(Fig 5-C.05) MRI Findings of Microfracture Repair

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📌 Marrow-Stimulating Procedures

• Marrow-stimulating procedures, including microfracture, are widely used to treat articular cartilage injuries in the knee. 
• Techniques such as abrasion arthroplasty, subchondral drilling, and microfracture stimulate the growth of new fibrocartilage from marrow-derived stem cells. 
• The process involves creating small holes in the subchondral bone beneath the cartilage defect, leading to bleeding and clot formation, which aids in fibrocartilage repair.

 

📌 Microfracture

• Microfracture is primarily used for small osteochondral defects (< 4 cm²), but its effectiveness decreases with larger lesions.
• Younger patients tend to have better outcomes compared to those older than 40 years. 
• However, larger defects with arthritic changes have less favorable outcomes, and the cartilage tends to deteriorate within a few years. 
• MFx can be enhanced with scaffolds or polymers (e.g., chitosan) to stabilize the clot, and synthetic plugs are available to promote bone marrow cell ingrowth, creating both bone and cartilage layers.

 

✅ Fibrocartilage Tissue

• The fibrocartilage tissue formed in the cartilage defect is less durable than normal hyaline cartilage, leading to faster deterioration and affecting long-term clinical outcomes. 
• T2 mapping can characterize the biochemical composition of cartilage at native and repair sites, distinguishing fibrocartilage from native cartilage and quantifying the similarity of the reparative tissue to hyaline cartilage.

 

✅ Postoperative MRI After Microfracture Surgery

• Postoperative imaging after microfracture surgery should focus on cartilage morphology, fill degree, peripheral integration, and the condition of the native cartilage and subchondral bone. 
• The signal intensity of repair cartilage decreases over time, eventually producing a smooth surface without fissures at the repair-native cartilage interface. 
• In the early postoperative period, the repair tissue appears hyperintense to native cartilage on fluid-sensitive images but becomes less distinguishable from adjacent fluid and appears thin. 
• As the fibrocartilage matures, its signal intensity decreases and aligns smoothly with adjacent hyaline cartilage.

 

✅  Failure of Treatment After Microfracture Surgery

• Poorly filled defects and incomplete peripheral integration after two years are associated with poor functional outcomes. 
• Persistent bone marrow edema and irregular reparative tissue after two years suggest treatment failure.

 

References

1. J Knee Surg. 2021 Jan;34(1):2-10.
2. Clin Imaging. 2019 Nov-Dec;58:129-139.
3. Sci Rep. 2024 Feb 9;14(1):3333.
4. Semin Musculoskelet Radiol. 2022 Jun;26(3):216-229.
5. Semin Musculoskelet Radiol. 2018;22:377–385.
6. Radiology. 2015;277:23–43.

 

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#Microfracture #CartilageRepair #KneeSurgery #MarrowStimulating #Fibrocartilage #T2Mapping #Orthopedics #SportsMedicine #PostoperativeImaging #CartilageHealing