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Semin Musculoskelet Radiol 2011; 15(1): 069-088
DOI: 10.1055/s-0031-1271960
© Thieme Medical Publishers

Clinical and MRI Considerations in Sports-Related Knee Joint Cartilage Injury and Cartilage Repair

Richard J. Hughes1 , David G. Houlihan-Burne2
  • 1Department of Radiology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, United Kingdom
  • 2Department of Orthopaedic Surgery, Hillingdon and Mount Vernon NHS Trust, Northwood, Middlesex, United Kingdom
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Publication History

Publication Date:
17 February 2011 (online)

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ABSTRACT

Cartilage injuries of the knee occur frequently in professional and amateur athletes and can be associated with severe debilitation and morbidity. They are commonly associated with ligament injuries but also may be frequently isolated. Increasing awareness and advances in magnetic resonance imaging (MRI) have led to increasing diagnosis and recognition of these injuries. Articular cartilage is just 2 to 4 mm thick and is avascular, alymphatic, and aneural. It has a limited capacity for healing, and there has been increasing use of cartilage repair techniques to treat these lesions in the active population. Strategies for cartilage repair include marrow stimulation techniques such as microfracture/drilling, osteochondral grafting, and autologous chondrocyte transplants. MRI is an important tool in the diagnosis and grading of cartilage injury and is useful in the follow-up and monitoring of these repair procedures. It is important for radiologists and clinicians to be aware of the capabilities and limitations of MRI in assessing cartilage injury and to be familiar with common postsurgical appearances to facilitate assessment and follow-up in this population. This article reviews the clinical findings and MRI imaging appearances of cartilage injury. The management options are discussed as well as common postsurgical appearances following the various interventions.

KEYWORDS

Cartilage - articular - athletic injuries - MRI - arthroscopy

REFERENCES

  • 1 Hunter W. On the structure and disease of articulating cartilage.  Philos Trans R Soc Lond B Biol Sci. 1743;  9 267
    PubMedGoogle Scholar
  • 2 Messner K, Wei X. Healing chondral injuries.  Sports Med Arthrosc Rev. 1998;  6 13-24
    PubMedGoogle Scholar
  • 3 Curl W W, Krome J, Gordon E S, Rushing J, Smith B P, Poehling G G. Cartilage injuries: a review of 31,516 knee arthroscopies.  Arthroscopy. 1997;  13(4) 456-460
    CrossrefPubMedGoogle Scholar
  • 4 Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies.  Knee. 2007;  14(3) 177-182
    CrossrefPubMedGoogle Scholar
  • 5 Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies.  Arthroscopy. 2002;  18(7) 730-734
    CrossrefPubMedGoogle Scholar
  • 6 Widuchowski W, Lukasik P, Kwiatkowski G et al.. Isolated full thickness chondral injuries. Prevalence and outcome of treatment. A retrospective study of 5233 knee arthroscopies.  Acta Chir Orthop Traumatol Cech. 2008;  75(5) 382-386
    PubMedGoogle Scholar
  • 7 Bauer M, Jackson R W. Chondral lesions of the femoral condyles: a system of arthroscopic classification.  Arthroscopy. 1988;  4(2) 97-102
    CrossrefPubMedGoogle Scholar
