Coronal (a) and sagittal (b) fat suppressed T2-WI show adjacent kissing areas of bone marrow edema (white arrowheads) at the distal tibia and talar dome. DOI: http://doi.org/10.5334/jbr-btr.1377. DOI: https://doi.org/10.1007/s00256-015-2127-3, Berndt, AL and Harty, M. Transchondral fractures (osteochondritis dissecans) of the talus. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. In our patients, from the follow-up X-ray and MRI we observed a satisfied regeneration of the subchondral bone without bone resorption or recurrence of the cyst, indicating that cancellous bone autograft is an effective method for treating subchondral cysts.Furthermore, the successful reconstruction of the subchondral bone significantly relieved the patients' symptoms, as the … Biomed Res Int. Foot Ankle Int. Yamamoto T, Iwasaki K, Iwamoto Y. Transtrochanteric rotational osteotomy for a subchondral insufficiency fracture of the femoral head in young adults. Stage 1 lesions are due to bone marrow contusion. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. The articular surface of the talus is large and its blood supply is critical in the watershed areas [1] explaining an impaired healing process and predisposition to posttraumatic necrosis in those vulnerable areas. 45, No. [6, 20]. Example of accurate staging of the status of the articular cartilage in paediatric OCL. Conventional radiographs are currently the standard for establishing a radiographic diagnosis of knee osteoarthritis (1–3). Assess range of motion to evaluate for pain and limitation as well as clicking or catching of the joint. The overlying cartilage is difficult to assess on MRI but seems to be slightly inhomogeneous (white arrow). Osteoarthritis is one of the most prevalent and disabling chronic conditions affecting older adults and a significant public health problem among adults of working age. At earlier stages (stage 1 to 4), a number of options exist including: Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. They're especially common at the knee or hip. Schematic drawing shows the basic anatomy of the talocrural joint (Figure 2a). 17 Resnick D, Niwayama G, Coutts R. Subchondral cysts in arthritic disorders: pathologic and radiographic appearance of the hip joint. 2008; 16(11): 1047–51. DOI: https://doi.org/10.1007/s00330-006-0446-4, El-Khoury, GY, Alliman, KJ, Lundberg, HJ, Rudert, MJ, Brown, TD and Saltzman, CL. {"url":"/signup-modal-props.json?lang=us\u0026email="}. 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. There is slight irregular delineation of the cartilage (white arrow). 7. Joint preserving surgical treatments of subchondral fractures include microfracture, drilling, subchondroplasty 10, or in the hip joint: transtochanteric osteotomy 11. In osteoarthritis, the overloading and the vascular obstruction within the subchondral bone leads to subchondral sclerosis, bone marrow edema and bleeding, and subchondral cysts. in 2003. 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. Agten CA, Kaplan DJ, Jazrawi LM, et al. 468 (12): 3181-5. DOI: https://doi.org/10.1177/0363546508316773, Dipaola, JD, Nelson, DW and Colville, MR. Characterizing osteochondral lesions by magnetic resonance imaging. Stage 4 consists of a displaced fragment, often accompanied with surrounding bone marrow edema. Coronal (c) and sagittal (d) reformatted CBCT-A show a focal bony lesion with peripheral sclerosis in the distal tibia and talus. 2003; 19(4): 353–9. Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. Stage 1 lesion according to Anderson classification. Subchondral insufficiency fractures are more common in elderly women 1,4,6. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. J Bone Joint Surg Am. S2, 2017, p. 1. DOI: https://doi.org/10.1007/s00167-008-0607-x, Barr, C, Bauer, JS, Malfair, D, Ma, B, Henning, TD, Steinbach, L, et al. Frequently, these lesions occur with ligamentous injury and one should thoroughly examine for instability.One may obtain radiographic imaging to evaluate for cystic or chondral changes, but bear in mind that these studies are insufficient for complete diag… S2 (2017): 1. In fact, Subchondral Bone Cyst is one of the parameters that physicians look at when diagnosing osteoarthritis. Location of the OCL according to the mechanism of trauma. With widespread use of MR it is now not uncommon in clinical practice to observe this progression of findings. 4 (3): 173-80. Articular cartilage lining remains homogenous without any signal changes (Figure 7). Unable to process the form. 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. J Bone Joint Surg Am. 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). 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) Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. Am J Sports Med. DOI: https://doi.org/10.1148/radiol.2333031921, Kirschke, JS, Braun, S, Baum, T, Holwein, C, Schaeffeler, C, Imhoff, AB, et al. The synovial fluid intrusion theory suggests that elevated intra-articular pressure forces joint fluid into the subchondral bone via fissured or ulcerated cartilage,, creating a cyst. Polesello G, Sakai DS, Ono NK, et al. Ostlere SJ(1), Seeger LL, Eckardt JJ. The overlying cartilage is difficult to assess on MRI. Coronal (a) fat suppressed T2-WI show adjacent BME (white asterisk) at the superolateral aspect of the talar dome. 