Subchondral bone plate disruptions are evident (arrowheads in c and d) and are best depicted on the CT image (d). Histological evaluation of juvenile osteochondritis dissecans of the knee: a case series, Histologic findings and possible causes of osteochondritis dissecans of the knee, Hypothesis--a diagram of the form and origin of loose bodies in osteochondritis dissecans, Intact bone vitality and increased accumulation of nonmineralized bone matrix in biopsy specimens of juvenile osteochondritis dissecans: a histological analysis, Juvenile osteochondritis dissecans: correlation between histopathology and MRI, Osteochondritis dissecans of the knee: a clinical survey, Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society, Novel radiographic feature classification of knee osteochondritis dissecans: a multicenter reliability study, Insights into the epiphyseal cartilage origin and subsequent osseous manifestation of juvenile osteochondritis dissecans with a modified clinical MR imaging protocol: a pilot study, Stage-I osteochondritis dissecans versus normal variants of ossification in the knee in children, MRI differentiates femoral condylar ossification evolution from osteochondritis dissecans: a new sign, Management of osteochondritis dissecans of the femoral condyle, Treatment algorithm for osteochondritis dissecans of the knee, Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects, Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle, Juvenile versus adult osteochondritis dissecans of the knee: appropriate MR imaging criteria for instability, Novel arthroscopic classification of osteochondritis dissecans of the knee: a multicenter reliability study, Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings, Bone marrow edema pattern in advanced hip osteoarthritis: quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology, Magnetic resonance imaging of subchondral bone marrow lesions in association with osteoarthritis, Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint, Prevalence and MRI-anatomic correlation of bone cysts in osteoarthritic knees, The bone cysts of osteoarthritis, The cysts of osteoarthritis of the hip; a radiological and pathological study, MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts, Subchondral cystlike lesions develop longitudinally in areas of bone marrow edema-like lesions in patients with or at risk for knee osteoarthritis: detection with MR imaging—the MOST study, Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: the MOST study: a longitudinal multicentre study of knee osteoarthritis, Subchondral bone marrow lesions are highly associated with, and predict subchondral bone attrition longitudinally: the MOST study, The association between subchondral bone cysts and tibial cartilage volume and risk of joint replacement in people with knee osteoarthritis: a longitudinal study, Radiographic evaluation of osteoarthritis, Osteoarthritis of the knee: correlation of subchondral MR signal abnormalities with histopathologic and radiographic features, Open in Image Subchondral bone plate collapse, demonstrated by the presence of a frank depression or a fluid-filled cleft, can be seen in advanced stages of both AVN and SIF, indicating irreversibility. Radiographs, coronal T1-weighted images, proton-density–weighted fat-suppressed images, and sagittal proton-density–weighted images (left to right in rows a and b) were obtained at the onset of knee pain (a) and 7 years later (b). Advanced SIF in a 69-year-old woman with several months of unrelenting knee pain after walking down stairs. Subchondral hypointense fracture lines tend to resolve with conservative therapy and can be seen in patients with transient reversible SIF and in 78% of those with clinical SONK. With regard to true primary osteonecrosis of the knee, general imaging principles of primary osteonecrosis can be applied, and some features established in studies of AVN of the hip can be extrapolated (19,29). Figure 4a. These are essential findings to acknowledge in patients with acute traumatic injuries and SIF. (a) Coronal proton-density–weighted fat-suppressed image shows an extensive bone marrow edema pattern involving the medial femoral condyle (*), accompanied by a subchondral area of low signal intensity (arrowhead) located immediately subjacent to a subchondral bone plate, producing its apparent thickening. The distal femoral physis is closed (*). Figure 5a. Although there is evidence that both mechanisms may operate together, results of recent studies (71,72) support the bone contusion theory of osteoarthritis by showing that subchondral cysts arise in preexisting regions of subchondral bone marrow edema-like lesions, and their development is predicted much more strongly by bone marrow edema-like lesions than by full-thickness cartilage loss (71,72). Figure 14a. (b–d) Sagittal T2-weighted fat-suppressed MR image (b), proton-density–weighted MR image (c), and CT image (d) show a curvilinear fracture (arrow in b and c) encircling a portion of subchondral bone and overlying cartilage. Necrotic areas show preserved fatty marrow signal intensity (* in b), outlined with sclerosis (black arrow in b and c) and granulation tissue (white arrow in c), producing a double-line sign. Although there is evidence that both mechanisms may operate together, results of recent studies (71,72) support the bone contusion theory of osteoarthritis by showing that subchondral cysts arise in preexisting regions of subchondral bone marrow edema-like lesions, and their development is predicted much more strongly by bone marrow edema-like lesions than by full-thickness cartilage loss (71,72). Figure 4d. Healing juvenile OCD in a 13-year-old boy. The edema spares the devascularized infarcted segment. Figure 12b. A bone contusion (* in b) is visible at the posterior aspect of the lateral tibial plateau. Subchondral fracture in a 32-year-old man with an acute medial collateral ligament tear (arrow in d) and an anterior cruciate ligament rupture (not shown). The spectrum of acute traumatic injuries to the articular surface of the bone includes bone bruises and chondral, subchondral, and osteochondral fractures. Focal discontinuity of the subchondral bone plate is seen (arrowhead). Sagittal proton-density–weighted (a) and T2-weighted fat-suppressed (b) MR images of the medial femoral condyle show subchondral cystlike lesions (arrow) and bone marrow edema-like lesions (* in b). Advanced SIF in a 69-year-old woman with several months of unrelenting knee pain after walking down stairs. Classic SIF in a 64-year-old man. If the lesion consists of a distinct subchondral region demarcated from the surrounding bone, such demarcation should be examined closely for completeness and the presence of a “double-line sign,” as seen in AVN, and for findings of instability, which are important for proper evaluation of OCD. At MRI, SIF is associated with marked bone marrow edema emanating from the subchondral region and extending over large areas (10,17,18), often involving the entire femoral condyle. An osteochondral lesion is a defect in the cartilage of a joint and the bone underneath. Figure 6a. (a) Diagram shows a fracture that is creating an osteochondral fragment. Note articular surface collapse of the medial femoral condyle (arrowhead in b and c), with depression of the subchondral bone plate (c) and loss of subchondral fatty signal intensity (b). 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. Osteochondral defect is a term for a localized defect of the articular cartilage and subchondral bone. 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