Relationship between patellofemoral joint morphology and chondromalacia patella.

BACKGROUND: For the normal functioning of the patellofemoral joint (PF), the relationship between the patella and the trochlear groove must be compatible. PURPOSE: To investigate the relationship between patellofemoral joint morphology (PFM) and patellar chondromalacia. MATERIAL AND METHODS: Overall, 136 knees of patients aged 20-55 years examined between March 2020 and March 2021 were included in this study. In all patients, trochlear sulcus angle, trochlear sulcus depth, trochlear facet asymmetry, patella alta (Insall-Salvati [IS] index), and patellar facet asymmetry were measured. Of these cases, 66 knees with an abnormality detected in any of the measurements for PFM were included in the case group. Moreover, 70 knees with demonstrating normal PFM measurements were included in the control group. RESULTS: The incidence and grade of chondromalacia was higher in the case group than in the control group (P < 0.001). Between the patients with and without chondromalacia trochlear sulcus angle (mean = 138.25° ± 10.02° vs. 132.58° ± 7.24°; P = 0.001), IS index (mean = 1.25 ± 0.21 vs. 1.16 ± 0.15; P = 0.014), patellar facet asymmetry (mean = 0.77 ± 0.09 vs. 0.73 ± 0.12; P = 0.039), trochlear sulcus depth (mean = 5.39 ± 1.42 mm vs. 6.27 ± 1.04 mm; P < 0.001), and trochlear facet asymmetry (mean = 0.67 ± 0.11 vs. 0.71 ± 0.09; P = 0.023) measurements, there was a significant difference. CONCLUSION: The presence of at least one of the measures indicating pathology in PFM is associated with the presence and severity of chondromalacia.

Atelocollagen-associated autologous chondrocyte implantation for the repair of large cartilage defects of the knee: Results at three to seven years.

BACKGROUND: Recently, various types of engineered autologous chondrocyte implantation (ACI) have been developed. Atelocollagen-associated ACI (A-ACI) is the only ACI procedure covered by Japanese Health Insurance since 2013. The indications of the A-ACI are traumatic cartilage defects and osteochondral dissecans (OCD) for knee joints. PURPOSE: To evaluate midterm clinical results after A-ACI for the treatment for full-thickness cartilage defects of the knee. METHODS: Thirteen consecutive patients who underwent A-ACI between 2014 and 2018 had been prospectively enrolled in this study. There were 11 men and 2 women with a mean age of 34 years at the time of surgery. The causes of the cartilage defect were trauma in 10 knees and OCD in 3 knees. The total number of lesions was 15, which were comprised of the medial femoral condyle in 5 knees, the lateral femoral condyle in 5 knees, and the femoral trochlea in 5 knees. The mean size of the lesion was 5.3 cm2. Each knee was clinically and radiologically evaluated preoperatively and postoperatively. RESULTS: The mean Lysholm score improved significantly from 74.0 points to 94.0 points (p = 0.008) and each subscale in Knee injury and Osteoarthritis Outcome Score improved significantly (p < 0.001) at the mean final follow-up period of 51 months (range, 36-84 months). The magnetic resonance observation of cartilage repair tissue 2.0 score at the mean follow-up of 38 months was significantly higher than that at 2 months postoperatively (p = 0.014). According to the International Cartilage Repair Society (ICRS) grading scale, 3 knees were graded as normal, 3 knees as nearly normal, and 1 knee as severely abnormal in second-look arthroscopic evaluation at a mean of 22 months (range, 8-41 months) after A-ACI. CONCLUSION: The present study showed a significant subjective and objective clinical improvement in the A-ACI for large cartilage defects of the knee at a mean follow-up of 51 months (range, 36-84 months).

Abnormalities of the pericruciate fat pad: Correlations with the location and severity of chondral lesions of the knee.

