetic resonance imaging - osteochondral defects
 

  • References

  • 1 Kessler JI, Nikizad H, Shea KG, Jacobs Jr JC, Bebchuk JD, Weiss JM. The demographics and epidemiology of osteochondritis dissecans of the knee in children and adolescents. Am J Sports Med 2014; 42 (02) 320-326
    CrossrefPubMedGoogle Scholar
  • 2 McElroy MJ, Riley PM, Tepolt FA, Nasreddine AY, Kocher MS. Catcher's knee: posterior femoral condyle juvenile osteochondritis dissecans in children and adolescents. J Pediatr Orthop 2016
    PubMedGoogle Scholar
  • 3 Ghahremani S, Griggs R, Hall T, Motamedi K, Boechat MI. Osteochondral lesions in pediatric and adolescent patients. Semin Musculoskelet Radiol 2014; 18 (05) 505-512
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Kocher MS, Tucker R, Ganley TJ, Flynn JM. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 2006; 34 (07) 1181-1191
    PubMedGoogle Scholar
  • 5 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 (04) 1118-1126
    CrossrefPubMedGoogle Scholar
  • 6 Chiroff RT, Cooke III CP. Osteochondritis dissecans: a histologic and microradiographic analysis of surgically excised lesions. J Trauma 1975; 15 (08) 689-696
    CrossrefPubMedGoogle Scholar
  • 7 Perumal V, Wall E, Babekir N. Juvenile osteochondritis dissecans of the talus. J Pediatr Orthop 2007; 27 (07) 821-825
    CrossrefPubMedGoogle Scholar
  • 8 Wall E, Von Stein D. Juvenile osteochondritis dissecans. Orthop Clin North Am 2003; 34 (03) 341-353
    CrossrefPubMedGoogle Scholar
  • 9 De Smet AA, Ilahi OA, Graf BK. Untreated osteochondritis dissecans of the femoral condyles: prediction of patient outcome using radiographic and MR findings. Skeletal Radiol 1997; 26 (08) 463-467
    CrossrefPubMedGoogle Scholar
  • 10 Bohndorf K. Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification. Eur Radiol 1998; 8 (01) 103-112
    CrossrefPubMedGoogle Scholar
  • 11 Kramer J, Stiglbauer R, Engel A, Prayer L, Imhof H. MR contrast arthrography (MRA) in osteochondrosis dissecans. J Comput Assist Tomogr 1992; 16 (02) 254-260
    CrossrefPubMedGoogle Scholar
  • 12 Saupe N, Zanetti M, Pfirrmann CWA, Wels T, Schwenke C, Hodler J. Pain and other side effects after MR arthrography: prospective evaluation in 1085 patients. Radiology 2009; 250 (03) 830-838
    CrossrefPubMedGoogle Scholar
  • 13 Giaconi JC, Link TM, Vail TP. , et al. Morbidity of direct MR arthrography. AJR Am J Roentgenol 2011; 196 (04) 868-874
    CrossrefPubMedGoogle Scholar
  • 14 Samora WP, Chevillet J, Adler B, Young GS, Klingele KE. Juvenile osteochondritis dissecans of the knee: predictors of lesion stability. J Pediatr Orthop 2012; 32 (01) 1-4
    CrossrefPubMedGoogle Scholar
  • 15 Wu Y-Y, Orth RC, Guillerman RP, Zhang W, Kan JH. Marginal value of radiographs in the interpretation of MR images obtained for pediatric knee pain. AJR Am J Roentgenol 2013; 200 (04) 891-894
    CrossrefPubMedGoogle Scholar
  • 16 Cahill BR, Berg BC. 99m-Technetium phosphate compound joint scintigraphy in the management of juvenile osteochondritis dissecans of the femoral condyles. Am J Sports Med 1983; 11 (05) 329-335
    CrossrefPubMedGoogle Scholar
  • 17 Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 1959; 41-A (06) 988-1020
    CrossrefPubMedGoogle Scholar
  • 18 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 (05) 804-808
    CrossrefPubMedGoogle Scholar
  • 19 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 (04) 231-245
    PubMedGoogle Scholar
  • 20 Chen C-H, Liu Y-S, Chou P-H, Hsieh C-C, Wang C-K. MR grading system of osteochondritis dissecans lesions: comparison with arthroscopy. Eur J Radiol 2013; 82 (03) 518-525
    CrossrefPubMedGoogle Scholar
  • 21 Jacobs Jr JC, Archibald-Seiffer N, Grimm NL, Carey JL, Shea KG. A review of arthroscopic classification systems for osteochondritis dissecans of the knee. Orthop Clin North Am 2015; 46 (01) 133-139
