A hyperintense rim or cysts at the osteochondral fragment periphery on MRI are less specific for OCD fragment instability in children compared to adults; however, MRI is still useful to determine the best method of treatment [41,50]. Following cartilage repair, MRI can grade the repair site and even guide the retrograde drilling of the OCD lesion [51-54]. MRI with and without IV contrast is not usually indicated to evaluate patients with OCD, loose bodies, or history of cartilage repair because of the usual larger volume of joint fluid, the lesser degree of synovial invagination, and the longer time required to achieve steady state gadolinium in the joint compared to the shoulder [16]. MR Arthrography Knee MR arthrography is typically reserved for patients with known prior meniscal surgery, chondral and osteochondral lesions, prior cartilage repair procedures, or suspected loose bodies [10,16]. US Knee US is not often useful as a screening test or a comprehensive examination. It may be appropriate to localize suspected loose bodies, especially if the loose bodies might be within a popliteal cyst, lateral recess, or suprapatellar recess. Bone Scan Knee Radionuclide bone scan is usually not indicated to evaluate patients with OCD, loose bodies, or history of cartilage repair. Image-Guided Aspiration Knee Joint aspiration is usually not indicated to evaluate patients with OCD, loose bodies, or history of cartilage repair. Variant 4: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph demonstrates degenerative changes or chondrocalcinosis. Next imaging procedure. Radiography Hip An ipsilateral hip radiograph is usually not indicated to evaluate patients with osteoarthritis or chondrocalcinosis. Chronic Knee Pain CT Knee Dual-energy CT without IV contrast may be indicated if gout or mixed crystal disease is a consideration. Otherwise, CT is not commonly used as a diagnostic test to evaluate patients with osteoarthritis or chondrocalcinosis.
Chronic Knee Pain. A hyperintense rim or cysts at the osteochondral fragment periphery on MRI are less specific for OCD fragment instability in children compared to adults; however, MRI is still useful to determine the best method of treatment [41,50]. Following cartilage repair, MRI can grade the repair site and even guide the retrograde drilling of the OCD lesion [51-54]. MRI with and without IV contrast is not usually indicated to evaluate patients with OCD, loose bodies, or history of cartilage repair because of the usual larger volume of joint fluid, the lesser degree of synovial invagination, and the longer time required to achieve steady state gadolinium in the joint compared to the shoulder [16]. MR Arthrography Knee MR arthrography is typically reserved for patients with known prior meniscal surgery, chondral and osteochondral lesions, prior cartilage repair procedures, or suspected loose bodies [10,16]. US Knee US is not often useful as a screening test or a comprehensive examination. It may be appropriate to localize suspected loose bodies, especially if the loose bodies might be within a popliteal cyst, lateral recess, or suprapatellar recess. Bone Scan Knee Radionuclide bone scan is usually not indicated to evaluate patients with OCD, loose bodies, or history of cartilage repair. Image-Guided Aspiration Knee Joint aspiration is usually not indicated to evaluate patients with OCD, loose bodies, or history of cartilage repair. Variant 4: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph demonstrates degenerative changes or chondrocalcinosis. Next imaging procedure. Radiography Hip An ipsilateral hip radiograph is usually not indicated to evaluate patients with osteoarthritis or chondrocalcinosis. Chronic Knee Pain CT Knee Dual-energy CT without IV contrast may be indicated if gout or mixed crystal disease is a consideration. Otherwise, CT is not commonly used as a diagnostic test to evaluate patients with osteoarthritis or chondrocalcinosis.