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DOI: 10.1148/rg.271065064
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Postoperative Evaluation of the Knee after Autologous Chondrocyte Implantation: What Radiologists Need to Know1

Yvonne Yiwan Ho, MB, BS, FRANZCR, Anthony Joseph Stanley, MB, BCh, FRCR, James Hoi-Po Hui, MB, BS, FRCS (Edin) and Shih-Chang Wang, MB, BS, FRANZCR

1 From the Department of Diagnostic Imaging, National University Hospital of Singapore, 5 Lower Kent Ridge Rd, Singapore 119074. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received April 17, 2006; revision requested May 11 and received May 30; accepted May 31. All authors have no financial relationships to disclose.

Figure 1
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  		Figure 1.  Histologic zones of cartilage. A = superficial zone (consists of collagen fibers parallel to the articular surface, with flattened chondrocytes; provides resistance to shearing forces), B = intermediate zone (consists of collagen fibers oriented obliquely to the articular surface, with spherical chondrocytes; provides resistance to shearing and compressive forces), C = deep zone (consists of collagen fibers and chondrocytes in perpendicular orientation to the articular surface; resists compressive forces), D = calcified layer (consists of degenerated chondrocytes and osteoblasts, is penetrated by blood vessels from the diaphysis; joins cartilage to underlying bone). Sub. = subchondral.

 

Figure 2
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  		Figure 2a.  Intraoperative photographs of an autologous chondrocyte implant in a patellar ulcer. (a) Photograph obtained before implantation shows a large central patellar ulcer (arrow) highlighted with gentian violet. (b) Photograph obtained after implantation shows a chondrocyte-filled periosteal pouch that has been attached with microsutures to the patella (arrow).

 

Figure 2
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  		Figure 2b.  Intraoperative photographs of an autologous chondrocyte implant in a patellar ulcer. (a) Photograph obtained before implantation shows a large central patellar ulcer (arrow) highlighted with gentian violet. (b) Photograph obtained after implantation shows a chondrocyte-filled periosteal pouch that has been attached with microsutures to the patella (arrow).

 

Figure 3
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  		Figure 3.  Schematics of autologous chondrocyte implantation in a flexed knee viewed from a cranial perspective. A shows the articular aspect of the femoral condyle, a common site of cartilage ulceration. In the first stage of the procedure, the ulcer (red oval) is debrided arthroscopically. B provides a close-up of the ulcerated femoral condyle (FC) and the site of harvesting of healthy chondrocytes (lavender oval) in the non-weight-bearing surface of the joint (eg, intertrochanteric notch of the femur [F]). C and D represent the in vitro culture of harvested chondrocytes. E shows the second stage of the procedure, in which autologous periosteum (white oval) is harvested from the proximal tibia (T), a non-weight-bearing location that is commonly used as a harvest site. In F, the harvested periosteum is fashioned into a patch and sutured to the edges of the debrided ulcer. In G and H, cultured chondrocytes are injected beneath the periosteal patch. In I, the periosteal patch is securely fastened and sealed with fibrin glue.

 

Figure 4
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  		Figure 4a.  (a) Coronal short inversion time inversion recovery (repetition time msec/echo time msec/inversion time msec, 5300/25/170) image obtained after autologous chondrocyte implantation in a 39-year-old man shows signal intensity characteristic of edema in the marrow adjacent to the site of cartilage repair at the right femoral condyle (arrow). F = femur, T = tibia. (b) Arthroscopic image obtained after implantation shows a healed ulcer with fibrillation at the graft site ({blacksquare}) but does not depict the change in marrow signal intensity found at MR imaging.

 

Figure 4
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  		Figure 4b.  (a) Coronal short inversion time inversion recovery (repetition time msec/echo time msec/inversion time msec, 5300/25/170) image obtained after autologous chondrocyte implantation in a 39-year-old man shows signal intensity characteristic of edema in the marrow adjacent to the site of cartilage repair at the right femoral condyle (arrow). F = femur, T = tibia. (b) Arthroscopic image obtained after implantation shows a healed ulcer with fibrillation at the graft site ({blacksquare}) but does not depict the change in marrow signal intensity found at MR imaging.