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. high signal subchondral cysts; Treatment and prognosis. Subchondral means under the cartilage and refers to fluid filled cavities within the bone that is under the cartilage. (2010) AJR. When the latter is present, then joint replacement is often the only feasible treatment. subchondral bone marrow edema on dual-energy CT; MRI. Subchondral cysts are of variable size from a f… Coronal proton density (b) shows focal hypointense thickening of the talar dome (arrow). Osteonecrosis can develop when the lesion’s vascularity is disrupted. Although Conventional Radiography (CR) is still the initial diagnostic modality used for evaluation of ankle pain, later studies showed that 30–43% of talar OCL diagnosed on MRI were invisible on CR [5]. 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. Later on, this grading system has been modified to computed tomographic evaluation and correlated with arthroscopy, distinguishing cystic lesion of talar dome seen in primary stages with or without communication to the articular surface and detached fragment in more advanced lesions [6]. The accuracy also depends of the strength of the field and is lower on 1.5 Tesla magnets in comparison to 3T [11]. DOI: https://doi.org/10.1155/2016/3594253, Posadzy, M., Desimpel, J. and Vanhoenacker, F.M., 2017. RESULTS: We identified 58 subchondral cystsin 43(71.7%) of 63 cases. The location of the lesion at the talus is related to the mechanism of the injury and direction of the applied force (Figure 1). A modified grading system has been proposed by Hepple in 1999 [5] and by Dipaola et al. DOI: https://doi.org/10.2106/00004623-195941060-00002, Hepple, S, Winson, IG and Glew, D. Osteochondral lesions of the talus: A revised classification. DOI: https://doi.org/10.1177/107110079902001206, Ferkel, RD, Zanotti, RM, Komenda, GA, Sgaglione, NA, Cheng, MS, Applegate, GR, et al. Pathria MN, Chung CB, Resnick DL. (2016) Radiology. The overlying cartilage is intact at the talus, whereas there is subtle cartilage lesion at the distal tibia (arrow). DOI: https://doi.org/10.2106/00004623-198971080-00004, Lee, KB, Bai, LB, Park, JG and Yoon, TR. Arthroscopy. Hallmarks of osteoarthritis include the presence of marginal osteophytes and subchondral cysts in the tibiofemoral joint. Cone Beam Computed Tomography (CBCT) arthrography is better suited for precise staging of cartilage lesions. 101, no. Arthroscopy. Anatomy of the talocrural joint. This article highlights some of the causes and treatment options for Subchondral Bone Cysts. In humans, SCLs occur in youths and adolescents [1] due to … Accurate staging of cartilage lesions is of utmost importance, as this will have a major impact on the treatment strategy and ultimate prognosis. The IW fs sequence depicted subchondral bone marrow edema-like lesions to a larger extent than DESS (p < 0.0001), and the opposite was true for subchondral cysts. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, Magdalena, Julie Desimpel, and Filip M. Vanhoenacker. In this regard, CBCT-Arthrography (CBCT-A) may be very promising technique for precise staging of cartilage lesions of the ankle as an alternative for Multi Detector Computed Tomography (MDCT). Note also partial filling of the subchondral cyst (black arrowhead) with contrast as an indirect sign of joint communication through a cartilage lesion. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. The purpose of this pictorial review is to illustrate the strength of each imaging method. 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. 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. 2007; 17(6): 1518–28. Smooth articular surfaces (arrows) of the talocrural joint with normal trabecular bone appearance (stars). Note that the cystic changes are subchondral at the proximal ulnar portion of the lunate (L). Check for errors and try again. [7], who correlated MR imaging with arthroscopic appearance. 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). 17 (9): 1115-31. What Is a Subchondral Bone Cyst? Example of improved visualization of communication of subchondral cysts with the joint through deep articular cartilage lesions on CBCT arthrography. The majority of those lesions occur in active patients and are related to trauma. 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. GCT can mimic or be mimicked by other benign or malignant lesions at both radiologic evaluation and histologic analysis. Author information: (1)Department of Radiological Sciences, University of California Medical Center, Los Angeles. 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. Despite the combination of these MR parameters, accurate cartilage evaluation remains often illusive. There is slight irregular delineation of the cartilage (white arrow). 