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Imaging of cartilage repair procedures.

Sanghvi D, Munshi M, Pardiwala D - Indian J Radiol Imaging (2014)

Bottom Line: The gamut of surgical techniques, normal postoperative radiological appearances, and possible complications have been described.The five common techniques of cartilage repair currently offered include bone marrow stimulation (microfracture or drilling), mosaicplasty, synthetic resorbable scaffold grafts, osteochondral allograft transplants, and autologous chondrocyte implantation (ACI).Complications of cartilage repair procedures that may be demonstrated on magnetic resonance imaging (MRI) include plug loosening, graft protuberance, graft depression, and collapse in mosaicplasty, graft hypertrophy in ACI, and immune response leading to graft rejection, which is more common with synthetic grafts and cadaveric allografts.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kokilaben Dhirubhai Ambani Hospital, Andheri (W), Mumbai, Maharashtra, India.

ABSTRACT
The rationale for cartilage repair is to prevent precocious osteoarthritis in untreated focal cartilage injuries in the young and middle-aged population. The gamut of surgical techniques, normal postoperative radiological appearances, and possible complications have been described. An objective method of recording the quality of repair tissue is with the magnetic resonance observation of cartilage repair tissue (MOCART) score. This scoring system evaluates nine parameters that include the extent of defect filling, border zone integration, signal intensity, quality of structure and surface, subchondral bone, subchondral lamina, and records presence or absence of synovitis and adhesions. The five common techniques of cartilage repair currently offered include bone marrow stimulation (microfracture or drilling), mosaicplasty, synthetic resorbable scaffold grafts, osteochondral allograft transplants, and autologous chondrocyte implantation (ACI). Complications of cartilage repair procedures that may be demonstrated on magnetic resonance imaging (MRI) include plug loosening, graft protuberance, graft depression, and collapse in mosaicplasty, graft hypertrophy in ACI, and immune response leading to graft rejection, which is more common with synthetic grafts and cadaveric allografts.

No MeSH data available.


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Mosaicplasty with poor MOCART score of 55. (A) Intraoperative image shows large osteochondral lesion (arrow) of medial femoral condyle. (B) Osteochondral plugs (arrow) have been placed in the lesion. (C) Postoperative sagittal T2W MRI shows graft subsidence (arrow) and poor congruity with the adjacent parent cartilage
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Figure 4: Mosaicplasty with poor MOCART score of 55. (A) Intraoperative image shows large osteochondral lesion (arrow) of medial femoral condyle. (B) Osteochondral plugs (arrow) have been placed in the lesion. (C) Postoperative sagittal T2W MRI shows graft subsidence (arrow) and poor congruity with the adjacent parent cartilage

Mentions: This entails harvesting osteochondral plugs from a non–weight-bearing area and transplanting at the site of the cartilage defect in the weight-bearing segment [Figures 3 and 4]. The aim of surgery is to have osteochondral plugs perpendicular to the articular surface and congruent with the adjacent normal cartilage. As compared to the microfracture technique, where the repair tissue is fibrocartilage, OATS involves transplantation of the patient's own hyaline cartilage. As compared to cadaveric allografts, osteochondral autografts are less likely to induce immune-mediated graft rejection and rate of graft incorporation is higher.[7] Limitations of this technique are possible donor site morbidities.


Imaging of cartilage repair procedures.

Sanghvi D, Munshi M, Pardiwala D - Indian J Radiol Imaging (2014)

Mosaicplasty with poor MOCART score of 55. (A) Intraoperative image shows large osteochondral lesion (arrow) of medial femoral condyle. (B) Osteochondral plugs (arrow) have been placed in the lesion. (C) Postoperative sagittal T2W MRI shows graft subsidence (arrow) and poor congruity with the adjacent parent cartilage
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4126139&req=5

Figure 4: Mosaicplasty with poor MOCART score of 55. (A) Intraoperative image shows large osteochondral lesion (arrow) of medial femoral condyle. (B) Osteochondral plugs (arrow) have been placed in the lesion. (C) Postoperative sagittal T2W MRI shows graft subsidence (arrow) and poor congruity with the adjacent parent cartilage
Mentions: This entails harvesting osteochondral plugs from a non–weight-bearing area and transplanting at the site of the cartilage defect in the weight-bearing segment [Figures 3 and 4]. The aim of surgery is to have osteochondral plugs perpendicular to the articular surface and congruent with the adjacent normal cartilage. As compared to the microfracture technique, where the repair tissue is fibrocartilage, OATS involves transplantation of the patient's own hyaline cartilage. As compared to cadaveric allografts, osteochondral autografts are less likely to induce immune-mediated graft rejection and rate of graft incorporation is higher.[7] Limitations of this technique are possible donor site morbidities.

Bottom Line: The gamut of surgical techniques, normal postoperative radiological appearances, and possible complications have been described.The five common techniques of cartilage repair currently offered include bone marrow stimulation (microfracture or drilling), mosaicplasty, synthetic resorbable scaffold grafts, osteochondral allograft transplants, and autologous chondrocyte implantation (ACI).Complications of cartilage repair procedures that may be demonstrated on magnetic resonance imaging (MRI) include plug loosening, graft protuberance, graft depression, and collapse in mosaicplasty, graft hypertrophy in ACI, and immune response leading to graft rejection, which is more common with synthetic grafts and cadaveric allografts.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kokilaben Dhirubhai Ambani Hospital, Andheri (W), Mumbai, Maharashtra, India.

ABSTRACT
The rationale for cartilage repair is to prevent precocious osteoarthritis in untreated focal cartilage injuries in the young and middle-aged population. The gamut of surgical techniques, normal postoperative radiological appearances, and possible complications have been described. An objective method of recording the quality of repair tissue is with the magnetic resonance observation of cartilage repair tissue (MOCART) score. This scoring system evaluates nine parameters that include the extent of defect filling, border zone integration, signal intensity, quality of structure and surface, subchondral bone, subchondral lamina, and records presence or absence of synovitis and adhesions. The five common techniques of cartilage repair currently offered include bone marrow stimulation (microfracture or drilling), mosaicplasty, synthetic resorbable scaffold grafts, osteochondral allograft transplants, and autologous chondrocyte implantation (ACI). Complications of cartilage repair procedures that may be demonstrated on magnetic resonance imaging (MRI) include plug loosening, graft protuberance, graft depression, and collapse in mosaicplasty, graft hypertrophy in ACI, and immune response leading to graft rejection, which is more common with synthetic grafts and cadaveric allografts.

No MeSH data available.


Related in: MedlinePlus