Grade IV Lesions

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Full thickness lesions with exposure of the underlying subchondral bone are classified as Grade IV lesions. The margin of the lesion can suggest the mechanism of cartilage injury. Sharply marginated borders are characteristic of traumatic cartilage injuries, whereas shallow or irregular margins are features more characteristic of chronic degeneration. Abnormal signal from the underlying bone marrow and central osteophytes are frequently associated with Grade

Grading Stress Fracture

Fig. 6. Flap tear: 40-year-old male runner with 3-month history of persistent knee pain and intermittent locking. Coronal fat-suppressed, PD-weighted FSE image demonstrates a partial-thickness flap tear of the medial femoral condyle (arrow). A linear zone of T2 hypointensity present in the deep margin of the flap tear can be seen in the setting of chronic cartilage injury.

Fig. 6. Flap tear: 40-year-old male runner with 3-month history of persistent knee pain and intermittent locking. Coronal fat-suppressed, PD-weighted FSE image demonstrates a partial-thickness flap tear of the medial femoral condyle (arrow). A linear zone of T2 hypointensity present in the deep margin of the flap tear can be seen in the setting of chronic cartilage injury.

IV lesions. MRI has demonstrated high specificity and sensitivity for detection of Grade IV defects.

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