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Magnetic Resonance Imaging of Cartilage Repair: A Review.

Trattnig S, Winalski CS, Marlovits S, Jurvelin JS, Welsch GH, Potter HG - Cartilage (2011)

Bottom Line: Articular cartilage lesions are a common pathology of the knee joint, and many patients may benefit from cartilage repair surgeries that offer the chance to avoid the development of osteoarthritis or delay its progression.This goal is best fulfilled by magnetic resonance imaging (MRI).In the third section, a short overview is provided on the regulatory issues of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) regarding MR follow-up studies of patients after cartilage repair surgeries.

View Article: PubMed Central - PubMed

Affiliation: MR Centre - High Field MR, Department of Radiology, Medical University of Vienna, Vienna, Austria.

ABSTRACT
Articular cartilage lesions are a common pathology of the knee joint, and many patients may benefit from cartilage repair surgeries that offer the chance to avoid the development of osteoarthritis or delay its progression. Cartilage repair surgery, no matter the technique, requires a noninvasive, standardized, and high-quality longitudinal method to assess the structure of the repair tissue. This goal is best fulfilled by magnetic resonance imaging (MRI). The present article provides an overview of the current state of the art of MRI of cartilage repair. In the first 2 sections, preclinical and clinical MRI of cartilage repair tissue are described with a focus on morphological depiction of cartilage and the use of functional (biochemical) MR methodologies for the visualization of the ultrastructure of cartilage repair. In the third section, a short overview is provided on the regulatory issues of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) regarding MR follow-up studies of patients after cartilage repair surgeries.

No MeSH data available.


Related in: MedlinePlus

Conventional sagittal proton density fast spin-echo (PD FSE) sequence (TR/TE: 2400/28) with ultra-high resolution (512 × 512; 12 cm; slice thickness: 2 mm) of a 28-year-old male patient 24 months after matrix-associated autologous chondrocyte transplantation (MACT) of the medial femoral condyle shows a partial delamination (incomplete integration of the anterior cartilage and bone interface) of the MACT (arrow).
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fig3-1947603509360209: Conventional sagittal proton density fast spin-echo (PD FSE) sequence (TR/TE: 2400/28) with ultra-high resolution (512 × 512; 12 cm; slice thickness: 2 mm) of a 28-year-old male patient 24 months after matrix-associated autologous chondrocyte transplantation (MACT) of the medial femoral condyle shows a partial delamination (incomplete integration of the anterior cartilage and bone interface) of the MACT (arrow).

Mentions: Following ACI, MRI can help define the defect fill, the integration of the graft with the underlying bone and adjacent native cartilage, and the status of the subchondral bone plate and bone marrow.50 At most ACI sites, the chondral defect is completely filled with the repair tissue to the expected level of the adjacent articular cartilage.50 In cases of incomplete defect fill, MR can demonstrate underfilling of the repair site either in focal areas or as an overall thin cartilage.50 Graft failure through delamination has been reported to occur in approximately 5% of patients and usually presents within the first 6 postoperative months.80 The interface between an ACI and native cartilage may be indiscernible or appear as a sharp line. In ACI procedures, the term “partial delamination” is used for incomplete integration of the repair tissue (Fig. 3).50 A common complication after ACI is hypertrophy of the periosteal cover, which often occurs between the third and ninth postoperative months and has been reported in up to 20% to 25% of ACI patients.81 On MRI, periosteal hypertrophy results in a graft that is thicker than the native cartilage and distorts the articular contour (Fig. 4). In 5% to 10% of ACI patients, intra-articular adhesions can lead to knee stiffness that requires arthroscopic debridement. Adhesions are most commonly identified in the infrapatellar fat pad, suprapatellar pouch, and parapatellar recesses and appear as thickened bands of intermediate to dark signal tissue extending from the capsule to the articular cartilage or ACI surface. The subchondral bone plate should appear regular on MRI following ACI. The subchondral marrow frequently demonstrates edema-like signal in the early postoperative period, likely a result of the normal healing process. The intensity and volume of the edema-like region tend to diminish over time and regress to normal signal. Persistent or increasing edema-like signal in the marrow beneath an ACI site suggests a problem with the graft or poor integration of the ACI with the subchondral bone and requires close clinical follow-up.50


Magnetic Resonance Imaging of Cartilage Repair: A Review.

