Understanding Magnetic Resonance Imaging of Knee Cartilage Repair: A Focus on Clinical Relevance

The aims of this review article are (a) to describe the principles of morphologic and compositional magnetic resonance imaging (MRI) techniques relevant for the imaging of knee cartilage repair surgery and their application to longitudinal studies and (b) to illustrate the clinical relevance of pre- and postsurgical MRI with correlation to intraoperative images. First, MRI sequences that can be applied for imaging of cartilage repair tissue in the knee are described, focusing on comparison of 2D and 3D fast spin echo and gradient recalled echo sequences. Imaging features of cartilage repair tissue are then discussed, including conventional (morphologic) MRI and compositional MRI techniques. More specifically, imaging techniques for specific cartilage repair surgery techniques as described above, as well as MRI-based semiquantitative scoring systems for the knee cartilage repair tissue—MR Observation of Cartilage Repair Tissue and Cartilage Repair OA Knee Score—are explained. Then, currently available surgical techniques are reviewed, including marrow stimulation, osteochondral autograft, osteochondral allograft, particulate cartilage allograft, autologous chondrocyte implantation, and others. Finally, ongoing research efforts and future direction of cartilage repair tissue imaging are discussed.

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Magnetic Resonance Imaging to Assess Knee Cartilage Repair Tissue After Microfracture of Chondral Defects

The Journal of Knee Surgery ◽

10.1055/s-0030-1248048 ◽

2010 ◽

Vol 20 (03) ◽

pp. 228-234 ◽

Cited By ~ 22

Author(s):

Arun Ramappa ◽

Thomas Gill ◽

Catharine Bradford ◽

Charles Ho ◽

J. Steadman

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cartilage Repair ◽

Resonance Imaging ◽

Knee Cartilage ◽

Repair Tissue ◽

Chondral Defects

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Magnetic Resonance Imaging of Knee Cartilage Repair

Topics in Magnetic Resonance Imaging ◽

10.1097/00002142-199812000-00006 ◽

1998 ◽

Vol 9 (6) ◽

pp. 377???392 ◽

Cited By ~ 26

Author(s):

Garry E. Gold ◽

A. Gahrielle Bergman ◽

John M. Pauly ◽

Philipp Lang ◽

R. Kim Butts ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cartilage Repair ◽

Resonance Imaging ◽

Knee Cartilage

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Correlation Between Magnetic Resonance Imaging and Clinical Outcomes After Knee Cartilage Repair: Letter to the Editor

The American Journal of Sports Medicine ◽

10.1177/0363546513510140 ◽

2013 ◽

Vol 41 (11) ◽

pp. NP48-NP50 ◽

Cited By ~ 7

Author(s):

Tommy S. de Windt ◽

Goetz H. Welsch ◽

Mats Brittberg ◽

Lucienne Vonk ◽

Stefan Marlovits ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Clinical Outcomes ◽

Cartilage Repair ◽

Resonance Imaging ◽

Knee Cartilage ◽

Letter To The Editor

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Chondral and Osteochondral Femoral Cartilage Lesions Treated with GelrinC: Significant Improvement of Radiological Outcome Over Time and Zonal Variation of the Repair Tissue Based on T2 Mapping at 24 Months

Cartilage ◽

10.1177/1947603520926702 ◽

2020 ◽

pp. 194760352092670

Author(s):

Markus M. Schreiner ◽

Marcus Raudner ◽

Pavol Szomolanyi ◽

Kitty Ohel ◽

Livnat Ben-Zur ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cartilage Repair ◽