 

Figure 5
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  		Figure 5.  Sagittal MR arthrogram obtained with a spoiled GRE sequence (repetition time msec/echo time msec, 6.1/1.6; flip angle, 15°) in a 36-year-old man 11 months after autologous chondrocyte implantation shows focal underfilling of a cartilage defect (arrow) at the central aspect of the right patella. F = femur, T = tibia.

 

Figure 6
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  		Figure 6a.  Coronal (a) and sagittal (b) spoiled GRE (6.1/1.6; flip angle, 15°) MR arthrograms obtained in an 18-year-old man 44 months after autologous chondrocyte implantation show heterogeneous hypertrophic repair tissue at the articular portion of the right medial femoral condyle (arrow). F = femur, T = tibia.

 

Figure 6
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  		Figure 6b.  Coronal (a) and sagittal (b) spoiled GRE (6.1/1.6; flip angle, 15°) MR arthrograms obtained in an 18-year-old man 44 months after autologous chondrocyte implantation show heterogeneous hypertrophic repair tissue at the articular portion of the right medial femoral condyle (arrow). F = femur, T = tibia.

 

Figure 7
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  		Figure 7.  Sagittal spoiled GRE (6.1/1.6; flip angle, 15°) MR arthrogram, obtained in a 30-year-old man 10 months after a right patellar autologous chondrocyte implantation, shows displaced delamination with folding of a retropatellar cartilage flap (arrow) in the superior direction and resultant denudation of the inferior articular surface. F = femur, P = patella, T = tibia.

 

Figure 8
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  		Figure 8.  Variations in signal intensity of repair tissue on GRE (8.8/4.2; flip angle, 60°) images obtained in three patients after autologous chondrocyte implantation at the right femoral trochlea. Axial image obtained in a 21-year-old man 17 months after implantation shows isointense signal with minimal irregularity at the cartilage reconstruction site (arrow).

 

Figure 9
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  		Figure 9.  Variations in signal intensity of repair tissue on GRE (8.8/4.2; flip angle, 60°) images obtained in three patients after autologous chondrocyte implantation at the right femoral trochlea. Sagittal image obtained in a 39-year-old man 12 months after implantation shows hypointense signal with perfect depth of cartilage filling at the repair site (arrow).

 

Figure 10
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  		Figure 10.  Variations in signal intensity of repair tissue on GRE (8.8/4.2; flip angle, 60°) images obtained in three patients after autologous chondrocyte implantation at the right femoral trochlea. Sagittal image obtained in a 40-year-old man 11 months after implantation shows hyperintense signal with perfect depth of cartilage filling at the repair site (arrow). F = femur, P = patella, T = tibia.

 

Figure 11
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  		Figure 11a.  Coronal (a) and sagittal (b) spoiled GRE (6.1/1.6; flip angle, 15°) MR arthrograms obtained in a 51-year-old man 8 months after autologous chondrocyte implantation show near-perfect incorporation of cartilage at the right medial femoral condyle, with only a tiny cartilage fissure (arrow). F = femur, T = tibia.

 

Figure 11
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  		Figure 11b.  Coronal (a) and sagittal (b) spoiled GRE (6.1/1.6; flip angle, 15°) MR arthrograms obtained in a 51-year-old man 8 months after autologous chondrocyte implantation show near-perfect incorporation of cartilage at the right medial femoral condyle, with only a tiny cartilage fissure (arrow). F = femur, T = tibia.

