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Articular Cartilage: Postoperative Imaging
Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS

  • Imaging

    • Pathology

      TERMINOLOGY

      • Abbreviations

        • Osteochondral autograft transfer system (OATS)
        • Autologous osteochondral transplant (AOT)
        • Autologous chondrocyte implantation (ACI)
      • Synonyms

        • Mosaicplasty: Trade name for 1 method of performing osteochondral transplant of multiple small osteochondral plugs
      • Definitions

        • Variety of surgical techniques to repair or replace damaged or missing articular cartilage surfaces in knee
        • All techniques begin with removal of abnormal articular cartilage
        • Marrow stimulation techniques
          • Appropriate for smaller lesions
          • Puncture of subchondral bone releases pluripotential stem cells that form fibrocartilaginous scar
          • Resulting scar does not have biomechanical properties of normal cartilage
          • Long-term results not as good as with transplant and ACI techniques
          • Types of procedures; may be used in combination
            • Microfracture ("pick" procedure)
              • Multiple small holes are created in subchondral bone with awl to promote bleeding → fibrocartilaginous scar
              • Most commonly performed marrow stimulation procedure
              • Integrity of repair may degrade at 18-36 weeks
              • Newer procedures add scaffold or polymer to site to augment process
              • e.g., autologous matrix-induced chondrogenesis: Porcine collagen matrix added to surgical site with fibrin glue
            • Abrasion arthroplasty
              • Underlying subchondral bone is roughened using arthroscopic burr to promote bleeding and subsequent scar formation in chondral defect
            • Subchondral drilling
              • Drill used to trephine subchondral bone and promote bleeding → fibrocartilaginous scar
        • Biodegradable pin/screw fixation
          • Biodegradable pins used to stabilize lesion
            • In situ unstable osteochondral lesions
            • Chondral flap tears
          • Pins resorb in 6-24 months
          • Variably threaded metallic screws still used by some surgeons
        • Osteochondral transplantation
          • OATS, AOT, and mosaicplasty often used interchangeably in literature and clinical practice: Osteochondral autograft will be used to refer to all procedures here
          • Appropriate for lesions 1-4 cm²
          • Osteochondral plugs inserted into lesion
          • Osteochondral autograft
            • Harvested from non-weight-bearing surface, usually lateral trochlea > margin of intercondylar notch
            • Relies on presence of usable donor cartilage
            • Possibility of donor site morbidity
            • Several fragments may be placed to fill 1 large defect (mosaicplasty)
              • Spaces between plugs eventually fill in with fibrocartilaginous grout
          • Allogeneic graft
            • Cadaveric graft material
            • Used for larger lesions
            • Allows for rectangular or round grafts
            • Original concern for immune response and disease transmission not substantiated in practice
        • ACI
          • Appropriate for lesions 2-12 cm²
          • Patient's own cartilage harvested from non-weight-bearing surface
          • Cells grown in culture for 3-5 weeks to produce chondrocytes
          • Periosteal or synthetic cover/membrane sewn or glued over defect
          • Cultured chondrocytes injected under cover
          • Resulting cartilage hyaline-like, thought to have biomechanical properties similar to native cartilage
          • Increased long-term durability
        • Matrix-associated autologous chondrocyte transplantation
          • 3D biologic scaffold optimized for culture of seeded chondrocytes implanted in defect by miniarthrotomy
          • Trimmed to fit defect and glued in place

