Articular Cartilage Defects Flashcards
What is the cartilage wear pattern a/w chronic ACL tears?
Anterior LFC and posterolateral tibia
Where are most OCD lesions found in the knee?
Posterolateral aspect of MFC (>70%)
What is the classification for articular cartilage defects?
Outerbridge: I- softening II- fissures III- crabmeat IV- exposed subchondral bone
ICRS (International Cartilage Repair Society): 0- normal cartilage I- nearly normal (superficial lesions) II- less than 50% cartilage depth III- >50% cartilage depth IV- exposed subchondral bone
What is the best radiographic view for visualizing early articular cartilage loss?
45 degree standing PA knee
What is a general algorithm for osteochondral defects?
If less than 2-3cm: microfracture or osteochondral autograft transfer
If >3cm: osteochondral allograft transfer or autologous chondrocyte implantation
Or if less than 4cm^2 then microfracture/autograft
If >4cm^2 then Allograft
What is done post-operatively for microfracture?
Protected weight bearing for 6-8 weeks with CPM
How long is a patient NWB after osteochondral autograft transfer (Mosiacplasty)?
3 months; bone plugs are taken from a low contact area (preiphery of trochlea or notch) and transferred to the high contact area with a defect
What is osteochondral allograft implantation?
Use of cadaveric frozen articular cartilage. Plugs are cut out and fit intraoperatively. Risk of disease transmission
What are contraindications to the Fulkerson procedure?
1) skeletal immaturity
2) Superior or medial patellar arthritis
3) MFC arthritis
What is an evolving imaging technique to evaluate cartilage defects?
dGEMRIC (delayed gadolinium-enhanced MRI for cartilage); normal MRI sequences [Fat-suppressed T2, proton density, T2 fast spin-echo (FSE)]
What tissue type does microfracture heal with?
Fibrocartilage (made up of mostly Type I cartilage)
