(b) Subsequently, a frank articular collapse (arrowheads) has developed, followed by loss of fatty signal intensity in the necrotic area (arrows). We refer to this band as the subchondral bone plate. The literature on osteonecrosis of femoral condyles is often mixed with and sometimes dedicated entirely to spontaneous osteonecrosis of the knee. (a) Initially, a large area of necrosis shows normal marrow signal intensity that represents mummified fat (black *) outlined with a sclerotic rim (arrows) that is convex to the articular surface. MR imaging of epiphyseal lesions of the knee: current concepts, challenges, and controversies, Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns, Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome, Fat-suppressed T2-weighted MRI appearance of subchondral insufficiency fracture of the femoral head, MRI of subchondral fractures: a review, Subchondral insufficiency fractures of the knee: review of imaging findings, Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy, Osteonecrosis of the knee after arthroscopic surgery: diagnosis with MR imaging, The importance of early diagnosis in spontaneous osteonecrosis of the knee: a case series with six year follow-up, Imaging of osteonecrosis: radiologic-pathologic correlation, Osteonecrosis and transient osteoporosis of the femoral head, MR imaging of avascular necrosis and transient marrow edema of the femoral head, Subchondral avascular necrosis: a common cause of arthritis, The role of sclerotic changes in the starting mechanisms of collapse: a histomorphometric and FEM study on the femoral head of osteonecrosis, Morphological analysis of collapsed regions in osteonecrosis of the femoral head, MRI evaluation of steroid- or alcohol-related osteonecrosis of the femoral condyle, Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis, Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging, Diagnostic performance of MR imaging in the assessment of subchondral fractures in avascular necrosis of the femoral head, Osteonecrosis of the femoral head: using CT, MRI and gross specimen to characterize the location, shape and size of the lesion, Osteochondritis dissecans: editorial comment, AAOS appropriate use criteria: management of osteochondritis dissecans of the femoral condyle, A review of knowledge in osteochondritis dissecans: 123 years of minimal evolution from König to the ROCK study group, American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis and treatment of osteochondritis dissecans, Osteochondritis dissecans 1887-1987: a centennial look at König’s memorable phrase, Studies on hereditary, multiple epiphyseal disorder, Hypertrophy and laminar calcification of cartilage in loose bodies as probable evidence of an ossification abnormality. MRI appearance of the osteochondral junction. Figure 3d. The risk of collapse in the femoral condyle seems to be related directly to the size and location of the infarct: Lesions involving more than one-third of the condyle on midcoronal MR images or the middle and posterior one-third of the condyle on midsagittal MR images are at higher risk of collapse (34). Figure 8b. Figure 18d. Osteoarthritis in a 50-year-old woman. Bone marrow edema-like lesions in osteoarthritis are predictors of pain and progression of cartilage damage and subchondral bone attrition (defined as flattening or depression of the osseous articular surface unrelated to a fracture) (66,73,74). Osteochondral fracture with a subchondral bone plate depression in an 18-year-old man. A saucerized defect of the articular surface may develop in advanced cases (23,24) (Fig 10). ). Viewer. Figure 11a. The clinical significance of AVN largely depends on the likelihood or presence of articular collapse. This MRI scan shows an OCD lesion in the femur of an 18-year-old patient. (a) Radiograph demonstrates the absence of normal ossification in the subchondral area of the medial femoral condyle (arrow). Figure 1. (a) Diagram shows a fracture that is creating an osteochondral fragment. 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. Coronal proton-density–weighted fat-suppressed MR image (a) sagittal proton-density–weighted MR image (b), and T2-weighted fat-suppressed MR image (c) show an OCD lesion in a classic location at the lateral aspect of the medial femoral condyle with cysts (curved arrow in a and c) and a high-signal-intensity rim (straight arrow in b) at the interface between the fragment and parent bone associated with breaks in the subchondral bone plate and articular cartilage along the periphery of the lesion (arrowhead in b and c). The two layers appear as one low-signal-intensity band overlying the subarticular marrow. Common entities include acute traumatic osteochondral injuries, subchondral insufficiency fracture, so-called spontaneous osteonecrosis of the knee, avascular necrosis, osteochondritis dissecans, and localized osteochondral abnormalities in osteoarthritis. This article provides a comparative analysis of several of the most common entities that manifest as osteochondral lesions of the knee, in particular of the femoral condyles. 15 October 2019 | Radiology, Vol. (c) Radiograph obtained 6 months later shows the progression of normal ossification (arrow). A bone contusion (* in b) is visible at the posterior aspect of the lateral tibial plateau. Sometimes doctors call them geodes. 1). Figure 5c. Focal discontinuity of the subchondral bone plate is seen (arrowhead). Figure 11a. Coronal T1-weighted, proton-density–weighted fat-suppressed, and sagittal T2-weighted fat-suppressed MR images (left to right in each row of a, b, and c) at presentation (a) show extensive bone marrow edema (* in a), hypointense fracture lines, and areas of low signal intensity subjacent to the subchondral bone plate (arrowheads in a) associated with minimal flattening of the articular surface; images obtained 6 months later (b) show articular surface collapse (black arrow in b) associated with numerous cystlike areas (white arrow in b) and marrow edema confined to the periarticular region; images obtained at 16 months (c) show that a large saucerized articular surface defect has formed (arrows in c). (b) Coronal proton-density–weighted fat-suppressed MR image shows an OCD lesion surrounded by a rim of increased signal intensity (thick arrow) that is not as intense as the joint fluid (thin arrow). Enter your email address below and we will send you the reset instructions. The distal femoral growth plate is open (* in a and b). A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. Additional secondary criteria are employed for a juvenile OCD lesion to increase specificity. The terms bone bruise or bone contusion refer to trabecular microfractures that manifest as a pattern of bone marrow edema on MR images, without contour abnormalities or a discrete fracture line (2,9,10). A saucerized defect of the articular surface may develop in advanced cases (23,24) (Fig 10). Several pathologic conditions may manifest as an osteochondral lesion of the knee, which is a localized abnormality of the subchondral marrow, subchondral bone, and articular cartilage. Diagram of image from a fluid-sensitive sequence (a), coronal T1-weighted MR image (b), and proton-density–weighted fat-suppressed MR image (c) show multiple regions of AVN in the femur and tibia. 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