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Navigation & Imaging
Figure 1: Sagittal Spoiled Figure 2: Coronal T1-weighted
Another sub-group of cartilage repair includes the autogenic or
Gradient Echo Image with Spin Echo Image with Fat
allogenic osteochondral transfers. These techniques are most often
Water Excitation Saturation after Intravenous
Contrast Administration
used for the repair of large osteochondral defects. Autologous
osteochondral plug is reported to have better clinical outcome than
ACI.
20
It is most effective in small- to medium-sized full-thickness
defects. For larger lesions, several osteochondral plugs can be fitted in
the defect. The gaps between the plugs are filled with fibrocartilage,
reducing the durability of the repair.
Imaging Cartilage Repair
MRI is a good technique for evaluating cartilage repair by displaying
The normal cartilage has high signal intensity and is Although the cartilage is clearly distinguishable from
thickness, edge integration, surface and subchondral bone plate and
well delineated by the subchondral bone, fat, menisci both subchondral bone and joint fluid, lack of
and water, all of which have intermediate to low distension of the joint makes it harder to separate marrow. After surgical cartilage repair, the repair tissue should ideally have
signal intensity. femoral and tibial cartilage.
the same thickness and signal intensity as the surrounding cartilage.
Figure 3: Sagittal Proton- Figure 4: Coronal 3D Dual Echo
Furthermore, it should have a smooth surface and the margins should be
density Weighted Fast Spin Steady State Sequence Image
continuous with the native cartilage (see Figure 3). The subchondral bone
Echo Image
plate beneath the repair tissue should be smooth and on a level with the
adjacent endplate. There should be no abnormal signal in the underlying
bone marrow. MRI is ideally suited to evaluate these variables.
21–23
Other
valuable information is location and size of the repair site, as this is not
always easy to assess – particularly during arthroscopic procedures.
When evaluating the filling of a defect, the result is best recorded as a
percentage of the thickness of the surrounding native cartilage. This can
exceed 100% if the repair tissue is hypertrophic, which is often noted in the
Twelve months after autologous chondrocyte Autologous osteochondral plug transfer in the medial
first months.
24–26
If the repaired lesion had an osseous component, separate
implantation (ACI) cartilage repair, the repair tissue femoral condyle with good incorporation of the
fills the entire defect, but shows incomplete osseous component of the graft. The graft is evaluation of bone and cartilage repair should be made (see Figure 4). In a
integration with the surrounding cartilage. Note also positioned too deeply, with subsequent ‘overgrowth’
majority of patients, the interface between native and repair cartilage is
the blunted free edge of the posterior horn of the of the surrounding cartilage.
medial meniscus. visible and can be seen as an interface between two regions of different
signal intensity or as a fluid-filled fissure (see Figure 3). MR arthrography is
and is likely less durable over time. The ideal patient for this type of helpful in evaluating detachment of the graft.
24
The subchondral bone
repair procedure is young and has small, stage III or IV articular surface plate can display irregularities, subchondral cysts – especially located
lesion and a well-defined history of trauma. Other reparative underneath the interface of native and repaired cartilage – and outright
procedures are 17 drilling and abrasion arthroplasty.
18
The restorative defects. In the early post-operative period, bone marrow oedema is a
procedures are more numerous and more diverse. The most promising common finding. Persistence of this abnormal signal after one year may
technique is cell transplantation-based repair, such as autologous indicate graft failure and is associated with pain complaints.
chondrocyte implantation (ACI). The procedure consists of two stages.
In the first stage, chondrocytes are harvested in a region of healthy Conclusion
cartilage. After cultivation of these cells, an arthrotomy is performed MRI is capable of depicting articular cartilage, cartilage lesions and
during which the cultivated cells are re-implanted. The repair site is cartilage repair in great detail. The clinical use of high field strength
then covered by a piece of periosteum. Autologous chondrocyte scanners and the advent of high-resolution 3D sequences will allow an
transplantation results in durable repair for the majority of patients. If even better evaluation of cartilage and repair tissue. Add to that the
there is failure of the repair tissue, this occurs almost always in the first advances in ultrastructural imaging and biochemical evaluation of
two years.
19
In vivo, only hyaline-like repair tissue has been formed, cartilage and it should be possible to replace invasive diagnostic
without the structural or mechanical properties of mature cartilage.
11
procedures with MRI in all cases of surgical cartilage repair. ■
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42 EUROPEAN MUSCULOSKELETAL REVIEW 2007
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