Kucera T, Shaikh HH, Sponer P (2016) Charcot neuropathic arthropathy of the foot: a literature review and single-center experience. The authors developed a minimally invasive method with computer-assisted navigation for retrograde drilling of osteochondral lesions of the talus. The .gov means its official. A 16-year-old male with chronic posterior ankle pain and a suspected os trigonum with impingement. 2) usually resolves after a few months (usually 3months); however, the clinical symptoms disappear sooner, usually after 6weeks [6, 8, 9]. (1) BME in the lateral malleolus, (2) the anterior talofibular ligament, (3) the posterior talofibular ligament, and (4) an avulsed bone fragment from the lateral malleolus, A 39-year-old male imaged 10days after an ankle injury on suspicion of deltoid ligament rupture. AJR Am J Roentgenol 197:W720W729 https://doi.org/10.2214/AJR.10.5880, Costa-Paz M, Muscolo DL, Ayerza M, Makino A, Aponte-Tinao L (2001) Magnetic resonance imaging follow-up study of bone bruises associated with anterior cruciate ligament ruptures. Acta Radiol 49:771786 https://doi.org/10.1080/02841850802161023, Ahn JM, El-Khoury GY (2007) Role of magnetic resonance imaging in musculoskeletal trauma. AJR Am J Roentgenol 182:323328 https://doi.org/10.2214/ajr.182.2.1820323, Docquier P-L, Maldaque P, Bouchard M (2019) Tarsal coalition in paediatric patients. Treatment of juvenile osteochondritis dissecans of the talus: current concepts review. 2003;24(6):509-13. BME in the subchondral part of the distal tibia (6). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. A BME near the tendon may reveal tendinopathy (Figs. (Fig.1)1) [2]. (1) A partial rupture of the tibialis posterior tendon and (2) BME in the medial malleolus were visible, A 49-year-old male with chronic pain at the Achilles tendon enthesis and suspicion of a Haglund deformity. (2) BME was seen at the level of the Lisfranc joint. 2001 Apr;20(2):299-320. doi: 10.1016/s0278-5919(05)70308-2. An edema-like high signal may also be related to physiologic stress or altered biomechanics in the growing skeleton [36], as well as in highly active individuals. T1-weighted MRI characteristics of pedal osteomyelitis. The central third of the navicular is a watershed area and it is prone more to avascular necrosis and stress fractures ref. Retrocalcaneal bursitis may lead to BME [30, 31]. The .gov means its official. Osteochondral impaction injuries are noted typically in either the medial or the lateral talar trochlea and less commonly at the navicular articulation. In spondyloarthritis, many patients, even if asymptomatic, have BME and other arthritis-related changes [30, 33]. Orr JD, Sabesan V, Major N, Nunley J. Terms and Conditions, BME associated with overuse or trauma (Fig. 1948;50(4):545-6. BME usually occurs both in the os trigonum and the adjacent part of the talus (Fig. The distraction of bone, which is visible in an avulsion injury, causes a linear trabecular disruption in a limited area (Fig. 9)functional dysfunction, overuse, or ruptures [17, 18]. Saxena A, Eakin C. Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Lancet 352:11371140 https://doi.org/10.1016/S0140-6736(97)12004-9, Rudwaleit M, van der Heijde D, Landew R et al (2011) The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. The alteration of the bone marrow signal is located mostly peripherally and has a patchy appearance (Fig. BME usually surrounds both primary malignant bone tumors (like osteosarcoma, Ewings sarcoma, or chondrosarcoma) and metastases [35]. The reason is that the thin cartilage layer is difficult to image on MRI. National Library of Medicine J Pediatr Orthop. 2010;38(2):392404. Bone marrow oedema of the knee. Early avascular necrosis, inflammation, or stress fracture may lead to more diffuse BME; therefore, a detailed medical history is crucial for correct diagnosis. (Fig.30).30). Samora WP, Chevillet J, Adler B, Young GS, Klingele KE. Article Lesion stability was classified using clinical and surgical findings. In the region of the sinus tarsi in the calcaneus, a cystic structure is often observed which is a vascular remnant (Fig. MRI showed anterior impingement with osteophytes (arrows) and bone marrow edema, A 55-year-old male with chronic anterior ankle pain. (1) BME in the fibula adjacent to (2) the tendinopathy of the peroneus brevis tendon. However, the clinical manifestation of these lesions may be nonspecific. