Partial-thickness Cartilage Lesions Research Articles

Reliability of Conventional Hip MRI in Detecting Labral Tear and Labrocartilagenous Lesions in cases of Femoroacetabular Impingement, A Comparative Study with Hip Arthroscopy.

Imaging studies play a crucial role in diagnosing femoroacetabular impingement (FAI), including plain radiography and Magnetic Resonance Imaging (MRI). FAI is a combined pathology of bony abnormality, labral and labrocartilagenous erosions. Surgical treatment for such cases has become more established and preoperative imaging is the roadmap that includes the assessment of labrum and articular cartilage. During a period of 2 years, thirty-seven patients with a clinical diagnosis of FAI were retrospectively enrolled in this study, including 17 men and 20 women, aged 27-62 years. There were 22 right hips and 15 left hips. MRI was done for all patients to identify bony details, labral and chondral abnormalities and to exclude coexisting disorders. The imaging findings were compared with the arthroscopic data. 15 patients had Pincer FAI, 11 patients had CAM, and 11 patients had combined Cam/Pincer FAI. Labral tear was detected in 100 % of patients, 97 % had an anterosuperior labral tear. 82 % of patients had partial thickness cartilage lesions and 8 % had full thickness cartilage lesions. MRI had a sensitivity of 100 % compared to hip arthroscopy in detecting labral tear, 60 % in detecting cartilage erosion. Conventional hip MRI detects bony changes in FAI, type of impingement and associated labral tear and cartilage erosions in comparison to the hip arthroscopy.

Long-term outcome after stifle arthroscopy in 82 Western performance horses (2003-2010).

To report the outcome of horses engaged in Western performance disciplines after stifle arthroscopy and identify prognostic factors for return to performance. Retrospective case series. Eighty-two Western performance horses undergoing stifle arthroscopy. Medical records were reviewed for horses involved in athletic performance/training for various Western performance disciplines and undergoing arthroscopy for lameness localized to the stifle. Follow-up was obtained ≥2 years postoperatively by telephone interviews with the owners. Preoperative and intraoperative findings as well as postoperative treatment were analyzed for their association with return to athletic performance as the primary outcome of interest. The most common disciplines represented were cutting (n = 38), Western pleasure (n = 13), and reining (n = 13). Approximately 40% (32/82) of horses returned to intended use after surgery. Increased age, higher degree of lameness, longer duration of lameness, and the presence of partial-thickness cartilage lesions decreased the odds of returning to athletic performance. Postoperative therapies (intra-articular: stem cells, corticosteroids, interleukin-1 receptor antagonist protein, hyaluronic acid/polysulfated glycosaminoglycans; systemic: nonsteroid anti-inflammatory drugs, hyaluronic acid/polysulfated glycosaminoglycans, oral joint supplements) did not affect the odds of returning to intended use. Less than half of the Western performance horses that underwent stifle arthroscopy returned to intended use. Older age, longer duration of lameness, and presence of partial-thickness cartilage lesions affected the odds of a horse returning to intended use. Postoperative therapies did not affect the outcome in this population. The prognosis of Western performance horses undergoing stifle arthroscopy is as guarded as that previously reported in horses of other disciplines.

Effect of Concomitant Cartilage Lesions on Patient-Reported Outcome After ACL-Reconstruction-A Nationwide Cohort Study from Norway and Sweden of 8470 Patients With 5-Year Follow-Up

