Download PDF
J Knee Surg 2011; 24(4): 225-240
DOI: 10.1055/s-0031-1286193
SPECIAL FOCUS SECTION

© Thieme Medical Publishers

Magnetic Resonance Imaging of Cartilage Repair Techniques

Catherine Hayter1 , Hollis Potter2
  • 1Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
  • 2Department of Magnetic Resonance Imaging, Hospital for Special Surgery, New York, New York
Further Information

Publication History

Publication Date:
04 October 2011 (online)

    Permissions and Reprints

ABSTRACT

Magnetic resonance (MR) imaging offers a noninvasive method to assess cartilage repair, allowing objective evaluation of the repair tissue and insight into the natural history of cartilage repair procedures. MR imaging allows assessment of the percent fill, signal morphology of the repair tissue, subchondral bone and three-dimensional geometry of the joint. The information gained from MR imaging therefore plays a valuable role in patient follow-up after cartilage repair. This article discusses the MR imaging techniques available for the assessment of articular cartilage, including quantitative imaging techniques that allow assessment of cartilage biochemistry. The MR imaging appearance and assessment of microfracture, autologous chondrocyte implantation, and osteochondral autograft and allograft transplantation is reviewed.

KEYWORDS

Magnetic resonance imaging - cartilage repair - knee - articular cartilage

REFERENCES

  • 1 Mainil-Varlet P, Aigner T, Brittberg M International Cartilage Repair Society et al. Histological assessment of cartilage repair: a report by the Histology Endpoint Committee of the International Cartilage Repair Society (ICRS).  J Bone Joint Surg Am. 2003;  85-A (Suppl 2) 45-57
    PubMedGoogle Scholar
  • 2 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) 214-223
    PubMedGoogle Scholar
  • 3 Buckwalter J A, Hunziker E, Rosenberg J. Articular cartilage and knee joint function. In: Whit E J, ed. Articular Cartilage: Composition, Structure, Response to Injury and Methods of Facilitation of Repair. New York: Raven Press; 1990: 19-56
    Google Scholar
  • 4 Rosenberg L, Hellmann W, Kleinschmidt A K. Electron microscopic studies of proteoglycan aggregates from bovine articular cartilage.  J Biol Chem. 1975;  250 (5) 1877-1883
    PubMedGoogle Scholar
  • 5 Buckwalter J A, Mankin H J. Articular cartilage: tissue design and chondrocyte-matrix interactions.  Instr Course Lect. 1998;  47 477-486
    PubMedGoogle Scholar
  • 6 Black B R, Chong R, Potter H G. Cartilage imaging in sports medicine.  Sports Med Arthrosc. 2009;  17 (1) 68-80
    CrossrefPubMedGoogle Scholar
  • 7 Shindle M K, Foo L F, Kelly B T et al.. Magnetic resonance imaging of cartilage in the athlete: current techniques and spectrum of disease.  J Bone Joint Surg Am. 2006;  88 (Suppl 4) 27-46
    PubMedGoogle Scholar
  • 8 Eckstein F, Schnier M, Haubner M et al.. Accuracy of cartilage volume and thickness measurements with magnetic resonance imaging.  Clin Orthop Relat Res. 1998;  (352) 137-148
    PubMedGoogle Scholar
  • 9 Eckstein F, Hudelmaier M, Wirth W et al.. Double echo steady state magnetic resonance imaging of knee articular cartilage at 3 Tesla: a pilot study for the Osteoarthritis Initiative.  Ann Rheum Dis. 2006;  65 (4) 433-441
    CrossrefPubMedGoogle Scholar
  • 10 Glaser C, Tins B J, Trumm C G, Richardson J B, Reiser M F, McCall I W. Quantitative 3D MR evaluation of autologous chondrocyte implantation in the knee: feasibility and initial results.  Osteoarthritis Cartilage. 2007;  15 (7) 798-807
    CrossrefPubMedGoogle Scholar
  • 11 Potter H G, Foo L F. Magnetic resonance imaging of articular cartilage: trauma, degeneration, and repair.  Am J Sports Med. 2006;  34 (4) 661-677
    CrossrefPubMedGoogle Scholar
  • 12 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
  • 13 Potter H G, Foo L F. Magnetic resonance imaging of joint arthroplasty.  Orthop Clin North Am. 2006;  37 (3) 361-373 vi-vii
    CrossrefPubMedGoogle Scholar
  • 14 Erickson S J, Prost R W, Timins M E. The “magic angle” effect: background physics and clinical relevance.  Radiology. 1993;  188 (1) 23-25
