Treatable Chondral Injuries in the Knee
Frequency of Associated Focal Subchondral Edema
David A. Rubin1,2,
Christopher D. Harner3 and
Joanna M. Costello1,2
1
Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop
St., Pittsburgh, PA 15213.
2
Present address: Mallinckrodt Institute of Radiology, 510 S. Kingshighway, St.
Louis, MO 63110.
3
Department of Orthopedic Surgery, Center for Sports Medicine and
Rehabilitation, University of Pittsburgh Medical Center, Baum Blvd. at Craig
St., Pittsburgh, PA 15213.
View larger version (61K):
[in a new window]
|
Fig. 1A. —Articular cartilage: normal anatomy and lesions. Drawing shows
normal articular surface and subchondral bone.
|
|
View larger version (53K):
[in a new window]
|
Fig. 1B. —Articular cartilage: normal anatomy and lesions. Drawing shows
cartilage flap tear. Chondral fragment is typically separated from underlying
bone at tidemark and may hinge at one end, opening and closing like a
trapdoor. Note sharp margination with normal cartilage at lesion border.
|
|
View larger version (69K):
[in a new window]
|
Fig. 1C. —Articular cartilage: normal anatomy and lesions. Drawing shows
chondral fracture (separation). Because fragment is composed solely of
cartilage, lesion will be radiographically occult. Fragment may remain in situ
or may displace and become intraarticular body.
|
|
View larger version (59K):
[in a new window]
|
Fig. 1D. —Articular cartilage: normal anatomy and lesions. Drawing shows
osteochondral fracture or osteochondritis dissecans. Injury involves
subchondral bone and will be visible radiographically.
|
|
View larger version (59K):
[in a new window]
|
Fig. 1E. —Articular cartilage: normal anatomy and lesions. Drawing shows
advanced chondromalacia or degenerative chondrosis. Lesion margins are
indistinct. Angle of lesion wall is shallow compared with wall of cartilage
flaps and fractures.
|
|
View larger version (92K):
[in a new window]
|
Fig. 2A. —22-year-old man with suspected meniscal tear who was injured playing
collegiate football. Sagittal spin-echo MR image (TR/TE, 2583/75) through
lateral compartment shows sharply marginated, fluidfilled defect in articular
surface of lateral femoral condyle (between arrows), which was seen
by both observers. Subchondral edema was seen only by observer 1.
|
|
View larger version (103K):
[in a new window]
|
Fig. 2B. —22-year-old man with suspected meniscal tear who was injured playing
collegiate football. Corresponding fast inversion-recovery MR image (3616/69;
inversion time, 166 msec) shows associated subchondral edema within lateral
femoral condyle (arrow), which was seen by both observers.
|
|
View larger version (118K):
[in a new window]
|
Fig. 2C. —22-year-old man with suspected meniscal tear who was injured playing
collegiate football. Arthroscopic image of lateral femoral condyle shows
full-thickness cartilage defect with exposed subchondral bone
(asterisk). Arthroscopist found this bone to be "abnormally
soft" when pick was used to treat defect. Note relatively sharp margins
of defect.
|
|
View larger version (114K):
[in a new window]
|
Fig. 3A. —28-year-old man who was injured playing recreational basketball.
Sagittal fast inversion-recovery MR image (TR/TE, 3733/69; inversion time, 155
msec) shows well-defined full-thickness cartilage defect (black
arrows) of medial femoral condyle with typical hemispheric area of
subchondral edema centered over lesion. Note also intraarticular chondral body
(white arrow) anterior relative to crater.
|
|
View larger version (90K):
[in a new window]
|
Fig. 3B. —28-year-old man who was injured playing recreational basketball.
Coronal fast spin-echo MR image (TR/TEeff, 5050/96) obtained with
fat suppression also shows defect and characteristic dome-shaped overlying
subchondral edema (arrow). Lesion was treated by microfracture at
arthroscopy. Medial meniscus was also torn at arthroscopy.
|
|
View larger version (135K):
[in a new window]
|
Fig. 4A. —29-year-old man with trochlear cartilage defect. Lesion was treated
by microfracture. Sagittal spin-echo MR image (TR/TE, 2333/75) shows chondral
defect (between arrows). This defect was seen only by observer 1.
|
|
View larger version (94K):
[in a new window]
|
Fig. 4B. —29-year-old man with trochlear cartilage defect. Lesion was treated
by microfracture. Subtle subchondral edema (arrow) on fast
inversion-recovery MR image (2933/69; inversion time, 155 msec) is clue to
overlying cartilage defect.
|
|
View larger version (106K):
[in a new window]
|
Fig. 5A. —Cartilage flap lesion in 39-year-old man who fell from ladder.
Sagittal spin-echo MR image (TR/TE, 2533/75) shows full-thickness defect with
in situ chondral fragment (arrow) on weight-bearing surface of medial
femoral condyle.
|
|
View larger version (109K):
[in a new window]
|
Fig. 5B. —Cartilage flap lesion in 39-year-old man who fell from ladder.
Coronal fat-suppressed fast spin-echo MR image (4550/96) shows that fragment
(arrow) remains attached laterally through intact bridge of cartilage
(arrowhead). Compare with Figure
1B. Note edema is present within overlying subchondral bone but
not in chondral fragment. At arthroscopy (not shown) flap was removed and
subchondral bed was treated by microfracture technique.
|
|
View larger version (135K):
[in a new window]
|
Fig. 6A. —Prospectively missed chondral defect in 29-year-old woman. Both
observers retrospectively saw full-thickness cartilage defect in medial
femoral condyle (arrow) on sagittal spin-echo MR image (TR/TE,
2150/75).
|
|
View larger version (107K):
[in a new window]
|
Fig. 6B. —Prospectively missed chondral defect in 29-year-old woman. Coronal
fat-suppressed fast spin-echo MR image (4800/96) also shows articular surface
defect (arrow). Neither observer saw overlying subchondral edema,
which may have contributed to this lesion being overlooked prospectively.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2000 by the American Roentgen Ray Society.