Objectives:To evaluate (1) the effect of concomitant partial-thickness (International Cartilage Repair Society [ICRS] grades 1-2) and full-thickness (ICRS grades 3-4) cartilage lesions on patient-reported outcome 5 years after Anterior Cruciate Ligament Reconstruction (ACLR), and (2) the effect of debridement or microfracture (MF) compared with no treatment of concomitant full-thickness cartilage lesions on patient-reported outcome 5 years after ACLR.Methods:All patients that underwent unilateral primary ACLR registered in the Norwegian and Swedish National Knee Ligament Registries from 2005 through 2008 (n = 15,783) were included the study. At the 5-year follow-up, 8470 (54%) patients completed The Knee Injury and Osteoarthritis Outcome Score (KOOS). A subgroup of all patients with concomitant full-thickness cartilage lesions (n = 644), treated with debridement (n = 129), or MF (n = 164), or no surgical treatment (n = 351) at the time of ACLR, was included in the treatment component of the study. At the 5-year follow-up, 368 (57%) patients completed the KOOS. Linear regression models were used to estimate the effect of concomitant focal cartilage lesions on the patient-reported outcome (KOOS) 5 years after ACLR, and to estimate the effect of surgical debridement or MF of concomitant full-thickness cartilage lesions, on patient-reported outcome 5 years after ACLR.Results:Of the 8470 patients available for follow-up at 5 years, 2248 (27%) had 1 or more concomitant cartilage lesions at the time of ACLR, comprised of 1685 (20%) patients with 1 or more partial-thickness cartilage lesions and 563 (7%) patients with 1 or more full-thickness cartilage lesions. Of the 368 patients available for the 5-year follow-up in the treatment component of the study, 203 (55%) patients received no surgical treatment to their full-thickness cartilage lesion at the time of ACLR, 70 (19%) were treated with debridement and 95 (26%) with MF. In the adjusted analyses, partial-thickness cartilage lesions showed significant associations with inferior KOOS scores at follow-up in all subscales. Full-thickness cartilage lesions were significantly associated with inferior KOOS scores in all subscales, both in the unadjusted and the adjusted analyses. With no treatment of the concomitant cartilage lesion as the reference, no significant effects of debridement or MF were detected in the unadjusted or adjusted regression analyses in any of the KOOS subscales at the 5-year follow-up. However, there was a trend in both the unadjusted and adjusted analyses towards negative effects of MF in the KOOS subscales Sport/Rec and QoL with regression coefficient (β) of -5; 95% CI, -12.3-2.2 and -5.7; 95% CI, -12.5-1.1, respectively.Conclusion:ACL-injured patients with concomitant full-thickness cartilage lesions reported worse outcomes and less improvement than those without cartilage lesions 5 years after ACLR. Compared to leaving concomitant full-thickness cartilage lesions untreated at the time of ACLR, debridement and MF showed no effect on patient-reported outcome at 5-year follow-up.

Debridement in Focal Cartilage Damage of the knee. Systematical review of the literature and recommendations of the working group "clinical tissue regeneration" of the German Society of Orthopaedics and Trauma (DGOU)

In clinical practice, there is still no definite treatment algorithm for focal, partial thickness cartilage lesions (grade II - III). It is well-established that debridement (shaving/lavage) of large degenerative cartilage lesions is not recommended, but there is no such recommendation in the case of focal, partial thickness cartilage defects. The scientific rationale of cartilage shaving and joint lavage was investigated and a systematic analysis was performed of the literature on the clinical effect of cartilage debridement. Furthermore, a consensus statement on this issue was developed by the working group on Clinical Tissue Regeneration of the German Society of Orthopaedics and Trauma (DGOU). The therapeutic approach is different for asymptomatic lesions with biomechanical stable residual cartilage tissue and clinically symptomatic defects with unstable fragments. The benefit of a joint lavage or surface smoothening of focal partial thickness has not been proved. Even more importantly, the mechanical or thermal resection of cartilage tissue even induces a zone of necrosis in adjacent cartilage, and thus leads to additional injury. Therefore, large scale smoothening (shaving) of clinically asymptomatic, fibrillated or irregular cartilage defects should not be performed. However, if there are clinical symptoms, resection of unstable and delaminated cartilage fragments may be reasonable, as it can reduce harmful shear tension in residual tissue. This can help to brake the progression of the damage and avoid formation of free bodies. The decision criteria for debridement of partial thickness focal cartilage lesions are multifactorial and include the clinical symptoms, the size and the degree of the defect, the stability of remaining cartilage, localisation of the defect, and individual patient-specific parameters. Debridement is not recommended for asymptomatic lesions, but may be reasonable for symptomatic cases with unstable tissue.

