Meniscal injuries are recognized as a cause of significant musculoskeletal morbidity. The menisci are vital for the normal function and long-term health of the knee joint. The purpose of this review is to provide current knowledge regarding the anatomy and biomechanical functions of the menisci, incidence, injury patterns and the advancements in treatment options of meniscal injury. A literature search was performed by a review of PubMed, Google Scholar, MEDLINE, and OVID for all relevant articles published between 1897 and 2014. This study highlights the anatomical and biomechanical characteristics of the menisci, which may be relevant to injury patterns and treatment options. An understanding of the normal anatomy and biomechanical functions of the knee menisci is a necessary prerequisite to understanding pathologies associated with the knee.

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Hip arthroplasty is one of the most common and successful orthopedic procedures performed for the treatment of advanced osteoarthritis. Due to the high prevalence of these implants within the population, complications related to hip arthroplasty are commonly encountered by clinicians and radiologists alike. Knowledge of the diagnostic imaging options available for evaluation of these implants, as well as of the expected range of normal and pathologic findings following hip arthroplasty, is crucial in allowing the radiologist to formulate an appropriate imaging strategy and accurately interpret the subsequent imaging findings.

Background Accurate, reproducible, and noninvasive assessment of hip cartilage is clinically relevant and provides a means by which to assess the suitability of candidates for arthroscopic or open surgical procedures and the response to such interventions over time. Given the relatively thin cartilage of the hip and the complex spherical anatomy, however, accurately assessing the cartilage poses a challenge for traditional MRI techniques. Questions/Purposes We assessed the current status of imaging articular cartilage of the hip through a comprehensive review of recent literature. Methods We performed a literature review using PubMed. Topics included quantitative MRI, imaging of the hip cartilage and labrum, femoroacetabular impingement syndrome, and osteoarthritis of the hip. Where Are We Now? With the use of high in-plane and through-plane resolution, reproducible assessment of hip cartilage and labrum is clinically feasible. More recent quantitative MR techniques also allow for noninvasive assessment of collagen orientation and proteoglycan content in articular cartilage, thus providing insight into early matrix degeneration. These techniques can be applied to cohorts at risk for osteoarthritis, helping to predict cartilage degeneration before symptoms progress and osteoarthritic changes are visible on radiographs. Where Do We Need to Go? Prospective longitudinal data registries are necessary for developing predictive models of osteoarthritis and subsequent joint failure to assess the results of surgical intervention and predict the timing of arthroplasty. How Do We Get There? By establishing more hip cartilage registries, a correlation can be made between subjective measures and morphologic MRI to assess the cartilage, labrum, bone, and synovial lining of the hip.

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Background:Osteochondral allograft transplantation (OCA) is a recognized option for full-thickness articular cartilage defects of the knee, especially in the setting of large lesions or those involving the subchondral bone. Previous heterogenous studies of athletes have shown a 75% to 79% rate of return to play after the procedure.Purpose:To define return-to-play rates in a cohort of elite collegiate and professional basketball players following osteochondral allograft of the knee.Study Design:Case series; Level of evidence, 4.Methods:Prospectively collected data from an institutional cartilage repair registry were retrospectively reviewed. Patients were eligible for inclusion if they were collegiate or professional basketball players at the time of surgery. Patient demographics, lesion size and location, and surgical details were collected. Postoperative magnetic resonance imaging scans were scored with the OCAMRISS system. Time to return to play and pre- versus postoperative player performance were determined with publicly available internet resources.Results:Eleven athletes (4 professional, 7 collegiate) with a total of 14 treated lesions (1 to the medial femoral condyle, 6 to the lateral femoral condyle, 5 to the trochlea, and 2 to the patella) were eligible for study inclusion. Mean lesion size was 509 mm2. All patients underwent OCA through an arthrotomy, with fresh grafts. The overall rate of return to play at the same level of competition was 80%. Median time to return to play was 14 months (range, 6-26 months). Among players with available statistics, there was no significant reduction in any performance category.Conclusion:OCA in elite basketball players results in an 80% return to previous level of competition, which is consistent with previous reports of athletes playing other sports. Osteochondral allografting is a reasonable option to consider for full-thickness cartilage lesions of the knee, even for elite jumping athletes.

Update This article was updated on December 4, 2018, because of previous errors. On pages 1949 and 1958, in the byline, the second author was incorrectly listed as “Dean X. Wang, MD,” which was then abbreviated to “D.X. Wang” in the ORCID iD list. The author's name is now listed as “Dean Wang, MD” in the byline and abbreviated to “D. Wang” in the ORCID iD list. Additionally, on page 1958, in the ORCID iD list, the ORCID iD for Dr. Scott A. Rodeo was incorrectly listed as “0000-0003-2991-7173.” Dr. Rodeo's ORCID iD is now listed as “0000-0002-0745-9880.” An erratum has been published: J Bone Joint Surg Am. 2019 Jan 16;101(2):e9. Background: Fresh osteochondral allograft transplantation is an appealing option to address a failed cartilage repair surgical procedure, given the ability to treat large lesions and to address the subchondral osseous changes commonly seen in the revision setting. We hypothesized that osteochondral allograft transplantation after failed cartilage repair would result in low failure rates and improved function and that improved graft incorporation on postoperative magnetic resonance imaging (MRI) would correlate with a superior clinical outcome. Methods: A retrospective review of prospectively collected data was used to identify 43 patients treated with fresh osteochondral allograft transplantation after a previous cartilage repair surgical procedure and having a minimum follow-up of 2 years. Clinical outcomes were evaluated using the Short Form-36 (SF-36) score, International Knee Documentation Committee (IKDC) Subjective Knee Score, Marx Activity Scale, Knee Outcome Survey-Activities of Daily Living (KOS-ADL) Questionnaire, Cincinnati Sports Activity Score, and Cincinnati Overall Symptom Assessment. Postoperative MRI scans were obtained at a mean time of 19.7 months and were independently reviewed by a musculoskeletal radiologist using the Osteochondral Allograft MRI Scoring System (OCAMRISS). Results: At a mean 3.5-year follow-up after osteochondral allograft transplantation, significant improvements (p < 0.05) in SF-36 Physical Function, SF-36 Pain, KOS-ADL, IKDC Subjective Knee Score, and Cincinnati Overall Symptom Assessment were seen. Over 90% of grafts remained in situ at the time of the latest follow-up, although 17 knees (40%) underwent reoperation, the majority for arthroscopic debridement or manipulation for stiffness. Body mass index (BMI) of >30 kg/m2 was associated with worse clinical outcomes. The mean total OCAMRISS score demonstrated poorer allograft integration in patients with graft failure, but the total score did not meaningfully correlate with clinical outcome scores. However, better individual articular cartilage appearance and osseous integration subscores were associated with better clinical outcome scores. Conclusions: Significant improvements in pain and function were seen following fresh osteochondral allograft transplantation after failed cartilage repair, with an overall graft survival rate of >90%. Patients with greater bone and cartilage incorporation on MRI had superior clinical outcomes, although persistent osseous edema was frequently seen. We concluded that osteochondral allograft transplantation is an effective salvage treatment after failed cartilage repair and recommend further evaluation of techniques to optimize graft integration. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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