Osteochondral Lesions ◽

Resonance Imaging ◽

Repair Tissue ◽

Cartilage Lesions ◽

Femoral Cartilage ◽

Magnetic Resonance Imaging Mri

Objective To prospectively assess the efficacy of GelrinC in the treatment of chondral and osteochondral femoral cartilage lesions using morphological (Magnetic Resonance Observation of Cartilage Repair Tissue [MOCART]) and quantitative (T2-mapping) magnetic resonance imaging (MRI). Design This study was designed as a prospective single-arm, open label, multicenter study. Morphological magnetic resonance imaging (MRI) for MOCART assessment and T2 mapping was performed 1 week and 6, 12, 18, and 24 months after GelrinC implantation. Evaluation of T2 mapping was based on the assessment of global T2 indices (T2 of the repair tissue [RT] divided by T2 of healthy reference cartilage) and zonal variation. Results Fifty-six (20 female) patients were prospectively enrolled. The mean MOCART score significantly increased from baseline to the 24-month follow-up with 88.8 (95% CI, 85.8-91.9; P < 0.001) for all lesions combined as well as 86.8 (95% CI, 83.0-90.6) for chondral lesions and 94.1 (95% CI, 68.55-100) for osteochondral lesions. Furthermore, based on T2 mapping, significant zonal variation of the RT was observed at 24 months ( P = 0.039), which did not differ significantly from healthy reference cartilage ( P = 0.6). Conclusion Increasing MOCART scores were observed throughout the follow-up period, indicative of maturation of the cartilage repair. Significant zonal variation of the RT at 24 months might indicate the transformation into hyaline cartilage–like RT. Slightly differing morphological outcome between chondral and osteochondral lesions, but similar global and zonal T2 indices at 24 months, support the potential of GelrinC as a treatment option for both lesion types.

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Magnetic Resonance Imaging Parameters at 1 Year Correlate With Clinical Outcomes Up to 17 Years After Autologous Chondrocyte Implantation

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118788280 ◽

2018 ◽

Vol 6 (8) ◽

pp. 232596711878828 ◽

Cited By ~ 14

Author(s):

Helen S. McCarthy ◽

Iain W. McCall ◽

John M. Williams ◽

Claire Mennan ◽

Marit N. Dugard ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Clinical Outcomes ◽

Cartilage Repair ◽

Hyaline Cartilage ◽

Resonance Imaging ◽

Repair Tissue ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

Background: The ability to predict the long-term success of surgical treatment in orthopaedics is invaluable, particularly in clinical trials. The quality of repair tissue formed 1 year after autologous chondrocyte implantation (ACI) in the knee was analyzed and compared with clinical outcomes over time. Hypothesis: Better quality repair tissue and a better appearance on magnetic resonance imaging (MRI) 1 year after ACI lead to improved longer-term clinical outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Repair tissue quality was assessed using either MRI (11.5 ± 1.4 [n = 91] or 39.2 ± 18.5 [n = 76] months after ACI) or histology (16.3 ± 11.0 months [n = 102] after ACI). MRI scans were scored using the whole-organ magnetic resonance imaging score (WORMS) and the magnetic resonance observation of cartilage repair tissue (MOCART) score, with additional assessments of subchondral bone marrow and cysts. Histology of repair tissue was performed using the Oswestry cartilage score (OsScore) and the International Cartilage Repair Society (ICRS) II score. Clinical outcomes were assessed using the modified Lysholm score preoperatively, at the time of MRI or biopsy, and at a mean 8.4 ± 3.7 years (maximum, 17.8 years) after ACI. Results: At 12 months, the total MOCART score and some of its individual parameters correlated significantly with clinical outcomes. The degree of defect fill, overall signal intensity, and surface of repair tissue at 12 months also significantly correlated with longer-term outcomes. The presence of cysts or effusion (WORMS) significantly correlated with clinical outcomes at 12 months, while the presence of synovial cysts/bursae preoperatively or the absence of loose bodies at 12 months correlated significantly with long-term clinical outcomes. Thirty percent of repair tissue biopsies contained hyaline cartilage, 65% contained fibrocartilage, and 5% contained fibrous tissue. Despite no correlation between the histological scores and clinical outcomes at the time of biopsy, a lack of hyaline cartilage or poor basal integration was associated with increased pain; adhesions visible on MRI also correlated with significantly better histological scores. Conclusion: These results demonstrate that MRI at 12 months can predict longer-term clinical outcomes after ACI. Further investigation regarding the presence of cysts, effusion, and adhesions and their relationship with histological and clinical outcomes may yield new insights into the mechanisms of cartilage repair and potential sources of pain.

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