Osteochondritis dissecans: analysis of mechanical stability with radiography, scintigraphy, and MR imaging

Twenty-one joints with stable (n = 9) or loose (n = 12) osteochondritis dissecans (OCD) lesions were examined in 15 subjects with plain radiography, three-phase bone scintigraphy, and magnetic resonance (MR) imaging. The lesion size and the thickness of the sclerotic margin as measured on plain radiographs were good parameters for predicting loosening. However, bone scintigraphy was more sensitive and specific in determining the mechanical stability of OCD lesions. MR imaging permitted direct visualization of loosening and fragment displacement; the latter permits differentiation of in situ loosening from a grossly unstable lesion. The noninvasive nature of bone scintigraphy and MR imaging makes them potentially preferable diagnostic modalities to arthrography for evaluating the mechanical status of OCD lesions.