 

Figure 12
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  		Figure 12a.  (a) Arthroscopic image obtained before autologous chondrocyte implantation in a 40-year-old man shows an ulcer of the right femoral trochlea. (b) Axial spoiled GRE (6.1/1.6; flip angle, 15°) image obtained 11 months after implantation shows near-perfect incorporation of cartilage at the recipient site, with a minor irregularity of the cartilage at the central part of the trochlea (arrow). F = femur, P = patella.

 

Figure 12
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  		Figure 12b.  (a) Arthroscopic image obtained before autologous chondrocyte implantation in a 40-year-old man shows an ulcer of the right femoral trochlea. (b) Axial spoiled GRE (6.1/1.6; flip angle, 15°) image obtained 11 months after implantation shows near-perfect incorporation of cartilage at the recipient site, with a minor irregularity of the cartilage at the central part of the trochlea (arrow). F = femur, P = patella.

 

Figure 13
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  		Figure 13a.  Coronal (a) and sagittal (b) spoiled GRE (6.1/1.6; flip angle, 15°) MR arthrograms obtained in a 59-year-old woman 1 month after autologous chondrocyte implantation show a small cyst (arrow) and adjacent partial delamination (arrowhead) in the interface between native and transplanted cartilage at the left lateral femoral condyle. F = femur, T = tibia.

 

Figure 13
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  		Figure 13b.  Coronal (a) and sagittal (b) spoiled GRE (6.1/1.6; flip angle, 15°) MR arthrograms obtained in a 59-year-old woman 1 month after autologous chondrocyte implantation show a small cyst (arrow) and adjacent partial delamination (arrowhead) in the interface between native and transplanted cartilage at the left lateral femoral condyle. F = femur, T = tibia.

 

Figure 14
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  		Figure 14.  Sagittal GRE (8.8/4.2; flip angle, 60°) image, obtained in a 58-year-old man 18 months after autologous chondrocyte implantation and surgical elevation of the tibial tubercle, shows low-signal-intensity material (arrow) suggestive of intraarticular adhesions in the infrapatellar fat pad. F = femur, P = patella, T = tibia.

 

Figure 15
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  		Figure 15a.  (a) Axial spoiled GRE (6.1/1.6; flip angle, 15°) MR arthrogram obtained in a 40-year-old man 8 months after autologous chondrocyte implantation shows a focal cartilage defect (arrow) at the medial patellar facet of the left knee. (b) Axial GRE (8.8/4.2; flip angle, 60°) MR image obtained without the use of intraarticular contrast material does not show the defect (arrow). F = femur, P = patella.

 

Figure 15
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  		Figure 15b.  (a) Axial spoiled GRE (6.1/1.6; flip angle, 15°) MR arthrogram obtained in a 40-year-old man 8 months after autologous chondrocyte implantation shows a focal cartilage defect (arrow) at the medial patellar facet of the left knee. (b) Axial GRE (8.8/4.2; flip angle, 60°) MR image obtained without the use of intraarticular contrast material does not show the defect (arrow). F = femur, P = patella.

 

Figure 16
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  		Figure 16a.  (a) Axial GRE (8.8/4.2; flip angle, 60°) MR image obtained in a 21-year-old man 17 months after autologous chondrocyte implantation shows near-perfect graft incorporation at the right patella (arrow). (b) Postoperative arthroscopic image obtained 1 month later shows minimal fibrillation of cartilage at the patella (arrows). Because minor fibrillation is not always visible on MR images, the findings at arthroscopy generally were considered to correlate well with those at MR imaging. F = femur, P = patella.

 

Figure 16
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  		Figure 16b.  (a) Axial GRE (8.8/4.2; flip angle, 60°) MR image obtained in a 21-year-old man 17 months after autologous chondrocyte implantation shows near-perfect graft incorporation at the right patella (arrow). (b) Postoperative arthroscopic image obtained 1 month later shows minimal fibrillation of cartilage at the patella (arrows). Because minor fibrillation is not always visible on MR images, the findings at arthroscopy generally were considered to correlate well with those at MR imaging. F = femur, P = patella.

 




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