MR imaging of articular cartilage at 1.5T and 3.0T: comparison of IDEAL 2D FSE and 3D SPGR with fat-saturated 2D FSE and 3D SPGR in a porcine model

IDEAL technique is a robust fat-water separation method which is potentially useful in cartilage imaging with significant improvement in the cartilage signal-to-noise ratio (SNR). To identify whether iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) improved diagnostic performance for IDEAL 2D fast spin echo (FSE) and 3D spoiled gradient-recalled echo (SPGR) versus fat-saturated (FS) protocols at 1.5 and 3.0 T in the evaluation of patella-femoral cartilage lesions. Forty-six artificial cartilage lesions were created in femoro-patellar articular cartilages of 11 porcine knees. All knees underwent MR examination at 1.5 and 3.0 T with MR protocol consisting of sagittal FS 2D FSE and 3D SPGR and IDEAL 2D FSE and IDEAL 3D SPGR, respectively. Qualitative assessment was performed to compare the diagnostic performance between 1.5- and 3.0-T protocols and between IDEAL and FS protocols. IDEAL 3D SPGR had a significantly higher accuracy for detecting partial thickness cartilage lesions (P < 0.01) than FS SPGR protocols, whereas there was no significant difference in diagnostic performance between IDEAL and FS 2D FSE except for one cartilage lesion. For all imaging sequences, no significant difference was observed in the diagnostic performance between 1.5- and 3.0-T imaging protocols (P = 0.42-0.91). Compared with conventional FS SPGR imaging, IDEAL 3D SPGR provided a better diagnostic performance for evaluation of porcine knee articular cartilage lesions in the knee joints at 1.5 and 3.0 T. IDEAL 3D SPGR may therefore be useful for detecting partial-thickness cartilage lesions in patients with degenerative osteoarthritis.

Effect of Meniscal and Focal Cartilage Lesions on Patient-Reported Outcome After Anterior Cruciate Ligament Reconstruction

Background: The effect of concomitant intra-articular injury on patient-reported outcome after anterior cruciate ligament (ACL) reconstruction is debated. Purpose: To evaluate the effect of meniscal and articular cartilage lesions on patient-reported outcome 2 years after ACL reconstruction. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: The study included all patients with primary, unilateral ACL reconstruction registered in the Norwegian and the Swedish National Knee Ligament Registry from 2005 through 2008 who had completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) Knee-Related Quality of Life subscale at a 2-year follow-up (mean ± SD, 2.1 ± 0.2 years) after surgery (n = 8476). Multiple linear regression analyses were used to evaluate the associations between each KOOS subscale (Pain, Other Symptoms, Activities of Daily Living, Sport and Recreation Function, Knee-Related Quality of Life) as the measure for patient-reported outcome and meniscal and cartilage lesions. Results: A total of 3674 (43%) patients had meniscal lesion(s), 1671 (20%) had partial-thickness (International Cartilage Repair Society [ICRS] grades 1-2) cartilage lesion(s), and 551 (7%) had full-thickness (ICRS grades 3-4) cartilage lesion(s). Multiple linear regression analyses detected no significant associations between meniscal lesions or partial-thickness cartilage lesions and the scores in any of the KOOS subscales at the 2-year follow-up. Full-thickness cartilage lesions were significantly associated with decreased scores in all of the KOOS subscales. Conclusion: Patients with concomitant full-thickness cartilage lesions reported worse outcome in all of the KOOS subscales compared with patients without cartilage lesions 2 years after ACL reconstruction. Meniscal lesions and partial-thickness cartilage lesions did not impair patient-reported outcome 2 years after ACL reconstruction.