  • 8 Outerbridge R E. The etiology of chondromalacia patellae.  J Bone Joint Surg Br. 1961;  43-B(4) 752-757
    CrossrefPubMedGoogle Scholar
  • 9 Kleemann R U, Krocker D, Cedraro A, Tuischer J, Duda G N. Altered cartilage mechanics and histology in knee osteoarthritis: relation to clinical assessment (ICRS grade).  Osteoarthritis Cartilage. 2005;  13(11) 958-963
    CrossrefPubMedGoogle Scholar
  • 10 Brittberg M, Winalski C S. Evaluation of cartilage injuries and repair.  J Bone Joint Surg Am. 2003;  85-A(Suppl 2) 58-69
    PubMedGoogle Scholar
  • 11 Disler D G, McCauley T R, Kelman C G et al.. Fat-suppressed three-dimensional spoiled gradient echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy.  AJR Am J Roentgenol. 1996;  167(1) 127-132
    CrossrefPubMedGoogle Scholar
  • 12 Brophy R H, Zeltser D, Wright R W, Flanigan D. Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment.  Arthroscopy. 2010;  26(1) 112-120
    CrossrefPubMedGoogle Scholar
  • 13 Hunt N, Sanchez-Ballester J, Pandit R, Thomas R, Strachan R. Chondral lesions of the knee: a new localization method and correlation with associated pathology.  Arthroscopy. 2001;  17(5) 481-490
    CrossrefPubMedGoogle Scholar
  • 14 Buckwalter J A. Sports, joint injury, and posttraumatic osteoarthritis.  J Orthop Sports Phys Ther. 2003;  33(10) 578-588
    PubMedGoogle Scholar
  • 15 Wilk K E, Briem K, Reinold M M, Devine K M, Dugas J, Andrews J R. Rehabilitation of articular lesions in the athlete's knee.  J Orthop Sports Phys Ther. 2006;  36(10) 815-827
    CrossrefPubMedGoogle Scholar
  • 16 Nakamae A, Engebretsen L, Bahr R, Krosshaug T, Ochi M. Natural history of bone bruises after acute knee injury: clinical outcome and histopathological findings.  Knee Surg Sports Traumatol Arthrosc. 2006;  14(12) 1252-1258
    CrossrefPubMedGoogle Scholar
  • 17 Brophy R H, Rodeo S A, Barnes R P, Powell J W, Warren R F. Knee articular cartilage injuries in the National Football League: epidemiology and treatment approach by team physicians.  J Knee Surg. 2009;  22(4) 331-338
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Golightly Y M, Marshall S W, Callahan L F, Guskiewicz K. Early-onset arthritis in retired National Football League players.  J Phys Act Health. 2009;  6(5) 638-643
    PubMedGoogle Scholar
  • 19 Elleuch M H, Guermazi M, Mezghanni M et al.. Knee osteoarthritis in 50 former top-level soccer players: a comparative study.  Ann Readapt Med Phys. 2008;  51(3) 174-178
    CrossrefPubMedGoogle Scholar
  • 20 Widuchowski W, Widuchowski J, Koczy B, Szyluk K. Untreated asymptomatic deep cartilage lesions associated with anterior cruciate ligament injury: results at 10- and 15-year follow-up.  Am J Sports Med. 2009;  37(4) 688-692
    CrossrefPubMedGoogle Scholar
  • 21 Kaplan L D, Schurhoff M R, Selesnick H, Thorpe M, Uribe J W. Magnetic resonance imaging of the knee in asymptomatic professional basketball players.  Arthroscopy. 2005;  21(5) 557-561
    CrossrefPubMedGoogle Scholar
  • 22 Major N M, Helms C A. MR imaging of the knee: findings in asymptomatic collegiate basketball players.  AJR Am J Roentgenol. 2002;  179(3) 641-644
    CrossrefPubMedGoogle Scholar
  • 23 De Smet A A, Tuite M J. Use of the “two-slice-touch” rule for the MRI diagnosis of meniscal tears.  AJR Am J Roentgenol. 2006;  187(4) 911-914
