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Articular Cartilage Defects: In Vitro Evaluation of Accuracy and Interobserver Reliability for Detection and Grading with US¹

¹ From the Departments of Radiology (D.G.D., E.R., D.A.M.), Orthopaedic Surgery (D.G.D., J.S.W.), and Biomedical Engineering (J.S.W.), Medical College of Virginia of Virginia Commonwealth University, Main Hospital, 3rd Floor, 401 N 12th St, Richmond, VA 23298-0615, and the Department of Radiology, Yale University School of Medicine (T.R.M.). From the 1999 RSNA scientific assembly. Received July 20, 1999; revision requested August 17; revision received September 2; accepted September 16. Supported in part by ATL Ultrasound, Bothell, Washington. Address correspondence to D.G.D.

View larger version (44K): [in a new window]   Figure 1a. Transverse US images of porcine articular surfaces. (a) Normal articular cartilage appears as a smoothly contoured structure of uniform thickness with a hyperechoic superficial interface (solid arrows) and strongly hyperechoic subchondral bone (open arrows) with posterior acoustic shadowing. (b) Articular cartilage surface abrasion (grade 1 defect) appears as a loss of the hyperechoic superficial margin of articular cartilage (arrows) with reverberation artifacts (arrowheads). The overall thickness remains normal. (c) Partial-thickness articular cartilage defect (grade 2 defect) is shown as diminished thickness of cartilage (arrow) relative to the thickness of adjacent normal cartilage, with remnant echogenicity similar to that of normal cartilage at the base of the defect. (d) Full-thickness articular cartilage defect (grade 3 defect) appears as a complete loss of cartilage-like echogenicity but with a normal contour of the subchondral bone plate (arrow). (e) Osteochondral defect (grade 4 defect) appears as a complete loss of the cartilage substance and a contour defect of subchondral bone, with loss of uniformity (arrow) of the strongly hyperechoic subchondral bone interface.

View larger version (47K): [in a new window]   Figure 1b. Transverse US images of porcine articular surfaces. (a) Normal articular cartilage appears as a smoothly contoured structure of uniform thickness with a hyperechoic superficial interface (solid arrows) and strongly hyperechoic subchondral bone (open arrows) with posterior acoustic shadowing. (b) Articular cartilage surface abrasion (grade 1 defect) appears as a loss of the hyperechoic superficial margin of articular cartilage (arrows) with reverberation artifacts (arrowheads). The overall thickness remains normal. (c) Partial-thickness articular cartilage defect (grade 2 defect) is shown as diminished thickness of cartilage (arrow) relative to the thickness of adjacent normal cartilage, with remnant echogenicity similar to that of normal cartilage at the base of the defect. (d) Full-thickness articular cartilage defect (grade 3 defect) appears as a complete loss of cartilage-like echogenicity but with a normal contour of the subchondral bone plate (arrow). (e) Osteochondral defect (grade 4 defect) appears as a complete loss of the cartilage substance and a contour defect of subchondral bone, with loss of uniformity (arrow) of the strongly hyperechoic subchondral bone interface.

View larger version (49K): [in a new window]   Figure 1c. Transverse US images of porcine articular surfaces. (a) Normal articular cartilage appears as a smoothly contoured structure of uniform thickness with a hyperechoic superficial interface (solid arrows) and strongly hyperechoic subchondral bone (open arrows) with posterior acoustic shadowing. (b) Articular cartilage surface abrasion (grade 1 defect) appears as a loss of the hyperechoic superficial margin of articular cartilage (arrows) with reverberation artifacts (arrowheads). The overall thickness remains normal. (c) Partial-thickness articular cartilage defect (grade 2 defect) is shown as diminished thickness of cartilage (arrow) relative to the thickness of adjacent normal cartilage, with remnant echogenicity similar to that of normal cartilage at the base of the defect. (d) Full-thickness articular cartilage defect (grade 3 defect) appears as a complete loss of cartilage-like echogenicity but with a normal contour of the subchondral bone plate (arrow). (e) Osteochondral defect (grade 4 defect) appears as a complete loss of the cartilage substance and a contour defect of subchondral bone, with loss of uniformity (arrow) of the strongly hyperechoic subchondral bone interface.

View larger version (51K): [in a new window]   Figure 1d. Transverse US images of porcine articular surfaces. (a) Normal articular cartilage appears as a smoothly contoured structure of uniform thickness with a hyperechoic superficial interface (solid arrows) and strongly hyperechoic subchondral bone (open arrows) with posterior acoustic shadowing. (b) Articular cartilage surface abrasion (grade 1 defect) appears as a loss of the hyperechoic superficial margin of articular cartilage (arrows) with reverberation artifacts (arrowheads). The overall thickness remains normal. (c) Partial-thickness articular cartilage defect (grade 2 defect) is shown as diminished thickness of cartilage (arrow) relative to the thickness of adjacent normal cartilage, with remnant echogenicity similar to that of normal cartilage at the base of the defect. (d) Full-thickness articular cartilage defect (grade 3 defect) appears as a complete loss of cartilage-like echogenicity but with a normal contour of the subchondral bone plate (arrow). (e) Osteochondral defect (grade 4 defect) appears as a complete loss of the cartilage substance and a contour defect of subchondral bone, with loss of uniformity (arrow) of the strongly hyperechoic subchondral bone interface.

View larger version (42K): [in a new window]   Figure 1e. Transverse US images of porcine articular surfaces. (a) Normal articular cartilage appears as a smoothly contoured structure of uniform thickness with a hyperechoic superficial interface (solid arrows) and strongly hyperechoic subchondral bone (open arrows) with posterior acoustic shadowing. (b) Articular cartilage surface abrasion (grade 1 defect) appears as a loss of the hyperechoic superficial margin of articular cartilage (arrows) with reverberation artifacts (arrowheads). The overall thickness remains normal. (c) Partial-thickness articular cartilage defect (grade 2 defect) is shown as diminished thickness of cartilage (arrow) relative to the thickness of adjacent normal cartilage, with remnant echogenicity similar to that of normal cartilage at the base of the defect. (d) Full-thickness articular cartilage defect (grade 3 defect) appears as a complete loss of cartilage-like echogenicity but with a normal contour of the subchondral bone plate (arrow). (e) Osteochondral defect (grade 4 defect) appears as a complete loss of the cartilage substance and a contour defect of subchondral bone, with loss of uniformity (arrow) of the strongly hyperechoic subchondral bone interface.

View larger version (46K): [in a new window]   Figure 2a. Transverse US images of a human knee articular surface with severe osteoarthritis. (a) Weight-bearing denuded surface (grade 3 defect) demonstrates strongly hyperechoic bone interface with an overlying area of complete cartilage loss (solid arrows) and smooth transition (open arrow) to an area of remnant cartilage (arrowheads). Cartilage echogenicity is uniform. (b) Focal partial-thickness defect (grade 2 defect) shows incomplete loss of cartilage echogenicity at the site of the defect (arrows).

View larger version (52K): [in a new window]   Figure 2b. Transverse US images of a human knee articular surface with severe osteoarthritis. (a) Weight-bearing denuded surface (grade 3 defect) demonstrates strongly hyperechoic bone interface with an overlying area of complete cartilage loss (solid arrows) and smooth transition (open arrow) to an area of remnant cartilage (arrowheads). Cartilage echogenicity is uniform. (b) Focal partial-thickness defect (grade 2 defect) shows incomplete loss of cartilage echogenicity at the site of the defect (arrows).