PURPOSE: The aim of this study was to evaluate the relationship between the grade of signal change of the pericruciate fat pad (PCFP) and the location and severity of cartilage alterations in the knee on magnetic resonance imaging (MRI). MATERIALS AND METHODS: This retrospective study included 234 patients (M:F = 96:138, mean: 51 years) who underwent knee MRI. Two experienced musculoskeletal radiologists assessed any PCFP alterations (as grades 0-3) and chondral lesions using the modified Outerbridge grade (as grades 0-4). Bone marrow lesions (BMLs), meniscal status, anterior cruciate ligament alterations, and effusion-synovitis were also evaluated on the MRI. The relationships between PCFP alteration and MR findings (including the grade of chondral lesion) were evaluated. RESULTS: Signal changes in the PCFP were detected in 150 cases by Reader 1 (grade 0, 67 cases; grade 1, 53 cases; grade 2, 21 cases; grade 3, 9 cases) and in 154 cases by Reader 2 (grade 0, 59 cases; grade 1, 61 cases; grade 2, 24 cases; grade 3, 10 cases). The grade of PCFP signal change was statistically significantly correlated with the grade of the chondral lesion of the medial femoral condyle (MFC) (p = 0.029 and p = 0.003, respectively) and the medial tibial plateau (MTP) (p = 0.045, p = 0.002, Readers 1 and 2, respectively). The grade of PCFP signal change was significantly correlated with the grade of the BMLs of the MFC, MTP, and lateral femoral condyle (p < 0.05) for both readers. PCFP alteration was related to effusion-synovitis and tears of the medial meniscus. CONCLUSIONS: The grade of PCFP signal change was correlated with the severity of the cartilage alteration in the medial compartment of the knee joint and was also correlated with BMLs in the medial compartment, medial meniscal tears, and synovitis. Therefore, signal change in the PFCP seen on MRI can be an additional clue of the presence of osteoarthritis in the knee, particularly in the medial compartment.

Assessment of patellar cartilage cross-sectional area in patients with lower grade chondromalacia patella.

Chondromalacia patella (CMP) is abnormal softening of the cartilage of the underside the patella. It is a cause of anterior knee pain. Previous study has demonstrated that the patellar cartilage hypertrophy is correlated with early signs of CMP (Grade 1 or 2). However, no studies have investigated the clinical cutoff value of patella cartilage hypertrophy. Thus, we devised the patellar cartilage cross-sectional area (PCCSA) as a new predictive parameter for diagnosing the CMP. The purpose of this research was to compare MR measured PCCSA between CMP patients and gender matched healthy controls. The PCCSA samples were collected from 50 patients with CMP, and from 50 healthy controls who underwent knee MRI with no evidence of CMP. The T2-weighted turbo spin echo transverse MRI images were acquired. We measured the PCCSA on MRI using a PACS system. The PCCSA was measured on the axial angled sections through the whole images by drawing outlines. The average PCCSA was 104.28 ±â€…23.28 mm2 in the healthy controls and 134.09 ±â€…26.55 mm2 in the CMP group. CMP patients had significantly higher PCCSA (P < .001). Regarding the validity of PCCSA as predictors of CMP, Receiver Operating Characteristic curve analysis showed that the best cutoff point for the PCCSA was 116.24 mm2, with 72.0% sensitivity, 72.0% specificity, and the area under curve (AUC) of 0.79 (0.71-0.88). The PCCSA is a sensitive measurement parameter to predict low grade CMP. Thus, to evaluate CMP patients, the treating physician carefully inspect the PCCSA.

T1Gd is reduced in bone marrow lesions overlying cartilage in the hip.

OBJECTIVE: Bone Marrow Lesions (BMLs) are areas in bone with high fluid signal on MRI associated with painful and progressive OA. While cartilage near BMLs in the knee has been shown to be degenerated, this relationship has not been investigated in the hip. RESEARCH QUESTION: is T1Gd lower in areas of cartilage overlying BMLs in the hip? DESIGN: 128 participants were recruited from a population-based study of hip pain in 20-49-year-olds. Proton-density weighted fat-suppressed and delayed Gadolinium Enhanced MR Imaging of Cartilage (dGEMRIC) images were acquired to locate BMLs and quantify hip cartilage health. BML and cartilage images were registered and cartilage was separated into BML overlying and surrounding regions. Mean T1Gd was measured in 32 participants with BMLs in both cartilage regions and in matched regions in 32 age- and sex-matched controls. Mean T1Gd in the overlying cartilage was compared using linear mixed-effects models between BML and control groups for acetabular and femoral BMLs, and between cystic and non-cystic BML groups. RESULTS: Mean T1Gd of overlying cartilage was lower in the BML group compared to the control group (acetabular: -105 ms; 95% CI: -175, -35; femoral: -8 ms; 95% CI: -141, 124). Mean T1Gd in overlying cartilage was lower in cystic compared to non-cystic BML subjects, but the confidence interval is too large to provide certainty in this difference (-3 [95% CI: -126, 121]). CONCLUSIONS: T1Gd is reduced in overlying cartilage in hips from a population-based sample of adults aged 20-49, which suggests BMLs are associated with local cartilage degeneration in hips.

