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Cartilage Injury, Knee
Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR; Donna G. Blankenbaker, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Cartilage fracture, cartilage tear, cartilage defect, cartilage lesion, chondral flap, chondral fissure, chondral defect, delamination
            • Definitions

              • Damage to hyaline cartilage surfaces in knee joint sparing underlying bone, caused by injury
              • Can be overlap in imaging of true traumatic lesions, degenerative cartilage loss, and focal defects occurring acutely in background of degeneration

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Jones KJ et al: Articular cartilage lesion characteristic reporting is highly variable in clinical outcomes studies of the knee. Cartilage. 10(3):299-304, 2019
                                            2. Liu YW et al: MR imaging of cartilage repair surgery of the knee. Clin Imaging. 58:129-39, 2019
                                            3. Gorbachova T et al: Osteochondral lesions of the knee: differentiating the most common entities at MRI. Radiographics. 38(5):1478-95, 2018
                                            4. Oei EHG et al: Cartilage imaging: techniques and developments. Semin Musculoskelet Radiol. 22(2):245-60, 2018
                                            5. Alizai H et al: An update on risk factors for cartilage loss in knee osteoarthritis assessed using MRI-based semiquantitative grading methods. Eur Radiol. 25(3):883-93, 2015
                                            6. Oussedik S et al: Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy. 31(4):732-44, 2015
                                            7. Alizai H et al: Cartilage lesion score: comparison of a quantitative assessment score with established semiquantitative MR scoring systems. Radiology. 271(2):479-87, 2014
                                            8. Kijowski R et al: Quantitative magnetic resonance imaging of the articular cartilage of the knee joint. Magn Reson Imaging Clin N Am. 22(4):649-69, 2014
                                            9. Markhardt BK et al: Hypointense signal lesions of the articular cartilage: a review of current concepts. Clin Imaging. 38(6):785-91, 2014
                                            10. Stephens T et al: The cartilage black line sign: an unexpected MRI appearance of deep cartilage fissuring in three patients. Skeletal Radiol. 40(1):113-6, 2011
                                            11. 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
                                            12. Black BR et al: Cartilage imaging in sports medicine. Sports Med Arthrosc. 17(1):68-80, 2009
                                            13. Gobbi A et al: Biological approaches for cartilage repair. J Knee Surg. 22(1):36-44, 2009
                                            14. Gold GE et al: Recent advances in MRI of articular cartilage. AJR Am J Roentgenol. 193(3):628-38, 2009
                                            15. Kon E et al: Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med. 37(1):33-41, 2009
                                            16. Levine DW et al: Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med. 37(3):e3; author reply e4, 2009
                                            17. Mathieu L et al: Knee MR-arthrography in assessment of meniscal and chondral lesions. Orthop Traumatol Surg Res. 95(1):40-7, 2009
                                            18. Mithoefer K et al: Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 37(10):2053-63, 2009
                                            19. Tohyama H et al: Atelocollagen-associated autologous chondrocyte implantation for the repair of chondral defects of the knee: a prospective multicenter clinical trial in Japan. J Orthop Sci. 14(5):579-88, 2009
                                            20. Trattnig S et al: MR imaging of cartilage and its repair in the knee--a review. Eur Radiol. 19(7):1582-94, 2009
                                            21. Gaissmaier C et al: Growth and differentiation factors for cartilage healing and repair. Injury. 39 Suppl 1:S88-96, 2008
                                            22. Hettrich CM et al: Cartilage repair: third-generation cell-based technologies--basic science, surgical techniques, clinical outcomes. Sports Med Arthrosc. 16(4):230-5, 2008
                                            23. Kon E et al: Second generation issues in cartilage repair. Sports Med Arthrosc. 16(4):221-9, 2008
                                            24. McNickle AG et al: Overview of existing cartilage repair technology. Sports Med Arthrosc. 16(4):196-201, 2008
                                            25. Pelttari K et al: The use of mesenchymal stem cells for chondrogenesis. Injury. 39 Suppl 1:S58-65, 2008
                                            26. Williams III RJ et al: Cartilage repair procedures: clinical approach and decision making. Instr Course Lect. 57:553-61, 2008
                                            27. Hennig A et al: Osteochondral allografts in the treatment of articular cartilage injuries of the knee. Sports Med Arthrosc. 15(3):126-32, 2007
                                            28. Noyes FR et al: A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med. 17(4):505-13, 1989
                                            29. Outerbridge RE et al: The problem of chondromalacia patellae. Clin Orthop Relat Res. (110):177-96, 1975
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Cartilage fracture, cartilage tear, cartilage defect, cartilage lesion, chondral flap, chondral fissure, chondral defect, delamination
                                                      • Definitions

