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📌 Differential Diagnosis of Osteochondritis Dissecans
- Osteochondral defects can present in various forms and distinguishing between them is crucial for accurate diagnosis and treatment.
- This overview summarizes the key features of several conditions that can mimic or be confused with osteochondritis dissecans (OCD).
1️⃣ Osteochondritis Dissecans (OCD)
Mechanism: “Inside-out”
- OCD is characterized by a chronic osteochondral lesion occurring in children and young adults, specifically in classic locations.
- The hallmark of OCD is the separation and detachment of the osteochondral fragment.
- This process begins deep underneath the articular surface and subsequently involves the articular cartilage at the peripheral border of the lesion, following an “inside-out” mechanism.
2️⃣ Acute Traumatic Osteochondral Injury
Mechanism: “Outside-in”
- This condition begins with damage to the articular cartilage, which, if subjected to sufficient force, progresses to disrupt the subchondral bone, demonstrating an “outside-in” mechanism.
3️⃣ Subchondral Insufficiency Fracture (SIF)
- SIFs often occur associated with meniscal tears in the same compartment in 76%–94% of patients, with more than 50% demonstrating radial and posterior root tears.
- Case: On fluid-sensitive imaging, SIFs appear as abnormal areas of fluid-like linear hyperintensity that undermine and separate the subchondral bone plate from the rest of the epiphysis.
References
- RadioGraphics 2018; 38:1478–1495
- AJR 2019; 213:963–982
"Visualizing MSK Radiology: A Practical Guide to Radiology Mastery"
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#OsteochondritisDissecans, #OsteochondralDefects, #Radiology, #Musculoskeletal, #Orthopedics, #SportsInjuries, #Imaging, #SubchondralFracture, #AcuteInjury, #MRI
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