0:00

Now let's look first at some classic patterns

0:03

of cartilage failure related to compression

0:06

or shearer forces,

0:08

or both type of forces apply to the surface.

0:11

There are certain terms that we use

0:13

and I wanna just define them at this particular point.

0:18

Chondral fibrillation.

0:20

If you go to the English dictionary

0:22

and look up the word fibrillation, it's a process

0:24

of forming fine fibers or fis.

0:28

So as I show you the surface

0:30

of this articular cartilage at the bottom,

0:33

minimal irregularity as shown here, this is

0:38

chondral fibrillation.

0:41

The second word is chondral fissuring.

0:44

If you go to the English dictionary

0:46

and look up the word fissuring, it means a split

0:50

or crack that is long and generally narrow.

0:53

So here I show you examples of cartilage fissuring, some

0:58

of them quite extensive,

1:00

running from the surface to the deep portion.

1:03

I show you another example with an MR on your left

1:08

and a specimen on the right to show you

1:11

chondral fissuring involving the articular cartilage

1:15

of the patella.

1:17

And my favorite point

1:18

of fissuring in the knee is this one often seen

1:22

as a black line.

1:24

One of our fellows called this,

1:26

the dreaded black line of death.

1:28

This represents fissuring cartilage fissuring in the

1:33

central troia.

1:34

And you can be certain about

1:36

that if the black line reaches the surface

1:39

of the articular cartilage.

1:42

In general, it will be visible arthroscopically,

1:46

the word chondro lac.

1:49

If you go to a medical dictionary

1:50

and you look up the word lac,

1:52

that's the definition you're going to see abnormal softening

1:57

of tissue, osteomalacia, laryngomalacia,

2:01

and chondromalacia.

2:03

So it represents subtle abnormalities

2:05

that were originally described involving the patella

2:08

cartilage, often seen as altered signal intensity,

2:12

as in the case I'm showing you,

2:14

beginning often in the mid zone

2:17

and then extending toward the surface.

2:20

I know orthopedic surgeons sometimes use this particular

2:23

term, chondro lac, for all kinds

2:27

of extensive cartilage loss,

2:29

but I don't know if they're really good articles

2:31

that have in fact coupled the appearance

2:34

of chondromalacia in the young, where we see it to

2:39

extensive loss of cartilage

2:41

and osteoarthrosis in the elderly.

2:43

So in my view, this is a term softening, generally seen

2:48

as altered signal intensity.