Association between the subcutaneous fat thickness of the knee and chondromalacia patella: a magnetic resonance imaging-based study.

OBJECTIVE: Subcutaneous fat tissue thickness (SFTT) is a representative marker of obesity. This study was performed to determine the relationship between SFTT and chondromalacia patella (CP) through routine 1.5-Tesla magnetic resonance imaging (MRI) of the knee. METHODS: In this retrospective cross-sectional study, 440 knee MRI scans were re-examined and divided into those with and without CP. A 1.5-Tesla MRI machine with a standard knee coil was used. Prepatellar SFTT (PSFTT) and medial SFTT (MSFTT) were measured on each MRI scan. PSFTT and MSFTT were compared between patients with and without CP. RESULTS: Both the PSFTT and MSFTT values were significantly higher in patients with than without CP. Women had significantly higher PSFTT and MSFTT values than men. A statistically significant correlation was found between the PSFTT and MSFTT values and the CP grades. CONCLUSIONS: The results of this study indicate an association between SFTT and CP. A positive correlation was also found between SFTT and CP severity.

Application of quantitative T1, T2 and T2* mapping magnetic resonance imaging in cartilage degeneration of the shoulder joint.

To investigate and compare the values of 3.0 T MRI T1, T2 and T2* mapping quantification techniques in evaluating cartilage degeneration of the shoulder joint. This study included 123 shoulder joints of 119 patients, which were scanned in 3.0 T MRI with axial Fat Suppression Proton Density Weighted Image (FS-PDWI), sagittal fat suppression T2 Weighted Image (FS-T2WI), coronal T1Weighted Image (T1WI), FS-PDWI, cartilage-specific T1, T2 and T2* mapping sequences. Basing on MRI images, the shoulder cartilage was classified into grades 0 1, 2, 3 and 4 according to the International Cartilage Regeneration & Joint Preservation Society (ICRS). The grading of shoulder cartilage was based on MRI images with ICRS as reference, and did not involve arthroscopy or histology.The T1, T2 and T2* relaxation values in the superior, middle and inferior bands of shoulder articular cartilage were measured at all grades, and the differences in various indicators between groups were analyzed and compared using a single-factor ANOVA test. The correlation between T1, T2 and T2* relaxation values and MRI-based grading was analyzed by SPSS software. There were 46 shoulder joints with MRI-based grade 0 in healthy control group (n = 46), while 49 and 28 shoulder joints with grade 1-2 (mild degeneration subgroup) and grade 3-4 (severe degeneration subgroup) in patient group (n = 73), accounting for 63.6% and 36.4%, respectively. The T1, T2 and T2* relaxation values of the superior, middle and inferior bands of shoulder articular cartilage were significantly and positively correlated with the MRI-based grading (P < 0.01). MRI-basedgrading of shoulder cartilage was markedly associated with age (r = 0.766, P < 0.01). With the aggravation of cartilage degeneration, T1, T2 and T2* relaxation values showed an upward trend (all P < 0.01), and T1, T2 and T2* mapping could distinguish cartilage degeneration at all levels (all P < 0.01). The T1, T2 and T2* relaxation values were significantly different between normal group and mild degeneration subgroup, normal group and severe degeneration subgroup, mild degeneration subgroup and severe degeneration subgroup (all P < 0.05). Quantitative T1, T2 and T2* mapping can quantify the degree of shoulder cartilage degeneration. All these MRI mapping quantification techniques can be used as critical supplementary sequences to assess shoulder cartilage degeneration, among which T2 mapping has the highest value.