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. The cause, however, is not fully understood [1, 9, 25]. Magnetic resonance imaging (MRI) after ankle trauma often shows alteration of bone marrow signal with a low signal on T1-weighted and a high signal on T2-weighted and fluid-sensitive sequences (like short tau inversion-recovery (STIR) or fat-suppressed (FS) sequences). Niva MH, Sormaala MJ, Kiuru MJ, Haataja R, Ahovuo JA, Pihlajamaki HK. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. 2012;20(2):17680. 30). A 65-year-old male with chronic ankle pain after ankle trauma about 3weeks earlier and a suspected rupture of the tibialis posterior tendon. Rios AM, Rosenberg ZS, Bencardino JT, Rodrigo SP, Theran SG. MRI (a, b) revealed traction cysts at the insertion of the posterior talofibular ligament. Rosenberg ZS, Beltran J, Bencardino JT. Careers, Unable to load your collection due to an error. The coalition prevents proper movement in the joint, which causes deformity, pain, and soft tissue changes. volume49,pages 13051311 (2020)Cite this article. A geographic BME in the medial part of the talar trochlea may indicate an avulsion of the deltoid ligament [8, 9]. There is a minor irregularity of the cartilage signal in the subchondral central part of the talar trochlea, probably after previous injuries. If symptoms persist then findings of tarsal coalition should be sought. 16). There were no changes in the Achilles tendon. (Fig.33).33). Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. MRI showed a calcaneonavicular coalition (arrows) with adjacent BME (dashed arrow). MRI showed osteophytes at the anterior border of the distal tibia with bone marrow edema (arrows) showing anterior impingement. 1993;21(1):139. Retrocalcaneal bursitis may lead to BME [30, 31]. The distribution of BME allows for a determination of the trauma mechanism and a correct assessment of soft tissue injury. Early visualization of a low-grade soft tissue injury is challenging on MRI, which is why the BME makes it easier to evaluate the MR examination. If untreated, it may cause subchondral damage (Fig. Jie C. Nguyen. BME appears after immobilization, sooner in younger than in older individuals [1]. CrossRef View in Scopus Google Scholar [2] MRI showed a calcaneonavicular coalition (arrows) with adjacent BME (dashed arrow). Br J Radiol 90:20160735 https://doi.org/10.1259/bjr.20160735, Article History and etymology Several authors report BME at the tendon insertion (Figs. 2022 Jun 8;10(6):1061. doi: 10.3390/healthcare10061061. J Diabetes Res 2016(3207043) https://doi.org/10.1155/2016/3207043, James SLJ, Panicek DM, Davies AM (2008) Bone marrow oedema associated with benign and malignant bone tumours. A 28-year-old male presented with 3-month history of ankle pain and a suspected osteochondral lesion. J Bone Joint Surg Am. T2 relaxation time changes in distal femoral articular cartilage in children with juvenile idiopathic arthritis: a 3-year longitudinal study. a Osteomyelitis in calcaneus was suspected clinically and on radiographs. An official website of the United States government. Foot Ankle Int 28:463471 https://doi.org/10.3113/FAI.2007.0463, Article It is only seen in children and adolescents who are still growing. Arthroscopy. Patel, M., Francavilla, M.L., Lawrence, J.T.R. A 65-year-old male with chronic ankle pain after ankle trauma about 3weeks earlier and a suspected rupture of the tibialis posterior tendon. Fowkes LA, Toms AP. These correspond to infarct and hyperemia, respectively, called a double line sign (Fig. Freyschmidt's "Koehler/Zimmer" Borderlands of Normal and Early Pathologic Findings in Skeletal Radiography. An incidental osteochondritis dissecans (OCD) lesion was found in a left tarsus of a 3-year-old Freiberger stallion . Eismann EA, Pettit RJ, Wall EJ, Myer GD. Erdem CZ, Tekin NS, Sarikaya S, Erdem LO, Gulec S. MR imaging features of foot involvement in patients with psoriasis. Perumal V, Wall E, Babekir N. Juvenile osteochondritis dissecans of the talus. Clin Sports Med. Some authors instead use the term bone marrow lesion (BML) in those cases, which is a more universal term and use the term BME for trauma-related cases [8]. The distraction of bone, which is visible in an avulsion injury, causes a linear trabecular disruption in a limited area (Fig. The anterolateral gutter becomes filled with synovitis, scar tissue, and small osseous fragments [20]. Initial plain radiographs of right foot demonstrating