Lin Kenneth M, Gadinsky Naomi E, Klinger Craig E, Kleeblad Laura J, Shea Kevin G, Dyke Jonathan P, Helfet David L, Rodeo Scott A, Green Daniel W, Lazaro Lionel E
Hospital for Special Surgery/New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA.
J Child Orthop. 2022 Apr;16(2):152-158. doi: 10.1177/18632521221084179. Epub 2022 Apr 30.
Injury to or abnormality of developing distal femoral chondroepiphysis blood supply has been implicated in osteochondritis dissecans development. Progressive decrease in epiphyseal cartilage blood supply occurs in normal development; however, based on animal studies, it is hypothesized that there is greater decrease in regions more prone to osteochondritis dissecans lesions. We aimed to quantify differential regional perfusion of the immature distal femoral chondroepiphysis. We hypothesized there is decreased perfusion in the lateral aspect of the medial femoral condyle, the classic osteochondritis dissecans lesion location.
Five fresh-frozen human cadaveric knees (0-6 months old) were utilized. The superficial femoral artery was cannulated proximally and contrast-enhanced magnetic resonance imaging performed using a previously reported protocol for quantifying osseous and soft tissue perfusion. Regions of interest were defined, and signal enhancement changes between pre- and post-contrast images, normalized to background muscle, were compared.
When comparing average normalized post-contrast signal enhancement of whole condyles, as well as distal, posterior, and inner (toward the notch) aspects of the medial and lateral condyles, no significant perfusion differences between condyles were found. In the medial condyle, no significant perfusion difference was found between the medial and lateral aspects.
We quantified immature distal femoral chondroepiphysis regional vascularity in the early post-natal knee. In specimens aged 0-6 months, no distinct watershed region was detected. Despite possible limitations, given small sample size, as well as resolution of magnetic resonance imaging and analysis, our results suggest the hypothesized vascular abnormality predisposing osteochondritis dissecans either does not occur universally or occurs after this developmental age.
股骨远端软骨骨骺发育过程中的血供损伤或异常被认为与剥脱性骨软骨炎的发生有关。在正常发育过程中，骨骺软骨血供会逐渐减少；然而，基于动物研究推测，在更易发生剥脱性骨软骨炎病变的区域，血供减少更为明显。我们旨在量化未成熟股骨远端软骨骨骺的不同区域灌注情况。我们假设股骨内侧髁外侧（即经典的剥脱性骨软骨炎病变部位）的灌注减少。
使用了5个新鲜冷冻的人类尸体膝关节（0 - 6个月大）。在股浅动脉近端插管，并采用先前报道的用于量化骨和软组织灌注的方案进行对比增强磁共振成像。定义感兴趣区域，并比较对比前后图像之间的信号增强变化，并以背景肌肉进行归一化处理。
比较整个髁以及内侧和外侧髁的远端、后部和内侧（朝向髁间切迹）方面的平均归一化对比后信号增强时，未发现髁之间存在显著的灌注差异。在内侧髁中，内侧和外侧方面之间未发现显著的灌注差异。
我们量化了出生后早期膝关节未成熟股骨远端软骨骨骺的区域血管情况。在0 - 6个月大的标本中，未检测到明显的分水岭区域。尽管存在可能的局限性，鉴于样本量小以及磁共振成像和分析的分辨率，我们的结果表明，推测的易引发剥脱性骨软骨炎的血管异常要么并非普遍存在，要么发生在这个发育阶段之后。