    CrossrefPubMedGoogle Scholar
  • 15 Fullerton G D, Rahal A. Collagen structure: the molecular source of the tendon magic angle effect.  J Magn Reson Imaging. 2007;  25 (2) 345-361
    CrossrefPubMedGoogle Scholar
  • 16 Potter H G, Chong R. Magnetic resonance imaging assessment of chondral lesions and repair.  J Bone Joint Surg Am. 2009;  91 (Suppl 1) 126-131
    CrossrefPubMedGoogle Scholar
  • 17 Glaser C. New techniques for cartilage imaging: T2 relaxation time and diffusion-weighted MR imaging.  Radiol Clin North Am. 2005;  43 (4) 641-653, vii vii.
    CrossrefPubMedGoogle Scholar
  • 18 de Visser S K, Bowden J C, Wentrup-Byrne E et al.. Anisotropy of collagen fibre alignment in bovine cartilage: comparison of polarised light microscopy and spatially resolved diffusion-tensor measurements.  Osteoarthritis Cartilage. 2008;  16 (6) 689-697
    CrossrefPubMedGoogle Scholar
  • 19 Meder R, de Visser S K, Bowden J C, Bostrom T, Pope J M. Diffusion tensor imaging of articular cartilage as a measure of tissue microstructure.  Osteoarthritis Cartilage. 2006;  14 (9) 875-881
    CrossrefPubMedGoogle Scholar
  • 20 Mosher T J, Dardzinski B J. Cartilage MRI T2 relaxation time mapping: overview and applications.  Semin Musculoskelet Radiol. 2004;  8 (4) 355-368
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Mosher T J, Dardzinski B J, Smith M B. Human articular cartilage: influence of aging and early symptomatic degeneration on the spatial variation of T2—preliminary findings at 3 T.  Radiology. 2000;  214 (1) 259-266
    CrossrefPubMedGoogle Scholar
  • 22 David-Vaudey E, Ghosh S, Ries M, Majumdar S. T2 relaxation time measurements in osteoarthritis.  Magn Reson Imaging. 2004;  22 (5) 673-682
    CrossrefPubMedGoogle Scholar
  • 23 Alhadlaq H A, Xia Y, Moody J B, Matyas J R. Detecting structural changes in early experimental osteoarthritis of tibial cartilage by microscopic magnetic resonance imaging and polarised light microscopy.  Ann Rheum Dis. 2004;  63 (6) 709-717
    CrossrefPubMedGoogle Scholar
  • 24 Glaser C, Mendlik T, Dinges J et al.. Global and regional reproducibility of T2 relaxation time measurements in human patellar cartilage.  Magn Reson Med. 2006;  56 (3) 527-534
    CrossrefPubMedGoogle Scholar
  • 25 Raya J G, Dietrich O, Horng A, Weber J, Reiser M F, Glaser C. T2 measurement in articular cartilage: impact of the fitting method on accuracy and precision at low SNR.  Magn Reson Med. 2010;  63 (1) 181-193
    PubMedGoogle Scholar
  • 26 Mosher T J, Zhang Z, Reddy R et al.. Knee articular cartilage damage in osteoarthritis: analysis of MR image biomarker reproducibility in ACRIN-PA 4001 multicenter trial.  Radiology. 2011;  258 (3) 832-842
    CrossrefPubMedGoogle Scholar
  • 27 Lesperance L M, Gray M L, Burstein D. Determination of fixed charge density in cartilage using nuclear magnetic resonance.  J Orthop Res. 1992;  10 (1) 1-13
    CrossrefPubMedGoogle Scholar
  • 28 Shapiro E M, Borthakur A, Gougoutas A, Reddy R. 23Na MRI accurately measures fixed charge density in articular cartilage.  Magn Reson Med. 2002;  47 (2) 284-291
    CrossrefPubMedGoogle Scholar
  • 29 Wheaton A J, Borthakur A, Shapiro E M et al.. Proteoglycan loss in human knee cartilage: quantitation with sodium MR imaging—feasibility study.  Radiology. 2004;  231 (3) 900-905
    CrossrefPubMedGoogle Scholar
  • 30 Borthakur A, Shapiro E M, Akella S V, Gougoutas A, Kneeland J B, Reddy R. Quantifying sodium in the human wrist in vivo by using MR imaging.  Radiology. 2002;  224 (2) 598-602
    CrossrefPubMedGoogle Scholar
  • 31 Bashir A, Gray M L, Burstein D. Gd-DTPA2- as a measure of cartilage degradation.  Magn Reson Med. 1996;  36 (5) 665-673
    CrossrefPubMedGoogle Scholar
  • 32 Wheaton A J, Dodge G R, Borthakur A, Kneeland J B, Schumacher H R, Reddy R. Detection of changes in articular cartilage proteoglycan by T(1rho) magnetic resonance imaging.  J Orthop Res. 2005;  23 (1) 102-108
    CrossrefPubMedGoogle Scholar
  • 33 Li X, Han E T, Ma C B, Link T M, Newitt D C, Majumdar S. In vivo 3T spiral imaging based multi-slice T(1rho) mapping of knee cartilage in osteoarthritis.  Magn Reson Med. 2005;  54 (4) 929-936