Meniscal extrusion, cartilage, bone, and ligament lesions associated with medial meniscus posterior root tear gap.

OBJECTIVES: To determine the relationship between the severity of the tear gap resulting from medial meniscus posterior root (MMPR) tear and medial meniscal extrusion, cartilage, bone, and ligament lesions on MRI. METHODS: A total of 133 patients with MMPR tear were retrospectively evaluated. The patients were divided into two groups according to the tear gap width as minor (≤ 4 mm) and widely (4 mm<) displaced. Medial meniscal extrusion and medial compartmental chondromalacia, bone and ligament lesions were analyzed. RESULTS: There were 61 patients (56 women and 5 men) in the minor displaced group (mean age: 56.3 years, range: 29-82 years) and 72 patients (59 women, 13 men) in the widely displaced group (mean age: 53.2 years, range: 20-86 years). There was no significant difference in terms of age and sex (p = 0.31 and p = 0.09, respectively). The mean absolute extrusion was 3.51 mm (range: 1.5-5 mm) in the minor displaced group and 4.52 mm (range: 2.4-7.2 mm) in the widely displaced group (p < 0.001). High-grade medial femoral condylar chondromalacia was more common in the widely displaced group (p = 0.002). Osteophyte, bone marrow edema, and subchondral cyst in the medial compartment, and ligament injury were higher in the widely displaced group, but were not statistically significant (p > 0.05). CONCLUSION: The amount of medial meniscal extrusion and the prevalence of high-grade medial femoral condylar chondromalacia were found to be significantly more in patients with wider tear gap. Determining the amount of tear gap in the evaluation of root ligament tears on MRI is important to predict knee joint internal derangement.

The infrapatellar plica of the knee: analysis of relationship with femoral trochlear chondrosis using radiographs and 3.0-T MRI.

OBJECTIVE: To assess the relationship of the infrapatellar plica (IPP) with femoral trochlear chondrosis (FTC) using radiographs and 3.0-T MRI. MATERIALS AND METHODS: Four hundred eighty-three knees of 476 patients undergoing radiography and MRI were reviewed, and 280 knees of 276 patients were included. We performed a comparison of the frequency of the IPP between men and women, and that of FTC and chondromalacia patella between knees with and without the IPP. In knees with the IPP, we analyzed the correlation between FTC and sex, age, laterality, Insall-Salvati ratio (ISR), femoral sulcus angle, tilting angle, height of insertion of the IPP to Hoffa's fat pad, and width of the IPP. RESULTS: The IPP was found in 192 of 280 knees (68.6%) overall and was more common in men than in women (100 of 132 [75.8%], 92 of 148 [62.2%], p = 0.01). FTC was observed in 26 of 280 (9.3%) and was only in knees with the IPP (knees with the IPP: 26 of 192 [13.5%], knees without the IPP: 0 of 88 [0%], p < 0.001). In knees with the IPP, ISR was significantly greater in knees with FTC (p = 0.002). ISR was the only significant factor associated with FTC (odds ratio: 2.87, 95% confidence interval: 1.14, 7.22, p = 0.03), and the cutoff value of ISR for FTC was > 1.00 with sensitivity of 69.2% and specificity of 63.9%. CONCLUSION: Presence of the IPP combined with ISR > 1.00 was correlated with FTC.

[Knee cartilage injuries in athletes]. / Knorpelschäden des Kniegelenks beim Sport.

BACKGROUND: Acute and chronic cartilage injuries are often encountered in professional and recreational athletes. They can compromise the athlete's performance and career and are considered a potential risk factor for early joint degeneration. OBJECTIVES: Incidence of cartilage injury in athletes, understanding of cartilage composition, injury mechanism and suitable diagnostic imaging are summarized and established therapeutic procedures, postoperative imaging including detection of relevant complications and assessment of reasonable indications for follow-up examinations are described. METHODS: Original research and review articles were analyzed. RESULTS: Cartilage injury can mimic meniscal or ligamentous injury and cannot be ruled out by clinical examination alone. Magnetic resonance imaging (MRI) is the method of choice to (1) detect (sensitivity 87-93%, specificity 94-99%) and grade cartilage lesions to facilitate choice of therapy and (2) to exclude concomitant injuries that require treatment to improve the prognosis of the chosen cartilage therapy. Postoperatively MRI allows noninvasive assessment of the repaired cartilage tissue and is an appropriate method to detect therapeutically relevant complications. CONCLUSIONS: Knowledge of mechanisms and appearance of cartilage injuries, current cartilage repair techniques and their imaging is crucial for the medical care of athletes.