Trattnig S, Winalski CS, Marlovits S, Jurvelin JS, Welsch GH, Potter HG - Cartilage (2011)

Conventional sagittal proton density fast spin-echo (PD FSE) sequence (TR/TE: 2400/28) with ultra-high resolution (512 × 512; 12 cm; slice thickness: 2 mm) of a 28-year-old male patient 24 months after matrix-associated autologous chondrocyte transplantation (MACT) of the medial femoral condyle shows a partial delamination (incomplete integration of the anterior cartilage and bone interface) of the MACT (arrow).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4300792&req=5

fig3-1947603509360209: Conventional sagittal proton density fast spin-echo (PD FSE) sequence (TR/TE: 2400/28) with ultra-high resolution (512 × 512; 12 cm; slice thickness: 2 mm) of a 28-year-old male patient 24 months after matrix-associated autologous chondrocyte transplantation (MACT) of the medial femoral condyle shows a partial delamination (incomplete integration of the anterior cartilage and bone interface) of the MACT (arrow).
Mentions: Following ACI, MRI can help define the defect fill, the integration of the graft with the underlying bone and adjacent native cartilage, and the status of the subchondral bone plate and bone marrow.50 At most ACI sites, the chondral defect is completely filled with the repair tissue to the expected level of the adjacent articular cartilage.50 In cases of incomplete defect fill, MR can demonstrate underfilling of the repair site either in focal areas or as an overall thin cartilage.50 Graft failure through delamination has been reported to occur in approximately 5% of patients and usually presents within the first 6 postoperative months.80 The interface between an ACI and native cartilage may be indiscernible or appear as a sharp line. In ACI procedures, the term “partial delamination” is used for incomplete integration of the repair tissue (Fig. 3).50 A common complication after ACI is hypertrophy of the periosteal cover, which often occurs between the third and ninth postoperative months and has been reported in up to 20% to 25% of ACI patients.81 On MRI, periosteal hypertrophy results in a graft that is thicker than the native cartilage and distorts the articular contour (Fig. 4). In 5% to 10% of ACI patients, intra-articular adhesions can lead to knee stiffness that requires arthroscopic debridement. Adhesions are most commonly identified in the infrapatellar fat pad, suprapatellar pouch, and parapatellar recesses and appear as thickened bands of intermediate to dark signal tissue extending from the capsule to the articular cartilage or ACI surface. The subchondral bone plate should appear regular on MRI following ACI. The subchondral marrow frequently demonstrates edema-like signal in the early postoperative period, likely a result of the normal healing process. The intensity and volume of the edema-like region tend to diminish over time and regress to normal signal. Persistent or increasing edema-like signal in the marrow beneath an ACI site suggests a problem with the graft or poor integration of the ACI with the subchondral bone and requires close clinical follow-up.50

Bottom Line: Articular cartilage lesions are a common pathology of the knee joint, and many patients may benefit from cartilage repair surgeries that offer the chance to avoid the development of osteoarthritis or delay its progression.This goal is best fulfilled by magnetic resonance imaging (MRI).In the third section, a short overview is provided on the regulatory issues of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) regarding MR follow-up studies of patients after cartilage repair surgeries.

View Article: PubMed Central - PubMed

Affiliation: MR Centre - High Field MR, Department of Radiology, Medical University of Vienna, Vienna, Austria.

ABSTRACT
Articular cartilage lesions are a common pathology of the knee joint, and many patients may benefit from cartilage repair surgeries that offer the chance to avoid the development of osteoarthritis or delay its progression. Cartilage repair surgery, no matter the technique, requires a noninvasive, standardized, and high-quality longitudinal method to assess the structure of the repair tissue. This goal is best fulfilled by magnetic resonance imaging (MRI). The present article provides an overview of the current state of the art of MRI of cartilage repair. In the first 2 sections, preclinical and clinical MRI of cartilage repair tissue are described with a focus on morphological depiction of cartilage and the use of functional (biochemical) MR methodologies for the visualization of the ultrastructure of cartilage repair. In the third section, a short overview is provided on the regulatory issues of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) regarding MR follow-up studies of patients after cartilage repair surgeries.

No MeSH data available.


Related in: MedlinePlus