(Fig 5-A.14) Chondral Delamination in Cartilage

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https://youtu.be/YyQWPfrVkxI

 

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📌Chondral Delamination in Cartilage

✅ Definition and Mechanism

• Cartilage delamination separates the articular cartilage at the tidemark from the underlying subchondral bone. 
• This occurs due to the discrepancy in compressive stiffness between the noncalcified cartilage and the much stiffer underlying calcified cartilage and bone. 
• The lateral deformation of the articular cartilage is constrained by the calcified cartilage bed, leading to shear forces at the tidemark, causing delamination. 
• The tidemark delaminates more easily than the deeper junctional region between cartilage and subchondral bone.
• This injury may appear intact at arthroscopy and be seen only as a bulge of the cartilage surface. In contrast to cartilage flaps, where the cartilaginous surface is always violated, delamination injuries may not fit easily into a chondral lesion grading system.

✅  MRI Appearance

• On MRI, chondral delamination typically appears as a thin line of near-fluid signal intensity beneath the deep zone of articular cartilage at the tidemark, separating the noncalcified cartilage from the underlying bone and calcified cartilage. 
• The separation zone may be thin and regular or thick and irregular, and the overlying cartilage surface may or may not be violated.

 

✅ Classification

• If there is superficial cartilage injury, the modified Outerbridge classification usually places delamination injuries as grade 3 (deep ulceration or a chondral flap involving 50% or more of the depth of the articular cartilage without exposure of subchondral bone) or grade 4 (exposed bone). 
• According to Bauer and Jackson's arthroscopic system, delamination injuries are either flap or crater types. 
• The modified ICRS classification categorizes delamination injuries as ICRS grade 3b or 3d lesions, depending on the status of the superficial cartilage.

 

✅ Skeletal Maturity and Delamination

• In skeletally immature individuals, the lack of well-formed tidemark and minimal calcified cartilage results in osteochondral fractures predominating over chondral injuries such as delamination.

 

References

• MRI Web Clinic – June 2021 Tissue Delamination
• AJR 2017; 209:W317–W321

 

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#ChondralDelamination, #CartilageInjury, #Tidemark, #SubchondralBone, #MRI, #SkeletalMaturity, #TraumaticStress, #ArticularCartilage, #ICRSClassification, #Orthopedics