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MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence and Pattern of Injury After Transient Lateral Dislocation of the Patella

Timothy G. Sanders1,2, Narayan Babu Paruchuri1,3 and Michael B. Zlatkin1,3

1 National Musculoskeletal Imaging, 1930 N Commerce Pkwy., Suite 5, Weston, FL 33326.
2 Uniformed Services University, Bethesda, MD
3 Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL 33136.


Figure 1
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  		Fig. 1A —16-year-old boy with pain and swelling after fall. Axial T2-weighted image (TR/TE, 3,800/35) shows bone contusions involving both nonarticular surface of lateral femoral condyle (long arrow) and inferomedial aspect of patella (short arrow).

 

Figure 2
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  		Fig. 1B —16-year-old boy with pain and swelling after fall. Coronal STIR image (3,016/29) with fat saturation shows bone bruise involving non-weight-bearing portion of lateral femoral condyle. An osteochondral fragment (long arrow) is located immediately adjacent to osteochondral defect (short arrow) involving marginal aspect of lateral trochlear groove articular cartilage.

 

Figure 3
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  		Fig. 1C —16-year-old boy with pain and swelling after fall. T2-weighted sagittal proton-density image (3,000/14) with fat saturation shows small osteochondral defect (short arrows) involving lower aspect of lateral trochlear groove. Small osteochondral fragment (long arrow) is noted immediately adjacent to defect. Note that osteochondral injury is located at posterior margin of lateral femoral condyle contusion.

 

Figure 4
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  		Fig. 2A —18-year-old man with persistent medial joint line tenderness after twisting injury of knee. Axial T2-weighted image (TR/TE, 3,766/35) with fat saturation shows classic bone contusion pattern involving inferomedial patella (short arrow) and nonarticular surface of lateral femoral condyle (long arrow).

 

Figure 5
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  		Fig. 2B —18-year-old man with persistent medial joint line tenderness after twisting injury of knee. Coronal STIR image (5,766/39) shows full-thickness chondral defect (long arrows) involving midlateral weight-bearing portion of lateral femoral condyle with subjacent marrow edema (short arrow).

 

Figure 6
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  		Fig. 2C —18-year-old man with persistent medial joint line tenderness after twisting injury of knee. Sagittal proton-density image (3,500/15) with fat saturation shows full-thickness chondral defect (long arrows) involving midlateral weight-bearing portion of lateral femoral condyle centered at posterior margin of lateral femoral condyle bone contusion (short arrows).

 

Figure 7
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  		Fig. 3A —22-year-old man evaluated with MRI on a low-field-strength unit after twisting injury to knee. Coronal STIR image (TR/TE, 1,560/16) shows typical bone contusion pattern (arrows) involving nonarticular portion of lateral femoral condyle, indicating recent transient dislocation of patella.

 

Figure 8
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  		Fig. 3B —22-year-old man evaluated with MRI on a low-field-strength unit after twisting injury to knee. Coronal STIR image (1,560/16) posterior to A shows full-thickness chondral defect (long arrows) involving midlateral weight-bearing portion of lateral femoral condyle with subjacent marrow edema (short arrow).

 

Figure 9
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  		Fig. 3C —22-year-old man evaluated with MRI on a low-field-strength unit after twisting injury to knee. Sagittal T2-weighted image (2,800/80) shows full-thickness chondral defect (arrows) involving midlateral weight-bearing portion of lateral femoral condyle.

 

Figure 10
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  		Fig. 4A —Artwork illustrates proposed mechanism of injury to patellar and femoral articular surfaces during two stages of transient dislocation of patella. Dislocation stage. During first stage of transient dislocation of patella, as patella dislocates laterally, shearing mechanism can result in damage to either patellar (short arrow) or lateral femoral condyle (long arrow) articular surfaces.

 

Figure 11
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  		Fig. 4B —Artwork illustrates proposed mechanism of injury to patellar and femoral articular surfaces during two stages of transient dislocation of patella. Reduction stage. During second stage of transient dislocation of patella, as patella bounces back into normal position, impaction of medial patellar facet against nonarticular surface of lateral femoral condyle results in bone contusions of lateral femoral condyle and medial aspect of patella (long arrows). Osteochondral impaction injury can occur to medial patellar facet (short arrow), but concave configuration of trochlear groove protects femoral articular surface from impaction injury during reduction stage.

 

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