    CrossrefPubMedGoogle Scholar
  • 24 Disler D G. Fat-suppressed three-dimensional spoiled gradient-recalled MR imaging: assessment of articular and physeal hyaline cartilage.  AJR Am J Roentgenol. 1997;  169(4) 1117-1123
    CrossrefPubMedGoogle Scholar
  • 25 Kawahara Y, Uetani M, Nakahara N et al.. Fast spin-echo MR of the articular cartilage in the osteoarthrotic knee. Correlation of MR and arthroscopic findings.  Acta Radiol. 1998;  39(2) 120-125
    PubMedGoogle Scholar
  • 26 Potter H G, Linklater J M, Allen A A, Hannafin J A, Haas S B. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging.  J Bone Joint Surg Am. 1998;  80(9) 1276-1284
    CrossrefPubMedGoogle Scholar
  • 27 Recht M, Bobic V, Burstein D et al.. Magnetic resonance imaging of articular cartilage.  Clin Orthop Relat Res. 2001;  (391, Suppl) S379-S396
    PubMedGoogle Scholar
  • 28 McCauley T R, Recht M P, Disler D G. Clinical imaging of articular cartilage in the knee.  Semin Musculoskelet Radiol. 2001;  5(4) 293-304
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Bobic V. ICRS Articular Cartilage Imaging Committee .ICRS MR Imaging Protocol for Knee Articular Cartilage. Zollikon, Switzerland: ICRS; 2000: 12
    Google Scholar
  • 30 Alparslan L, Winalski C S, Boutin R D, Minas T. Postoperative magnetic resonance imaging of articular cartilage repair.  Semin Musculoskelet Radiol. 2001;  5(4) 345-363
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Marlovits S, Mamisch T C, Vekszler G, Resinger C, Trattnig S. Magnetic resonance imaging for diagnosis and assessment of cartilage defect repairs.  Injury. 2008;  39(Suppl 1) S13-S25
    CrossrefPubMedGoogle Scholar
  • 32 Bredella M A, Tirman P F, Peterfy C G et al.. Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients.  AJR Am J Roentgenol. 1999;  172(4) 1073-1080
    CrossrefPubMedGoogle Scholar
  • 33 Recht M P, Piraino D W, Paletta G A, Schils J P, Belhobek G H. Accuracy of fat-suppressed three-dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities.  Radiology. 1996;  198(1) 209-212
    PubMedGoogle Scholar
  • 34 Yoshioka H, Stevens K, Genovese M, Dillingham M F, Lang P. Articular cartilage of knee: normal patterns at MR imaging that mimic disease in healthy subjects and patients with osteoarthritis.  Radiology. 2004;  231(1) 31-38
    CrossrefPubMedGoogle Scholar
  • 35 Krampla W, Roesel M, Svoboda K, Nachbagauer A, Gschwantler M, Hruby W. MRI of the knee: how do field strength and radiologist's experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?.  Eur Radiol. 2009;  19(6) 1519-1528
    CrossrefPubMedGoogle Scholar
  • 36 Yulish B S, Montanez J, Goodfellow D B, Bryan P J, Mulopulos G P, Modic M T. Chondromalacia patellae: assessment with MR imaging.  Radiology. 1987;  164(3) 763-766
    PubMedGoogle Scholar
  • 37 Disler D G, McCauley T R, Wirth C R, Fuchs M D. Detection of knee hyaline cartilage defects using fat-suppressed three-dimensional spoiled gradient-echo MR imaging: comparison with standard MR imaging and correlation with arthroscopy.  AJR Am J Roentgenol. 1995;  165(2) 377-382
    CrossrefPubMedGoogle Scholar
  • 38 Trattnig S, Mlynárik V, Huber M, Ba-Ssalamah A, Puig S, Imhof H. Magnetic resonance imaging of articular cartilage and evaluation of cartilage disease.  Invest Radiol. 2000;  35(10) 595-601
