MR imaging for surgical planning and postoperative assessment in early osteoarthritis

Chondral lesions in young active patients are a common problem encountered by orthopedic surgeons. Owing to the lack of vascularity, isolated chondral lesions do not heal spontaneously and may lead to osteoarthritis, creating a difficult treatment conundrum. Arthroscopic lavage and debridement provide temporary symptomatic relief without addressing the underlying pathology. Marrow stimulation techniques fill the defects with fibrocartilage that is believed to be biomechanically inferior. Osteoarticular autografts are useful for small lesions but are technically demanding. ACI can provide durable hyaline cartilage even in salvage reconstruction scenarios; however, complications such as periosteal overgrowth, arthrofibrosis, and failure of graft incorporation may occur and require reoperation. Arthroplasty remains the ultimate salvage for the arthritic joint, but biomechanical limitations preclude its use in young athletic adults. MR imaging has a crucial role in the diagnosis and treatment planning of chondral lesions and continues to remain valuable in followup of cartilage reconstructions longitudinally. MR imaging shows promise in reducing the need for more costly and invasive diagnostic arthroscopy.