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Autologous Chondrocyte Implantation in Knee Joint: MR Imaging and Histologic Features at 1-year Follow-up¹

¹ From the Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry SY10 7AG, England. From the 2002 RSNA Scientific Assembly. Received December 8, 2003; revision requested February 16, 2004; revision received April 13; accepted June 2. Address correspondence to B.J.T. (e-mail: bernhard.tins@rjah.nhs.uk).

View larger version (144K): [in a new window]   Figure 1a. MR images in 40-year-old man. (a) Sagittal FLASH (50/11; field of view, 18 cm; flip angle, 30°; spectral fat saturation) and (b) double-echo steady-state (58.6/9; field of view, 18 cm; flip angle, 40°; spectral fat saturation and magnetization transfer) images obtained at 1-year follow-up after ACI. There is a small amount of artifact (short arrow) and mildly decreased signal intensity in the graft (long arrows) compared with the signal intensity of adjacent cartilage. The graft is well integrated and has a thickness that is similar to that of the adjacent cartilage; the graft surface is smooth.

View larger version (149K): [in a new window]   Figure 1b. MR images in 40-year-old man. (a) Sagittal FLASH (50/11; field of view, 18 cm; flip angle, 30°; spectral fat saturation) and (b) double-echo steady-state (58.6/9; field of view, 18 cm; flip angle, 40°; spectral fat saturation and magnetization transfer) images obtained at 1-year follow-up after ACI. There is a small amount of artifact (short arrow) and mildly decreased signal intensity in the graft (long arrows) compared with the signal intensity of adjacent cartilage. The graft is well integrated and has a thickness that is similar to that of the adjacent cartilage; the graft surface is smooth.

View larger version (138K): [in a new window]   Figure 2a. MR images in 43-year-old man. (a) Sagittal FLASH (50/11; field of view, 18 cm; flip angle, 30°; spectral fat saturation) and (b) double-echo steady-state (58.6/9; field of view, 18 cm; flip angle, 40°; spectral fat saturation and magnetization transfer) images obtained at 1-year follow-up after ACI. A full-thickness defect is seen in the graft (long arrow in b), and there is edema-like signal intensity (short arrows near graft in a and b) in the underlying bone marrow and marked narrowing of the opposite tibial cartilage. These features are much better appreciated in b. Osteophytes and severe degeneration of the lateral meniscus, as well as a joint effusion (topmost short arrow in b), are also seen.

View larger version (131K): [in a new window]   Figure 2b. MR images in 43-year-old man. (a) Sagittal FLASH (50/11; field of view, 18 cm; flip angle, 30°; spectral fat saturation) and (b) double-echo steady-state (58.6/9; field of view, 18 cm; flip angle, 40°; spectral fat saturation and magnetization transfer) images obtained at 1-year follow-up after ACI. A full-thickness defect is seen in the graft (long arrow in b), and there is edema-like signal intensity (short arrows near graft in a and b) in the underlying bone marrow and marked narrowing of the opposite tibial cartilage. These features are much better appreciated in b. Osteophytes and severe degeneration of the lateral meniscus, as well as a joint effusion (topmost short arrow in b), are also seen.

View larger version (141K): [in a new window]   Figure 3a. MR images in 33-year-old man. (a) Sagittal FLASH (50/11; field of view, 18 cm; flip angle, 30°; spectral fat saturation) and (b) double-echo steady-state (58.6/9; field of view, 18 cm; flip angle, 40°; spectral fat saturation and magnetization transfer) images obtained at 1-year follow-up after ACI show overgrowth of the graft (long arrows), which is otherwise well integrated. Some artifact is seen. Note the subtle bone marrow edema (short arrows) underneath the graft.

View larger version (143K): [in a new window]   Figure 3b. MR images in 33-year-old man. (a) Sagittal FLASH (50/11; field of view, 18 cm; flip angle, 30°; spectral fat saturation) and (b) double-echo steady-state (58.6/9; field of view, 18 cm; flip angle, 40°; spectral fat saturation and magnetization transfer) images obtained at 1-year follow-up after ACI show overgrowth of the graft (long arrows), which is otherwise well integrated. Some artifact is seen. Note the subtle bone marrow edema (short arrows) underneath the graft.

View larger version (154K): [in a new window]   Figure 4a. MR images in 45-year-old man. (a) Sagittal FLASH (50/11; field of view, 18 cm; flip angle, 30°; spectral fat saturation) and (b) double-echo steady-state (58.6/9; field of view, 18 cm; flip angle, 40°; spectral fat saturation and magnetization transfer) images obtained at 1-year follow-up after ACI show generalized loss of thickness of the graft (long arrows), which has an irregular surface and decreased signal intensity compared with that of normal adjacent cartilage. Edema-like signal intensity (short arrow) is present in bone marrow in the posterior femoral condyle that is unrelated to the graft site. Osteophytes and subchondral cysts are present in the anterior tibia.

View larger version (143K): [in a new window]   Figure 4b. MR images in 45-year-old man. (a) Sagittal FLASH (50/11; field of view, 18 cm; flip angle, 30°; spectral fat saturation) and (b) double-echo steady-state (58.6/9; field of view, 18 cm; flip angle, 40°; spectral fat saturation and magnetization transfer) images obtained at 1-year follow-up after ACI show generalized loss of thickness of the graft (long arrows), which has an irregular surface and decreased signal intensity compared with that of normal adjacent cartilage. Edema-like signal intensity (short arrow) is present in bone marrow in the posterior femoral condyle that is unrelated to the graft site. Osteophytes and subchondral cysts are present in the anterior tibia.

View larger version (19K): [in a new window]   Figure 5. Graph illustrates comparison of ratio of signal intensity of graft to average signal intensity of posterior femoral condyles (as measured on images obtained with 3D FLASH sequence) with histologic appearance of graft (the graph for ACI graft signal intensity versus ipsilateral posterior condylar signal intensity looks virtually identical). There was no statistically relevant correlation (P = .34) between graft histologic appearance and signal intensity. It is not possible to predict graft histologic appearance by measuring signal intensity. fibrocart. = fibrocartilage.