Osteochondral lesion is a general term that encompasses a variety of acute or chronic localized abnormalities of the articular cartilage and subchondral bone. A bone contusion (* in b) is visible at the posterior aspect of the lateral tibial plateau. Once SIF progresses to collapse and articular surface destruction, distinguishing it from primary osteoarthritis at imaging may be impossible, and it is likely to be clinically irrelevant. We offer a summary of current concepts for each condition to aid in their differentiation at MRI. These findings are essential in diagnosis of acute traumatic injuries, subchondral insufficiency fracture, and its potentially irreversible form, spontaneous osteonecrosis of the knee. The most common histologic findings in bone marrow edema-like lesions include bone necrosis, fibrosis, hemorrhage, and trabecular abnormalities, while edema is infrequent (64–66). Material and Methods: We retrospectively evaluated MR imaging findings of all knee MRI exams performed at our institution over the past five years. Figure 10c. Additional secondary criteria are employed for a juvenile OCD lesion to increase specificity. Several pathologic conditions may manifest as an osteochondral lesion of the knee that consists of a localized abnormality involving subchondral marrow, subchondral bone, and articular cartilage. Subchondral bone plate disruptions are evident (arrowheads in c and d) and are best depicted on the CT image (d). AVN of the knee in a 59-year-old woman who was undergoing long-term corticosteroid treatment. Figure 19a. The most commonly affected joint is the knee, with the majority of lesions located in the femoral condyle and/or patellofemoral articulation (Wheeless, 2012). Note the macerated and extruded medial meniscus (black arrow in b). Osteochondral lesion is a general term that encompasses a variety of acute or chronic localized abnormalities of the articular cartilage and subchondral bone. If it is thicker than 4 mm or longer than 14 mm, the lesion may be irreversible and may evolve into irreparable epiphyseal collapse and articular destruction (17). The lack of skeletal maturity in this patient population can lead to injuries and injury patterns not commonly encountered in the adult population. Bone marrow edema surrounding the infarct is present on the femoral side (* in c) but not the tibial side. (a) Radiograph shows a localized ossification defect of the medial femoral condyle containing linear calcifications (white arrow) and surrounded by sclerosis (black arrow). Figure 10b. Authors of many studies have emphasized the role of chronic repetitive trauma in active children, particularly those who are high-level athletes (52,53). Several descriptive terms and abbreviations can be applied to focal abnormalities of the articular cartilage and subchondral bone. The suffix “-like” is used because of a large spectrum of histologic changes responsible for these patterns of signal intensity alteration on MR images. An osteochondral injury is an injury to the smooth surface on the end of bones, called articular cartilage (chondro), and the bone (osteo) underneath it. Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? Figure 8b. (d) MR image obtained 6 months later shows restoration of the subchondral bone plate (arrowhead). This condition typically is seen in older patients after the 6th decade of life and more frequently in women. Figure 17a. SIF in a 51-year-old woman with atraumatic sudden onset of knee pain and swelling. He denies fevers or mechanical knee symptoms. 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