                                                        • Damage to hyaline cartilage surfaces in knee joint sparing underlying bone, caused by injury
                                                        • Can be overlap in imaging of true traumatic lesions, degenerative cartilage loss, and focal defects occurring acutely in background of degeneration

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Jones KJ et al: Articular cartilage lesion characteristic reporting is highly variable in clinical outcomes studies of the knee. Cartilage. 10(3):299-304, 2019
                                                                                      2. Liu YW et al: MR imaging of cartilage repair surgery of the knee. Clin Imaging. 58:129-39, 2019
                                                                                      3. Gorbachova T et al: Osteochondral lesions of the knee: differentiating the most common entities at MRI. Radiographics. 38(5):1478-95, 2018
                                                                                      4. Oei EHG et al: Cartilage imaging: techniques and developments. Semin Musculoskelet Radiol. 22(2):245-60, 2018
                                                                                      5. Alizai H et al: An update on risk factors for cartilage loss in knee osteoarthritis assessed using MRI-based semiquantitative grading methods. Eur Radiol. 25(3):883-93, 2015
                                                                                      6. Oussedik S et al: Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy. 31(4):732-44, 2015
                                                                                      7. Alizai H et al: Cartilage lesion score: comparison of a quantitative assessment score with established semiquantitative MR scoring systems. Radiology. 271(2):479-87, 2014
                                                                                      8. Kijowski R et al: Quantitative magnetic resonance imaging of the articular cartilage of the knee joint. Magn Reson Imaging Clin N Am. 22(4):649-69, 2014
                                                                                      9. Markhardt BK et al: Hypointense signal lesions of the articular cartilage: a review of current concepts. Clin Imaging. 38(6):785-91, 2014
                                                                                      10. Stephens T et al: The cartilage black line sign: an unexpected MRI appearance of deep cartilage fissuring in three patients. Skeletal Radiol. 40(1):113-6, 2011
                                                                                      11. 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
                                                                                      12. Black BR et al: Cartilage imaging in sports medicine. Sports Med Arthrosc. 17(1):68-80, 2009
                                                                                      13. Gobbi A et al: Biological approaches for cartilage repair. J Knee Surg. 22(1):36-44, 2009
                                                                                      14. Gold GE et al: Recent advances in MRI of articular cartilage. AJR Am J Roentgenol. 193(3):628-38, 2009
                                                                                      15. Kon E et al: Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med. 37(1):33-41, 2009
                                                                                      16. Levine DW et al: Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med. 37(3):e3; author reply e4, 2009
                                                                                      17. Mathieu L et al: Knee MR-arthrography in assessment of meniscal and chondral lesions. Orthop Traumatol Surg Res. 95(1):40-7, 2009
                                                                                      18. Mithoefer K et al: Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 37(10):2053-63, 2009
                                                                                      19. Tohyama H et al: Atelocollagen-associated autologous chondrocyte implantation for the repair of chondral defects of the knee: a prospective multicenter clinical trial in Japan. J Orthop Sci. 14(5):579-88, 2009
                                                                                      20. Trattnig S et al: MR imaging of cartilage and its repair in the knee--a review. Eur Radiol. 19(7):1582-94, 2009
                                                                                      21. Gaissmaier C et al: Growth and differentiation factors for cartilage healing and repair. Injury. 39 Suppl 1:S88-96, 2008
                                                                                      22. Hettrich CM et al: Cartilage repair: third-generation cell-based technologies--basic science, surgical techniques, clinical outcomes. Sports Med Arthrosc. 16(4):230-5, 2008
                                                                                      23. Kon E et al: Second generation issues in cartilage repair. Sports Med Arthrosc. 16(4):221-9, 2008
                                                                                      24. McNickle AG et al: Overview of existing cartilage repair technology. Sports Med Arthrosc. 16(4):196-201, 2008
                                                                                      25. Pelttari K et al: The use of mesenchymal stem cells for chondrogenesis. Injury. 39 Suppl 1:S58-65, 2008
                                                                                      26. Williams III RJ et al: Cartilage repair procedures: clinical approach and decision making. Instr Course Lect. 57:553-61, 2008
                                                                                      27. Hennig A et al: Osteochondral allografts in the treatment of articular cartilage injuries of the knee. Sports Med Arthrosc. 15(3):126-32, 2007
                                                                                      28. Noyes FR et al: A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med. 17(4):505-13, 1989
                                                                                      29. Outerbridge RE et al: The problem of chondromalacia patellae. Clin Orthop Relat Res. (110):177-96, 1975