Intraoperative Acoustic Evaluation of Living Human Knee Cartilage-Comparison with Respect to Cartilage Degeneration and Aging.

OBJECTIVE: The objective of the study was to evaluate the mechanical properties of living human knee cartilage using our ultrasonic device, and to compare the measurements with respect to cartilage degeneration and aging. DESIGN: A total of 95 knees which had undergone arthroscopic knee surgery, from 88 patients, were included in the study, with informed consent. All procedures were reviewed and approved by the ethical committee of our hospital. In the study group, there were 41 men, 47 women, 39 right knees, and 56 left knees. The conditions primarily included knee osteoarthritis and anterior cruciate ligament rupture. The mean operative age was 44.1 years old (range = 10-83). We compared mechanical properties of the knee cartilage with respect to aging and gender, in comparison with normal cartilage. A P value of <0.05 represented statistical significance. RESULTS: In the context of the International Cartilage Repair Society (ICRS) classification of cartilage degeneration (grade 0-3), the signal intensity in grade 0 was significantly larger than that in grade 1, 2, or 3. The thickness in grade 0 was significantly higher than that in grade 1, 2, or 3. Normal cartilage in older women had the lowest signal intensity and the least cartilage thickness among all the groups. CONCLUSION: The ultrasonic system we developed was able to detect early degenerative changes in living cartilage in knees. The lowest signal intensity and least cartilage thickness in normal cartilage among older women were correlated to a large prevalence of knee osteoarthritis in women. LEVEL OF EVIDENCE: Level IV, case series.

Worsening of Articular Tissue Damage as Defined by Semi-Quantitative MRI Is Associated With Concurrent Quantitative Cartilage Loss Over 24 Months.

OBJECTIVE: To assess the association of worsening of magnetic resonance imaging (MRI) semi-quantitative (SQ) tissue features with concurrent change in quantitative (Q) cartilage thickness measurements over 24 months within the Foundation for the National Institutes of Health (FNIH) Biomarker Consortium study. METHODS: In all, 599 participants were included. SQ assessment included cartilage damage, meniscal extrusion and damage, osteophytes, bone marrow lesions (BMLs), and effusion- and Hoffa-synovitis. Change in medial compartment Q cartilage thickness was stratified by concurrent ipsicompartmental SQ changes. Between-group comparisons were performed using analysis of covariance (ANCOVA) with adjustment for age, sex, and body mass index (BMI). Results were presented as adjusted mean difference. RESULTS: Knees with any increase in SQ cartilage scores in the medial compartment (n = 268) showed more Q cartilage loss compared to knees that remained stable (mean adjusted difference [MAD] = -0.16 mm, 95% confidence interval [CI]: [-0.19, -0.13] mm). Knees with any increase in meniscal extrusion in the medial compartment (n = 98) showed more Q cartilage loss than knees without (MAD = -0.18 mm, 95% CI: [-0.22, -0.14] mm. Comparable findings were seen for meniscal damage worsening. Regarding BMLs, an increase by one subregion resulted in a MAD of Q cartilage loss of -0.10 mm, 95% CI: [-0.14, -0.06] mm, while this effect almost tripled for change in two or more subregions. Increase in either effusion- and/or Hoffa-synovitis by one grade resulted in a MAD of -0.07 mm, 95% CI: [-0.10, -0.03] mm. CONCLUSION: Worsening of SQ cartilage damage, meniscal extrusion and damage, number of subregions affected by BML, maximum size of BMLs and worsening of effusion- and/or Hoffa synovitis is associated with increased Q cartilage loss.

Injectable autologous chondrocyte implantation in acetabular cartilage defects: 2-year minimum clinical and MRI results.