os supranaviculare and suggestive of navicular osteochondral lesion. Top Magn Reson Imaging 18:155168 https://doi.org/10.1097/RMR.0b013e318093e670, Niva MH, Sormaala MJ, Kiuru MJ, Haataja R, Ahovuo JA, Pihlajamaki HK (2007) Bone stress injuries of the ankle and foot: an 86-month magnetic resonance imaging-based study of physically active young adults. PubMed stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. a Osteomyelitis in calcaneus was suspected clinically and on radiographs. Usually, small areas of BME are visible on the avulsion side in the lateral malleolus. In inflammatory arthritides like rheumatoid arthritis (RA) or spondyloarthritis, hindfoot pain is not uncommon and is especially in spondyloarthritis an important diagnostic component if caused by enthesopathy with BME. MRI showed bone infarcts in the distal tibia (1), fibula (4), talus (2), and calcaneus (5) and a talar fracture (3). Sharp R, Calder J, Saxby T. Osteochondritis of the Navicular: A Case Report. CRMO was diagnosed after a couple of months. 8600 Rockville Pike Google Scholar, Eustace S, Keogh C, Blake M, Ward RJ, Oder PD, Dimasi al M (2001) MR imaging of bone oedema: mechanisms and interpretation. Lam KY, Siow HM. 3). Spontaneous Osteonecrosis of the Tarsal Navicular in Adults: Imaging Findings. the contents by NLM or the National Institutes of Health. In clinical and radiographic evaluations, midtarsal sprains are frequently underdiagnosed and are missed at initial evaluation in up to 41% of cases, resulting in delayed treatment [ 1 ]. Skeletal Radiology - Osteochondral lesions (OCLs) of the talar dome consist of a multifactorial pathology of the articular cartilage and subchondral bone and can result in persistent ankle pain and. Changes in the bone marrow in direct contact with the tendon may indicate pathology of these tendons or tendon maltracking (Fig. The manuscript does not contain individual persons data in any form. Bethesda, MD 20894, Web Policies J Orthop Sports Phys Ther. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. Abstract. (1) A partial rupture of the tibialis posterior tendon and (2) BME in the medial malleolus were visible, A 59-year-old female with 10-month history of lateral ankle pain and suspicion of an osteochondral lesion. However, the clinical manifestation of these lesions may be nonspecific. In areas of bone with inflammation, fluid signal replaces the fat signal. The range of osseous injuries includes contusions, avulsions, or impaction fractures of the anterior process of the calcaneus, talar head, cuboid bone, and navicular bone [2, 4, 5]. Anteroposterior view demonstrates sclerosis of the navicular bone articulating with the talus, while lateral view best demonstrates loss of the sharp cortical line of the navicular bone articulating with the talus. A 57-year-old male with pain in the medial malleolus without a history of trauma. Before Healthcare (Basel). Unauthorized use of these marks is strictly prohibited. An edema-like high signal may also be related to physiologic stress or altered biomechanics in the growing skeleton [36], as well as in highly active individuals. A 19-year-old male athlete had pain in the dorsal right midfoot on weight-bearing. and transmitted securely. and transmitted securely. Elias I, Zoga AC, Schweitzer ME, Ballehr L, Morrison WB, Raikin SM. (1) BME in the fibula adjacent to (2) the tendinopathy of the peroneus brevis tendon. MR Imaging of the Ankle and Foot. Maillefert JF, Dardel P, Cherasse A, Mistrih R, Krause D, Tavernier C. Magnetic resonance imaging in the assessment of synovial inflammation of the hindfoot in patients with rheumatoid arthritis and other polyarthritis. Br J Radiol. Google Scholar. 2014;2(4):18891. 32); the patients history confirms the interpretation. Intracortical changes occur while the limb is still bearing weight. Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Posttraumatic changes such as local synovitis, scars, thickened articular capsule or ligaments, and osteophytes may cause different impingement syndromes based on the localization. Conclusion: Bancroft LW, Pettis C, Wasyliw C, Varich L. Semin Musculoskelet Radiol. Arch Orthop Trauma Surg. Khler disease. Injury results in delamination and potential sequestration of the affected bone. Usually, there is little difficulty in making the diagnosis. This classification helps to determine the cause of the BME: type I usually corresponds to an injury from a contrecoup mechanism making it more extensive, whereas type II usually indicates trauma to the ligament attachment, articular capsule, or retinaculum and therefore is more localized. Early avascular necrosis, inflammation, or stress fracture may lead to more diffuse BME; therefore, a detailed medical history is crucial for correct diagnosis. Overload injuries are especially common in sports such as running. MRI showed an avulsion of the anterior talofibular ligament. Canon CXDI-801C Wireless Digital Radiology System, CA) of the right and left tarsi . (Fig.13).13). A 30-year old patient after ankle joint sprain. Stress reaction can often be seen in the distal tibia, distal fibula, or the calcaneus. On T2-weighted images, this line usually comprises two components; a low signal located internally and a high signal externally. An unstable osteochondral lesion is a bone fragment which loses contact, displaces, or separates from the bone into the surrounding joint fluid [8, 19]. Bone marrow edema (BME) is one of the most common findings on magnetic resonance imaging (MRI) after an ankle injury but can be present even without a history of trauma. An accessory bone in a tendon (e.g., os peroneum) may cause tendon overload and faster tendon degeneration and rupture (Fig. Not applicable. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Osteochondritis dissecans (OCD) may be loose in situ if there is surrounding BME [3, 8]. MRI showed an occult fracture of the medial malleolus (arrow) which in retrospect was visible on the radiographs. BME in the subchondral part of the distal tibia (6). BME in RA, known as osteitis and most commonly investigated in the hand and forefoot, is associated with erosive progression and poor functional outcome [32]. A 7-year-old girl with chronic pain in both feet. MR imaging of the foot and ankle: patterns of bone marrow signal abnormalities. MRI showed osteonecrosis of the navicular bone (arrows; Mueller-Weiss syndrome), A 45-year-old male, 2years after kidney transplantation, presented with 6-week history of ankle pain and a suspected talar stress fracture. The defects cause deep ankle pain associated with weightbearing. An osteochondral lesion covers both the cartilaginous and subchondral layers (Fig. 1) [2]. http://creativecommons.org/licenses/by/4.0/. 2014 Dec;24(4):213-6. doi: 10.1016/j.foot.2014.07.002. Privacy Kozoriz MG, Grebenyuk J, Andrews G, Forster BB. By using this website, you agree to our Accurate non-traumatic bone marrow edema analysis enables precise radiological reporting. 2006;27(3):15766. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. An 18-year-old runner with Achilles tendon pain. The foot and ankle: MR imaging of uniquely pediatric disorders. Mnchener medizinische Wochenschrift. Inclusion in an NLM database does not imply endorsement of, or agreement with, There is a minor irregularity of the cartilage signal in the subchondral central part of the talar trochlea, probably after previous injuries. A 22-year-old soccer player presented with chronic anterior ankle pain. Usually, the fluid shows a higher signal than usual on T1-weighted images because of an increased protein concentration [8]. 2. (Fig.21)21) if it is symptomatic [21]. Before An elongated posterior process of the talus or an os trigonum causes posterior ankle impingement. MRI showed stress fractures of the tibia and calcaneus (arrows), An 18-year-old female with diffuse pain at the level of the navicular bone. Epub 2013 Dec 10. 5. BME is common in patients with septic arthritis and osteomyelitis. The authors contributed equally to this review. Newman JS, Newberg AH. Hyperemia of the bone marrow (Fig. 1992;16(2):25460. 2003;19(4):3539. The mobility produces a folding of the joint capsule, occurrence of joint fluid, and conflict with the synovial sheath of the flexor hallucis longus tendon or Kagers fat pad. Patel CV. Osteochondral lesions are acquired, potentially reversible injuries of the subchondral bone with or without associated articular cartilage involvement. MRI showed a talocalcaneal coalition (arrow) with BME in the talus (dashed arrow), A 51-year-old female with diffuse pain in the ankle and Chopart joints with suspected osteoarthritis. Arch Orthop Trauma Surg. A coalition is an abnormal developmental fusion between bones. This is known as bone marrow edema (BME) or bone bruise (Fig. The most frequent problem they cause is being mistaken for a fracture. 