Juvenile Osteochondral Defect 1
Generally says conservative management (= do nothing for 6 months), is better for majority of cases.
- Majority of Classic Juvenile OCD ( = on the Medial femoral condyle) being stable. 88%.
- Healing rate of ~ 60%
Important to think this is in JUVENILE with vascularised cartilage and thus potential to heal and not in ADULTS who mostly need surgery and have increased risk of DJD.
Healing of JOCD takes 6 to 18 months. So, is a big undertaking.
Aims to define the OCD as Stable, Indeterminate or Unstable. Dependent on the distance and degree of radiological findings from the normal.
But clinical features such as pain and loss of function are also important.
No good data demonstrating what the performance of these features are.
Technique
Uses Radiographs and MRI in complimentary fashion
Radiographs 2
Uses system developed by 7 Orthopods on 45 cases :side_eye, but says it is ok.
Based on Following Radiographic Features:
- PROGENY BONE FRAGMENT
- Mineralization: Normal | Abnormal
- Fragmentation: None | Present
- Displacement: Non-displaced | Partial | Complete
- Centre Density: Unchanged | Increased | Reduced.
- Contour: Convex | Linear | Concave
- BOUNDARY AT INTERFACE :
- Distinct | Indistinct.
- PARENT BONE
- Peripheral Radiodensity: Normal | Abnormal
Also add in measure of bone maturation.
I wonder if I should merge mineralisation and centre density of progeny together. I have already got rid of rim density as had v poor interrater reliability
MRI 1
Based on Following MRI Features:
Of instability.
-
DIRECT SIGNS
- Crater +/- IA body: None | Present
- Loss of radius of curvatures: None | Present
- Cartilage Injury : None | Present
-
INDIRECT SIGNS
- High signal interface: None | Present
- Cysts : None | Non-significant | Circumferential small | >5mm cyst(s)
NB: Loss of Radius means the plane of the overlying cartilage being smooth.
Cartilage injury is normally at worst subtle = often just a small linear low signal. High signal interface needs to be FLUID and not just high as otherwise it is granulation tissue and a sign of repair.
Uses the phrase 'chondrosis' to describe the cartilage injury.
Some Examples from the Lecture