    CrossrefPubMedGoogle Scholar
  • 39 Rubenstein J D, Li J G, Majumdar S, Henkelman R M. Image resolution and signal-to-noise ratio requirements for MR imaging of degenerative cartilage.  AJR Am J Roentgenol. 1997;  169(4) 1089-1096
    CrossrefPubMedGoogle Scholar
  • 40 Recht M P, Goodwin D W, Winalski C S, White L M. MRI of articular cartilage: revisiting current status and future directions.  AJR Am J Roentgenol. 2005;  185(4) 899-914
    CrossrefPubMedGoogle Scholar
  • 41 Masi J N, Sell C A, Phan C et al.. Cartilage MR imaging at 3.0 versus that at 1.5 T: preliminary results in a porcine model.  Radiology. 2005;  236(1) 140-150
    CrossrefPubMedGoogle Scholar
  • 42 Barr C, Bauer J S, Malfair D et al.. MR imaging of the ankle at 3 Tesla and 1.5 Tesla: protocol optimization and application to cartilage, ligament and tendon pathology in cadaver specimens.  Eur Radiol. 2007;  17(6) 1518-1528
    CrossrefPubMedGoogle Scholar
  • 43 Kijowski R, Blankenbaker D G, Davis K W, Shinki K, Kaplan L D, De Smet A A. Comparison of 1.5- and 3.0-T MR imaging for evaluating the articular cartilage of the knee joint.  Radiology. 2009;  250(3) 839-848
    CrossrefPubMedGoogle Scholar
  • 44 Kijowski R, Blankenbaker D G, Woods M A, Shinki K, De Smet A A, Reeder S B. 3.0-T evaluation of knee cartilage by using three-dimensional IDEAL GRASS imaging: comparison with fast spin-echo imaging.  Radiology. 2010;  255(1) 117-127
    CrossrefPubMedGoogle Scholar
  • 45 Mathieu L, Bouchard A, Marchaland J P et al.. Knee MR-arthrography in assessment of meniscal and chondral lesions.  Orthop Traumatol Surg Res. 2009;  95(1) 40-47
    CrossrefPubMedGoogle Scholar
  • 46 Burstein D, Gray M L. Is MRI fulfilling its promise for molecular imaging of cartilage in arthritis?.  Osteoarthritis Cartilage. 2006;  14(11) 1087-1090
    CrossrefPubMedGoogle Scholar
  • 47 Mamisch T C, Trattnig S, Quirbach S, Marlovits S, White L M, Welsch G H. Quantitative T2 mapping of knee cartilage: differentiation of healthy control cartilage and cartilage repair tissue in the knee with unloading—initial results.  Radiology. 2010;  254(3) 818-826
    CrossrefPubMedGoogle Scholar
  • 48 Welsch G H, Trattnig S, Scheffler K et al.. Magnetization transfer contrast and T2 mapping in the evaluation of cartilage repair tissue with 3T MRI.  J Magn Reson Imaging. 2008;  28(4) 979-986
    CrossrefPubMedGoogle Scholar
  • 49 White L M, Sussman M S, Hurtig M, Probyn L, Tomlinson G, Kandel R. Cartilage T2 assessment: differentiation of normal hyaline cartilage and reparative tissue after arthroscopic cartilage repair in equine subjects.  Radiology. 2006;  241(2) 407-414
    CrossrefPubMedGoogle Scholar
  • 50 Watanabe A, Boesch C, Anderson S E, Brehm W, Mainil Varlet P. Ability of dGEMRIC and T2 mapping to evaluate cartilage repair after microfracture: a goat study.  Osteoarthritis Cartilage. 2009;  17(10) 1341-1349
    CrossrefPubMedGoogle Scholar
  • 51 Salzmann G M, Paul J, Bauer J S et al.. T2 assessment and clinical outcome following autologous matrix-assisted chondrocyte and osteochondral autograft transplantation.  Osteoarthritis Cartilage. 2009;  17(12) 1576-1582
    CrossrefPubMedGoogle Scholar
  • 52 Barclay T S, Tsourounis C, McCart G M. Glucosamine.  Ann Pharmacother. 1998;  32(5) 574-579
    PubMedGoogle Scholar
