Radiology Teaching Files > Case 157543

Contributed by: Anthony Giauque, Radiologist, University of Washington, Washington, USA.
Patient: 12 year old female
History: 12 year old girl with progressive knee pain.

Fig. 1: Coronal T1 with fat saturation and intra-articular gadolinium

Fig. 2: Coronal T1 with fat saturation and intra-articular gadolinium

Fig. 3: Sagittal T1 with fat saturation and intra-articular gadolinium
Findings: Irregularly marginated lesion in the lateral aspect of the medial epicondyle. The margins are dark on T1 and have a small rim of high signal. Intra-articular gadolinium was injected prior to the study and the sequences are fat-saturated; thus, the high signal is likely a small rim of gadolinium which suggests that the bony button is trying to separate.
Diagnosis: Ostoechondritis dessicans.

Quoted reference:

"Osteochondritis Dissecans of the Knee
Brian M. Ralston, MD; James S. Williams, MD; Bernard R. Bach, Jr, MD; Charles A. Bush-Joseph, MD; William D. Knopp, MD


In Brief: Osteochondritis dissecans is a disorder in which a fragment of cartilage and subchondral bone separates from an articular surface. The etiology is uncertain, although trauma and ischemia have been implicated. The knee is most commonly affected, but the elbow and ankle may also be involved. Patients typically present during their adolescent or early adult years with nonspecific knee pain and swelling that worsens with activity. The diagnosis is confirmed by radiographic findings. Management decisions are based on the patient's age and the stability, location, and size of the lesion....

MRI is useful in OCD management decisions because it provides excellent imaging of the articular surface, helps determine the size and viability of the subchondral bone fragment, and reveals information about fragment stability. In T2-weighted images, a bright signal between the fragment and the subchondral bone is consistent with synovial fluid. This finding indicates that the fragment is unstable and will require surgical treatment. MRI is also useful for evaluating the progress of fragment healing and revascularization."


Please choose from many of the fine references below:

Federico DJ, Lynch JK, Jokl P: Osteochondritis dissecans of the knee: a historical review of etiology and treatment. Arthroscopy 1990;6(3):190-197
Pappas AM: Osteochondrosis dissecans. Clin Orthop 1981;Jul-Aug(158):59-69
Smillie IS: Osteochondritis Dissecans: Loose Bodies in Joints: Etiology, Pathology, Treatment. Edinburgh, Livingstone, 1960
Aichroth P: Osteochondritis dissecans, in Insall JN, et al (eds): Surgery of the Knee, ed 2. New York, Churchill Livingstone, 1993
Green WT, Banks HH: Osteochondritis dissecans in children. J Bone Joint Surg 1990;255:3-12
Stanitski CL: Osteochondritis dissecans of the knee, in: Stanitski CL (ed): Pediatric and Adolescent Sports Medicine. Philadelphia, WB Saunders Co, 1994
Garrett JC: Osteochondritis dissecans. Clin Sports Med 1991;10(3):569-593
Aichroth P: Osteochondritis dissecans of the knee: a clinical survey. J Bone Joint Surg (Br) 1971;53(3):440-447
Mubarak SJ, Carroll NC: Juvenile osteochondritis dissecans of the knee: etiology. Clin Orthop 1981;Jun(157):200-211
Wilson JN: A diagnostic sign in osteochondritis dissecans of the knee. J Bone Joint Surg (Am) 1967;49(3):477-480
Dipaola JD, Nelson DW, Colville MR: Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 1991;7(1):101-104
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(5):329-335
Wu C, Bach BR: Global osteochondritis dissecans of the lateral femoral condyle treated by Herbert screw fixation. Am J Knee Surgery 1993;6(1):24-30
Anderson AF, Lipscomb AB, Coulam C: Antegrade curettement, bone grafting and pinning of osteochondritis dissecans in the skeletally mature knee. Am J Sports Med 1990;18(3):254-261
Slough JA, Noto AM, Schmidt TL: Tibial cortical bone peg fixation in osteochondritis dissecans of the knee. Clin Orthop 1991;Jun(267):122-127

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Additional Details:

Case Number: 157543Last Updated: 2003-09-18
Anatomy: Skeletal System   Pathology: Trauma
Modality: MRAccess Level: Readable by all users
Keywords: osteochondritis dessicans

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