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Osteochondral Injury

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The osteochondral injuries that we should be aware of, um,

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are at number of locations.

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You may have an avulsion fracture at the medial patella

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or an osteochondral injury medially.

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It may involve the median ridge.

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You can get flattening

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or contusion involving the lateral femur.

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So any of these sites, small chondral abnormalities

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of the lateral condyle should make you think about a

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patellar dislocation.

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And here in this case, we can see a defect on the x-ray

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that is displaced.

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Here it is showing you the Oreo sign

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of cartilage with subc chondral bone still attached to it.

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I wanna just caution you

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that sometimes the defects look smaller on MR than they

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really are because when you get into

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that osteochondral bone, it bleeds

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and tends to fill in the defect.

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We're seeing some hemorrhagic products here nearby,

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so you can underestimate it on your MR imaging.

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So look at all of the studies that you have available.

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This is a very commonplace

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to see fractures along the medial patella

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that is directly in the area

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where the RET macular is inserting,

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and I think we're all really familiar with that.

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This is a really typical fracture.

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So even though the alignment looks quite good on this case,

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we don't have any flattening or contusion laterally.

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Just seeing that lets us know

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that we at least experienced a lateral subluxation, uh,

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of the patella in this patient.

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The bone is normal, but we have chondral abnormalities.

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Again, they dominate at the median ridge

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and medial facet of the patella.

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Certainly better seen here on the fluid sensitive sequence

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than on T one associated here

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with the he arthrosis in the joint.

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Now this, I'm not gonna see on x-ray

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'cause the bone itself is not involved.

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Notice again, this contusion,

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which is very characteristic along the lateral femoral

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condyle that we see with this dislocation.

Report

Faculty

Donald Resnick, MD

Professor Emeritus, Department of Radiology

University of California, San Diego

Mini N. Pathria, MD, FRCP(C)

Division Chief, Musculoskeletal Imaging

University of California San Diego

Eric Y. Chang, MD

Adjunct Professor, Radiology

University of California, San Diego

Brady K. Huang, MD

Clinical Professor of Radiology

UC San Diego Medical Center

Tags

Musculoskeletal (MSK)

MRI

Knee