    CrossrefPubMedGoogle Scholar
  • 22 Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 58-69
    PubMedGoogle Scholar
  • 23 Ellermann JM, Donald B, Rohr S. , et al. Magnetic resonance imaging of osteochondritis dissecans: validation study for the ICRS classification system. Acad Radiol 2016; 23 (06) 724-729
    CrossrefPubMedGoogle Scholar
  • 24 Aglietti P, Buzzi R, Bassi PB, Fioriti M. Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy 1994; 10 (03) 286-291
    CrossrefPubMedGoogle Scholar
  • 25 Milgram JW. Radiological and pathological manifestations of osteochondritis dissecans of the distal femur. A study of 50 cases. Radiology 1978; 126 (02) 305-311
    CrossrefPubMedGoogle Scholar
  • 26 Gebarski K, Hernandez RJ. Stage-I osteochondritis dissecans versus normal variants of ossification in the knee in children. Pediatr Radiol 2005; 35 (09) 880-886
    CrossrefPubMedGoogle Scholar
  • 27 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 (03) 555-558
    CrossrefPubMedGoogle Scholar
  • 28 Kumai T, Takakura Y, Higashiyama I, Tamai S. Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 1999; 81 (09) 1229-1235
    CrossrefPubMedGoogle Scholar
  • 29 O'Farrell TA, Costello BG. Osteochondritis dissecans of the talus. The late results of surgical treatment. J Bone Joint Surg Br 1982; 64 (04) 494-497
    CrossrefPubMedGoogle Scholar
  • 30 Chang GH, Paz DA, Dwek JR, Chung CB. Lower extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment. Clin Imaging 2013; 37 (05) 836-846
    CrossrefPubMedGoogle Scholar
  • 31 Canale ST, Belding RH. Osteochondral lesions of the talus. J Bone Joint Surg Am 1980; 62 (01) 97-102
    CrossrefPubMedGoogle Scholar
  • 32 Letts M, Davidson D, Ahmer A. Osteochondritis dissecans of the talus in children. J Pediatr Orthop 2003; 23 (05) 617-625
    CrossrefPubMedGoogle Scholar
  • 33 Higuera J, Laguna R, Peral M, Aranda E, Soleto J. Osteochondritis dissecans of the talus during childhood and adolescence. J Pediatr Orthop 1998; 18 (03) 328-332
    PubMedGoogle Scholar
  • 34 Bruns J, Rosenbach B. Osteochondrosis dissecans of the talus. Comparison of results of surgical treatment in adolescents and adults. Arch Orthop Trauma Surg 1992; 112 (01) 23-27
    CrossrefPubMedGoogle Scholar
  • 35 Zellner B, May MM. Elbow injuries in the young athlete—an orthopedic perspective. Pediatr Radiol 2013; 43 (Suppl. 01) S129-S134
    CrossrefPubMedGoogle Scholar
  • 36 Marshall KW, Marshall DL, Busch MT, Williams JP. Osteochondral lesions of the humeral trochlea in the young athlete. Skeletal Radiol 2009; 38 (05) 479-491
    CrossrefPubMedGoogle Scholar
  • 37 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 (03) 298-301
    PubMedGoogle Scholar
  • 38 Delgado J, Jaramillo D, Chauvin NA. Imaging the injured pediatric athlete: upper extremity. Radiographics 2016; 36 (06) 1672-1687
    CrossrefPubMedGoogle Scholar
  • 39 Pruthi S, Parnell SE, Thapa MM. Pseudointercondylar notch sign: manifestation of osteochondritis dissecans of the trochlea. Pediatr Radiol 2009; 39 (02) 180-183
    CrossrefPubMedGoogle Scholar
  • 40 Cahill BR. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg 1995; 3 (04) 237-247
    CrossrefPubMedGoogle Scholar
  • 41 Hughston JC, Hergenroeder PT, Courtenay BG. Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 1984; 66 (09) 1340-1348
    CrossrefPubMedGoogle Scholar
  • 42 Smillie IS. Treatment of osteochondritis dissecans. J Bone Joint Surg Br 1957; 39-B (02) 248-260
    CrossrefPubMedGoogle Scholar
  • 43 Ewing JW, Voto SJ. Arthroscopic surgical management of osteochondritis dissecans of the knee. Arthroscopy 1988; 4 (01) 37-40
    CrossrefPubMedGoogle Scholar
  • 44 Guhl JF. Arthroscopic treatment of osteochondritis dissecans. Clin Orthop Relat Res 1982; (167) 65-74
    PubMedGoogle Scholar