      IMAGING

      • General Features

        • CT Findings

          • MR Findings

            • Imaging Recommendations

              PATHOLOGY

              • Microscopic Features

                CLINICAL ISSUES

                • Natural History & Prognosis

                  DIAGNOSTIC CHECKLIST

                  • Consider

                    • Reporting Tips

                      Selected References

                      1. Campbell AB et al: Return to sport after articular cartilage repair in athletes' knees: a systematic review. Arthroscopy. ePub, 2015
                      2. Oussedik S et al: Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy. 31(4):732-744, 2015
                      3. Forney MC et al: Magnetic resonance imaging of cartilage repair procedures. Magn Reson Imaging Clin N Am. 22(4):671-701, 2014
                      4. Trattnig S et al: MR imaging of postoperative talar dome lesions. Semin Musculoskelet Radiol. 16(3):177-84, 2012
                      5. Hughes RJ et al: Clinical and MRI considerations in sports-related knee joint cartilage injury and cartilage repair. Semin Musculoskelet Radiol. 15(1):69-88, 2011
                      6. Harris JD et al: Treatment of chondral defects in the athlete's knee. Arthroscopy. 26(6):841-52, 2010
                      7. Van Assche D et al: Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 18(4):486-95, 2010
                      8. Gold GE et al: Recent advances in MRI of articular cartilage. AJR Am J Roentgenol. 193(3):628-38, 2009
                      9. Kon E et al: Matrix-assisted autologous chondrocyte transplantation for the repair of cartilage defects of the knee: systematic clinical data review and study quality analysis. Am J Sports Med. 37 Suppl 1:156S-66S, 2009
                      10. Nehrer S et al: Treatment of full-thickness chondral defects with hyalograft C in the knee: a prospective clinical case series with 2 to 7 years' follow-up. Am J Sports Med. Suppl 1:81S-87S, 2009
                      11. Potter HG et al: New techniques in articular cartilage imaging. Clin Sports Med. 28(1):77-94, 2009
                      12. Trattnig S et al: MR imaging of cartilage and its repair in the knee--a review. Eur Radiol. 19(7):1582-94, 2009
                      13. Van Assche D et al: Physical activity levels after characterized chondrocyte implantation versus microfracture in the knee and the relationship to objective functional outcome with 2-year follow-up. Am J Sports Med. 37 Suppl 1:42S-49S, 2009
                      14. Welsch GH et al: T2 and T2* mapping in patients after matrix-associated autologous chondrocyte transplantation: initial results on clinical use with 3.0-Tesla MRI. Eur Radiol. Epub ahead of print, 2009
                      15. Choi YS et al: MR imaging of cartilage repair in the knee and ankle. Radiographics. 28(4):1043-59, 2008
                      16. Domayer SE et al: MRI monitoring of cartilage repair in the knee: a review. Semin Musculoskelet Radiol. 12(4):302-17, 2008
                      17. McNickle AG et al: Overview of existing cartilage repair technology. Sports Med Arthrosc. 16(4):196-201, 2008
                      18. Potter HG et al: Magnetic resonance imaging of cartilage repair. Sports Med Arthrosc. 16(4):236-45, 2008
                      19. Welsch GH et al: Cartilage T2 assessment at 3-T MR imaging: in vivo differentiation of normal hyaline cartilage from reparative tissue after two cartilage repair procedures--initial experience. Radiology. 247(1):154-61, 2008
                      20. Williams Iii RJ et al: Cartilage repair procedures: clinical approach and decision making. Instr Course Lect. 57:553-61, 2008
                      21. Tins BJ et al: Autologous chondrocyte implantation in knee joint: MR imaging and histologic features at 1-year follow-up. Radiology. 234(2):501-8, 2005
                      22. Recht M et al: MR imaging of cartilage repair procedures. Skeletal Radiol. 32(4):185-200, 2003
                      Related Anatomy
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                      Related Differential Diagnoses
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Imaging

                        • Pathology

                          TERMINOLOGY

                          • Abbreviations

                            • Osteochondral autograft transfer system (OATS)
                            • Autologous osteochondral transplant (AOT)
                            • Autologous chondrocyte implantation (ACI)
                          • Synonyms

                            • Mosaicplasty: Trade name for 1 method of performing osteochondral transplant of multiple small osteochondral plugs
                          • Definitions

                            • Variety of surgical techniques to repair or replace damaged or missing articular cartilage surfaces in knee
                            • All techniques begin with removal of abnormal articular cartilage
                            • Marrow stimulation techniques
                              • Appropriate for smaller lesions
                              • Puncture of subchondral bone releases pluripotential stem cells that form fibrocartilaginous scar
                              • Resulting scar does not have biomechanical properties of normal cartilage
                              • Long-term results not as good as with transplant and ACI techniques
                              • Types of procedures; may be used in combination
                                • Microfracture ("pick" procedure)
                                  • Multiple small holes are created in subchondral bone with awl to promote bleeding → fibrocartilaginous scar
                                  • Most commonly performed marrow stimulation procedure
                                  • Integrity of repair may degrade at 18-36 weeks
                                  • Newer procedures add scaffold or polymer to site to augment process
                                  • e.g., autologous matrix-induced chondrogenesis: Porcine collagen matrix added to surgical site with fibrin glue
                                • Abrasion arthroplasty
                                  • Underlying subchondral bone is roughened using arthroscopic burr to promote bleeding and subsequent scar formation in chondral defect
                                • Subchondral drilling
                                  • Drill used to trephine subchondral bone and promote bleeding → fibrocartilaginous scar
                            • Biodegradable pin/screw fixation
                              • Biodegradable pins used to stabilize lesion
                                • In situ unstable osteochondral lesions
                                • Chondral flap tears
                              • Pins resorb in 6-24 months
                              • Variably threaded metallic screws still used by some surgeons
                            • Osteochondral transplantation
                              • OATS, AOT, and mosaicplasty often used interchangeably in literature and clinical practice: Osteochondral autograft will be used to refer to all procedures here
                              • Appropriate for lesions 1-4 cm²
                              • Osteochondral plugs inserted into lesion
                              • Osteochondral autograft
                                • Harvested from non-weight-bearing surface, usually lateral trochlea > margin of intercondylar notch
                                • Relies on presence of usable donor cartilage
                                • Possibility of donor site morbidity
                                • Several fragments may be placed to fill 1 large defect (mosaicplasty)
                                  • Spaces between plugs eventually fill in with fibrocartilaginous grout
                              • Allogeneic graft
                                • Cadaveric graft material
                                • Used for larger lesions
                                • Allows for rectangular or round grafts
                                • Original concern for immune response and disease transmission not substantiated in practice
                            • ACI
                              • Appropriate for lesions 2-12 cm²
                              • Patient's own cartilage harvested from non-weight-bearing surface
                              • Cells grown in culture for 3-5 weeks to produce chondrocytes
                              • Periosteal or synthetic cover/membrane sewn or glued over defect
                              • Cultured chondrocytes injected under cover
                              • Resulting cartilage hyaline-like, thought to have biomechanical properties similar to native cartilage
                              • Increased long-term durability
                            • Matrix-associated autologous chondrocyte transplantation
                              • 3D biologic scaffold optimized for culture of seeded chondrocytes implanted in defect by miniarthrotomy
                              • Trimmed to fit defect and glued in place

