Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography.

Gagliardi, Joseph A.; Chung, Emma; Chandnani, Vijay P.; Kesling, K L; Christensen, Kevin P.; Null, R N; Radvany, M. G.; Hansen, Mark F.

doi:10.2214/ajr.163.3.8079858

Cited by 175 publications

(94 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%

“…The data from reviewed studies are summarised in Table 4 which also includes studies with less than 40 patients. The comparative studies (3, 5, 8, 13,18,19,36,41) provide complete or partial data regarding sensitivity, specificity, positive and negative predictive values and accuracy of MR. The results concerning the ability of MR to detect articular cartilage lesions are quite confusing.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

MR Imaging before Arthroscopy in Knee Joint Disorders?

Rappeport¹,

Mehta²,

Wieslander³

et al. 1996

Acta Radiol

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“…Grade I lesions were excluded as a result of the difficulties in differentiating these lesions from normal (ICRS Grade 0) cartilage by MRI [9]. Because previous studies have shown MRI is unreliable in detecting superficial lesions (softening) [13,16,27], only Graded II to IV lesions were documented to avoid false-positive MRI findings. ICRS Grade II describes articular cartilage defects extending down to less than 50% of cartilage depth, Grade III extending deeper than 50% of cartilage depth, and Grade IV are defects with full-thickness articular cartilage loss.…”

Section: Methodsmentioning

confidence: 99%

Ligament Reconstruction versus Distal Realignment for Patellar Dislocation

Sillanpää

Mattila

Visuri

et al. 2008

Clinical Orthopaedics &Amp; Related Research

107

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“…MR arthrography seems to be superior to standard MRI in the detection of cartilage lesions at the knee especially for early lesions. But again MR arthrography is not perfect with reported sensitivities in detecting grade 1 lesions at the patellar cartilage ranging from 29 to 53% [5,6]. To be able to benefit from the advantages of MR arthrography it is essential that enough contrast material enters between the articular surfaces.…”

Section: Discussionmentioning

confidence: 99%

“…MR arthrography also has the potential to identify intra-articular bodies [4], and chondral [5,6] and osteochondral [7] lesions and is helpful after reconstruction of the anterior cruciate ligament [8].…”

Section: Introductionmentioning

confidence: 99%