Capitellar Cartilage Injuries Concomitant With Radial Head Fractures

To evaluate the incidence and types of capitellar cartilage injuries associated with higher-grade radial head fractures. Fifty-one consecutive patients with operatively treated, unstable, displaced Mason type II to III radial head fractures were identified. Ten of 51 patients had capitellar cartilage injuries concomitant with these fractures. All cartilage injuries were identified at the time of surgery except in 1 patient whose injury was determined via computed tomography. There were 8 men and 2 women with an average age of 33 years (range, 24-39 years). Lesions were seen with direct inspection and recorded by location, size, and thickness. The incidence of capitellar chondral lesions concomitant with operatively treated Mason type II to III radial head fractures appeared in 10 of 51 patients. The average size was 5 x 5 mm (range, 2 x 2 mm to 10 x 10 mm). Four patients had Mason type II and 6 had Mason type III radial head fractures. The average surface of the cartilage injury was 6 x 7 mm (range, 3 x 6 mm to 10 x 10 mm) for Mason type II fractures and 4 x 4 mm (range, 2 x 2 mm to 5 x 10 mm) for Mason type III fractures. Two Mason type III fractures had full-thickness cartilage lesions, and 4 Mason type III fractures had partial-thickness cartilage lesions. Two Mason type II fractures had full-thickness cartilage lesions and the other 2 had partial-thickness cartilage lesions. Capitellar cartilage lesions frequently occurred concomitantly with higher-grade radial head fractures. The incidence of these lesions increased with greater severity of radial head fractures. Low-grade radial head fractures created higher-grade cartilage lesions as the intact radial head can cause more damage to the capitellum. Careful evaluation of the joint should be performed for these subtle injuries. Prognostic IV.

Development of Partial-thickness Articular Cartilage Injury in a Rabbit Model

In humans, partial-thickness cartilage lesions frequently result in premature osteoarthritis. While rabbits often are used as a model for partial-thickness cartilage lesions, the natural course of cartilage surrounding such a lesion is largely unknown. We developed a rabbit model of a chronic partial-thickness cartilage defect and asked whether these defects led to (1) deterioration of surrounding cartilage macroscopically and microscopically (increased Mankin score) and (2) disturbances in proteoglycan metabolism. In 55 rabbits, we created a 4-mm-diameter partial-thickness cartilage defect on one medial femoral condyle. The surrounding cartilage was characterized during the course of 26 weeks. Contralateral knees were sham-operated. In experimental knees, we found cartilage softening and fibrillation at 13 and 26 weeks. High Mankin scores observed at 1 week were partially restored at 13 weeks but worsened later and were most pronounced at 26 weeks. Mankin scores in the experimental groups were worse at 1 and 26 weeks when compared with the sham groups. Mankin scores at 26 weeks improved compared with 1 week in the sham groups. Disturbances in proteoglycan metabolism were less evident. In this rabbit model, a partial-thickness cartilage lesion resulted in early markers of degenerative changes resembling the human situation.

Arthroscopic Evaluation of Radiofrequency Chondroplasty of the Knee

Background Considerable debate exists over the use of radiofrequency-based chondroplasty to treat partial-thickness chondral defects of the knee. This study used second-look arthroscopy to evaluate cartilage defects previously treated with bipolar radiofrequency—based chondroplasty. Hypothesis Partial-thickness articular cartilage lesions treated with bipolar radiofrequency—based chondroplasty will show no progressive deterioration. Study Design Case series; Level of evidence, 4. Methods One hundred ninety-three consecutive patients underwent bipolar radiofrequency—based chondroplasty over 38 months; 15 (25 defects treated with bipolar radiofrequency—based chondroplasty) underwent repeat arthroscopy for recurrent or new injuries. Time from the initial to repeat arthroscopy ranged from 0.7 to 32.7 months. At both procedures, the location, size, grade, and stability of lesions were evaluated, recorded, and photographed arthroscopically. Results At the initial procedure, 25 lesions treated using bipolar radiofrequency—based chondroplasty ranged from 9 to 625 mm2 (mean, 170.2 ± 131.2 mm2; median, 120 mm2); at second look, lesion size was 9 to 300 mm2 (mean, 107.7 ± 106.7 mm2; median, 100 mm2). At second look, 3 (12%) demonstrated unstable borders with damage in the surrounding cartilage that appeared to be progressive. Eight (32%) lesions were unchanged in size. Eight (32%) demonstrated partial filling with stable repair tissue, and 6 (24%) demonstrated complete filling with stable repair tissue. Lesions in the tibiofemoral compartments showed better response to radiofrequency chondroplasty than did those within the patellofemoral joint (P < .05). Conclusion Only 3 of 25 lesions demonstrated progression. More than 50% showed partial or complete filling of the defect. Bipolar radiofrequency chondroplasty is an effective way to treat partial-thickness cartilage lesions; however, long-term effects of this treatment on cartilage remain unknown.

