[Radiology between cartilage and bone : New perspectives on osteochondritis dissecans].

clinical problemIn children and adolescents, osteochondritis dissecans (OCD) represents an important differential diagnosis of chronic joint pain. Because the disease typically begins with nonspecific symptoms, imaging plays a pivotal role in establishing the diagnosis. Early-stage lesions, if identified correctly, can heal completely, whereas unstable lesions usually require surgical treatment. RADIOLOGICAL STANDARD TECHNIQUES: Conventional radiography remains the cornerstone of initial diagnostic evaluation. METHODOLOGICAL INNOVATION: Magnetic resonance imaging (MRI) is currently the most important imaging technique for evaluating OCD lesions. It enables early detection of subchondral signal alterations, detailed morphological assessment of the lesion, evaluation of stability through direct and indirect signs of instability, and follow-up under conservative or postoperative treatment. ASSESSMENT: Radiologists play a central role in the early detection and characterization of OCD, providing clinicians with critical information for further management. RECOMMENDATION FOR CLINICAL PRACTICE: OCD should always be considered in cases of unexplained joint pain in children, adolescents, and young adults. Conventional radiographs should be performed as the initial diagnostic evaluation. However, only MRI enables reliable early detection and accurately differentiates stable and unstable disease. In children, both sides should be examined when appropriate, since OCD frequently affects both joints.