  • 53 Black C, Clar C, Henderson R et al.. The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation.  Health Technol Assess. 2009;  13(52) 1-148
    PubMedGoogle Scholar
  • 54 Shelbourne K D, Jari S, Gray T. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study.  J Bone Joint Surg Am. 2003;  85-A(Suppl 2) 8-16
    PubMedGoogle Scholar
  • 55 Choi Y S, Potter H G, Chun T J. MR imaging of cartilage repair in the knee and ankle.  Radiographics. 2008;  28(4) 1043-1059
    CrossrefPubMedGoogle Scholar
  • 56 Roberts S, McCall I W, Darby A J et al.. Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology.  Arthritis Res Ther. 2003;  5(1) R60-R73
    CrossrefPubMedGoogle Scholar
  • 57 Marlovits S, Striessnig G, Resinger C T et al.. Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging.  Eur J Radiol. 2004;  52(3) 310-319
    CrossrefPubMedGoogle Scholar
  • 58 Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S. Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years.  Eur J Radiol. 2006;  57(1) 16-23
    CrossrefPubMedGoogle Scholar
  • 59 Domayer S E, Welsch G H, Dorotka R et al.. MRI monitoring of cartilage repair in the knee: a review.  Semin Musculoskelet Radiol. 2008;  12(4) 302-317
    Article in Thieme ConnectPubMedGoogle Scholar
  • 60 Burman M, Finkelstein H, Mayer L. Arthroscopy of the knee.  J Bone Joint Surg Am. 1934;  16 255-268
    PubMedGoogle Scholar
  • 61 Bert J M, Maschka K. The arthroscopic treatment of unicompartmental gonarthrosis: a five-year follow-up study of abrasion arthroplasty plus arthroscopic debridement and arthroscopic debridement alone.  Arthroscopy. 1989;  5(1) 25-32
    CrossrefPubMedGoogle Scholar
  • 62 Dines J S, Fealy S, Potter H G, Warren R F. Outcomes of osteochondral lesions of the knee repaired with a bioabsorbable device.  Arthroscopy. 2008;  24(1) 62-68
    CrossrefPubMedGoogle Scholar
  • 63 Wouters D B, van Horn J R, Bos R R. The use of biodegradables in the treatment of osteochondritis dissecans of the knee: fiction or future?.  Acta Orthop Belg. 2003;  69(2) 175-181
    PubMedGoogle Scholar
  • 64 Sirlin C B, Boutin R D, Brossmann J et al.. Polydioxanone biodegradable pins in the knee: MR imaging.  AJR Am J Roentgenol. 2001;  176(1) 83-90
    PubMedGoogle Scholar
  • 65 Verstraete K L, Almqvist F, Verdonk P et al.. Magnetic resonance imaging of cartilage and cartilage repair.  Clin Radiol. 2004;  59(8) 674-689
    CrossrefPubMedGoogle Scholar
  • 66 Furukawa T, Eyre D R, Koide S, Glimcher M J. Biochemical studies on repair cartilage resurfacing experimental defects in the rabbit knee.  J Bone Joint Surg Am. 1980;  62(1) 79-89
    PubMedGoogle Scholar
  • 67 Steadman J R, Ramappa A J, Maxwell R B, Briggs K K. An arthroscopic treatment regimen for osteoarthritis of the knee.  Arthroscopy. 2007;  23(9) 948-955
    CrossrefPubMedGoogle Scholar
  • 68 Blevins F T, Steadman J R, Rodrigo J J, Silliman J. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance.  Orthopedics. 1998;  21(7) 761-767; discussion 767–768
    PubMedGoogle Scholar
  • 69 Gudas R, Kalesinskas R J, Kimtys V et al.. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes.  Arthroscopy. 2005;  21(9) 1066-1075
    Google Scholar
  • 70 Namdari S, Baldwin K, Anakwenze O, Park M J, Huffman G R, Sennett B J. Results and performance after microfracture in National Basketball Association athletes.  Am J Sports Med. 2009;  37(5) 943-948
