Chondral Loss Research Articles

Meniscal and chondral loss in the anterior cruciate ligament injured knee.

Rupture of the anterior cruciate ligament (ACL) of the knee is a commonly occurring injury in the athletic population. Associated meniscal and chondral injury is well recognised. This occurs both at the time of index injury and also secondarily over time in the ACL-deficient knee as a result of several related pathways culminating in osteoarthritis. ACL reconstruction is a well established surgical technique for treatment of symptomatic instability in ACL-deficient knees but the role of ACL reconstruction in the prevention of osteoarthritis remains unclear. This article reviews the contemporary literature on the pathophysiology of chondral and meniscal loss in ACL-injured knees and the role of current treatment techniques, including surgical reconstruction of ligamentous, meniscal and chondral pathology, in altering the natural history of the ACL-deficient knee.

MR imaging of meniscal allografts: correlation with clinical and arthroscopic outcomes.

To correlate magnetic resonance (MR) imaging findings after meniscal transplantation with those at clinical, arthroscopic, and histologic examination. Twenty-four patients (29 menisci) underwent MR imaging after meniscal transplantation. Nineteen patients underwent arthroscopy, and the peripheral capsular attachment, degenerative areas, or both were sampled for biopsy. MR findings were correlated with those at clinical, arthroscopic, and histologic examination. MR imaging enabled accurate assessment of allograft attachments. Fragmentation and frank extrusion were associated with full-thickness chondral loss. Allograft degeneration, indicated by an increase in signal intensity, was seen with moderate and severe chondral wear. Clinical results were worse with meniscal extrusion, with complaints of locking. Patients with mild fragmentation reported pain without locking. Histologic examination of excised allografts revealed myxomatous degeneration without immunologic reaction. MR imaging can help assess allograft placement and articular cartilage and enable differentiation of fragmentation from extrusion. Preoperative assessment of articular cartilage is important to identify patients who may be at risk for failure.

Posterolateral arthritis of the knee

Arthritis in the posterolateral quadrant of the knee presents typical arthroscopic findings. With careful history, physical examination, and appropriate radiographs, it can be an office diagnosis. The history, physical findings, and arthroscopic findings in 15 patients with this problem were reviewed. Symptoms of posterolateral pain, give-way, and pain with stairclimbing were common. The only frequent physical findings were those of pain with the lateral meniscal entrapment test or pain with the pivot shift test. No ligamentous instability was noted. Weight-bearing radiographs demonstrated severe lateral chondral loss in flexion, but not in extension. Arthroscopic findings were typical. Previous injury to the posterior portion of the lateral meniscus was common. This seems to be a traumatic rather than a degenerative, process. Three patients had varus-producing osteotomy of the distal femur. This was not effective in relieving their symptoms.