The researches find that the arthroscopy to stage a lesion in the chondral area of the knee is more accurate than MRI, according to researchers from the Rothman Institute, La Jolla, Calif. The findings were presented today at the American Orthopedic Society of Sports Medicine Annual Meeting. Chondral injuries of the knee are a common source of pain in athletes but one of the main methods of diagnosing and staging these injuries, MRI; has a specificity of 73% and sensitivity of 42%.
Knee is more accurate than MRI
Using arthroscopy to stage the degree of the injury is a more accurate way to evaluate the knee prior to surgery. The knee joint joins the thigh with the leg and consists of two articulations: one between the femur and tibia; and one between the femur and patella. It is the largest and most complicated joint in the human body. The knee is a mobile trocho-ginglymus (i.e. a pivotal hinge joint); which permits flexion and extension as well as a slight medial and lateral rotation.
Since in humans the knee supports nearly the entire weight of the body; it is the joint most vulnerable both to acute injury and the development of osteoarthritis. The doctors reviewed 98 patients who had autologous chondrocyte implantation; osteochondral allograft transplantation and meniscus allograft transplantation. “Based on our review; a change in treatment plan is make in 47% of cases in which staging arthroscopy is use to evaluate articular cartilage surfaces;” said lead researcher Dr. Hytham S. Salem of Rothman Institute.
Development of osteoarthritis
Arthroscopy is performed after a standard sterile skin preparation ;and involves injecting local anesthetic subcutaneously at the portal sites and within the knee joint. It is often performed in office while patients are awake and alert. “The results of our study indicate that staging arthroscopy is an important step in determining the most appropriate treatment plan for chondral defects prior to OCA, ACI and MAT;” Salem said.
“Addressing all knee’s pathology can be important for the success of cartilage restoration surgery; and treatment plans may change based on the extent and location of cartilage damage. “Transient lateral patellar dislocation is a common injury that typically occurs in the young; athletic individual. The typical MRI findings after transient lateral dislocation of the patella have been well describe and include a bone contusion pattern involving the inferomedial pole of the patella and the anterolateral aspect of the non articular portion of the lateral femoral condyle.
The typical MRI findings
Early reports of MRI findings after transient dislocation of the patella described chondral defects of the patella but made no mention of chondral injuries of the lateral femoral condyle. More recently; there has been brief mention in both the radiology and orthopedic literature of osteochondral injuries involving not only the patellar articular surface but also the articular surface of the lateral femoral condyle.