    CrossrefPubMedGoogle Scholar
  • 71 Steadman J R, Miller B S, Karas S G, Schlegel T F, Briggs K K, Hawkins R J. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players.  J Knee Surg. 2003;  16(2) 83-86
    PubMedGoogle Scholar
  • 72 Mithoefer K, Williams R J, Warren R F, Wickiewicz T L, Marx R G. High impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique.  Am J Sports Med. 2006;  34(9) 1413-1418
    CrossrefPubMedGoogle Scholar
  • 73 Kreuz P C, Steinwachs M R, Erggelet C et al.. Results after microfracture of full-thickness chondral defects in different compartments in the knee.  Osteoarthritis Cartilage. 2006;  14(11) 1119-1125
    CrossrefPubMedGoogle Scholar
  • 74 Steadman J R, Briggs K K, Rodrigo J J, Kocher M S, Gill T J, Rodkey W G. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up.  Arthroscopy. 2003;  19(5) 477-484
    CrossrefPubMedGoogle Scholar
  • 75 Bedi A, Feeley B T, Williams III R J. Management of articular cartilage defects of the knee.  J Bone Joint Surg Am. 2010;  92(4) 994-1009
    CrossrefPubMedGoogle Scholar
  • 76 Mithoefer K, Williams III R J, Warren R F et al.. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study.  J Bone Joint Surg Am. 2005;  87(9) 1911-1920
    CrossrefPubMedGoogle Scholar
  • 77 Brown W E, Potter H G, Marx R G, Wickiewicz T L, Warren R F. Magnetic resonance imaging appearance of cartilage repair in the knee.  Clin Orthop Relat Res. 2004;  422(422) 214-223
    CrossrefPubMedGoogle Scholar
  • 78 Ramappa A J, Gill T J, Bradford C H, Ho C P, Steadman J R. Magnetic resonance imaging to assess knee cartilage repair tissue after microfracture of chondral defects.  J Knee Surg. 2007;  20(3) 228-234
    Article in Thieme ConnectPubMedGoogle Scholar
  • 79 Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.  N Engl J Med. 1994;  331(14) 889-895
    CrossrefPubMedGoogle Scholar
  • 80 Briggs T W, Mahroof S, David L A, Flannelly J, Pringle J, Bayliss M. Histological evaluation of chondral defects after autologous chondrocyte implantation of the knee.  J Bone Joint Surg Br. 2003;  85(7) 1077-1083
    CrossrefPubMedGoogle Scholar
  • 81 Henderson I, Francisco R, Oakes B, Cameron J. Autologous chondrocyte implantation for treatment of focal chondral defects of the knee—a clinical, arthroscopic, MRI and histologic evaluation at 2 years.  Knee. 2005;  12(3) 209-216
    CrossrefPubMedGoogle Scholar
  • 82 Micheli L J, Browne J E, Erggelet C. Autologous chondrocyte implantation of the knee: multicentre experience and minimum 3-year follow-up.  Clin J Sport Med. 2001;  11(4) 223-228
    CrossrefPubMedGoogle Scholar
  • 83 Bentley G, Biant L C, Carrington R W et al.. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee.  J Bone Joint Surg Br. 2003;  85(2) 223-230
    CrossrefPubMedGoogle Scholar
  • 84 Wood J J, Malek M A, Frassica F J et al.. Autologous cultured chondrocytes: adverse events reported to the United States Food and Drug Administration.  J Bone Joint Surg Am. 2006;  88(3) 503-507
    CrossrefPubMedGoogle Scholar
  • 85 Peterson L, Minas T, Brittberg M, Nilsson A, Sjögren-Jansson E, Lindahl A. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee.  Clin Orthop Relat Res. 2000;  (374) 212-234
    PubMedGoogle Scholar
