2004; 233(3): 768–73. DOI: https://doi.org/10.2106/00004623-198668060-00007, De Smet, E, De Praeter, G, Verstraete, KL, Wouters, K, De Beuckeleer, L and Vanhoenacker, FM. Hallmarks of osteoarthritis include the presence of marginal osteophytes and subchondral cysts in the tibiofemoral joint. American journal of roentgenology. Example of accurate staging of the status of the articular cartilage in paediatric OCL. S2 (2017): 1. Almost always there will be associated bone marrow edema best appreciated in fat-saturated T2-weighted and intermediate or proton-density weighted images 4. ... extends to the subchondral bone, and occurs in patients with closed physes (4 ... Skeletal Radiology, Vol. Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. MRI coronal PD fat suppressed image (1.5 Tesla equipment) of the talocrural joint (c) with normal appearance of the thin cartilage layer (arrows) of intermediate signal, low signal of subchondral bone and homogenous bone marrow signal (stars). Image Findings: Spondylosis deformans (Osteophytes and osseoous ridging), Intervetebral osteochondrosis (disc spcae narrowing, Intradiscal vaccum phenomenom, disc calcification, subchondral bone sclerosis, Schmorl nodes), Uncovertebral joint osteoarthritis (Sclerosis, hypertrophy, joint spce narrowing, subluxation, capsular laxity, synovial cyst) Case 2: subchondral insufficiency fracture, subchondral insufficiency fracture of the knee, directly visible subchondral trabecular discontinuity on high resolution, signs of subcortical impaction visible as subchondral hyperdensity, grade 2: bone marrow edema with low signal intensity fracture line, grade 3: fluid-filled fracture line and cysts, grade 4: cortical collapse with a step off, concave, smooth half-moon/crescentic appearing necrotic segment, usually in conjunction with chondral damage. The sac is usually primarily filled with hyaluronic acid. 44 (2): 102-5. Similar to the Outerbridge classification widely used in staging of cartilage lesions of the knee, a modified staging system for evaluation of the depth of cartilage defects with correlation to arthroscopy may be used in the ankle (Figure 10). Crossref, Medline, Google Scholar; 18 Rhaney K, Lamb D. The cysts of osteoarthritis of the hip: a radiologic and pathologic study. Journal of the Belgian Society of Radiology 101 (S2): 1. The main reason for that is the fact that we need images with high spatial resolution to detect early changes of articular cartilage of the ankle joint. A modified grading system has been proposed by Hepple in 1999 [5] and by Dipaola et al. 1. Nowadays MR staging of OCL on MRI is usually done by the Anderson classification [9], which is another modification of the initial staging system based on plain film evaluation by Berndt and Harty (Figure 6). Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. With the advent of MRI, this grading system was further revised including evaluation of structures invisible on conventional radiology, such as the integrity of the cartilage and presence of BME. 2017. DOI: https://doi.org/10.1053/jars.2003.50041, Anderson, IF, Crichton, KJ, Grattan-Smith, T, Cooper, RA and Brazier, D. Osteochondral fractures of the dome of the talus. Biomed Res Int. 1991; 7(1): 101–4. 2003; 19(4): 353–9. Articular cartilage covering the articular surfaces (blue), cortical bone (black), normal bone marrow (yellow) and ligaments (brown). Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology. Coronal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (a). (2012) Clinics in orthopedic surgery. Unable to process the form. The presence of intraarticular contrast and high spatial resolution improves visualization of the cartilage surfaces compared to routine MRI on 1.5 Tesla. This process can evolve into cyst formation. Stage 4 consists of a displaced fragment, often accompanied with surrounding bone marrow edema. Due to its noninvasiveness, absence of radiation exposure and its ability to visualize associated concomitant soft tissue abnormalities, MRI is the initial technique for exclusion/confirmation of an osteochondral lesion of the ankle. Subchondral cysts are typically found within the hip joint. Sagittal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (b). Eur Radiol. Symptoms of subchondral cystic lesions can be mild to severe and can be of an acute onset. Check for errors and try again. Note also partial filling of the subchondral cyst (black arrowhead) with contrast as an indirect sign of joint communication through a cartilage lesion. Note the more subtle subchondral cyst formation in the proximal margin of the hamate (H), related to chronic repetitive abutment with the lunate (type II lunate morphology with an extra facet which articulates with the hamate). Agten CA, Kaplan DJ, Jazrawi LM, et al. RESULTS: We identified 58 subchondral cystsin 43(71.7%) of 63 cases. Coronal (c, d) reformatted CBCT-A clearly shows an extensive cartilage lesion down to bone with adjacent cartilage flap (black arrow). DOI: https://doi.org/10.1007/s00256-015-2127-3, Berndt, AL and Harty, M. Transchondral fractures (osteochondritis dissecans) of the talus. DOI: https://doi.org/10.1155/2016/3594253, Posadzy, M., Desimpel, J. and Vanhoenacker, F.M., 2017. 