CHAPTER 22 Arthroscopic Microfracture and Chondroplasty
Imaging and diagnostic studies
Magnetic resonance imaging may be helpful to obtain a cause of the pain; however, many authors have noted that articular cartilage defects are frequently not clearly identified by the imaging sequences and resolutions that are often used (Keeney CORR 2004). Secondary signs of articular cartilage damage may be identified, such as subchondral bony cysts, bone edema (Figure 22-1), and joint effusions. High-resolution images may demonstrate distinct defects (Figure 22-2), articular cartilage thinning, or heterogeneity of the articular cartilage signal (Figure 22-3). The use of a surface coil with high-resolution, cartilage-sensitive images in the axial, coronal, and sagittal planes may provide a higher spatial resolution that could be helpful for diagnosis. Magnetic resonance arthrography improves the ability to evaluate the articular surface, but current techniques lack reliable sensitivity. In the future, the use of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) may provide additional information about the proteoglycan content of the articular cartilage.