  • 86 Niemeyer P, Salzmann G, Steinwachs M et al.. Presence of subchondral bone marrow edema at the time of treatment represents a negative prognostic factor for early outcome after autologous chondrocyte implantation.  Arch Orthop Trauma Surg. 2010;  130(8) 977-983
    CrossrefPubMedGoogle Scholar
  • 87 Wada Y, Watanabe A, Yamashita T, Isobe T, Moriya H. Evaluation of articular cartilage with 3D-SPGR MRI after autologous chondrocyte implantation.  J Orthop Sci. 2003;  8(4) 514-517
    CrossrefPubMedGoogle Scholar
  • 88 Ho Y Y, Stanley A J, Hui JH-P, Wang S C. Postoperative evaluation of the knee after autologous chondrocyte implantation: what radiologists need to know.  Radiographics. 2007;  27(1) 207-220; discussion 221–222
    CrossrefPubMedGoogle Scholar
  • 89 Alparslan L, Minas T, Winalski C S. Magnetic resonance imaging of autologous chondrocyte implantation.  Semin Ultrasound CT MR. 2001;  22(4) 341-351
    CrossrefPubMedGoogle Scholar
  • 90 Henderson I J, Tuy B, Connell D, Oakes B, Hettwer W H. Prospective clinical study of autologous chondrocyte implantation and correlation with MRI at three and 12 months.  J Bone Joint Surg Br. 2003;  85(7) 1060-1066
    CrossrefPubMedGoogle Scholar
  • 91 Trattnig S, Ba-Ssalamah A, Pinker K, Plank C, Vecsei V, Marlovits S. Matrix-based autologous chondrocyte implantation for cartilage repair: noninvasive monitoring by high-resolution magnetic resonance imaging.  Magn Reson Imaging. 2005;  23(7) 779-787
    CrossrefPubMedGoogle Scholar
  • 92 Tins B J, McCall I W, Takahashi T et al.. Autologous chondrocyte implantation in knee joint: MR imaging and histologic features at 1-year follow-up.  Radiology. 2005;  234(2) 501-508
    CrossrefPubMedGoogle Scholar
  • 93 Henderson I, Gui J, Lavigne P. Autologous chondrocyte implantation: natural history of postimplantation periosteal hypertrophy and effects of repair-site debridement on outcome.  Arthroscopy. 2006;  22(12) 1318-1324, e1
    CrossrefPubMedGoogle Scholar
  • 94 Kreuz P C, Steinwachs M, Erggelet C et al.. Classification of graft hypertrophy after autologous chondrocyte implantation of full-thickness chondral defects in the knee.  Osteoarthritis Cartilage. 2007;  15(12) 1339-1347
    CrossrefPubMedGoogle Scholar
  • 95 Minas T. Autologous chondrocyte implantation for focal chondral defects of the knee.  Clin Orthop Relat Res. 2001;  (391, Suppl) S349-S361
    PubMedGoogle Scholar
  • 96 Caumo F, Russo A, Faccioli N et al.. Autologous chondrocyte implantation: prospective MRI evaluation with clinical correlation.  Radiol Med (Torino). 2007;  112(5) 722-731
    CrossrefPubMedGoogle Scholar
  • 97 Robertson W B, Fick D, Wood D J, Linklater J M, Zheng M H, Ackland T R. MRI and clinical evaluation of collagen-covered autologous chondrocyte implantation (CACI) at two years.  Knee. 2007;  14(2) 117-127
    CrossrefPubMedGoogle Scholar
  • 98 Bodo G, Hangody L, Modis L, Hurtig M. Autologous osteochondral grafting (mosaic arthroplasty) for treatment of subchondral cystic lesions in the equine stifle and fetlock joints.  Vet Surg. 2004;  33(6) 588-596
    CrossrefPubMedGoogle Scholar
  • 99 Hangody L, Kish G, Kárpáti Z, Udvarhelyi I, Szigeti I, Bély M. Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice.  Orthopedics. 1998;  21(7) 751-756
    PubMedGoogle Scholar
