(Fig 5-C.03) Illustrations of Cartilage Repair Failure

https://youtu.be/Tneyd6uYCqs

https://youtu.be/4EJKsB5eXFQ

 

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📌 Cartilage Repair Failure

1️⃣ Incomplete Filling

• Failure may be demonstrated as a full-thickness defect or graft absence. 
• The three main complications seen on MRI following ACI are graft hypertrophy, graft failure, and arthrofibrosis. 
• Degeneration and fraying with delamination may also be seen and can require revision/repair.

 

2️⃣ Delamination

• Poorly filled defects and incomplete peripheral integration can lead to delamination. 
• Delamination can be identified by displacement of all or a portion of the graft from the repair site or linear high signal intensity between the repair tissue and underlying bone. 
• Subjacent edemalike marrow signal intensity is usually present when delamination has occurred.

 

3️⃣ Persistent Marrow Edema Change

• Persistent bone marrow edema after 2 years suggests failure of treatment. 
• Persistent significant edema-like marrow signal intensity within subchondral bone beyond 18 months, increase in edemalike signal, articular surface collapse, and subchondral cyst formation are concerning and may be signs of poor tissue integration.

 

4️⃣ Interface Between Repair Tissue and Native Cartilage

• A smooth appearance without gap formation indicates successful integration of native and transplant tissue, whereas the presence of fissures suggests that integration of the repair tissue at its periphery is incomplete.

 

5️⃣ Graft Hypertrophy

• Hypertrophy of the graft occurs when the repair cartilage exceeds the space afforded by the native defect, leading to protrusion from the chondral surface. More than 150% graft hypertrophy typically requires surgical debridement, whereas lower amounts of graft hypertrophy can be monitored.

 

References

• Semin Musculoskelet Radiol 2011;15:69–88
• Radiology 2015; 277:23–43
• J Clin Orthop Trauma. 2021 Sep 25;22:101610
• J Knee Surg. 2021 Jan;34(1):2-10

 

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#CartilageRepairFailure, #IncompleteFilling, #GraftFailure, #Delamination, #MarrowEdema, #TissueIntegration, #GraftHypertrophy, #MRIComplications, #OrthopedicRadiology, #ChondralRepair