Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee

Smith, Toby; Drew, Benjamin; Toms, Andoni P.; Donell, Simon T.; Hing, Caroline B.

doi:10.1007/s00167-012-1905-x

Cited by 46 publications

(37 citation statements)

References 46 publications

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“…At 1-year followup, Rodkey et al 21 35 Outerbridge IV cartilage defects were excluded from the present study, and the grading of cartilage status to determine collagen meniscus implantation was assessed arthroscopically and not using MRI, as discrepancies between arthroscopic and MRI findings are well known. 24 In this research, no changes or slight improvement of cartilage status were reported in most patients at the 2-year follow-up MRI evaluation. This finding might be explained by the filling effect of the scaffold that is estimated to be about 69% of the meniscal defect at 5.8 years after medial collagen meniscus implantation.…”

Section: Discussionmentioning

confidence: 54%

Arthroscopic Collagen Meniscus Implantation for Partial Lateral Meniscal Defects

et al. 2012

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Section: Discussionmentioning

confidence: 54%

Arthroscopic Collagen Meniscus Implantation for Partial Lateral Meniscal Defects

et al. 2012

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“…A recent study has suggested that subchondral oedema may be associated with improved outcomes following UKR, however as this study was performed in a mixed FTCL and PTCL population, it is unclear whether extend of medial compartment disease was a confounding factor in this analysis 23 . Additionally, it has previously been reported that the diagnostic accuracy of MRI decreases as the grade of chondral lesion decreases and as such the use of MRI for patient selection for UKR may be misleading due the false-positive assessment of PTCL, which this study has identified as having worse results 24 . Further work is required to identify biomarkers that may be predictive of outcomes following UKR in the early arthritis population, however at present based on the results of this study we would recommend that UKR is not performed in the setting of PTCL.…”

Section: Discussionmentioning

confidence: 75%

Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss

Hamilton

Pandit

Inabathula

et al. 2017

The Bone & Joint Journal

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Aims While medial unicompartmental knee arthroplasty (UKA) is indicated for patients with full-thickness cartilage loss, it is occasionally used to treat those with partial-thickness loss. The aim of this study was to investigate the five-year outcomes in a consecutive series of UKAs used in patients with partial thickness cartilage loss in the medial compartment of the knee. Patients and Methods Between 2002 and 2014, 94 consecutive UKAs were undertaken in 90 patients with partial thickness cartilage loss and followed up independently for a mean of six years (1 to 13). These patients had partial thickness cartilage loss either on both femur and tibia (13 knees), or on either the femur or the tibia, with full thickness loss on the other surface of the joint (18 and 63 knees respectively). Using propensity score analysis, these patients were matched 1:2 based on age, gender and pre-operative Oxford Knee Score (OKS) with knees with full thickness loss on both the femur and tibia. The functional outcomes, implant survival and incidence of re-operations were assessed at one, two and five years post-operatively. A subgroup of 36 knees in 36 patients with partial thickness cartilage loss, who had pre-operative MRI scans, was assessed to identify whether there were any factors identified on MRI that predicted the outcome. Results Knees with partial thickness cartilage loss had significantly worse functional outcomes at one, two and five years post-operatively compared with those with full thickness loss. A quarter of knees with partial thickness loss had a fair or poor result and a fifth failed to achieve a clinically significant improvement in OKS from a baseline of four points or more; double that seen in knees with full thickness loss. Whilst there was no difference in implant survival between the groups, the rate of re-operation in knees with partial thickness loss was three times higher. Most of the re-operations (three-quarters), were arthroscopies for persistent pain. Compared with those achieving good or excellent outcomes, patients with partial thickness cartilage loss who achieved fair or poor outcomes were younger and had worse pre-operative functional scores. However, there were no other differences in the baseline demographics. MRI findings of full thickness cartilage loss, subchondral oedema, synovitis or effusion did not provide additional prognostic information. Conclusion Medial UKA should be reserved for patients with full thickness cartilage loss on both the femur and tibia. Whilst some patients with partial thickness loss achieve a good result we cannot currently identify which these will be and in this situation MRI is unhelpful and misleading. Cite this article: Bone Joint J 2017;99-B:475–82.

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“…As such, component rotation could not be analyzed. It is likely that the MRI-based technique provides improved imaging of the cartilage surfaces [6,9,22,44,47]. Based on the cartilage surface estimated by the surgeon with CT-based patient-specific instrumentation, deviations from the real joint surface are possible, which can result in a poorer fit.…”

Section: Discussionmentioning

confidence: 99%

Small Improvements in Mechanical Axis Alignment Achieved With MRI versus CT-based Patient-specific Instruments in TKA: A Randomized Clinical Trial

Pfitzner

Abdel

Roth

et al. 2014

Clinical Orthopaedics &Amp; Related Research

101

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Background Patient-specific instrumentation in TKA has the proposed benefits of improving coronal and sagittal alignment and rotation of the components. In contrast, the literature is inconsistent if the use of patient-specific instrumentation improves alignment in comparison to conventional instrumentation. Depending on the manufacturer, patient-specific instrumentation is based on either MRI or CT scans. However, it is unknown whether one patient-specific instrumentation approach is more accurate than the other and if there is a potential benefit in terms of reduction of duration of surgery. Questions/purposes We compared the accuracy of MRIand CT-based patient-specific instrumentation with conventional instrumentation and with each other in TKAs. The three approaches also were compared with respect to validated outcomes scores and duration of surgery. Methods A randomized clinical trial was conducted in which 90 patients were enrolled and divided into three groups: CT-based, MRI-based patient-specific instrumentation, and conventional instrumentation. The groups were not different regarding age, male/female sex distribution, and BMI. In all groups, coronal and sagittal alignments were measured on postoperative standing long-leg and lateral radiographs. Component rotation was measured on CT scans. Clinical outcomes (Knee Society and WOMAC scores) were evaluated preoperatively and at a mean of 3 months postoperatively and the duration of surgery was analyzed for each patient. MRI-and CT-based patientspecific instrumentation groups were first compared with conventional instrumentation, the patient-specific instrumentation groups were compared with each other, and all three approaches were compared for clinical outcome measures and duration of surgery. Results Compared with conventional instrumentation MRI-and CT-based patient-specific instrumentation showed higher accuracy regarding the coronal limb axis

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Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee

Abstract: II.

Cited by 46 publications

References 46 publications

Arthroscopic Collagen Meniscus Implantation for Partial Lateral Meniscal Defects

Arthroscopic Collagen Meniscus Implantation for Partial Lateral Meniscal Defects

Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss

Small Improvements in Mechanical Axis Alignment Achieved With MRI versus CT-based Patient-specific Instruments in TKA: A Randomized Clinical Trial

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