  • 100 Hangody L, Vásárhelyi G, Hangody L R et al.. Autologous osteochondral grafting—technique and long-term results.  Injury. 2008;  39(Suppl 1) S32-S39
    CrossrefPubMedGoogle Scholar
  • 101 Sanders T G, Mentzer K D, Miller M D, Morrison W B, Campbell S E, Penrod B J. Autogenous osteochondral “plug” transfer for the treatment of focal chondral defects: postoperative MR appearance with clinical correlation.  Skeletal Radiol. 2001;  30(10) 570-578
    CrossrefPubMedGoogle Scholar
  • 102 Solheim E, Hegna J, Oyen J, Austgulen O K, Harlem T, Strand T. Osteochondral autografting (mosaicplasty) in articular cartilage defects in the knee: results at 5 to 9 years.  Knee. 2010;  17(1) 84-87
    CrossrefPubMedGoogle Scholar
  • 103 Hangody L, Dobos J, Baló E, Pánics G, Hangody L R, Berkes I. Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study.  Am J Sports Med. 2010;  38(6) 1125-1133
    CrossrefPubMedGoogle Scholar
  • 104 Fitzpatrick P L, Morgan D A. Fresh osteochondral allografts: a 6-10-year review.  Aust N Z J Surg. 1998;  68(8) 573-579
    CrossrefPubMedGoogle Scholar
  • 105 Williams III R J, Ranawat A S, Potter H G, Carter T, Warren R F. Fresh stored allografts for the treatment of osteochondral defects of the knee.  J Bone Joint Surg Am. 2007;  89(4) 718-726
    CrossrefPubMedGoogle Scholar
  • 106 Recht M, White L M, Winalski C S, Miniaci A, Minas T, Parker R D. MR imaging of cartilage repair procedures.  Skeletal Radiol. 2003;  32(4) 185-200
    CrossrefPubMedGoogle Scholar
  • 107 Link T M, Mischung J, Wörtler K, Burkart A, Rummeny E J, Imhoff A B. Normal and pathological MR findings in osteochondral autografts with longitudinal follow-up.  Eur Radiol. 2006;  16(1) 88-96
    CrossrefPubMedGoogle Scholar
  • 108 Trattnig S, Millington S A, Szomolanyi P, Marlovits S. MR imaging of osteochondral grafts and autologous chondrocyte implantation.  Eur Radiol. 2007;  17(1) 103-118
    CrossrefPubMedGoogle Scholar
  • 109 Sirlin C B, Brossmann J, Boutin R D et al.. Shell osteochondral allografts of the knee: comparison of MR imaging findings and immunologic responses.  Radiology. 2001;  219(1) 35-43
    PubMedGoogle Scholar
  • 110 Carmont M R, Carey-Smith R, Saithna A, Dhillon M, Thompson P, Spalding T. Delayed incorporation of a TruFit plug: perseverance is recommended.  Arthroscopy. 2009;  25(7) 810-814
    CrossrefPubMedGoogle Scholar
  • 111 Williams R J, Gamradt S C. Articular cartilage repair using a resorbable matrix scaffold.  Instr Course Lect. 2008;  57 563-571
    PubMedGoogle Scholar
  • 112 Streitparth F, Schöttle P, Schlichting K et al.. Osteochondral defect repair after implantation of biodegradable scaffolds: indirect magnetic resonance arthrography and histopathologic correlation.  Acta Radiol. 2009;  50(7) 765-774
    CrossrefPubMedGoogle Scholar
  • 113 Welsch G H, Mamisch T C, Zak L et al.. Evaluation of cartilage repair tissue after matrix-associated autologous chondrocyte transplantation using a hyaluronic-based or a collagen-based scaffold with morphological MOCART scoring and biochemical T2 mapping: preliminary results.  Am J Sports Med. 2010;  38(5) 934-942
    CrossrefPubMedGoogle Scholar

Richard J. HughesM.A. M.R.C.P. F.R.C.R. 

Department of Radiology, Stoke Mandeville Hospital, Mandeville Road

Aylesbury HP21 8AL, UK

Email: Richard.Hughes@buckshosp.nhs.uk