    CrossrefPubMedGoogle Scholar
  • 34 Duvvuri U, Reddy R, Patel S D, Kaufman J H, Kneeland J B, Leigh J S. T1rho-relaxation in articular cartilage: effects of enzymatic degradation.  Magn Reson Med. 1997;  38 (6) 863-867
    CrossrefPubMedGoogle Scholar
  • 35 Wheaton A J, Casey F L, Gougoutas A J et al.. Correlation of T1rho with fixed charge density in cartilage.  J Magn Reson Imaging. 2004;  20 (3) 519-525
    CrossrefPubMedGoogle Scholar
  • 36 Regatte R R, Akella S V, Borthakur A, Kneeland J B, Reddy R. Proteoglycan depletion-induced changes in transverse relaxation maps of cartilage: comparison of T2 and T1rho.  Acad Radiol. 2002;  9 (12) 1388-1394
    CrossrefPubMedGoogle Scholar
  • 37 Li X, Benjamin Ma C, Link T M et al.. In vivo T(1rho) and T(2) mapping of articular cartilage in osteoarthritis of the knee using 3 T MRI.  Osteoarthritis Cartilage. 2007;  15 (7) 789-797
    CrossrefPubMedGoogle Scholar
  • 38 Regatte R R, Akella S V, Wheaton A J et al.. 3D-T1rho-relaxation mapping of articular cartilage: in vivo assessment of early degenerative changes in symptomatic osteoarthritic subjects.  Acad Radiol. 2004;  11 (7) 741-749
    PubMedGoogle Scholar
  • 39 Buckwalter J A. Articular cartilage: injuries and potential for healing.  J Orthop Sports Phys Ther. 1998;  28 (4) 192-202
    CrossrefPubMedGoogle Scholar
  • 40 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
  • 41 Trattnig S, Winalski C S, Marlovits S, Jurvelin J S, Welsch G H, Potter H G. Magnetic resonance imaging of cartilage repair: a review.  Cartilage. 2011;  2 (1) 5-26
    CrossrefPubMedGoogle Scholar
  • 42 Steadman J R, Rodkey W G, Rodrigo J J. Microfracture: surgical technique and rehabilitation to treat chondral defects.  Clin Orthop Relat Res. 2001;  (391, Suppl) S362-S369
    PubMedGoogle Scholar
  • 43 Minas T, Nehrer S. Current concepts in the treatment of articular cartilage defects.  Orthopedics. 1997;  20 (6) 525-538
    PubMedGoogle Scholar
  • 44 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
  • 45 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
  • 46 Frisbie D D, Morisset S, Ho C P, Rodkey W G, Steadman J R, McIlwraith C W. Effects of calcified cartilage on healing of chondral defects treated with microfracture in horses.  Am J Sports Med. 2006;  34 (11) 1824-1831
    CrossrefPubMedGoogle Scholar
  • 47 Frisbie D D, Oxford J T, Southwood L et al.. Early events in cartilage repair after subchondral bone microfracture.  Clin Orthop Relat Res. 2003;  (407) 215-227
    PubMedGoogle Scholar
  • 48 Frisbie D D, Trotter G W, Powers B E et al.. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses.  Vet Surg. 1999;  28 (4) 242-255
    CrossrefPubMedGoogle Scholar
  • 49 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
  • 50 Potter H G, Chong R, Sneag D B. Magnetic resonance imaging of cartilage repair.  Sports Med Arthrosc. 2008;  16 (4) 236-245
    CrossrefPubMedGoogle Scholar
  • 51 Domayer S E, Kutscha-Lissberg F, Welsch G et al.. T2 mapping in the knee after microfracture at 3.0 T: correlation of global T2 values and clinical outcome - preliminary results.  Osteoarthritis Cartilage. 2008;  16 (8) 903-908
    CrossrefPubMedGoogle Scholar
  • 52 Welsch G H, Mamisch T C, Domayer S E et al.. Cartilage T2 assessment at 3-T MR imaging: in vivo differentiation of normal hyaline cartilage from reparative tissue after two cartilage repair procedures—initial experience.  Radiology. 2008;  247 (1) 154-161
    CrossrefPubMedGoogle Scholar
  • 53 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
  • 54 Minas T. Autologous chondrocyte implantation for focal chondral defects of the knee.  Clin Orthop Relat Res. 2001;  (391, Suppl) S349-S361
    PubMedGoogle Scholar
  • 55 Marlovits S, Zeller P, Singer P, Resinger C, Vécsei V. Cartilage repair: generations of autologous chondrocyte transplantation.  Eur J Radiol. 2006;  57 (1) 24-31
    CrossrefPubMedGoogle Scholar
  • 56 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
  • 57 Breinan H A, Minas T, Hsu H P, Nehrer S, Sledge C B, Spector M. Effect of cultured autologous chondrocytes on repair of chondral defects in a canine model.  J Bone Joint Surg Am. 1997;  79 (10) 1439-1451