2000;21(2):12733. Nguyen JC, Lin B, Potter HG. Patchy lesions are visible in all bones (dashed arrows). A 13-year-old female with intermittent moderate ankle pain for 3weeks. Higuera J, Laguna R, Peral M, Aranda E, Soleto J. Osteochondritis dissecans of the talus during childhood and adolescence. This case report presents an arthroscopically assisted treatment of a navicular osteochondral lesion using curettage and backfilling with fibrin glue, flowable collagen, and autogenous bone grafting. This happens with weakened bone tissue (osteopenia) or with vigorously repeated mechanical forces (Fig. MeSH A slight periosteal edema is the first sign of stress fracture which, in the absence of treatment, is followed by BME in the medullary cavity. Foot Ankle Clin. Changed mechanical forces between bones in coalition may lead to BME. Ellermann J, Johnson CP, Wang L, Macalena JA, Nelson BJ, LaPrade RF. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Google Scholar. It usually results from the failure of segmentation of the bones during development, which in the foot occurs in about 1% of the population [22, 23]. Recent literature suggests successful outcomes with the use of microionized cartilage matrix allograft for the treatment of osteochondral lesions in the ankle. Tendinopathy encompasses a wide range of tendon changes involving the internal structure of the tendon (Figs. official website and that any information you provide is encrypted Osteochondritis dissecans of the ankle in children and adolescents: demographics and epidemiology. 2013 Nov;17(5):446-54. doi: 10.1055/s-0033-1360665. MRI can detect a stress fracture in the early stages [5, 8, 12, 13]. In CRMO, a transient BME manifests as a region of BME without trauma (Fig. A chondral lesion with subchondral BME was visible and could be identified retrospectively on the previous MRI (arrows), A 29-year-old male with 4-month history of medial ankle pain and suspicion of an osteochondral lesion. Histological diagnosis was giant cell tumor, A 19-year-old male presented with nightly ankle pain. MRI with (a) T2-weighted fat suppression and (b) T1-weighted coronal images revealed extensive BME (1) and a stress fracture in the navicular bone (2). Skelet Radiol. A coalition is an abnormal developmental fusion between bones. Reference article, Radiopaedia.org (Accessed on 05 Jun 2023) https://doi.org/10.53347/rID-8907. - 103.138.153.66. In CRMO, a transient BME manifests as a region of BME without trauma (Fig. cartilage injury with associated subchondral fracture but without detachment . (Fig.8).8). Physical examination revealed swelling of the ankle without any inflammation sings. Collins MS, Schaar MM, Wenger DE, Mandrekar JN. Summary location: lies within the medial aspect of the midfoot relations: the talus bone, cuboid bone and the three cuneiform bones arterial supply: branches of the dorsalis pedis, posterior tibial and medial plantar arteries 4 Gross anatomy Articulations Bone stress injuries of the ankle and foot: an 86-month magnetic resonance imaging-based study of physically active young adults. Progression of subchondral BME is usually associated with the progression of cartilage damage, typically in the talar trochlea and distal tibia. Type III is often associated with a fracture or osteochondral lesion; thus, it may have a different extent [5, 11]. A systematic BME analysis allows for correct interpretation, which enables a correct assessment of the entire MR study. (Fig.3535). Conservative treatment for juvenile osteochondritis dissecans of the talus. Unable to process the form. Common etiologies of bone marrow edema in the ankle [13]. Staging Osteochondral injuries are graded according to the stability and location of the fragment and presence of secondary degenerative changes (see: osteochondral injury staging ). A 19-year-old soccer player sustained an ankle sprain during a soccer match with suspicion of rupture of the anterior tibiofibular ligament. Osteochondrosis(plural: osteochondroses) is the descriptive term given to a group of disorders that affect the progress of bone growth by bone necrosis. Neglected Pediatric Osteochondral Fracture Dislocation of the Patella. At the time the article was created Jeremy Jones had no recorded disclosures. Haller J, Sartoris D, Resnick D et al. Case description: Bone in direct contact with a tendon may lead to alterations in the bone marrow signal where BME may indicate tendinopathy or dynamic tendon dysfunction. There was extensive bone marrow edema in all bones of the foot, most pronounced in the talus (dashed arrow on a) and calcaneus (arrow on b). Skeletal Radiology 1991;7(1):1014. Levels of Evidence: Therapeutic, Level IV. Citation, DOI, disclosures and article data. (Fig.14).14). 