2008; 16(11): 1047–51. In particular cases also alternative diagnoses can be made on basis of CBCT (Figure 11). in 2003. They're especially common at the knee or hip. Sagittal PD fat suppressed MRI image (a) showing BME (star) at the posteromedial part of the talar dome. Schematic drawing of talocrural joint injury in pronation (a) results in sprain of the medial collateral ligaments (brown) and lateral-sided OCL of the talar dome and/or kissing tibial lesion (orange zones), whereas injury in supination (b) causes sprain of the lateral ligaments and medial-sided OCL of the talar dome and/or kissing lesions at the tibia (orange zones). Sagittal (a) and coronal (b) fat suppressed T2-WI showing multilocular subchondral cysts (black arrowheads) at the medial aspect of the talar dome. Subchondral cysts in the superior outer and middle third of the femoral head (pressure zone) may arise from bone contusion and synovial intrusion or osteoclastic resorption of necrotic trabeculae following avascular necrosis 1. A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. Coronal (c) and sagittal (d) reformatted CBCT-A show a focal bony lesion with peripheral sclerosis in the distal tibia and talus. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. Pathria MN, Chung CB, Resnick DL. Although not comprehensive in scope, this article correlated the pathophysiology and imaging features of several of these disorders to better understand the associated subchondral lucencies. (2019) Skeletal radiology. They can also occur in conjunction with twisting and ligamentous injuries. 1989; 71(8): 1143–52. CBCT, which was first introduced for preoperative evaluation of dental implants, is currently also used for musculoskeletal applications. In stage 3 an undisplaced completely separated fragment can be seen on MRI with adjacent BME. Moreover, despite several modifications of the staging systems on MRI, not all combination of the degree of involvement of the cartilage and subchondral bone are included and therefore these classification systems remain uncomprehensive, complicated and less valuable for use in daily routine. Coronal (b) and sagittal (c) reformatted CBCT-A show subtle subchondral sclerosis (black arrow) at the superolateral aspect of the talar dome, but the overlying cartilage is intact. 2016; 2016: 3594253. 10. DOI: https://doi.org/10.1177/0363546508316773, Dipaola, JD, Nelson, DW and Colville, MR. Characterizing osteochondral lesions by magnetic resonance imaging. Anatomy of the talocrural joint. 3. Patients will usually present with pain on weight-bearing in the affected joint, improving with rest 2. The first system of classification has been reported by Berndt and Harty in 1959 [4], including four stages based on their radiological appearance. In such a case, leave the cartilage alone and only check it with ankle arthroscopy. It's a fluid-filled sac that forms in one or both of the bones that make up a joint. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. Prostaglandin I-1 and/or bisphosphonates might be considered 5. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of spatial resolution hampers accurate assessment of thin articular cartilage. As a result, the diagnosis of “spontaneous osteonecrosis of the knee” has been abandoned and is now recognized as osteonecrosis developing following a subchondral fracture (see Web clinic February 2004). (2016) AJR. Example of improved visualization of communication of subchondral cysts with the joint through deep articular cartilage lesions on CBCT arthrography. Osteonecrosis can develop when the lesion’s vascularity is disrupted. CBCT following intra-articular injection of Iodine contrast (CBCT-Arthrography) may render exquisite detail of the articular cartilage using very thin slices and multiplanar reformation. 8. Sayyid S, Younan Y, Sharma G, et al. Rather, these subchondral lesions are typically lined by a connective tis-sue membrane, such as collagen [22–24] and 48 (12): 1961-1974. Roemer FW, Frobell R, Hunter DJ, et al. Usually, subchondral fractures present as linear or curvilinear structures often paralleling the subchondral bone plate, with or without areas of subchondral collapse 2. Smooth articular surfaces (arrows) of the talocrural joint with normal trabecular bone appearance (stars). Subchondral insufficiency fractures of the knee: review of imaging findings. 