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IC 204-2023: The Cutting Edge in Osteochondritis D ...
IC 204 - The Cutting Edge in Osteochondritis Disse ...
IC 204 - The Cutting Edge in Osteochondritis Dissecans: Updates from the ROCK Group (5/7)
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Video Transcription
What we'll talk about is, hopefully, I'll try to go through this one quickly because I think it gets the point home pretty quick, and then we'll move on to some others. So this eight-year-old male, important to note that it was bilateral knee pain, no precipitating injury. Pain in both supermedial and anteromedial, and it's worse with activity. I point out the location because I definitely think the location matters. I think it's not uncommon to find incidental OCDs is kind of how I would phrase it. Patient comes in, is complaining of knee pain, and you see an OCD, but in fact, they have pain in other locations, and if they do, the radar has to go up about is this actually a symptomatic OCD or not. On exam, the patient had patellar crepitus, and there was no tenderness to palpation in either knee, including over the condyles, as I said. I think location matters, so for me, I always want to make sure that they actually have pain anteriorly over the site of the OCD lesion. So we got an MRI. There was no OCD found in the left knee, and then here's the MRIs from the right knee. So this is our typical T2 sequence, and you can see the lesion there in the coronal. Yuda nicely pointed out that our traditional sequences, T2 and T1 in particular, are a little bit challenging, so in the sequence with the bone window, the inverted sequence that Yuda was pointing out, we can really see this lesion in more detail because we can see the bone. And then here's the T2 star mapping. This I think in this case is a little less clear, but you can also appreciate on the dark blue there how the lesion is more well-defined. So for this patient, the plan was to avoid impact activity. This is kind of our protocol at our institution. And then follow-up at six weeks. So at six weeks, the patient had no pain with daily activities. And because of that, we allowed the patient to gradually return to regular activities. They came back at 18 months after initial presentation just for follow-up. Normally, we do that at about a year. In this case, it was 18 months. And the patient had returned to all activities, including sports, with no symptoms. So here's the MRI at that time. And you can compare in the bone window how that looks to what it looked like before. And then here's some of the images. Yuda showed you some of these nicely, but we can see the difference on the left versus the right and how it looks both on the bone windows and on the T2 mapping. And then here's some more imaging of that. So from top is before and bottom is after.
Video Summary
In this video, the speaker discusses a case of an eight-year-old male who presented with bilateral knee pain. The pain was located in the supermedial and anteromedial regions and worsened with activity. The speaker emphasizes the importance of assessing the location of the pain to determine if it is related to an osteochondritis dissecans (OCD) lesion or not. An MRI revealed an OCD lesion in the right knee, while the left knee was unaffected. The patient followed a protocol of avoiding impact activities and, after six weeks, reported no pain with daily activities. At 18 months, the patient had returned to all activities, including sports, without any symptoms. The video includes MRI images comparing before and after treatment. No credits were mentioned in the transcript.
Asset Caption
Kevin Shea, MD; Theodore Ganley, MD; Marc Tompkins, MD; Crystal Perkins, MD; Jutta Ellermann, MD
Keywords
bilateral knee pain
osteochondritis dissecans (OCD)
MRI
avoiding impact activities
return to all activities
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