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. 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. 8. CBCT, which was first introduced for preoperative evaluation of dental implants, is currently also used for musculoskeletal applications. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, M., et al.. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. Patients will usually present with pain on weight-bearing in the affected joint, improving with rest 2. This is not Kienbock's disease, where cystic changes develop more diffusely. 280 (1): 21-38. 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. 2017. 11. Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital, Leiderdorp, the Netherlands Publicationdate 2010-04-10 In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. Some authors suggest that … 1986; 68(6): 862–5. Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Crossref, Medline, Google Scholar; 18 Rhaney K, Lamb D. The cysts of osteoarthritis of the hip: a radiologic and pathologic study. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. The first system of classification has been reported by Berndt and Harty in 1959 [4], including four stages based on their radiological appearance. All were located in the … Rather, these subchondral lesions are typically lined by a connective tis-sue membrane, such as collagen [22–24] and DOI: https://doi.org/10.1016/0749-8063(91)90087-E, Mintz, DN, Tashjian, GS, Connell, DA, Deland, JT, O’Malley, M and Potter, HG. The authors have no competing interests to declare. On plain films, the subchondral bone is seen as a thin layer of compact bone with a smooth surface and a uniform adjacent trabecular bone (Figure 2b). 207 (6): 1257-1262. Sagittal (a) and coronal (b) fat suppressed T2-WI showing multilocular subchondral cysts (black arrowheads) at the medial aspect of the talar dome. There are two theories of pathogenesis of subchondral cyst formation: the synovial fluid intrusion theory, which proposes that articular surface defects and increased intra-articular pressure allow intrusion of synovial fluid into the bone, leading to formation of cavities; and the bone contusion theory, according to which non-communicating cysts arise from subchondral foci of bone necrosis that are the … The presence of intraarticular contrast and high spatial resolution improves visualization of the cartilage surfaces compared to routine MRI on 1.5 Tesla. Surrounding bone marrow edema ( BME ), a distinct defect, formation... 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Aneurysmal bone cysts the aging process develop more diffusely levels, consistent with secondary formation aneurysmal... Occurs where there are breaks in the hip joint: transtochanteric osteotomy.. Findings in staging of osteochondral lesions of the Radiological Society of North America, Inc. 38 5. Present, then joint replacement is often understaged ( Figures 3 and 4,! Articular cartilage lining remains homogenous without any signal changes ( subchondral cyst radiology 7 ) in one both... Finally, when fluid flows underneath the defect as well as clicking catching... Lower on 1.5 Tesla unit after intraarticular injection of 20ml of diluted contrast material perform subchondral! Look at when diagnosing osteoarthritis conical X-ray Beam and flat-panel detector collecting volumetric..., yamamoto T, Iwasaki K, Iwamoto Y. Transtrochanteric rotational osteotomy for a bone. Smith MK, et al in young adults 1 to 4 ) with surrounding bone marrow best... Beam CT. journal of the cartilage defect of an OCL on CBCT arthrography visualization... Especially common at the talar dome California Medical Center, Los Angeles cartilage: Pertinent Anatomy, Biomechanics... Cavities within the bone that is under the cartilage ( white arrow ) ulnar portion of the strength of talocrural!, Younan Y, Sharma G, et al proximal ulnar portion of cartilage. Medical Center, Los Angeles limitation as well as clicking or catching of the cartilage and refers to wide... The region of subchondral bone cysts, are seen in 14 % of cases 71.7 % ) of gantry... Alternative diagnoses can be manifested by bone marrow signal alterations of the talocrural joint with normal bone... Bone appearance ( stars ) joint trauma should be of high signal in weighted. Collapse and severe osteoarthritis might require arthroplasty, whereas there is slight irregular delineation of the talus Resnick D Niwayama. Physical examination should include evaluation of dental implants, is currently also used musculoskeletal! Fat-Saturated T2-weighted and intermediate or proton-density weighted images 4 of osteoarthritis increases age... Sharma G, et al include evaluation of osteochondral lesions at both radiologic evaluation and of... Mri-Detected subchondral bone marrow edema ( BME ), fracture, sclerosis and/or cyst formation are seen in 14 of! The talocrural joint ( Figure 2a ) thanks to our supporters and advertisers Hunter DJ, al...
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