IMAGING OF OSTEOCHONDRAL INJURIES
Section snippets
CARTILAGE INJURY
Detecting articular cartilage defects in the knee is important because the signs and symptoms associated with such defects can be confused clinically with meniscal tears, synovial problems, and extensor mechanism dysfunction.19 Unfortunately, cartilage is not visualized on conventional radiographs. Therefore, purely chondral lesions require standard arthrography, computed arthrotomography, magnetic resonance (MR) arthrography, or arthroscopy for accurate diagnosis. Unless there is a large free
SUBCHONDRAL INJURY
When the chondral injury is associated with subchondral bone involvement, there can be development of a bone contusion, an acute osteochondral fracture, or chronic osteochondritis dissecans.
IMAGING OF OSTEOCHONDRAL INJURIES
Orthopaedic surgeons have attempted to identify noninvasive or minimally invasive imaging modalities that would provide information about osteochondral fractures and osteochondritis dissecans similar to that provided by arthroscopic assessment. Standard arthrography has been used in the past to delineate large lesions; however, small lesions cannot be detected with this modality. Computed tomography (CT) and computed arthrotomography can be used to diagnose and localize lesions involving the
SPECIFIC LOCATIONS OF OSTEOCHONDRAL LESIONS
Osteochondral lesions are identified most frequently in the femoral condyles, capitellum of the elbow, dome of the talus, and the dorsal surface of the patella.
POST-TREATMENT EVALUATION
Treatment procedures for chondral injuries include abrasion arthroplasty, chondrocyte transplant, microfracture technique, articular cartilage transplant, fresh osteochondral allografts, and autogenous osteochondral “plug” transfers. As the number and types of treatment options have increased, so has the role of MR imaging in the evaluation of articular cartilage and, now, cartilage repair techniques.21 MR imaging appears to be the most promising noninvasive diagnostic modality for this purpose
SUMMARY
Acute injuries can produce fragments consisting of cartilage alone or cartilage and underlying bone. A purely cartilaginous fragment creates no direct radiographic abnormalities, whereas one containing calcified cartilage and bone appears as a radiodensity. The advent and refinement of MR imaging have led to the detection of occult injuries of subchondral bone and cartilage that can escape identification on routine radiographic analysis. The available data appear to indicate a substantial role
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Address reprint requests to Rebecca Loredo, MD, Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7800