MRI of Native Knee Cartilage Delamination Injuries

Abstract

Delamination injuries of knee cartilage signify surgical lesions that can lead to significant morbidity without treatment. These injuries may present with clinical symptoms identical to those associated with meniscal injury, and arthroscopic identification can be difficult, thereby creating a role for imaging diagnosis. A low sensitivity of imaging identification of delamination injury of the knee is reported in the available literature, although vast improvements in MRI of cartilage have since been introduced.

Knee chondral delaminations and blisters

“…Especially in elderly patients and early OA, also osteonecrosis may develop after a minor trauma and could fast develop into an open lesion. 23 Rubin et al 24 and White et al 25 have further speculated that chondral delamination could be part of a subcortical "ischemic insult. " Also, blisters seen in degenerative joints may have been started as localized delaminations initially.…”

“…Such sequences provide a higher total signal intensity in cartilage than standard T2-weighted sequences do and by that, allowing better differentiation between cartilage and subchondral bone. 38 White et al 25 recently suggested the use of a combination of orthogonally acquired 2D FSE sequences, including fat-suppressed T2-weighted and PD-weighted sequences, and a sagittal fat-suppressed DESS sequence. Loss of the laminar appearance has been reported in association with chondral lesions of the retropatellar cartilage 39 and cartilage elsewhere in the knee, 40 and may also reflect early degeneration or predict future delamination.…”

Glossary of terms for musculoskeletal radiology

“…During arthroscopic probing, it undulates like a carpet (carpet phenomenon, wave sign). Delamination occurs at the tidemark, the junction between uncalcified and calcified cartilage [52]. Imaging On MR, carpet lesions are difficult to diagnose because chondral thickness and surface contour are normal [53].…”

Perspective on Idiopathic Subchondral, Osteochondral, and Chondral Lesions with Emphasis on the Knee

“…64 Because the tidemark is not developed in children, delaminating injuries in the immature skeleton are rare, and osteochondral injuries are more common. 65 We do not know why delaminations occur. Shearing injuries were suspected to be the cause for delamination.…”