Partial-Thickness Articular Cartilage Defects: Evaluation and Treatment

Existing scientific publications regarding evaluation and treatment of partial-thickness articular cartilage defects report conflicting results. Magnetic resonance imaging is an excellent diagnostic evaluation tool. In the community setting, however, using magnetic resonance imaging to evaluate partial-thickness cartilage defects may have variable or low sensitivity and specificity. Today, diagnostic arthroscopy with visual inspection and probing of the entire articular surface may be the gold standard for diagnostic evaluation of partial-thickness cartilage lesions. However, before surgery, nonsurgical treatment is recommended based on the presumptive diagnosis. Mechanical debridement and lavage using a suction oscillating shaver (chondroplasty) is the accepted surgical treatment of choice. However, reported outcomes of mechanical chondroplasty are not so good as might be expected, and basic and clinical research suggests that thermal chondroplasty using radiofrequency energy may prove superior in the future. In addition, basic research suggests that treatments using growth factors may, in the future, expand management options.

Transgene-activated mesenchymal cells for articular cartilage repair: a comparison of primary bone marrow-, perichondrium/periosteum- and fat-derived cells

Adult primary mesenchymal cells of different origin which can be obtained with minor donor site morbidity are considered for articular cartilage repair. This study aims at a comparison of their chondrogenic potential. Mesenchymal cells were isolated from perichondrium/periosteum, bone marrow or fat of adult rats and found to be positive for the stem-cell-related antigens Sca-1, c-Kit, CD10, CD13 and CD90 by reverse transcription polymerase chain reaction (RT-PCR). Chondrogenic differentiation was induced by applying recombinant bone morphogenetic protein-2 (BMP-2) or adenoviral vectors carrying BMP-2 cDNA, followed by micromass culture. The stimulated cells were characterized by RT-PCR, cell proliferation and apoptosis assays. Expression of aggrecan, collagen type I, II, IX and X and alkaline phosphatase genes was analyzed by RT-PCR, immunofluorescence and immunohistochemistry in comparison with unstimulated control cells. Adenovirally stimulated cells were transplanted into mechanically generated partial-thickness cartilage lesions in the patellar groove of the rat femur. Quality and integration of the repair tissues were assessed by histochemical and immunohistochemical methods. Stimulation with BMP-2 or AdBMP-2 led to an up-regulation of cartilage-specific gene expression in all three cell populations studied, most rapidly and prominently in the perichondrial/periosteal cells, which showed a 3200-fold increase of type II collagen mRNA and reached the highest absolute levels of type II and IX collagen transcripts after stimulation. Similar results were obtained for the bone marrow stromal cells (BMSC), while the respective transcript levels in fat stromal cells declined after an initial more than 30-fold elevation. Following transplantation in vivo, AdBMP-2-infected perichondrial/periosteal cells produced a proteoglycan-rich, type II collagen-positive matrix with only faint staining for type I collagen. The repair tissue originating from AdBMP-2-infected BMSC showed less intense type II collagen staining, but a relatively proteoglycan-rich matrix, weakly positive for type I collagen. Transgene-activated fat stromal cells formed rather fibrous tissue mainly composed of type I collagen. Unstimulated cells of the three different populations gave only rise to fibrous tissue. Perichondrium/periosteum-derived cells and BMSC seem superior to cells isolated from fat with respect to forming hyaline cartilaginous tissue. A chondrogenic stimulus, e.g. by transfer of BMP-2 cDNA, appears to be required for initiation and support of chondrogenic differentiation.

