Osteochondral defect

Osteochondral defects are focal areas of articular damage with cartilage damage and injury of the adjacent subchondral bone. It is a term that encompasses osteochondritis dissecans and is used synonymously with osteochondral injury/defect in the paediatric population.

The recognised sites of osteochondral defects are:

  • femoral condyle (most common)
  • humeral head
  • talus
  • capitellum of the humerus
Causes

Osteochondral injuries are graded according to the stability and location of the fragment and presence of secondary degenerative changes (see: osteochondral injury staging).

Plain radiograph and CT

Both x-rays and CT are able to detect displaced defects with ease. However, they are insensitive in grading lower stage lesions and are inadequate in predicting stability.

MRI

MRI is the modality of choice, with high sensitivity and specificity for the detection of separation of the osteochondral fragment (see: osteochondral injury staging and osteochondritis dissecans surgical staging). This is essential in determining management.

  • T1
    • signal is variable with intermediate to low signal adjacent to fragment and variable fragment signal
  • T2
    • high signal line (rim sign) demarcating fragment from bone usually indicates an unstable lesion, however, false positives can result from oedema
    • low signal loose bodies, outlined by high signal fluid
    • donor defect filled with high signal fluid
    • high signal subchondral cysts

Treatment depends on the location and size of the defect as well as presence of secondary degenerative changes. When the latter is present, then joint replacement is often the only feasible treatment.

At earlier stages (stage 1 to 4), a number of options exist including:

  • osteochondral autograft (same patient)
  • osteochondral allografts (cadaveric donor)
  • subchondral bone drilling
  • chondral shaving and abrasion

Knee pathology

The knee is a complex synovial joint that can be affected by a range of pathologies:

Arthritides
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Article Information

rID: 1795
Section: Pathology
Synonyms or Alternate Spellings:
  • Osteochondral defects
  • Osteochondral defects (OCD's)
  • Osteochondral defect (OCD)

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Cases and Figures

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    Figure 1: Berndt and Harty classification for talus
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    Osteochondral Def...
     Case 1
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    Case 2: T2
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    Osteochondral def...
    Case 3
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     Case 4
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     Case 5: talar dome
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    Case 6
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    Case 7: talar dome
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    Case 8: talar dome - with AVN
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    Case 9
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    Case 10: lateral talar dome
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    Case 11
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    Case 12: medial talar dome
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    Talar osteochondral defect
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