INTRODUCTION: Early results using injectable autologous chondrocyte implantation (ACI) for the treatment of full thickness acetabular cartilage defects have been promising. However, so far there is no information on radiological results after injectable ACI using spheroids. The purpose of this sturdy was to (1) investigate the quality of tissue repair on MRI and (2) investigate the correlation between the MRI results and clinical results at a minimum follow-up of 24 months after third generation ACI in full thickness acetabular cartilage defects. It was hypothesized that ACI shows good MRI results in patients with large full thickness acetabular cartilage defects 24 months after surgery. It was also hypothesized that there is a correlation between postoperative clinical and MRI morphological results at a minimum follow-up of 24 months. STUDY DESIGN: Retrospective case series. MATERIALS AND METHODS: Patients with ACI for full thickness acetabular cartilage defects > 2 cm2 were evaluated by preoperative and postoperative clinical scoring tools including the modified Harris Hip Score (mHHS), the International Hip Outcome Tool (iHOT-33), and the Subjective Hip Value (SHV) as well as a high resolution indirect arthro-MRI 24 months after surgery utilizing an identical imaging protocol for all patients. The magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used to classify the repair tissue on MRI. Demographic patient data was evaluated for influencing factors for pre- and postoperative clinical as well as radiological results. RESULTS: Thirty six consecutive patients (5 women/31 men, average age 32.9 years) had undergone two stage ACI procedure. The average size of the cartilage defect was 5.0 (2-6) cm2. The average follow-up was 29.9 (24-42) months. Four patients were not available for the final follow-up (follow-up rate 89%). The postoperative average MOCART score was 82.2 (± 14.2). MOCART score showed medium correlation of the item defect fill and the postoperative mHHS (r = 0.384, p = 0.043). There was no correlation of the other items or the total score with postoperative results. The patients showed significant improvement in the outcome measurements between preoperative and postoperative in the mHHS, the iHOT-33, and the SHV. CONCLUSIONS: Despite the large acetabular cartilage defects included in this study, ACI showed good MRI results with complete defect fill in 87.5% after a minimum 24-month follow-up. Statistically significant correlation of MRI and clinical results could only be seen with the item defect fill. Further research with longer follow-up is needed to evaluate the long-term results of ACI in acetabular cartilage defects.

Dual-contrast micro-CT enables cartilage lesion detection and tissue condition evaluation ex vivo.

BACKGROUND: Post-traumatic osteoarthritis is a frequent joint disease in the horse. Currently, equine medicine lacks effective methods to diagnose the severity of chondral defects after an injury. OBJECTIVES: To investigate the capability of dual-contrast-enhanced computed tomography (dual-CECT) for detection of chondral lesions and evaluation of the severity of articular cartilage degeneration in the equine carpus ex vivo. STUDY DESIGN: Pre-clinical experimental study. METHODS: In nine Shetland ponies, blunt and sharp grooves were randomly created (in vivo) in the cartilage of radiocarpal and middle carpal joints. The contralateral joint served as control. The ponies were subjected to an 8-week exercise protocol and euthanised 39 weeks after surgery. CECT scanning (ex vivo) of the joints was performed using a micro-CT scanner 1 hour after an intra-articular injection of a dual-contrast agent. The dual-contrast agent consisted of ioxaglate (negatively charged, q = -1) and bismuth nanoparticles (BiNPs, q = 0, diameter ≈ 0.2 µm). CECT results were compared to histological cartilage proteoglycan content maps acquired using digital densitometry. RESULTS: BiNPs enabled prolonged visual detection of both groove types as they are too large to diffuse into the cartilage. Furthermore, proportional ioxaglate diffusion inside the tissue allowed differentiation between the lesion and ungrooved articular cartilage (3 mm from the lesion and contralateral joint). The mean ioxaglate partition in the lesion was 19 percentage points higher (P < 0.001) when compared with the contralateral joint. The digital densitometry and the dual-contrast CECT findings showed good subjective visual agreement. MAIN LIMITATIONS: Ex vivo study protocol and a low number of investigated joints. CONCLUSIONS: The dual-CECT methodology, used in this study for the first time to image whole equine joints, is capable of effective lesion detection and simultaneous evaluation of the condition of the articular cartilage.