2019 Oct 21;2019:2904782. doi: 10.1155/2019/2904782. Naran KN, Zoga AC. Bone marrow edema (BME) is one of the most common findings on magnetic resonance imaging (MRI) after an ankle injury but can be present even without a history of trauma. Anterior impingement manifests by a painful limitation of dorsal ankle flexion, mostly in football players, called footballers ankle. Accumulation of micro-trauma on the talar neck and anterior distal tibia may results in synovitis, thickening of the articular capsule, or osteophytes with BME (Figs. et al. J Am Podiatr Med Assoc. 22). An MR protocol for ankle imaging should include sequences in all three orthogonal planes and an axial oblique plane if the flexor tendons need more detailed analysis. 2000;21(2):11926. Eur J Radiol 67:521525 https://doi.org/10.1016/j.ejrad.2007.08.005, Kucera T, Shaikh HH, Sponer P (2016) Charcot neuropathic arthropathy of the foot: a literature review and single-center experience. Radiographs revealed a Lisfranc fracture-dislocation. As mentioned above, the differential diagnosis of BME is very wide (Fig. 2015;135(10):133741. This article will provide a systematic overview of the most common disorders in the ankle and foot associated with BME. The presence of BME is an unspecific but sensitive sign of primary pathology and may act as a guide to correct and systematic interpretation of the MR examination. MRI and radiography showed a Haglund deformity (arrow) with bone marrow edema again visible on MRI, A 43-year-old female with chronic pain in the plantar part of the heel and suspicion of a heel spur and plantar aponeurosis rupture. A 20-year-old soccer player presented after an ankle sprain during a soccer match with suspicion of a fracture in the lateral malleolus. Weishaupt D, Schweitzer ME. Correspondence to Bone infarction may also result from inflammatory, metabolic, or genetic diseases such as systemic lupus erythematosus or sickle-cell disease or may be a side-effect of medical treatment with, e.g., steroids. In this article a systematic approach is presented on how to describe a standard MRI of the ankle. A 57-year-old female with hindfoot pain for 4weeks and a suspected osteochondral lesion and osteoarthritis. By firstly determining if there is BME on only one side of the ankle joint or it is multifocal and secondly the type of BME, the BME pattern can reveal the mechanism of injury [1, 9]. Check for errors and try again. BME is common in patients with septic arthritis and osteomyelitis. There are edema features that can differentiate red bone marrow from BME, like a lower signal, localization in the metaphysis, or well-defined margins [7, 19]. Awareness of the seriousness of ankle sprains is critical . 2003;23(5):61725. MRI showed enthesopathy of the Achilles tendon (dashed arrow) and BME in the tuber calcanei (arrow) without evidence of a Haglund deformity (curved arrow), A 62-year-old female with recurring symptoms after previous surgery for a Haglund deformity. Osteochondritis Dissecans. BME can be a very sensitive sign in the different types of impingement [11, 20]. Juvenile osteochondritis dissecans of the knee: predictors of lesion stability. The cause, however, is not fully understood [1, 9, 25]. https://doi.org/10.1186/s13244-020-00900-8, DOI: https://doi.org/10.1186/s13244-020-00900-8. Overuse lesions occur in relatively constant locations like the subchondral part of talar trochlea. Disclaimer. AJR Am J Roentgenol. A 28-year-old male presented with 3-month history of ankle pain and a suspected osteochondral lesion. 25) related to a weight-bearing surface, a physiologic process, is often visible [9]. The presence of BME is probably due to altered tendon pressure on the bone [8, 12, 13]. Clin Sports Med. Open access funding provided by University of Gothenburg. A 19-year-old handball player with 3-month history of ankle pain imaged for suspected anterior tibiofibular ligament rupture and stress fracture. 2008;46(6):9951002 v. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. BME in RA, known as osteitis and most commonly investigated in the hand and forefoot, is associated with erosive progression and poor functional outcome [32]. A higher signal of the bone marrow in the distal fibula on fluid-sensitive sequences is related to a close location to the coil (Fig. Regional skeletal maturity was recorded. The distribution of BME seen in specific types of injury thus represents one of the most useful differential diagnostic clues in ankle trauma. FS imaging with T2- or proton-density (PD) weighted images is mandatory, as is the inclusion of at least one T1-weighted sequence for bone marrow evaluation. Springer Nature. Mintz DN, Tashjian GS, Connell DA, Deland JT, O'Malley M, Potter HG. Get full access to this article. https://doi.org/10.1053/crad.2000.0585, Fowkes LA, Toms AP (2010) Bone marrow oedema of the knee. 2012;32(1):14. Higashiyama I, Kumai T, Takakura Y, Tamail S. Follow-up study of MRI for osteochondral lesion of the talus. Meller-Weiss syndrome is the adult counterpart of navicular osteonecrosis 4,5. It is often associated with intra-articular loose bodies. Your US state privacy rights, Common etiologies of bone marrow edema in the ankle [1,2,3]. The anterior impingement syndrome may be caused by overuse and micro-injuries. Osteochondral lesion of the talus in children: Are there MRI findings of instability?. A 21-year-old male with inactive osteopenia after immobilization for some weeks. The measurement of observer agreement for categorical data. J Pediatr Orthop. The most common benign tumors are osteoid osteoma (Fig. MRI showed a typical artifact in the lateral malleolus on an FS sequence (arrows). {"url":"/signup-modal-props.json?lang=us"}, Jones J, Yap J, Bell D, et al. National Library of Medicine The normal variation in the ossification of the femoral condyle can mimic osteochondritis . PMC This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March 1, 2011, and May 31, 2018. Lee RK, Griffith JF, Yuen BT, Ng AW, Yeung DK. Radiographics 20:321332 quiz 526527, 532. https://doi.org/10.1148/radiographics.20.2.g00mc03321, Lazzarini KM, Troiano RN, Smith RC (1997) Can running cause the appearance of marrow edema on MR images of the foot and ankle? It revealed no fracture of the lateral malleolus. 2008;248(2):5718. Radiology 2002; 224:669-674. MRI showed avulsion (arrow) of the talar attachment of the dorsal talonavicular ligament, A 42-year-old male with 9-month history of ankle pain and suspicion of an osteochondral lesion. Patients with this type of lesion often undergo surgical treatment, whereas conservative therapy is sufficient in case of a stress fracture. 2007;35(10):16807. It was first described in 1908 by Alban Khler, a German radiologist (1874-1947)1,6. Docquier P-L, Maldaque P, Bouchard M. Tarsal coalition in paediatric patients. (1) MRI showed an os trigonum with BME, (2) effusion and synovitis, and (3) degenerative cysts (4) along the articulation with the posterior talar process. Radiographic features Plain radiograph Plain radiographs are the best initial test in a suspected navicular fracture. (Figs.19,19, ,20,20, and and2121). BME with associated soft tissue edema in patients with peripheral neuropathy can indicate neuropathic arthropathy (Fig. 29) [11, 26]. Am J Sports Med. 21) if it is symptomatic [21]. Sijbrandij ES, van Gils APG, de Lange EE. Ankle injuries have been identified as the single most common type of injury in 24/70 sports, with ankle sprain being the most common injury. statement and An eversion injury usually causes an inverse BME distribution. BME appears after immobilization, sooner in younger than in older individuals [1]. Foot (Edinb). Biometrics. Ann Anat. A rare case of an osteochondral lesion of the tarsal navicular with a subacute stress fracture in a high level athlete. Would you like email updates of new search results? The manuscript does not contain individual persons data in any form. Interpretation of BME is multilevel and usually starts with the patients history (traumatic or non-traumatic, acute, or insidious). Foot Ankle Int. MRI showed bone bruise in the tibia, fibula, and talus (arrows). PubMed Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden, Pawel Szaro,Mats Geijer&Nektarios Solidakis, Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Department of Clinical Sciences, Lund University, Lund, Sweden, You can also search for this author in 6. Kanazawa K, Yoshimura I, Shiokawa T, Hagio T, Naito M. J Foot Ankle Surg. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. National Library of Medicine Not applicable. (Figs.1919 and and20)20) [17, 20]. PubMed Central Skeletal Radiology - The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association. 8); BME in the posterior half of the lateral malleolus with pathology in the peroneal tendons (Fig. Google Scholar, Maillefert JF, Dardel P, Cherasse A, Mistrih R, Krause D, Tavernier C (2003) Magnetic resonance imaging in the assessment of synovial inflammation of the hindfoot in patients with rheumatoid arthritis and other polyarthritis. A perilesional reaction with perilesional BME sometimes surrounds a focal lesion (Fig. Subchondral bone marrow edema is a sensitive indicator of cartilage lesions. The reason is that the thin cartilage layer is difficult to image on MRI. Linear low-signal disturbances oriented perpendicular to the load axis, usually surrounded by extensive BME, are consistent with stress fracture (Fig. Articular epiphyses fail as a result . Eur J Radiol 67:1121 https://doi.org/10.1016/j.ejrad.2008.01.052, Shabshin N, Schweitzer ME, Morrison WB, Carrino JA, Keller MS, Grissom LE (2006) High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes? Anterior impingement manifests by a painful limitation of dorsal ankle flexion, mostly in football players, called footballers ankle. Accumulation of micro-trauma on the talar neck and anterior distal tibia may results in synovitis, thickening of the articular capsule, or osteophytes with BME (Figs. What is MRI bone oedema in rheumatoid arthritis and why does it matter? Google Scholar, Patel CV (2009) The foot and ankle: MR imaging of uniquely pediatric disorders. Intracortical changes occur while the limb is still bearing weight. 2017;282(3):798806. The authors declare that they have no competing interests. Management strategies for osteochondritis dissecans of the knee in the skeletally immature athlete. PMC Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. Evaluating bone marrow oedema patterns in musculoskeletal injury. Sometimes it may take longer for the BME to resolve [1]. The commoner examples include: Freiberg disease. 2016;46(8):113441. Am J Sports Med 35:643649 https://doi.org/10.1177/0363546506295701, McGonagle D, Gibbon W, Emery P (1998) Classification of inflammatory arthritis by enthesitis. MRI adds value by identifying unstable lesions that require surgical intervention. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. BME in an accessory bone shows that it is probably a symptomatic accessory bone. Degenerative changes or minor cartilage damage may lead to subchondral BME. Overuse injuries to the bones and soft tissue structures arise during repeated minor injuries, which are, however, too weak to cause a rupture of tendon or a full fracture. 2012;33(7):5917. Arthroscopy 17:445449 https://doi.org/10.1053/jars.2001.23581, Starr AM, Wessely MA, Albastaki U, Pierre-Jerome C, Kettner NW (2008) Bone marrow edema: pathophysiology, differential diagnosis, and imaging. Br J Sports Med 46:946953 https://doi.org/10.1136/bjsports-2011-090661, Rosenberg ZS, Beltran J, Bencardino JT (2000) MR imaging of the ankle and foot. Cooper Medical School of Rowan University, Camden, NJ, USA, Department of Radiology, Childrens Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA, Michael L. Francavilla,Christian A. Barrera,Michael K. Nguyen&Jie C. Nguyen, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA, Michael L. Francavilla,J. Todd R. Lawrence&Jie C. Nguyen, Divison of Orthopedic Surgery, Childrens Hospital of Philadelphia, Philadelphia, PA, USA, You can also search for this author in Type I: Diffuse or reticular BME, at some distance from the articular cartilage, Type II: Localized or geographic BME, often with a convex margin and contiguous to the articular cartilage or bony outline, Type III: The BME often has slight deformation or disruption of the bony outline, Bone marrow edema, Ankle trauma, Sports injury, Ankle sprain, Magnetic resonance imaging. 2000;20 Spec No(suppl_1):S153-79. 35). A slight periosteal edema is the first sign of stress fracture which, in the absence of treatment, is followed by BME in the medullary cavity. In 10 cadavers and four patients, accuracy of pin placement was in the range of 1.0-3.5 mm. This case report presents an arthroscopically assisted treatment of a navicular osteochondral lesion using curettage and backfilling with fibrin glue, flowable collagen, and autogenous bone grafting.
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