Department of Radiology, MC H066, Pennsylvania State University Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
he knee and ankle are the most frequently injured sites in athletes, either through direct trauma or repetitive microtrauma associated with training.
Osteochondral and chondral injuries are particularly prevalent in this population, particularly in younger, skeletally immature athletes [1,2]. Increased awareness of osteochondral injuries of the knee and ankle, combined with advanced imaging techniques, has increased the diagnostic frequency of these lesions . Although radiography continues to be the first-line imaging modality in evaluation of the injured athlete, it is insensitive to cartilage injury [4,5]. MRI has become a standard diagnostic tool in evaluation of articular injuries [6,7], because it is the only noninvasive imaging technique that provides direct assessment of articular cartilage and associated subchondral marrow pathology.
Despite the frequent use of MRI in evaluation of the knee and ankle, there is a continuing need for improved MRI diagnosis of chondral injury. Compared with evaluation of meniscal or ligamentous injury, the accuracy and sensitivity of MRI for cartilage injury is substantially lower and quite variable, depending on technique and experience [8-10]. Over recent years, advances in MRI hardware and acquisition techniques have improved the ability to visualize and quantitatively monitor morphologic changes in small cartilage lesions. In addition, there has been development of physiological MRI techniques that are sensitive to changes in cartilage composition and organization of the extracellular matrix that precede loss of tissue [11,12]. These techniques have the potential to provide novel information on the natural history of early cartilage injury, in vivo cartilage biomechanics, and longitudinal evaluation of cartilage repair [13,14]. This article focuses on imaging diagnosis of acute and chronic osteochondral injury using current clinical MRI techniques: beginning with a discussion of technical considerations, reviewing the MRI appearance of normal and injured osteochondral tissue, and concluding with a review of patterns of osteochondral injuries in the knee and ankle.
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