0:00

Now let's define some additional terms

0:03

that you may be using.

0:04

And certainly I use, there are terms chondral

0:08

and osteochondral injury.

0:10

What do you mean when you use those terms?

0:14

Well, here's what I mean.

0:17

A chondral injury means that the force is dissipated

0:21

in the articular cartilage

0:24

and does not reach the subc chondral bone.

0:27

An osteochondral injury means the force

0:31

is dissipated both in the articular cartilage

0:35

and in the subc chondral bone.

0:38

So I would ask you, as you look at Mr images,

0:40

do you think you are better identifying chondral injuries

0:45

or osteochondral injuries?

0:48

And without doubt, we are better at identifying

0:52

osteochondral injuries

0:54

because you see, we look for a light bulb

0:57

and alteration in marrow signal in the subc chondral bone on

1:02

the fluid sensitive sequences.

1:04

So if I look at this,

1:05

this is an osteochondral injury, right?

1:09

We see the light bulb in the subcon bone.

1:13

We see the sharp margins generally indicating

1:16

a traumatic event.

1:18

And we see the chondral defect that has been produced

1:23

and the intact subc chondral bone plate,

1:28

which we struggle with chondral injuries.

1:30

Look at this case. I'm showing you a sagittal image

1:33

through the troia here,

1:36

and at the time of the initial study following trauma,

1:40

and here everything looks good.

1:43

And then nine months later we can see this curva linear area

1:47

of intermediate signal that is

1:51

delamination in the region of the tide mark.

1:53

Right? So we struggle sometimes even with free Tesla

1:59

magnets, trying to decide if the cartilage is normal

2:04

or abnormal.

2:05

And indeed predicting what the future integrity

2:09

of the articular cartilage might

2:13

is extremely difficult.

2:15

I mean, look at the case.

2:16

This group of orthopedic surgeons is showing me,

2:19

it's this image here.

2:20

Here's what it looks like at the time of injury.

2:23

It's an old case. We can see there was an osteochondral

2:27

injury, but the cartilage looks pretty good.

2:29

There is a light bulb.

2:31

Now 11 months later, a chondral defect is seen.

2:36

So we struggle sometime predicting

2:39

what the articular cartilage is gonna look

2:41

like down the line.

2:43

Alright, here 11 months later.