Mapping tibiofemoral gonarthrosis: an MRI analysis of non-traumatic knee cartilage defects

Abstract

Objective: Arthroscopy is "the gold standard" for the diagnosis of knee cartilage lesions. However, it is invasive and expensive, and displays all the potential complications of an open surgical procedure. Ultra-high-field MRI now offers good opportunities for the indirect assessment of the integrity and structural changes of joint cartilage of the knee. The goal of the present study is to determine the site of early cartilaginous lesions in adults with non-traumatic knee pain. Methods: 3-T MRI examinations of 200 asymptomatic knees with standard and three-dimensional doubleecho steady-state (3D-DESS) cartilage-specific sequences were prospectively studied for early degenerative lesions of the tibiofemoral joint. Lesions were classified and mapped using the modified Outerbridge and modified International Cartilage Repair Society classifications.Results: A total of 1437 lesions were detected: 56.1% grade I, 33.5% grade II, 7.2% grade III and 3.3% grade IV. Cartographically, grade I lesions were most common in the anteromedial tibial areas; grade II lesions in the anteromedial L5 femoral areas; and grade III in the centromedial M2 femoral areas. Conclusion: 3-T MRI with standard and 3D-DESS cartilagespecific sequences demonstrated that areas predisposed to early osteoarthritis are the central, lateral and ventromedial tibial plateau, as well as the central and medial femoral condyle. Advances in knowledge: In contrast with previous studies reporting early cartilaginous lesions in the medial tibial compartment and/or in the medial femoral condyle, this study demonstrates that, regardless of grade, lesions preferentially occur at the L5 and M4 tibial and L5 and L2 femoral areas of the knee joint.

Reliable landmarks for precise topographical analyses of pathological structural changes of the ovine tibial plateau in 2-D and 3-D subspaces

“…Comparable regions were established on the human tibial plateau, for example by dividing it into meniscus covered and not-covered regions 33 , or in concentric zones (border and centre rings) 34 . Other studies divided the plateau into three 34 or nine regions 35 , 36 , 4 quadrants 31 , 11 areas in the largest possible elliptical region of interest (ROI) 37 or into 16 quadrants each (4 rows, 4 columns) 38 . Wirth and Eckstein provided a valuable MRI-based algorithm for the clinically increasingly important regional analysis of femorotibial cartilage thickness based on a central cylinder and 4 additional regions in radial arrangement 30 .…”

Osteoarthritis in the Knee Joints of Göttingen Minipigs after Resection of the Anterior Cruciate Ligament? Missing Correlation of MRI, Gene and Protein Expression with Histological Scoring

“…There is general agreement that cartilage damage evaluation with standard MRI examination remains problematic. However, recently cartilage specific MRI sequences were developed with different degrees in specificity and sensitivity [114,115]. Furthermore, there are significant differences in the detection of OA depending on the severity of the disease.…”

Improving visualization of the articular cartilage of the knee with magnetic resonance imaging under axial traction: a comparative study of different traction weights

“…At the medial tibiofemoral joint, the width of the joint space increased and the visualization of the outline of the articular cartilage improved by applying traction. Although the incidence of cartilage lesions has been reported to be almost as common in asymptomatic knees as in the medial and lateral tibiofemoral joints [5], several studies have reported that cartilage lesions occurred preferentially in the medial joint and/or medial femoral condyle in osteoarthritic knees or knees following anterior cruciate ligament reconstruction [22][23][24]. Therefore, MRI examination with traction would be useful in clinical practice.…”

“…The sensitivity and specificity of MRI are reportedly > 85% for advanced-grade articular cartilage lesions; however, MRI sensitivities are < 30% for early-grade lesions [2][3][4]. Usually, articular cartilage lesions of the knee occur at the articular surface that is not in contact with the meniscus [5]. It is important to depict the outline of the articular cartilage lesion for accurate evaluation.…”