    PubMedGoogle Scholar
  • 58 Minas T, Peterson L. Advanced techniques in autologous chondrocyte transplantation.  Clin Sports Med. 1999;  18 (1) 13-44 v-vi v–vi.
    CrossrefPubMedGoogle Scholar
  • 59 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
  • 60 Moriya T, Wada Y, Watanabe A et al.. Evaluation of reparative cartilage after autologous chondrocyte implantation for osteochondritis dissecans: histology, biochemistry, and MR imaging.  J Orthop Sci. 2007;  12 (3) 265-273
    CrossrefPubMedGoogle Scholar
  • 61 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
  • 62 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
  • 63 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
  • 64 Trattnig S, Mamisch T C, Welsch G H et al.. Quantitative T2 mapping of matrix-associated autologous chondrocyte transplantation at 3 Tesla: an in vivo cross-sectional study.  Invest Radiol. 2007;  42 (6) 442-448
    CrossrefPubMedGoogle Scholar
  • 65 Gillis A, Bashir A, McKeon B, Scheller A, Gray M L, Burstein D. Magnetic resonance imaging of relative glycosaminoglycan distribution in patients with autologous chondrocyte transplants.  Invest Radiol. 2001;  36 (12) 743-748
    CrossrefPubMedGoogle Scholar
  • 66 Glenn Jr R E, McCarty E C, Potter H G, Juliao S F, Gordon J D, Spindler K P. Comparison of fresh osteochondral autografts and allografts: a canine model.  Am J Sports Med. 2006;  34 (7) 1084-1093
    CrossrefPubMedGoogle Scholar
  • 67 Matsusue Y, Yamamuro T, Hama H. Arthroscopic multiple osteochondral transplantation to the chondral defect in the knee associated with anterior cruciate ligament disruption.  Arthroscopy. 1993;  9 (3) 318-321
    CrossrefPubMedGoogle Scholar
  • 68 Bobić V. Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study.  Knee Surg Sports Traumatol Arthrosc. 1996;  3 (4) 262-264
    CrossrefPubMedGoogle Scholar
  • 69 Nho S J, Foo L F, Green D M et al.. Magnetic resonance imaging and clinical evaluation of patellar resurfacing with press-fit osteochondral autograft plugs.  Am J Sports Med. 2008;  36 (6) 1101-1109
    CrossrefPubMedGoogle Scholar
  • 70 Koh J L, Wirsing K, Lautenschlager E, Zhang L O. The effect of graft height mismatch on contact pressure following osteochondral grafting: a biomechanical study.  Am J Sports Med. 2004;  32 (2) 317-320
    CrossrefPubMedGoogle Scholar
  • 71 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
  • 72 Pearce S G, Hurtig M B, Clarnette R, Kalra M, Cowan B, Miniaci A. An investigation of 2 techniques for optimizing joint surface congruency using multiple cylindrical osteochondral autografts.  Arthroscopy. 2001;  17 (1) 50-55
    CrossrefPubMedGoogle Scholar
  • 73 Lane J M, Brighton C T, Ottens H R, Lipton M. Joint resurfacing in the rabbit using an autologous osteochondral graft.  J Bone Joint Surg Am. 1977;  59 (2) 218-222
    PubMedGoogle Scholar
  • 74 Dew T L, Martin R A. Functional, radiographic, and histologic assessment of healing of autogenous osteochondral grafts and full-thickness cartilage defects in the talus of dogs.  Am J Vet Res. 1992;  53 (11) 2141-2152
    PubMedGoogle Scholar
  • 75 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
  • 76 Williams R J, Gamradt S C. Articular cartilage repair using a resorbable matrix scaffold.  Instr Course Lect. 2008;  57 563-571
    PubMedGoogle Scholar
  • 77 Bedi A, Foo L F, Williams III R J, Potter H G. The Cartilage Study Group . The maturation of synthetic scaffolds for osteochondral donor sites of the knee: an MRI and T2 mapping analysis.  Cartilage. 2010;  1 (1) 20-28
    CrossrefPubMedGoogle Scholar
  • 78 Foo L F, Jawetz S T, Williams R J. MRI and quantitative T2 mapping of cartilage repair using synthetic biphasic acellular scaffold. ISMRM annual meeting (paper presentation, abstract 1030). Berlin, Germany; 2007
    Google Scholar
  • 79 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

Hollis PotterM.D. 

Department of Magnetic Resonance Imaging, Hospital for Special Surgery

535 East 70th Street, New York, NY 10021

Email: potterh@hss.edu

      >