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high signal changes behind fragment indicating synovial fluid between fragment and under-lying subchondral bone Type IV: loose body Guhl 37 described 4 stages of OCD based on arthroscopic findings: Type I: softening and irregularity of cartilage but no fragment Type II: breached articular cartilage, low signal rim behind fragment indicating attachment Type III: definable fragment, partially attached but displaceable (flap lesion) Type IV: loose body and defect of articular surface More recently, the ROCK Study Group developed a new arthroscopic classification of OCD of the knee divided in two main categories with three subgroups for each category 38 with excellent intra and interobserver reliability: Immobile OCD lesions: Cue ball type (no abnormality) Shadow type (cartilage is intact and subtly demarcated) Wrinkle in the rug (cartilage is demarcated with a fissure, buckle and/or wrinkle) Mobile OCD lesions: Locked door (cartilage fissuring at periphery unable to hinge open) Trapped door (cartilage fissuring at periphery able to hinge open) Crater (exposed subchondral bone defect) Regardless classifications of OCD, the most important aspect is the fragment stability that is the key factor governing prognosis and treatment decisions

doi: 10.1371/journal.pone.0109027 162 LeungJMMalagoliASantoroABesuttiGLigabueGScaglioniRet al