Osteochondral injury staging

Last revised by Dr Jeremy Jones on 25 Sep 2021

Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.

  • stage I
    • injury limited to articular cartilage
    • MRI findings: subchondral edema
    • x-ray findings: none
  • stage II
    • cartilage injury with associated subchondral fracture but without detachment
    • thin sclerotic margin
    • x-ray findings: usually none; may see fracture as sclerotic or osteopenic area
    • two subtypes 2,3
      • type A: cystic on CT and/or edema on MRI
      • type B: non-displaced and incompletely undercut by fluid (MR) or lucency (CT), with an open connection to the articular cartilage (essentially 2a without edema on MRI)
  • stage III
    • detached, non-displaced fragment
    • MRI findings: high signal around osteochondral fracture (rim sign) but not displaced
    • x-ray findings: slight lucency between osteochondral fragment and remainder of the bone
  • stage IV
    • osteochondral fragment displaced
    • usually joint effusion present, surrounding fragment and filling donor site
    • x-ray findings: increased lucency between osteochondral fragment and remainder of the bone, or loose body with donor site irregularity
  • stage V
    • subchondral cyst formation
    • secondary degenerative change
    • x-ray findings: secondary osteoarthritis

See also

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Cases and figures

  • Figure 1
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  • Case 1: stage II
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  • Case 2: stage III
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  • Case 3: stage III
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  • Case 4: stage IV
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  • Case 5: stage IV
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  • Case 6: stage V
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  • Case 7: stage IV
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  • Case 8: stage IV
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