                          IMAGING

                          • General Features

                            • CT Findings

                              • MR Findings

                                • Imaging Recommendations

                                  PATHOLOGY

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Natural History & Prognosis

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Reporting Tips

                                          Selected References

                                          1. Campbell AB et al: Return to sport after articular cartilage repair in athletes' knees: a systematic review. Arthroscopy. ePub, 2015
                                          2. Oussedik S et al: Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy. 31(4):732-744, 2015
                                          3. Forney MC et al: Magnetic resonance imaging of cartilage repair procedures. Magn Reson Imaging Clin N Am. 22(4):671-701, 2014
                                          4. Trattnig S et al: MR imaging of postoperative talar dome lesions. Semin Musculoskelet Radiol. 16(3):177-84, 2012
                                          5. Hughes RJ et al: Clinical and MRI considerations in sports-related knee joint cartilage injury and cartilage repair. Semin Musculoskelet Radiol. 15(1):69-88, 2011
                                          6. Harris JD et al: Treatment of chondral defects in the athlete's knee. Arthroscopy. 26(6):841-52, 2010
                                          7. Van Assche D et al: Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 18(4):486-95, 2010
                                          8. Gold GE et al: Recent advances in MRI of articular cartilage. AJR Am J Roentgenol. 193(3):628-38, 2009
                                          9. Kon E et al: Matrix-assisted autologous chondrocyte transplantation for the repair of cartilage defects of the knee: systematic clinical data review and study quality analysis. Am J Sports Med. 37 Suppl 1:156S-66S, 2009
                                          10. Nehrer S et al: Treatment of full-thickness chondral defects with hyalograft C in the knee: a prospective clinical case series with 2 to 7 years' follow-up. Am J Sports Med. Suppl 1:81S-87S, 2009
                                          11. Potter HG et al: New techniques in articular cartilage imaging. Clin Sports Med. 28(1):77-94, 2009
                                          12. Trattnig S et al: MR imaging of cartilage and its repair in the knee--a review. Eur Radiol. 19(7):1582-94, 2009
                                          13. Van Assche D et al: Physical activity levels after characterized chondrocyte implantation versus microfracture in the knee and the relationship to objective functional outcome with 2-year follow-up. Am J Sports Med. 37 Suppl 1:42S-49S, 2009
                                          14. Welsch GH et al: T2 and T2* mapping in patients after matrix-associated autologous chondrocyte transplantation: initial results on clinical use with 3.0-Tesla MRI. Eur Radiol. Epub ahead of print, 2009
                                          15. Choi YS et al: MR imaging of cartilage repair in the knee and ankle. Radiographics. 28(4):1043-59, 2008
                                          16. Domayer SE et al: MRI monitoring of cartilage repair in the knee: a review. Semin Musculoskelet Radiol. 12(4):302-17, 2008
                                          17. McNickle AG et al: Overview of existing cartilage repair technology. Sports Med Arthrosc. 16(4):196-201, 2008
                                          18. Potter HG et al: Magnetic resonance imaging of cartilage repair. Sports Med Arthrosc. 16(4):236-45, 2008
                                          19. Welsch GH et al: Cartilage T2 assessment at 3-T MR imaging: in vivo differentiation of normal hyaline cartilage from reparative tissue after two cartilage repair procedures--initial experience. Radiology. 247(1):154-61, 2008
                                          20. Williams Iii RJ et al: Cartilage repair procedures: clinical approach and decision making. Instr Course Lect. 57:553-61, 2008
                                          21. Tins BJ et al: Autologous chondrocyte implantation in knee joint: MR imaging and histologic features at 1-year follow-up. Radiology. 234(2):501-8, 2005
                                          22. Recht M et al: MR imaging of cartilage repair procedures. Skeletal Radiol. 32(4):185-200, 2003