Cartilage Delamination Flap Mimicking a Torn Medial Meniscus

Abstract

We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis.

Chondral delamination of the knee and its management: a case report and review article

“…One example of these mechanisms is Synovial plicae that may cause injuries to the underlying cartilage through a combination of compression, friction, and shear forces. Furthermore, the increasing young’s modulus of the stiff medial parapatellar plica is associated with greater contact pressures on the underlying cartilage [ 6 ]. Another example is unstable knees (as in ACL deficient knees) that are more prone to initiate the delamination which may progress to cause locking of the chondral flap [ 11 ].…”

“…The size and the location of the lesion strongly affect the type of symptoms and may affect surgical treatment options [ 2 , 10 ]. For example, patellofemoral flaps cause anterior knee pain without instability, while posterior condylar flaps cause instability, sometimes they may resemble a torn discoid lateral meniscus or even medial meniscus tear [ 6 ]. Swelling and effusion related to the activity are also well mentioned.…”

“…Swelling and effusion related to the activity are also well mentioned. Joint line tenderness is present, crepitus, thigh atrophy, decreased ROM and Mechanical symptoms such as locking and catching and giving way are also frequent [ 6 , 11 ]. Early diagnosis of delamination appears to be challenging and important because cartilage detachment is irreversible and has an important effect on the treatment plan [ 1 ].…”

“…The calcified zone of cartilage contains cartilage fibers, anchored by hydroxyapatite crystals, to the subchondral bone. The junction between the calcified and noncalcified zone is the tidemark [ 4 , 6 ]. The hyaline cartilage has a limited capacity for healing meaning it does not possess the innate ability to restore its normal structure or to heal the subchondral bone once detached from it, so its preservation is paramount for joint health and mobility [ 4 , 7 – 9 ].…”

Therapy Decision Support Based on Recommender System Methods

“…Concerning data-driven therapy or treatment recommendation in general, some scientific works were proposed, ranging from approaches based on majority voting [24], systems based on association rules [25], or applying case-based reasoning [26]. In spite of the named benefits, as stated beforehand, the application of recommender system methods in the medical context is generally limited, and there is mainly work loosely related to the idea of using suchlike methods for therapy decision support.…”