Presentation
Possible lateral patellar dislocation. Patella reduced. Ongoing swelling and bruising.
Patient Data
On the lateral, there is irregularity of the anterior surface of the lateral femoral condyle suggesting an osteochondral defect.
No fracture. Normal tibial tuberosity ossification. Trace of fluid in the suprapatellar pouch.
Confirmation of the abnormality of the lateral femoral conydle anterior surface. Best seen on the lateral T1 and PDfs. 17 mm (craniocaudal) lesion with loss of normal subchondral marrow signal, low signal in the adjacent marrow, and minor surrounding marrow edema. This is osteochondritis dissecans. The cartillage surface is indented. There is no fluid undercutting or evidence of a loose fragment.
Extensive bone marrow edema throughout the lateral femoral condyle. Adjacent superficial soft-tissue edema and edema of the lateral patellofemoral ligament.
Case Discussion
Juvenille osteochondritis dissecans is sometimes also called an osteochondral defect. The etiology is unclear, but repetative trauma is a postulated mechanism.
The features here are of a non-acute OCD lesion with a superimposed injury with acute bone marrow edema and superficial soft-tissue edema. While osteochondral injury can occur following trauma, I do not think that this is the case in this situation.
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