Osteochondral defects (OCD) or lesions (OCL) are focal areas of articular cartilage damage and injury of the adjacent subchondral bone plate and subchondral cancellous bone.
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Terminology
Osteochondral defect is a broad term that describes the morphological changes associated to a localized gap in the articular cartilage and subchondral bone 5. It is often used synonymously with osteochondral injury/defect and in the pediatric population. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.
Please note that OCD is a commonly used abbreviation for both osteochondral defect and osteochondritis dissecans, two closely related conditions.
Pathology
Etiology
osteochondritis dissecans: thought to be due to repeated microtrauma
articular collapse secondary to osteonecrosis or subchondral insufficiency fracture
postsurgical (e.g. following anterior cruciate ligament reconstruction)
Location
The recognized sites of osteochondral defects are:
femoral condyle (most common in the lateral aspect of the medial femoral condyle)
capitellum of the humerus
Staging
Osteochondral injuries are graded according to the stability and location of the fragment and presence of secondary degenerative changes (see: osteochondral injury staging).
Radiographic features
Plain radiograph and CT
Both x-rays and CT are able to detect displaced defects with ease. However, they are insensitive to 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.
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T1
the signal is variable with intermediate to low signal adjacent to fragment and variable fragment signal
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T2
high signal line (rim sign) demarcating fragment from bone usually indicates an unstable lesion, however, false positives can result from edema
low signal loose bodies, outlined by high signal fluid
donor defect filled with high signal fluid
high signal subchondral cysts
Treatment and prognosis
Treatment depends on the location and size of the defect as well as the 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 allograft (cadaveric donor)
subchondral bone drilling
chondral shaving and abrasion
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