report cartilage 1

Cartilage injury - mild OAMild osteoarthritis with mild 20-25% irregular diffusecartilage thinning, particularly over the lateral patellarfacet and median patellar ridge... Cartilage inj

Practical Reporting of Musculoskeletal Imaging

Studies: MRI Knee

James F Griffith

We’re not going to talk about

 Didactic discussion on specific abnormalities

 Get a history

 Don’t rely on request form

 Ask radiographers to request history

clinical question

Grade ……….

Don’t mention any feature without grading it

Qualitative measure :

Minimal, mild, moderate, severe

Quantitative measure: Small, medium, large (mm long x mm deep x mm wide)

This talk : outline

If slightly more than this: “Slight increase inknee joint fluid”

Small Effusion

If see more than this: “small”, “medium-sized”

or “large” joint effusion

Medium-sized effusion

Synovial proliferation

Mild “reactive-type” synovial proliferation

Synovial proliferation

Moderate or severe synovitis : think of inflammatorysynovitis or low grade infection

medial patellar facet

medial trochear ridge

Descriptive subregions

femoral trochlea posterior

central weightbearing

ant mid- post

medial tibial condyle lateral tibial

condyle

Normal articular cartilage

Cartilage injury - fibrillation

Cartilage injury - mild OA

Mild osteoarthritis with mild (20-25%) irregular diffusecartilage thinning, particularly over the lateral patellarfacet and median patellar ridge

Cartilage injury - moderate OA

Moderate osteoarthritis with moderate (35-60%)

irregular cartilage thinning, most pronounced over thelateral patellar facet and median patellar ridge

Cartilage injury - severe OA

Severe (80- >95%) cartilage thinning, mainly affectingthe median patellar ridge and lateral patellar facet

Severe patellofemoral OA

“ severe patellofemoral osteoarthritis with severe (>95%) thinning of articular cartilage mainly at the lateral patellar facet”

Cartilage injury - Mild OA

“ Mild (10-25% ) cartilage thinning is present on theweightbearing areas of the medial femorotibial

compartment”

Cartilage injury - Moderate OA

“ Moderate (30-55% ) cartilage thinning is present onthe weightbearing areas of the medial femorotibial

compartment”

Cartilage injury - Severe OA

“ Severe (> 90% ) cartilage thinning is present on theweightbearing areas of the medial femorotibial

compartment”

Focal cartilage injury - location

Focal cartilage defect (mild)

Focal cartilage defect (moderate)

Focal cartilage defect (severe)

Focal cartilage defect

There is a localized (mm wide x mm long)…

…partial thickness (%)…

…near full-thickness (80-90%)

…full-thickness chondral defect on the…

Subchondral bone marrow oedema

Minimal, mild, moderate, severe

“ Localised” or “diffuse ”

Subacute chondral defect

Focal cartilage defect

“This seems like an acute injury with fluid filling thedefect”

“This defect seems partially healed with the defectpartially filled by reparative fibrocartilage”

“This lesion seems to have largely healed with

reparative fibrocartilage completely filling the chondraldefect “

Healing of chondral defects

Not healed Partially healed Largely

healed

Largely healed chondral defect

“localised (mm x mm) area of chondral thinning on the

more lateral aspect of the lateral patellar facet The cartilage is thinned by 30% This cartilage defect is partially healed and

filled mainly with fibrocartilage Mild subchondral bone marrow oedema is present”

Chronic osteochondral injury

“mild localised bone “quite severe ill-defined bone

marrow oedema” marrow oedema reflecting disease

activity”

‘Delamination’

“localised (mm x mm) area of chondral injury with delamination, moderate chondral swelling and mild subchondral bone marrow oedema”

Chondromalacia

“localised (mm x mm) area of chondral injury with chondral oedema and swelling consistent with moderate-severity

chondromalacia No focal chondral defect present”

Cartilage fracture

“full thickness cartilage fracture extending over a mm length.

No osteochondral separation or cartilage defect ”

Chondral separation

 Tear

 Anchorage

Meniscal degeneration

 Flattening

 Deformation

 Extrusion

Meniscal Flattening

Normal Mild

Moderate

Severe

Meniscal deformation

Normal Minimal Mild

Moderate Severe

No undue meniscal extrusion

Meniscal extrusion

Sample

Post root

Post root tear

“ There is a complete tear of posterior root of themedial meniscus This is retracted by mm from itsinsertional area (There is a mm wide x mm long area

of micro-cystic change deep to the insertional area)”

Post root tear

Meniscal tears

 Horizontal

 Longitudinal / bucket handle

 Radial

Meniscal tears

 Location : body , anterior horn, posterior horn

 Inner, mid-, peripheral one-third

 Horizontal tear - parameniscal cyst

whether attached at ant or posterior ends

ACL tear complete

Oedematous mass Discontinuity Mal-alignment

ACL tear complete

Mal-alignment with Mal-alignment with Complete attrition re-attachment attenuation

Tibiofemoral translation

>5mm

Associated with clinical instability

Tibiofemoral translation

Anterior tibial translation >5mm

Associated injuries

*

*

Bone bruising

 Anterocentral aspects femoral condyles

 Posterior aspects tibial condyles

*

*

Associated injuries

Peripheral meniscal tear Corner tear at posteromedial

medial meniscus

Corner meniscal tears at PM corner

ACL tear

PartialAnteromedial or posterolateral bundle

% tear of each bundle

Overall % torn

Different scenarios

1 Unequivocal ACL tear → stop

2 Probable complete tear

3 Possible partial tear

Knee flexion

n Complete ACL tear

Knee flexion

n Complete ACL tear

Knee flexion

n High grade partial ACL tear

Different scenarios

1 Unequivocal ACL tear → stop

2 Probable complete tear → flexion

3 Possible partial tear

Suspected ACL tear

Partial tear ACL oblique axial view

Low grade partial tear, PL > AM

Partial ACL tear oblique axial view

Partial AM with complete PL tear

Mucoid degeneration & ganglion cyst

Mucoid degen n Mucoid degen n Ganglion cyst

 Preservation of linear striations

 ‘Celery stick sign’

How do you know it is mucoid

degeneration?

 Typical appearances

 Intraosseous ganglion cysts or fluid leakage

 PCL also shows mucoid degeneration

PCL tear complete

Discontinuity Diffuse oedema Diffuse oedema

& discontinuity & discontinuity

 Swelling & discontinuity main signs of complete PCL tear

PCL partial tear

 Swelling without discontinuity → partial PCL tear

PCL tear vs ‘double PCL’ sign

Longitudinal split Double PCL sign

 Some partial tears may manifest as longitudinal split

 Don’t confuse with ‘double PCL’ sign

PCL tear & PL corner injury

G

LCL SMR

AL PFL

FFL

PT

PCL tear & LCL tear

Popliteofibular ligament

Popliteus tendon partial tear

Arcuate ligament injury

Posterolateral corner capsular injury

PCL has propensity for healing

 In healed PCL tears, the ligament may elongate

 Remains clinically lax

Thank you