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Postoperative Findings, Knee
Julia R. Crim, MD; William B. Morrison, MD
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KEY FACTS

  • Imaging

    TERMINOLOGY

    • Definitions

      • Meniscal surgery
        • Debridement: Partial meniscectomy
        • Repair: Meniscal suturing or transplantation
          • Sometimes performed with tibial bone graft including meniscal attachments
      • Cruciate surgery
        • ACL reconstruction
          • Graft tunnels in lateral femoral condyle, central tibia; bioabsorbable screws are not radiopaque
          • Graft sources: Central 1/3 of patellar tendon [a.k.a., bone-tendon-bone, (BTB)], quadriceps tendon, hamstrings, cadaveric allograft
          • "Double bundle" reconstruction: 2 grafts and 2 separate sets of tunnels used to recreate native ACL anatomy
        • PCL reconstruction
          • Tunnels in medial femoral condyle, posterior tibia
      • Articular cartilage surgery
        • Microfracture: Drilling through cartilage defect into bone; low-signal fibrocartilage "patch" forms
        • Osteochondral autograft transplant system (OATS)/surgery, a.k.a. mosaic chondroplasty: Plugs of healthy cartilage and bone harvested from non-weight-bearing surfaces and implanted into defect
          • Plugs incorporate into adjacent bone
          • Cobblestone pattern: Small gaps seen between adjacent, round graft plugs
        • Cartilage transplantation: Autologous chondrocyte implantation (ACI)
          • Cartilage harvested from non-weight-bearing region, cultured; cells injected under periosteal patch sewn over defect
          • Hyaline cartilage patch forms
        • Osteochondral allograft
          • Large piece of articular surface including cartilage and bone transplanted (cadaveric)
          • Used to reconstruct large osteochondral lesions or for tumor reconstruction

    IMAGING

    • Imaging Recommendations

      • MR Findings

        CLINICAL ISSUES

        • Presentation

          Selected References

          1. Guermazi A et al: State of the art: MR imaging after knee cartilage repair surgery. Radiology. 277(1):23-43, 2015
          2. Magee T: Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. Skeletal Radiol. 43(8):1057-64, 2014
          3. Gopez AG et al: MR imaging of the postoperative meniscus: repair, resection, and replacement. Semin Musculoskelet Radiol. 10(3):229-40, 2006
          4. White LM et al: MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage. Skeletal Radiol. 34(8):431-52, 2005
          5. Magee T et al: MR arthrography of postoperative knee: for which patients is it useful? Radiology. 229(1):159-63, 2003
          6. Recht MP et al: MR imaging of the postoperative knee: a pictorial essay. Radiographics. 22(4):765-74, 2002
          Related Anatomy
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          Related Differential Diagnoses
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          References
          Tables

          Tables

          KEY FACTS

          • Imaging

            TERMINOLOGY

            • Definitions

              • Meniscal surgery
                • Debridement: Partial meniscectomy
                • Repair: Meniscal suturing or transplantation
                  • Sometimes performed with tibial bone graft including meniscal attachments
              • Cruciate surgery
                • ACL reconstruction
                  • Graft tunnels in lateral femoral condyle, central tibia; bioabsorbable screws are not radiopaque
                  • Graft sources: Central 1/3 of patellar tendon [a.k.a., bone-tendon-bone, (BTB)], quadriceps tendon, hamstrings, cadaveric allograft
                  • "Double bundle" reconstruction: 2 grafts and 2 separate sets of tunnels used to recreate native ACL anatomy
                • PCL reconstruction
                  • Tunnels in medial femoral condyle, posterior tibia
              • Articular cartilage surgery
                • Microfracture: Drilling through cartilage defect into bone; low-signal fibrocartilage "patch" forms
                • Osteochondral autograft transplant system (OATS)/surgery, a.k.a. mosaic chondroplasty: Plugs of healthy cartilage and bone harvested from non-weight-bearing surfaces and implanted into defect
                  • Plugs incorporate into adjacent bone
                  • Cobblestone pattern: Small gaps seen between adjacent, round graft plugs
                • Cartilage transplantation: Autologous chondrocyte implantation (ACI)
                  • Cartilage harvested from non-weight-bearing region, cultured; cells injected under periosteal patch sewn over defect
                  • Hyaline cartilage patch forms
                • Osteochondral allograft
                  • Large piece of articular surface including cartilage and bone transplanted (cadaveric)
                  • Used to reconstruct large osteochondral lesions or for tumor reconstruction

            IMAGING

            • Imaging Recommendations

              • MR Findings

                CLINICAL ISSUES

                • Presentation

                  Selected References

                  1. Guermazi A et al: State of the art: MR imaging after knee cartilage repair surgery. Radiology. 277(1):23-43, 2015
                  2. Magee T: Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. Skeletal Radiol. 43(8):1057-64, 2014
                  3. Gopez AG et al: MR imaging of the postoperative meniscus: repair, resection, and replacement. Semin Musculoskelet Radiol. 10(3):229-40, 2006
                  4. White LM et al: MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage. Skeletal Radiol. 34(8):431-52, 2005
                  5. Magee T et al: MR arthrography of postoperative knee: for which patients is it useful? Radiology. 229(1):159-63, 2003
                  6. Recht MP et al: MR imaging of the postoperative knee: a pictorial essay. Radiographics. 22(4):765-74, 2002