Answer for CoW 19 Feb 2017
Chondral delamination injury anterior part of lateral femoral condyle with detached fragment displaced medially and lying in anterior intercondylar notch of femur.
Findings:
Anterior part of lateral femoral condyle cartilage shows a transversely oriented focal defect. Defect appears linear measuring 22mm in length and 8-9mm in width. The defect is located just superior to the anterior horn of lateral meniscus. The detached chondral fragment is seen displaced medially and lying with long axis anteroposteriorly oriented, along the lateral side of intercondylar notch of femur anteriorly. Mild joint effusion noted. Small granular intramedullary lesion (cartilaginous rest) seen in medial femoral condyle below the physeal plate.
Discussion:
Chondral and osteochondral injuries are the most common lesions discovered in children undergoing MRI for evaluation of internal derangement of the knee in one study(1). Before physeal closure, chondral injury of the femur is more commonly identified compared with patellar chondral injury after growth plate closure(1). Cartilage injuries of the knee are thought to arise from chronic abrasive wear resulting in superficial fibrillation of the cartilage or from acute shear forces (2).Delamination injuries are thought to be produced by the second mechanism of injury and involve separation of the uncalcified articular cartilage from the calcified cartilage (2). In MRI, there will be a well demarcated defect in articular cartilage surface(3). The displaced fragment may be within joint adjacent to defect or remotely displaced within the joint(3). NB: Post operative image of the chondral fragment that was removed.
References:
1. Oeppen RS, Connolly SU, Bencardino JT, Jaramillo D. Acute injury of the articular cartilage and subchondral bone: a common but unrecognized lesion in the immature knee. AJR 2004; 182:111–117.
2. Levy AS, Lohnes J, Sculley S, LeCroy M, Garrett W. Chondral delamination of the knee in soccer players. Am J Sports Med 1996;24:634–639.
3. Diagnostic Imaging: Musculoskeletal Trauma. second edition 2008. Donna G Blankenbaker, Kirkland W. Davis. Pg 691-692.
Findings:
Anterior part of lateral femoral condyle cartilage shows a transversely oriented focal defect. Defect appears linear measuring 22mm in length and 8-9mm in width. The defect is located just superior to the anterior horn of lateral meniscus. The detached chondral fragment is seen displaced medially and lying with long axis anteroposteriorly oriented, along the lateral side of intercondylar notch of femur anteriorly. Mild joint effusion noted. Small granular intramedullary lesion (cartilaginous rest) seen in medial femoral condyle below the physeal plate.
Discussion:
Chondral and osteochondral injuries are the most common lesions discovered in children undergoing MRI for evaluation of internal derangement of the knee in one study(1). Before physeal closure, chondral injury of the femur is more commonly identified compared with patellar chondral injury after growth plate closure(1). Cartilage injuries of the knee are thought to arise from chronic abrasive wear resulting in superficial fibrillation of the cartilage or from acute shear forces (2).Delamination injuries are thought to be produced by the second mechanism of injury and involve separation of the uncalcified articular cartilage from the calcified cartilage (2). In MRI, there will be a well demarcated defect in articular cartilage surface(3). The displaced fragment may be within joint adjacent to defect or remotely displaced within the joint(3). NB: Post operative image of the chondral fragment that was removed.
References:
1. Oeppen RS, Connolly SU, Bencardino JT, Jaramillo D. Acute injury of the articular cartilage and subchondral bone: a common but unrecognized lesion in the immature knee. AJR 2004; 182:111–117.
2. Levy AS, Lohnes J, Sculley S, LeCroy M, Garrett W. Chondral delamination of the knee in soccer players. Am J Sports Med 1996;24:634–639.
3. Diagnostic Imaging: Musculoskeletal Trauma. second edition 2008. Donna G Blankenbaker, Kirkland W. Davis. Pg 691-692.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!