1. Lesion location

2. Lesion size

3. Status of the Physis – Physeal Patency

4. Characteristics of Parent Bone

a) Sclerosis

5. Characteristics of Progeny Bone – Static Non-Comparison Measurements

a) Visualization

b) Fragmentation

c) Displacement

d) Radio-density of the Center of the Progeny Bone

e) Radio-density of the Rim of the Progeny Bone

f) Boundary (primary variable to assess healing)

g) Shape

6. Characteristics of Progeny Bone – Dynamic Comparison Measurements

a) Radio-density

b) Boundary

X-RAY CRITERIA

1. Standing AP – bilateral knees

2. Lateral – bilateral knees

3. Merchant – bilateral knees

4. Notch/Tunnel – bilateral knees

5. Left hand (for skeletal age)

X-ray Technique Protocol for these studies – Radiologist input?

X-RAY PROTOCOL

ClosingOpen Closed

1 – Open2 – Closing3 – Closed

CRITERION 3 – STATUS OF THE PHYSIS / PHYSEAL PATENCY

1 – Open2 – Closing3 – Closed

1 – Open2 – Closing3 – Closed

Assessment should consider only the femoral physis.

Closing’ Definition: - Must be able to see both some areas of the physis that appear

to be ‘closed’ and some areas that are clearly still ‘open’.

CRITERION 1 – LOCATION OF THE LESION

1 – Medial femoral condyle2 – Lateral femoral condyle3 – Patella4 – Trochlea

AP Lateral

1 – Anterior Condyle2 – Posterior Condyle3 – Patella4 – Trochlea

APostTPat

LATERAL VIEW: Project line off posterior femoral shaft. If posterior to line = Posterior. If between posterior femoral line and Blumenstadts line then =Anterior. If anterior to Blumenstadts then=Trochlear. Pick center of lesion surface predominant compartment

LateralAP Notch

1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion

1 – Length of OCD lesion2 – Length of condyle3 – Max. depth of lesion

1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion

CRITERION 2 – SIZE OF THE LESION

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AP1 – Width/Length OCD = normal parent bone to normal parent bone margin2 – Width = inter-epicondylar distance Length = maximal AP dimension measure parallel to

joint3 – Max Depth = in unossified, complete the arc of the parent bone contour and measure the

longest perpendicular line to the rim of parent bone and depth of the crater

1

32

32

1

1

2

3

LateralAP Notch

1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion

1 – Length of OCD lesion2 – Length of condyle3 – Max. depth of lesion

1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion

CRITERION 2 – SIZE OF THE LESION

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Lateral1 – Length of OCD lesion – normal parent bone to normal parent bone margin. 2 – Length of condyle (anterior-to-posterior). Measure the involved condyle. Measure parallel to

physis3 – Maximum depth of lesion (if unossified, complete the arc of the parent bone contour, and

measure the longest perpendicular line to the rim of parent bone in the depth of the crater)

1

32

32

1

1

2

3

LateralAP Notch

1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion

1 – Length of OCD lesion2 – Length of condyle3 – Max. depth of lesion

1 – Width of OCD lesion2 – Width of knee3 – Max. depth of lesion

CRITERION 2 – SIZE OF THE LESION

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Notch1 – Width of OCD lesion – normal parent bone to normal parent bone margin2 – Width of knee (inter-epicondylar distance) – Select the maximum distance parallel to joint

surface3 – Maximum depth of lesion (if unossified, complete the arc of the parent bone contour, and

measure the longest perpendicular line to the rim of parent bone in the depth of the crater)

1

32

32

1

1

2

3

Same DensityLess DenseMore Dense

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1 – More Dense2 – Less Dense3 – Same Density

CRITERION 4 – CHARACTERISTIC OF PARENT BONE - SCLEROSIS

In comparison to the unaffected parent bone, the radio-density of the rim of the parent bone is?

1 – More Dense2 – Less Dense3 – Same Density

1 – More Dense2 – Less Dense3 – Same Density

CRITERION 5a – CHARACTERISTIC OF PROGENY BONE - VISUALIZATION

Visualized Not-visualized

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1 – No2 – Yes

1 – No2 – Yes

Is the progeny bone visualized ON ALL VIEWS?

Evaluate all views to determine presence of ossification.

If ossification not visualized on any view and appears as a “black hole”, check NO (Not-visualized)

CRITERION 5b – CHARACTERISTIC OF PROGENY BONE - FRAGMENTATION

1 – No2 – Yes

Fragmented

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Non-fragmented

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1 – No2 – Yes

Is the progeny bone fragmented? Need to see 2 or more pieces of progeny bone

CRITERION 5c – CHARACTERISTIC OF PROGENY BONE - DISPLACEMENT

Completely displacedPartially displacedNon-displaced

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Is the progeny bone displaced?- If any view demonstrates partial displacement, then it should be

defined as such, unless any view demonstrates complete displacement, then it should be defined as complete.

- Look at all views before rating.

1 – Non-displaced2 – Partially3 – Totally

1 – Non-Displaced2 – Partially3 – Totally

1 – Non-displaced2 – Partially3 – Totally

Same DensityLess DensityMore Dense

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1 – More 2 – Less3 – Same

1 – More 2 – Less3 – Same

1 – More 2 – Less 3 – Same

CRITERION 5d – CHARACTERISTIC OF PROGENY – DENSITY OF CENTER

In comparison to the unaffected parent bone of the involved condyle, the radio-density of the Center of the progeny bone is……

Same DensityLess DensityMore Dense

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1 – More Dense2 – Less Dense3 – Same Density

1 – More Dense2 – Less Density3 – Same Density

1 – More Dense2 – Less Dense3 – Same Density

CRITERION 5e – CHARACTERISTIC OF PROGENY – DENSITY OF RIM

In comparison to the unaffected parent bone, the radio-density of the Rim of the progeny bone is? Progeny Rim is usually just beyond the Parent sclerotic rim.

CRITERION 5f – CHARACTERISTIC OF PROGENY BONE - BOUNDARY

1 – Distinct2 – Indistinct

Distinct

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Indistinct

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The boundary between the parent bone and progeny bone is?If “Distinct” on any view, pick “Distinct”

1 – Distinct2 – Indistinct

1 – Convex2 – Linear3 – Concave

CRITERION 5g – CHARACTERISTIC OF PROGENY BONE - SHAPE

Concave

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1 – Convex2 – Linear3 – Concave

1 – Convex2 – Linear3 – Concave

Convex Linear

The predominant shape/contour of the articular side of OCD lesion is?

END

CRITERION 6a – DYNAMIC COMPARISON CRITERION – RADIO-DENSITY

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Comparison Image Current image

1 – More dense2 – Less dense3 – Same density

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In comparison to previous radiographs, radio-density of progeny bone is?

CRITERION 6b – DYNAMIC COMPARISON CRITERION – BOUNDARY

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Comparison Image Current image

1 – More distinct2 – Less distinct3 – Equally distinct

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In comparison to previous radiographs, the boundary is?