Volume index as a new measure of cartilage loss: a retrospective MRI-based study of chondral injury patterns in adult patients with knee pain.

BACKGROUND: Knee pain is one of the commonest symptoms in patients who attend the Orthopaedic outpatient clinics. Chondral defects result in a painful knee. Incidence of chondral defect is reported to be between 5 and 10% over the age of 40. It is well documented that chondral defects can lead to osteoarthritis. Early detection of these lesions and cartilage repair surgery can delay the onset of osteoarthritis. The purpose of this study is to highlight the incidence, associations and correlations between opposing cartilage defects in patients who present to the knee clinic with pain. METHODS: A retrospective analysis was carried out on patients who had Magnetic Resonance Imaging scans for painful knees between June 2017 and May 2019. About 227 consecutive knees were studied for the incidence of chondral defects, number of lesions, grade and size of lesion, geographical location and associated pathology in the knee. RESULTS: All the 227 patients had chondral lesions. Most patients had 2-3 lesions (66.1%) with patellar lesions (76.6%) being the commonest followed by medial femoral condyle (59.9%). Significant correlation was found in grade and size between opposing surface lesions in patella-trochlea, Medial Femoral Condyle-Medial Tibial Plateau and Lateral Femoral Condyle-Lateral Tibial Plateau. Females were more predisposed to patella lesions. Significance between age and lesions were established. CONCLUSION: Incidence of cartilage defects in the knee is very high. Kissing lesions must be considered when treating cartilage lesions. Volume index could be a promising method to quantify lesions.

Association between Patellofemoral Anatomy and Chondral Lesions of the Knee in Patellofemoral Instability.

Chondral injury is a serious consequence of patellar dislocation and patellofemoral instability (PFI). There is limited data on the relationship between radiological features such as sulcus angle and patellar height to the presence, location, and severity of chondral lesions. The purpose of this study was to determine the association of anatomical variants in patellofemoral instability with injuries sustained due to patellar dislocation. A cohort of 101 patients who had four or more episodes of dislocation or instability undergoing isolated arthroscopy or arthroscopies at the time of corrective realignment surgery were identified. The prevalence of chondral, ligamentous, and meniscal injuries was determined and correlated to the sulcus angle, tibial tubercle trochlear groove distance, and patellar height on magnetic resonance imaging (MRI) scans. A total of 101 patients was identified. At arthroscopy, the patella demonstrated the highest incidence of chondral injury (68%) followed by the trochlear groove (40%). Lateral meniscal injuries were noted in 6% of patients, medial meniscal injuries in 2%, and anterior cruciate ligament (ACL) injury in 3%. Chondral injuries were graded using the Outerbridge criteria and there was a correlation between more severe chondral injuries and a greater tilt angle (p = 0.05). The occurrence of injury to the lateral meniscus was associated with a higher Insall-Salvati ratio (p = 0.05). More severe chondral injuries are seen in patients with a greater tilt angle.

Clinical and Magnetic Resonance Imaging Outcomes After Microfracture Treatment With and Without Augmentation for Focal Chondral Lesions in the Knee: A Systematic Review and Meta-analysis.

BACKGROUND: Focal cartilage lesions represent a common source of knee pain and disability, with the potential for the development and progression of osteoarthritis. Currently, microfracture (MFx) represents the most utilized first-line surgical treatment for small, focal chondral lesions. Recent investigations have examined methods of overcoming the limitations of MFx utilizing various augmentation techniques. PURPOSE: To perform a systematic review and meta-analysis evaluating clinical and radiographic outcomes in patients undergoing isolated MFx versus MFx augmented with orthobiologics or scaffolds for focal chondral defects of the knee. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 4. METHODS: A systematic review was performed to identify studies evaluating outcomes and adverse events in patients undergoing isolated MFx versus augmented MFx for focal chondral defects in the knee from 1945 to June 1, 2021. Data were extracted from each article that met the inclusion/exclusion criteria. Meta-analyses were performed for all outcomes reported in a minimum of 3 studies. RESULTS: A total of 14 studies were identified, utilizing 7 different types of injectable augmentation regimens and 5 different scaffolding regimens. Across the 14 studies, a total of 744 patients were included. The mean patient age was 46.8 years (range, 34-58 years), and 58.3% (n = 434/744) of patients were women. The mean final follow-up time was 26.7 months (range, 12-60 months). The mean chondral defect size ranged from 1.3 to 4.8 cm2. A post hoc analysis comparing mean improvement in postoperative outcomes scores compared with preoperative values found no significant differences in the improvement in the visual analog scale (VAS), International Knee Documentation Committee (IKDC), or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between patients undergoing isolated MFx and those undergoing MFx + augmentation. Patients undergoing MFx + augmentation reported significantly greater improvements in the Lysholm score and postoperative MOCART (magnetic resonance observation of cartilage repair tissue) scores compared with the isolated MFx group. CONCLUSION: Patients undergoing combined MFx + augmentation reported significant improvements in mean Lysholm and MOCART scores, without significant improvements in VAS, IKDC, or WOMAC scores when compared with patients undergoing isolated MFx.