Articular cartilage repair by gene therapy using growth factor-producing mesenchymal cells.

To investigate the repair of partial-thickness lesions in rat articular cartilage by combining cell transplantation with transfer of growth factor complementary DNA (cDNA). Mesenchymal cells isolated from rib perichondrium were infected ex vivo with adenoviral vectors carrying bone morphogenetic protein 2 (BMP-2) or insulin-like growth factor 1 (IGF-1) cDNA. The cells were suspended in fibrin glue and applied to mechanically induced partial-thickness cartilage lesions in the patellar groove of the rat femur. The filling of the defects was quantified and the quality and integration of the newly formed tissue were assessed by histochemical and immunohistochemical methods. Uninfected cells or cells infected with a LacZ reporter gene vector served as controls. Transplanted cells were able to attach to the wounded articular cartilage and were not displaced from the lesions by joint movement. Cells infected with both adenoviral vectors AdBMP-2 and AdIGF-1 produced repair cartilage of hyaline morphology containing a type II collagen-positive but type I collagen-negative proteoglycan-rich matrix that restored the articular surface in most lesions. Uninfected cells either failed to fill up the defects or formed fibrous tissue mainly composed of type I collagen. Excessive cells were partially dislocated to the joint margins, leading to osteophyte formation there if AdBMP-2-infected cells were used. These adverse effects, however, were not seen with AdIGF-1-infected cells. Stimulation of perichondrium-derived mesenchymal cells by transfer of growth factor cDNA in a partial-thickness defect model allows for satisfactory cartilage restoration by a repair tissue comparable with hyaline articular cartilage.

Visualization by magnetic resonance imaging of focal cartilage lesions in the excised mini-pig knee.

This study showed that magnetic resonance imaging can be used to visualize partial thickness cartilage lesions, 0.7 x 10 mm in area and 0.5 mm in depth, surgically induced in the femur (femoropatellar compartment) of a mini-pig knee joint. Formalin-fixed joints, intact as well as disarticulated, were studied by high resolution imaging using a 2.35 T, 31 cm horizontal-bore superconducting magnet. The two-dimensional and three-dimensional spatial resolutions achievable were as follows: 0.12 x 0.23 mm (two-dimensional) and 0.35 x 0.35 x 0.35 mm (three-dimensional) for the intact joint, and 0.08 x 0.08 mm (two-dimensional) and 0.14 x 0.14 x 0.27 mm (three-dimensional) for the disarticulated joint. These results demonstrate that magnetic resonance imaging, together with edge detection and volume rendering, can be used to visualize focal cartilage lesions.

Biochemical changes in articular cartilage opposing full- and partial-thickness cartilage lesions in horses

SUMMARY Using arthroscopic technique, identical diameter defects were created in the proximal articular surface of both intermediate carpal bones of 6 horses. One of each pair of defects was deepened to penetrate the subchondral plate. Removed cartilage was assayed for [35S] sulfate incorporation, total hexosamine content, and dna content. Six weeks later, cartilage was harvested and similarly analyzed from the distolateral portion of the radius directly opposite the created lesions and the distomedial portion of the radius distant from the lesion. The repair tissue filling the full-thickness defect and the cartilage at the periphery of the partial-thickness lesion also were analyzed. There was a marked increase in synthetic activity (35S sulfate incorporation) opposite the full-thickness defect, compared with the cartilage opposite the partial-thickness defect. A marked decrease in glycosaminoglycan content in the cartilage opposite the full-thickness defect was found as compared with that opposite the partialthickness defect. The repair tissue filling the full-thickness defect was highly cellular, high in synthetic activity, but low in glycosaminoglycan content. Insignificant changes occurred in the cartilage adjacent to the partialthickness defect. On the basis of these results, we suggest that full-thickness defects at 6 weeks result in more detrimental change to the cartilage opposite it than do partial-thickness lesions of the same diameter.