0:00

We have here an elbow of a

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pediatric patient with elbow pain.

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And one of the most common findings,

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if we do find something abnormal,

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is an osteochondral lesion.

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And the most common location for

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an osteochondral lesion about

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the elbow is the capitellum.

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On the image on your left is a

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coronal dual echo-static state.

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That's our gradient thin slice images.

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The image on your right is a fat

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suppressed fluid-sensitive sequence.

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You could tell that this is a There's

0:28

already something abnormal because

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there's a pretty moderate-sized

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joint effusion that has developed.

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There's lots of edema in the capitellum, and

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there's also irregularity to the surface of your

0:40

capitellum with tiny or small cysts associated.

0:44

So this right here is an osteochondral

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lesion with the lesion that

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extended out into the joint space.

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So this is an unstable lesion.

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It helps us to talk about

0:55

stability versus instability.

0:58

Uh, and it guides the orthopedic

1:00

surgeon to what to do.

1:01

The criteria for an unstable osteochondral

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lesion in the pediatric population is slightly

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different than it is in the adult population.

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That's because the pediatric cartilage or

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lesions such as these are more resilient,

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if you will, than the ones for adults.

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So we are less conservative in what

1:22

we say is, uh, abnormally unstable.

1:26

In the adult population, the

1:28

presence of a single cyst would make

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an osteochondral lesion unstable.

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In the pediatric population, the cyst has

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to be multiple, or if there is a single

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cyst, it has to be more than 5 millimeters.

1:40

Okay?

1:41

So if you have one of those

1:42

two criteria, it's unstable.

1:45

Sometimes people use size, but at

1:47

our institution and in a lot of the

1:49

literature, size is not mentioned.

1:51

Some literature says in the knee,

1:53

maybe a centimeter or centimeter and a half.

1:56

That doesn't naturally translate into other

1:58

joints, but if you see a large lesion, you can

2:01

suggest that maybe the size alone may make it

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unstable, but that's not a proven criterion.

2:07

In the adult population, if you had just

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edema, let me bring up another sequence

2:12

here, maybe a coronal, I'll make sure.

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If you had just edema around

2:16

your area of abnormality, that

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could be construed as unstable.

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In the pediatric population, not only

2:23

does it have to be edema, but there

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has to be clear fluid-like signal

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surrounding the osteochondral lesion.

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This one does not have it.

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However, as I mentioned before, we've already

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reached threshold for unstable osteochondral

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lesion by the fact that there are multiple

2:40

cysts and at least one of those cysts

2:41

is five millimeters or greater, right?

2:44

So this is an unstable osteochondral lesion.

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And of course, if you have a loose

2:49

body, in other words, a piece of the

2:50

osteochondral lesion has fallen out of

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its native location and is floating around

2:56

in the joint, that's of course unstable.

2:58

Your most important job when looking

3:01

at an osteochondral lesion is one,

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letting them know, letting the surgeons

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know if it's stable or unstable and

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two, finding a loose body if it exists.

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Oftentimes the symptoms are

3:13

related to loose bodies more so

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than the actual osteochondral lesion.

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And as I said before, children

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are much more resilient to these

3:22

things healing than adults are.

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So oftentimes periods of rest may

3:26

result in complete healing, while in

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other cases, surgery may be required.