title: Insights into the Epiphyseal Cartilage Origin and Subsequent Osseous Manifestation of Juvenile Osteochondritis Dissecans with a Modified Clinical MR Imaging Protocol: A Pilot Study.
abstract: Purpose To retrospectively determine if a modified clinical magnetic resonance (MR) imaging protocol provides information on the origin of juvenile osteochondritis dissecans (JOCD) lesions and allows for staging on the basis of the proposed natural history of JOCD to better guide clinical management of the disease. Materials and Methods This institutional review board-approved, HIPAA-compliant, retrospective study was performed in 13 consecutive patients (mean age, 14.9 years; age range, 10-22 years; nine male and four female patients) and one additional comparative patient (a 44-year-old man), in which 19 knees with 20 JOCD lesions were imaged. Seventeen lesions occurred in the medial femoral condyle, two occurred in the lateral femoral condyle, and one occurred in the medial trochlea. The clinical 3-T MR imaging protocol was supplemented with a routinely available multiecho gradient-recalled-echo sequence with the shortest attainable echo time of approximately 4 msec (T2* mapping). Results At the earliest manifestation, the lesion was entirely cartilaginous (n = 1). Subsequently, primary cartilaginous lesions within the epiphyseal cartilage developed a rim calcification that originated from normal subjacent bone, which defined a clear cleft between the lesion progeny and the parent bone (n = 9). Secondarily, progeny lesions became ossified (n = 7) while at the same time forming varying degrees of osseous bridging and/or clefting with the parent bone. Two healed lesions with a linear bony scar and one detached lesion were identified. Conclusion The modified MR imaging protocol allowed for identification of the epiphyseal cartilage origin and subsequent stages of ossification in JOCD. The approach allows further elucidation of the natural history of the disease and may better guide clinical management.©RSNA, 2016.
authors.affiliation: From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.).
authors.forename: Jutta
authors.initials: J
authors.lastname: Ellermann
authors.affiliation: From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.).
authors.forename: Casey P
authors.initials: CP
authors.lastname: Johnson
authors.affiliation: From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.).
authors.forename: Luning
authors.initials: L
authors.lastname: Wang
authors.affiliation: From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.).
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Macalena
authors.affiliation: From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.).
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Nelson
authors.affiliation: From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.).
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
mesh_terms: D000293:Adolescent; D002985:Clinical Protocols; D005260:Female; D006132:Growth Plate / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies