0:00

Well, let's look first at delamination using cellular rose

0:04

as our point of reference.

0:07

I show it schematically on a histologic slide on your left

0:12

and I show the uh, here with a specimen.

0:15

Top right. And Mr.

0:17

Here we have an obliquely oriented horizontal like

0:22

abnormality extending into the mid region

0:25

of the articular cartilage parallel to some

0:29

of the cellular rows.

0:30

So this would be delamination if you were using

0:34

cellular rows as your point of reference.

0:38

Let's look now at the collagen.

0:40

If we have a pattern of delamination like this

0:45

horizontal in orientation parallel to the collagen

0:48

and the laminate Splendas,

0:50

it would look like a lot like failure

0:53

of the shingles of a roof.

0:56

Here is what it looks like in cartilage using this

0:59

particular picture.

1:00

Here is what it looks like histologically.

1:03

So this pattern of delamination does use collagen

1:10

and the result is cartilage fi.

1:14

Fibrillation would be the proper term to describe it.

1:20

Let's look at another example here.

1:22

The pattern of delamination is mainly vertical along the

1:26

arcades of benninghoff shown here with surface disruption

1:31

of the articular cartilage

1:32

and a horizontal vector again at the tide mark

1:37

between the noncalcified and calcified cartilage.

1:41

So here is what that would look like.

1:43

You can see here the region of surface disruption.

1:47

You can see the failure involving the deep portion

1:50

of the articular cartilage.

1:52

This is delamination

1:55

and as you look at the vertical orientation,

1:58

this represents in large part cartilage fissuring.

2:03

So now we've addressed this fissuring and fibrillation.

2:09

Here is an example of deamination involving that deep region

2:14

in the area of the tide mark concealed without any evidence

2:19

surface disruption.

2:21

There is a little bit of surface disruption right here.

2:24

The good arthroscopist can go in and probe this area

2:28

and sense that there is a hidden carpet like lesion

2:34

near the subcon bone plate.

2:38

A number of years ago, one

2:39

of our fellows said it's a little bit like failure

2:42

of a grapefruit, and he showed me and gave me these slides.

2:46

I mean, here we see failure at the surface,

2:49

simulating fissuring and fibrillation,

2:52

and here he is, peeled away the pulp.

2:54

And you can see this looks like failure at the tide mark.

2:58

Alright, as we showed in some of our examples.