280 (1): 21-38. DOI: https://doi.org/10.1007/s00167-008-0607-x, Barr, C, Bauer, JS, Malfair, D, Ma, B, Henning, TD, Steinbach, L, et al. Subchondral cysts of the tibia secondary to osteoarthritis of the knee. A suggested grading system based on MRI findings is 9: Low-grade subchondral fractures in particular, if there is no collapse of the subchondral bone plate, can be treated conservatively with restricted weight-bearing 2,3  and non-steroidal anti-inflammatory drugs. When a small defect in the chondral plate is present, the intraarticular fluid will erode the subchondral bone, which will result in bone marrow edema. Subchondral cysts are often a part of the joint degenerative process and occurs where there are breaks in the hip joint cartilage. (2009) Osteoarthritis and cartilage. In fact, Subchondral Bone Cyst is one of the parameters that physicians look at when diagnosing osteoarthritis. High-grade fluid-filled lesions with cortical collapse and severe osteoarthritis might require arthroplasty. MRI allows for distinguishing normal cartilage from subchondral bone as well as evaluating the adjacent bone marrow, ligaments and other surrounding soft tissues (Figure 2c). This is not Kienbock's disease, where cystic changes develop more diffusely. Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. On CBCT arthrographic images, the contrast separating the OCL fragment from the talar dome can be evaluated with more confidence (Figure 8). 56 (6): 714-9. Yamamoto T, Iwasaki K, Iwamoto Y. Transtrochanteric rotational osteotomy for a subchondral insufficiency fracture of the femoral head in young adults. There are two generally accepted theories on the etiology of subchondral cysts. The authors have no competing interests to declare. These cysts are produced in areas of damaged articular cartilage, subjacent to the underlying subarticular cortical plate. A subchondral cyst without superficial cartilage damage is rare and requires a different approach. The overlying cartilage is difficult to assess on MRI. Arthroscopy. 1986; 68(6): 862–5. 1959; 41–A: 988–1020. Subchondroplasty: What the Radiologist Needs to Know. Subchondral cysts are of variable size from a f… The articular cartilage layer of the talocrural joint is indicated in blue. Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology. T1 andT2-weighted axial, oblique coronal, and oblique sagittal images were analysed for the presence, location, number,shape, size, and connection to the joint cavity of subchondral cysts. Subchondral cysts and intraosseous ganglion cysts cannot be differentiated histologically. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy M, Desimpel J and Vanhoenacker FM, ‘Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT’ (2017) 101 Journal of the Belgian Society of Radiology 1 DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, Magdalena, Julie Desimpel, and Filip M. Vanhoenacker. Assess range of motion to evaluate for pain and limitation as well as clicking or catching of the joint. J Bone Joint Surg Am. {"url":"/signup-modal-props.json?lang=us\u0026email="}. 2014; 20(1): 57–60. Sometimes visible as subchondral hyperlucency with a decrease in bone density. DOI: https://doi.org/10.2106/00004623-195941060-00002, Hepple, S, Winson, IG and Glew, D. Osteochondral lesions of the talus: A revised classification. In osteoarthritis, the overloading and the vascular obstruction within the subchondral bone leads to subchondral sclerosis, bone marrow edema and bleeding, and subchondral cysts. 1999; 20(12): 789–93. This underscores the value of preoperative imaging. This is an i… comments powered by DOI: https://doi.org/10.1016/j.fas.2013.10.005, https://doi.org/10.2106/00004623-198668060-00007, https://doi.org/10.1007/s00256-015-2127-3, https://doi.org/10.2106/00004623-195941060-00002, https://doi.org/10.1177/107110079902001206, https://doi.org/10.1016/0749-8063(91)90087-E, https://doi.org/10.2106/00004623-198971080-00004, https://doi.org/10.1007/s00167-008-0607-x, https://doi.org/10.1007/s00330-006-0446-4, https://doi.org/10.1148/radiol.2333031921. 4 (3): 173-80. DOI: https://doi.org/10.1016/j.fas.2013.10.005, Pritsch, M, Horoshovski, H and Farine, I. Arthroscopic treatment of osteochondral lesions of the talus. The equipment is designed to perform exams in sitting or supine position and is relatively compact, allowing installation in many radiology departments and private practices. Arthroscopic treatment of chronic osteochondral lesions of the talus: Long-term results. However, other arthritic conditions like rheumatoid arthritis also play a key role in an individual developing Subchondral Bone Cysts. J Bone Joint Surg Am. Joint preserving surgical treatments of subchondral fractures include microfracture, drilling, subchondroplasty 10, or in the hip joint: transtochanteric osteotomy 11. The presence of a subchondral edema with an acetabular cyst on MRI is indicative of a full-thickness cartilage lesion at the time of arthroscopy. The weight-bearing joints such as the knee, hip, and ankle joints are more commonly affected ref. Stage 1 lesions are due to bone marrow contusion. Unstable lesions – if left untreated – predispose for early osteoarthritis. The area between the fracture line and the articular surface should be of high signal in T2 weighted images 2,4. As the bulk of the U.S. population ages, the prevalence of osteoarthritis is expected to rise. 17 (9): 1115-31. 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