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Acute Injury of the Articular Cartilage and Subchondral Bone: A Common but Unrecognized Lesion in the Immature Knee

¹ Department of Pediatric Radiology, Massachusetts General Hospital, 32 Fruit St., Boston, MA 02114.
² Present address: Department of Radiology, Southampton General Hospital, Southampton, Hants SO16 6YD, England.
³ Department of Radiology, Children's Hospital, 300 Longwood Ave., Boston, MA 02115.
⁴ Department of Radiology, Huntington Hospital, Huntington, NY 11743.

View larger version (54K): [in a new window]   Fig. 1A. —Drawings show classification of osteochondral injuries. Grade 0 injury (not shown) is intact cartilage with normal signal and uniform thickness. Drawing shows grade 1 injury: thickening with abnormal signal.

View larger version (61K): [in a new window]   Fig. 1B. —Drawings show classification of osteochondral injuries. Grade 0 injury (not shown) is intact cartilage with normal signal and uniform thickness. Drawing shows grade 2 injury: superficial ulceration or fissuring.

View larger version (69K): [in a new window]   Fig. 1C. —Drawings show classification of osteochondral injuries. Grade 0 injury (not shown) is intact cartilage with normal signal and uniform thickness. Drawing shows grade 3 injury: deep ulceration or fissuring.

View larger version (68K): [in a new window]   Fig. 1D. —Drawings show classification of osteochondral injuries. Grade 0 injury (not shown) is intact cartilage with normal signal and uniform thickness. Drawing shows grade 4 injury: full-thickness chondral injury with bruising of subchondral bone.

View larger version (68K): [in a new window]   Fig. 1E. —Drawings show classification of osteochondral injuries. Grade 0 injury (not shown) is intact cartilage with normal signal and uniform thickness. Drawing shows grade 5 injury: osteochondral injury with separation of osteochondral fragment.

View larger version (145K): [in a new window]   Fig. 2. —Grade 1 lesion in 13-year-old girl with diffuse pain after trauma. Sagittal proton density–weighted image shows area of focal thickening (arrow) of cartilage of medial femoral condyle adjacent to posterior horn of medial meniscus. Hemarthrosis is also present.

View larger version (146K): [in a new window]   Fig. 3A. —Grade 2 lesion in 16-year-old boy with history of pain after fall. Sagittal proton density–weighted image shows subtle area of focal thinning (arrows) of cartilage of midportion of lateral femoral condyle.

View larger version (109K): [in a new window]   Fig. 3B. —Grade 2 lesion in 16-year-old boy with history of pain after fall. Coronal fat-suppressed proton density–weighted image shows subtle partial defect (arrow) of corresponding area of lateral femoral condyle cartilage.

View larger version (136K): [in a new window]   Fig. 4A. —Grade 3 lesion in 14-year-old girl with history of knee trauma and lateral joint pain. Patient also had osteochondral injury in medial patella. Coronal fat-suppressed proton density image shows area of absent articular cartilage (arrow) in anterior aspect of lateral femoral condyle. Large effusion and diffuse edema of marrow are also present.

View larger version (179K): [in a new window]   Fig. 4B. —Grade 3 lesion in 14-year-old girl with history of knee trauma and lateral joint pain. Patient also had osteochondral injury in medial patella. Sagittal proton density image shows area of cartilage discontinuity (arrow), anterior to anterior horn of lateral meniscus.

View larger version (176K): [in a new window]   Fig. 5. —Grade 4 lesion in 14-year-old girl with history of twisting injury. Other images (not shown) revealed anterior cruciate ligament tear and partial bucket-handle tear of medial meniscus. Sagittal proton density image shows discontinuity in cartilage in region of sulcus of lateral femoral condyle with adjacent edema (arrow).

View larger version (175K): [in a new window]   Fig. 6A. —Grade 5 lesion in 14-year-old boy with history of lateral patellar dislocation after fall. Axial proton density image shows discontinuity (thin arrow) of medial articular surface of patella at insertion of medial patellar retinaculum. Loose body (thick arrow) is adjacent to it.

View larger version (155K): [in a new window]   Fig. 6B. —Grade 5 lesion in 14-year-old boy with history of lateral patellar dislocation after fall. Axial fat-suppressed T2-weighted image shows that subchondral edema is adjacent to area of cartilaginous disruption (arrow).

View larger version (161K): [in a new window]   Fig. 7. —Grade 5 lesion in 12-year-old girl who experienced popping feeling in knee while playing basketball. Sagittal proton density–weighted image shows focal loss of cartilage (arrow) and subchondral bone in anterior aspect of lateral femoral condyle. Osteochondral fragment was seen on another image (not shown).

View larger version (119K): [in a new window]   Fig. 8. —Grade 4 lesion in tibia of 16-year-old boy with history of knee swelling after fall. Coronal fat-suppressed proton density–weighted image shows full-thickness lesion with accompanying slight subchondral edema in periphery of tibial plateau (arrow), adjacent to insertion of iliotibial band.

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