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Shell Osteochondral Allografts of the Knee: Comparison of MR Imaging Findings and Immunologic Responses¹

¹ From the Departments of Radiology (C.B.S., J.B., R.D.B., M.N.P., D.R.), Orthopedics (F.R.C., W.B.), and Immunogenetics (L.K.L.), and the General Clinical Research Center (R.D.), University of California, San Diego. From the 1996 RSNA scientific assembly. Received March 9, 2000; revision requested April 25; revision received June 15; accepted July 21. Supported in part by Johnson and Johnson Professional, Raynham, Mass, and National Institutes of Health grant M01RR00827. Address correspondence to D.R., Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161.

PURPOSE: To define the magnetic resonance (MR) imaging appearance of shell osteochondral allografts of the knee and compare the MR findings with antibody responses.

MATERIALS AND METHODS: Thirty-six grafts were evaluated with a 1.5-T unit with T1-, intermediate-, and T2-weighted, and three-dimensional spoiled gradient-recalled MR imaging at 3, 6, 12, 24, and/or 36 months after surgery. Nineteen patients underwent imaging serially. Two osteoradiologists scored by consensus host marrow edema, thickness of graft-host interface, signal intensity of graft marrow, cyst formation, joint effusion, articular cartilage defects, and surface collapse. Patients were divided into antibody-positive (AP) (n = 11) and antibody-negative (AN) (n = 25) groups evenly distributed across the different time points on the basis of results of anti–human leukocyte antigen antibody screening. MR findings for the two groups were compared.

RESULTS: AP patients demonstrated greater mean edema (P < .002), thicker interface (P < .03), and more abnormal graft marrow (P < .04) than AN patients, and they had a higher proportion of surface collapse (P < .03).

CONCLUSION: Humoral immune responses were associated with more inflammation and less complete incorporation after allograft placement. MR imaging shows promise as a surrogate biomarker for success of shell osteochondral allograft implantation.

Index terms: Antibodies • Bones, grafts, 45.44 • Immunity • Knee, ligaments, menisci, and cartilage, 45.44 • Knee, MR, 45.121411, 45.121415, 45.121419

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