Association of trochlear dysplasia with knee meniscal-cartilage damage and anterior cruciate ligament mucoid degeneration.

AIM: The purpose of this study was to evaluate meniscal and tibiofemoral cartilage injury in patients with trochlear dysplasia (TD) and investigate whether there were correlations between TD grade and meniscal and cartilage injury. In addition, the relationship between TD and mucoid degeneration of the anterior cruciate ligament (ACL-MD) was investigated. MATERIALS AND METHODS: Magnetic resonance imaging (MRI) examinations of 133 patients with TD were included in the study. TD was graded (types A, B, C, D). The tibial tuberosity (TT)-TG distance was also measured. The ACL was assessed for ACL-MD. Both menisci were evaluated for the degeneration and tears. Medial-lateral tibial plateau (MTP-LTP), medial-lateral femoral condyles (MFC-LFC), and trochlear cartilage were examined for focal cartilage defect (FCD). RESULTS: ACL-MD was present in 42 of the patients with TD (31.6%). There was a significant positive relationship between ACL-MD and TT-TG distance. Meniscal tear was detected in 40 (30.1%) of all patients. FCD were detected in the tibiofemoral compartments in 41 (30.8%) of 133 patients. There was a significant positive relationship between the presence of FCD in the LFC and the type of TD (p<0.01). FCD was present in the LFC of all cases in the type D. A significant positive relationship was found between the TT-TG distance and the presence of FCD, especially in the anterior part of LFC (p<0.01). There was a significant relationship between the lateral trochlear cartilage defect and the type of dysplasia (p=0.037). CONCLUSION: TD is a significant risk factor for ACL-MD, meniscal, and tibiofemoral cartilage injury.

Toward New Assessment of Knee Cartilage Degeneration.

OBJECTIVE: Assessment of human joint cartilage is a crucial tool to detect and diagnose pathological conditions. This exploratory study developed a workflow for 3D modeling of cartilage and bone based on multimodal imaging. New evaluation metrics were created and, a unique set of data was gathered from healthy controls and patients with clinically evaluated degeneration or trauma. DESIGN: We present a novel methodology to evaluate knee bone and cartilage based on features extracted from magnetic resonance imaging (MRI) and computed tomography (CT) data. We developed patient specific 3D models of the tibial, femoral, and patellar bones and cartilages. Forty-seven subjects with a history of degenerative disease, traumatic events, or no symptoms or trauma (control group) were recruited in this study. Ninety-six different measurements were extracted from each knee, 78 2D and 18 3D measurements. We compare the sensitivity of different metrics to classify the cartilage condition and evaluate degeneration. RESULTS: Selected features extracted show significant difference between the 3 groups. We created a cumulative index of bone properties that demonstrated the importance of bone condition to assess cartilage quality, obtaining the greatest sensitivity on femur within medial and femoropatellar compartments. We were able to classify degeneration with a maximum recall value of 95.9 where feature importance analysis showed a significant contribution of the 3D parameters. CONCLUSION: The present work demonstrates the potential for improving sensitivity in cartilage assessment. Indeed, current trends in cartilage research point toward improving treatments and therefore our contribution is a first step toward sensitive and personalized evaluation of cartilage condition.