Chondromalacia patellae: assessment with MR imaging.

Yulish, Barry S.; Montanez, Joel; Goodfellow, Donald B.; Bryan, Patrick J.; Mulopulos, George P.; Modic, Michael T.

doi:10.1148/radiology.164.3.3615877

Cited by 170 publications

(68 citation statements)

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“…The role of MR imaging in inflammatory arthropathy has not been reviewed in detail for this article. A good correlation between grading of cartilage lesions at MR imaging and grading at arthroscopy has been shown for chondromalacia patellae (5, 13,36,44), osteochondritis dissecans (9, 27) and osteoarthrosis (4) but as a common finding there was best correlation for the higher grade lesions. This suggests that MR may able to select the patients with more advanced cartilage lesions who require further treatment.…”

Section: Discussionmentioning

confidence: 88%

MR Imaging before Arthroscopy in Knee Joint Disorders?

Rappeport¹,

Mehta²,

Wieslander³

et al. 1996

Acta Radiol

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Purpose: To review the current literature examining the relative merits of arthroscopy and MR imaging of the knee.Material and Methods: Allgapers comparing MR imaging with arthroscopy published within the last 10 years according to Medline were collected and read.Results: Technology has improved considerably during recent years allowing detailed non-invasive visualization of the knee. In particular, the development of cheaper whole-body and dedicated low-field MR units has opened up for non-invasive inspection of the knee at reasonable cost. Meniscal tears can be detected with accuracy rates of around 90% and rupture of the anterior cruciate ligament with accuracy rates of around 93% compared to arthroscopy. However, arthroscopy is not the ideal gold standard, since it has weak points, e.g. peripheral meniscal tears or osteochondritis without apparent damage to the cartilage.Conclusion: Based on the overwhelming literature it seems safe to conclude that MR examinations of the knee should be performed before arthroscopy is undertaken.The knee joint is a common site for morbidity as a result of trauma or degenerative disease with resultant temporary or permanent disability characterized by pain, immobility or reduction in previous sporting activity. Symptomatology, clinical examination and conventional film studies are often insufficient for an accurate diagnosis (12,40). Supplementary diagnostic procedures are often required to determine prognosis and allow appropriate management including conservative therapy.During the 1970s and the 1980s arthroscopy of the knee joint became the gold standard in diagnosing knee disorders. The advent of MR imaging has, in most institutions, led to the virtual abandonment of arthrography as a diagnostic procedure in the knee. Over the last 10 years MR has gained worldwide acceptance as the imaging method of choice for the non-invasive evaluation of the knee (21). It provides excellent anatomical detail (Fig. 1) unobtainable by any other imaging modality (Fig. 2).A vast number of papers have been published that examine the diagnostic accuracy of MR examinations of the knee but the exact role of MR remains unclear. In some institutions, diagnostic arthroscopy is not performed in the presence of a normal MR examination (22). This role for MR has been disputed (30, 37, 39) by some orthopaedic surgeons who favour arthroscopy. The purpose of this article is to review the current literature to examine the relative merits of arthroscopy and MR of the knee.The central question in this debate is the diagnostic accuracy of the 2 procedures but other issues such as time, patient comfort, risk and cost need to be taken into account. Arthroscopy is an invasive procedure requiring anaesthesia, carrying a small risk of infection and produces variable pain and reduction in movement in the days following the procedure. MR is non-invasive without known risk to the patient. It can be uncomfortable for the patient owing to prolonged examination time or claustrophobia but such problems are r...

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Section: Discussionmentioning

confidence: 88%

MR Imaging before Arthroscopy in Knee Joint Disorders?

Rappeport¹,

Mehta²,

Wieslander³

et al. 1996

Acta Radiol

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“…The presence of both horizontal grade 3 and vertical signals was defined as "a complex tear" (grade 4). Cartilage degeneration of the femoral condyle and tibial plateau of the involved compartment was graded separately, as described by Yulish [15], such that, grade 1 was a normal contour, abnormal signal; grade 2 a superficial fraying, erosion or ulceration of less than 50 %; grade 3 a partial-thickness defect of more than 50 % but less than 100 %; and grade 4 a full-thickness cartilage loss.…”

Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair

Pujol

Tardy

Boisrenoult

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to assess the MRI features of the all-inside repaired meniscus in the long-term. Methods Among 27 consecutive all-inside arthroscopic meniscal repairs, 23 patients aged 25±5 years at the time of surgery were reviewed at a median follow-up of 10±1 years. Retrospective clinical examinations and imaging assessments using a 1.5-T MRI after all-inside arthroscopic meniscal repair were conducted. Results At follow-up, Lysholm and IKDC averaged 89±11 and 95±8, respectively. MRI examinations revealed no meniscal signal alteration in three patients (13 %), a vertical signal located in the previously torn area in seven (30 %), a horizontal grade 3 in nine (39 %), and a complex tear (grade 4) in four (17.5 %). There were no differences between medial and lateral menisci (p=0.15), stable and stabilised knees (p=0.56). Conclusions Several abnormal vertical and/or horizontal hypersignals are still present on MRI examination ten years after arthroscopic all-inside meniscal repair. The appearance of early signs of osteoarthritis is rare, suggesting a chondroprotective effect of the repaired meniscus.

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“…The surface extent of a diffuse or focal cartilaginous defect was estimated with its maximal diameter and classified as follows: grade 0, absent; grade 1, minimal (Ͻ5 mm); grade 2, moderate (5-10 mm); or grade 3, severe (Ͼ10 mm). The depth of a cartilaginous defect was classified by using a modification of the classification of Yulish et al (14): grade 0, absent (no abnormality in signal intensity or morphology); grade 1, less than 50% reduction of thickness of cartilage; grade 2, 50% or greater reduction of thickness of cartilage; or grade 3, full-thickness or near full-thickness cartilaginous defect.…”

Section: Mr Image Interpretationmentioning

confidence: 99%