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J Knee Surg 2022; 35(05): 470-474
DOI: 10.1055/s-0041-1739259
Special Focus Section

Dark Cartilage Lesions in the Knee: MRI Appearance and Clinical Significance

John Christopher Knoth
1   Medical School, University of Missouri - Columbia, Missouri
,
Jeremiah R. Long
2   Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
,
James Derek Stensby
3   Department of Radiology, 1 Hospital Dr, University of Missouri, Columbia, Missouri
› Author Affiliations Funding None.
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Abstract

Early investigations into the magnetic resonance imaging (MRI) appearance of articular cartilage imaging relied on assessment of the morphology, with subsequent investigators reporting identifying increased T2 signal intensity, bright signal, in degenerated cartilage. The cartilage “black line sign” is a finding that has recently been described in the radiology literature to characterize cartilage pathology. This sign refers to a focal linear hypointense signal within articular cartilage that is oriented perpendicular to the subchondral bone on T2-weighted MRI. The diagnostic significance and clinical relevance of this sign is debated. Since its first description, several papers have further delineated the etiology, prevalence, and clinical relevance of these and other dark cartilage abnormalities. The intent of this article is to summarize these findings, with hopes of bringing to light the importance of dark cartilage lesions and their clinical implication in the world of knee surgery. We will briefly discuss the most probable etiologies of dark cartilage abnormalities and the major factors determining the unique signal intensity. The described anatomical patterns of this finding, the clinical importance, potential mimics, and current treatment recommendations will be reviewed.

Keywords

MRI - cartilage - cartilage fissure


Publication History

Received: 30 July 2021

Accepted: 21 September 2021

Article published online:
15 November 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Goodwin DW. MRI appearance of normal articular cartilage. Magn Reson Imaging Clin N Am 2011; 19 (02) 215-227
    CrossrefPubMedGoogle Scholar
  • 2 Huber M, Trattnig S, Lintner F. Anatomy, biochemistry, and physiology of articular cartilage. Invest Radiol 2000; 35 (10) 573-580
    CrossrefPubMedGoogle Scholar
  • 3 Hayes CW, Conway WF. Evaluation of articular cartilage: radiographic and cross-sectional imaging techniques. Radiographics 1992; 12 (03) 409-428
    CrossrefPubMedGoogle Scholar
  • 4 Recht MP, Goodwin DW, Winalski CS, White LM. MRI of articular cartilage: revisiting current status and future directions. Am J Roentgenol 2005; 185 (04) 899-914
    CrossrefPubMedGoogle Scholar
  • 5 Forney M, Subhas N, Donley B, Winalski CS. MR imaging of the articular cartilage of the knee and ankle. Magn Reson Imaging Clin N Am 2011; 19 (02) 379-405
    CrossrefPubMedGoogle Scholar
  • 6 Rubenstein JD, Kim JK, Morova-Protzner I, Stanchev PL, Henkelman RM. Effects of collagen orientation on MR imaging characteristics of bovine articular cartilage. Radiology 1993; 188 (01) 219-226
    CrossrefPubMedGoogle Scholar
  • 7 Shakoor D, Guermazi A, Kijowski R. et al. Diagnostic performance of three-dimensional MRI for depicting cartilage defects in the knee: a meta-analysis. Radiology 2018; 289 (01) 71-82
    CrossrefPubMedGoogle Scholar
  • 8 Bredella MA, Tirman PF, Peterfy CG. et al. Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients. AJR Am J Roentgenol 1999; 172 (04) 1073-1080
    CrossrefPubMedGoogle Scholar
  • 9 Kijowski R, Blankenbaker DG, Woods MA, Shinki K, De Smet AA, Reeder SB. 3.0-T evaluation of knee cartilage by using three-dimensional IDEAL GRASS imaging: comparison with fast spin-echo imaging. Radiology 2010; 255 (01) 117-127
    CrossrefPubMedGoogle Scholar
  • 10 Sonin AH, