Before I summarize the responses, I want to let you know that our most recent Case Session, "Focus on Peds MSK" was really excellent….one of the best, in my opinion…everyone showed beautiful cases and the presentations were very informative. The video is available for On-Demand viewing on our website at https://ocadmsk.com/videos/
If you haven’t as yet, register for free access to the website at ocadmsk.com
Now….I reached out directly to the Peds MSK A team…
Jonathan Samet: I’ve never seen a real OCD in a 5 year old. The leading edge of the developing epiphysis often has little concavities and irregularities that look like lucent lesions en face.
Hamza Alizai:
Agree with Jonathan. Normal ongoing ossification. If anything, they can follow up with an X-ray and it will become less conspicuous.The rules on radsource regarding the location of normal developmental irregular ossification are not accurate.
Jie Nguyen:
Agreed with Jonathan
Initially proposed by Gebarski et al., followed up by Jans et al. 2011 and 2012, criteria listed. Full references below, a slide from a prior presentation.
Unfortunately, lateral view is oblique, epicenter is at boundary, not exactly over weight-bear central LFC è so, no deal-breaker. On AP, this is not tangential, so favor mover over posterior FC.
In the original papers, there are more images of ossification variant over LFC than MFC. Although spiculated contour is common over MFC, puzzle piece like configuration (most mimic early JOCD) is less common.
The prescription gives no other information….tech notes indicate "no trauma" which is accurate almost 50% of the time in my experience.
My question is if we can differentiate normal developmental variant from OCD.
Per the attached Radsource reference, I understand most of these in the LFC are posterior, and this is central—but I don’t know if that is a deal breaker.
I also wonder if the questionable subchondral lucency of the MFC is something I’m just hallucinating.
Does this warrant an MRI, or is it just all normal?
