At 4 weeks post-ACLX, 75% of the rodent knees had at least 1 cyst that formed in the medial tibial plateau; by 12 weeks all ACLX knees contained SBC. These include lack of ionizing radiation; multiplanar imaging capabilities; excellent resolution; and superior evaluation of the soft tissues, bone marrow, cartilage, muscle, ligaments, and tendons. If the lesion consists of a subchondral region demarcated from the surrounding bone, the demarcation should be examined for completeness and the presence of a “double-line sign” that is seen in avascular necrosis or findings of instability, which are important for proper evaluation of osteochondritis dissecans. Conclusions Authors of many studies have emphasized the role of chronic repetitive trauma in active children, particularly those who are high-level athletes (52,53). 293, No. The inferior lytic defects may be physical evidence of bone marrow lesions (BML), a clinical OA indicator visible via MRI. Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. The condition can manifest either in childhood (juvenile OCD) or middle age (adult OCD), but the most frequent age of onset is in preadolescence. The two layers appear as one low-signal-intensity band overlying the subarticular marrow. SIF in a 64-year-old woman with a complex tear in the medial meniscus with peripheral extrusion (arrow in a). Caution should be used when considering PFA for patients with minimal radiographic evidence of patellofemoral arthritis. The distal femoral physis is closed (*). Based on Barrie and Laor et al (43,46). (b–d) Sagittal T2-weighted fat-suppressed MR image (b), proton-density–weighted MR image (c), and CT image (d) show a curvilinear fracture (arrow in b and c) encircling a portion of subchondral bone and overlying cartilage. (a) Radiograph demonstrates the absence of normal ossification in the subchondral area of the medial femoral condyle (arrow). Patients with evidence of mild patellofemoral arthritis on plain radiographs demonstrated less improvement in pain and function after PFA than those with more advanced patellofemoral arthritis. Graphical Abstract Subchondral bone cysts commonly occur adjacent to a treated focal cartilage defect and are possibly connected to the joint cavity. Eighty-three percent of the lesions appeared largest on the PD-w FS sequence. Note the macerated and extruded medial meniscus (black arrow in b). This misnomer was entrenched in the medical lexicon for many years, persisting after recognition of this entity as a SIF (15,16). The subchondral bone plays a key role in the integrity and repair of the entire osteochondral unit. Clinical quantitative computed tomography (QCT) has the potential to characterize cysts in vivo but it is unclear which specific cyst parameters (e.g., number, size) are associated with clinical signs of OA, such as disease severity or pain. Several descriptive terms and abbreviations can be applied to focal abnormalities of the articular cartilage and subchondral bone. 2014;22(4):540-6. doi: 10.1016/j.joca.2014.01.006. The clinical scenario and histologic findings are typical of secondary osteonecrosis. The development of targeted therapies against the osteoarthritic processes in cartilage or bone will, therefore, require an understanding of the state of these joint tissues at the time of the intervention. AVN of the knee in a 59-year-old woman who was undergoing long-term corticosteroid treatment. Figure 6b. Of the 86 arthroscopically proven abnormalities, 81 were detected on MR imaging. Subjects with serial images were assessed (N = 50) for STV and subchondral BML volume. Sixteen consecutive patients (age range, 43-79 years; mean, 67 years) referred for total knee replacement were examined with sagittal short inversion time inversion-recovery (STIR) and T1- and T2-weighted turbo spin-echo MR imaging 1-4 days before surgery. Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? All knees showed structural abnormalities with MRI. Bone scintigraphy is one of the most valuable techniques for early diagnosis of spontaneous osteonecrosis about the knee. A localized osteochondral defect can be created acutely or can develop as an end result of several chronic conditions. Figure 14a. Imaging in osteoarthritis: What have we learned and where are we going? Inter-observer agreement for WORMS scores was high (most ICC values were >0.80). A bone contusion (* in b) at the lateral tibial plateau can be distinguished from a fracture because of the absence of a contour deformity or fracture line. Subchondral bone cysts (SBCs) ... marrow, and articular cartilage in pathogenesis of knee OA. Osteoarthritis is caused by the breakdown of cartilage in the joints.1 Cartilage serves as a cushion between joint bones, allowing them to glide over each other and absorb the shock from physical movements. Other imaging modalities, such as ultrasound, may provide complementary approaches for the assessment of synovitis. (a) Radiograph shows a localized ossification defect of the medial femoral condyle containing linear calcifications (white arrow) and surrounded by sclerosis (black arrow). 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). Clinical outcomes were evaluated using the Knee Society scores (KSS), University of California at Los Angeles (UCLA) and Tegner scores. In calcium pyrophosphate deposition disease, geodes resemble those in osteoarthritis but are larger, more numerous, and more widespread. 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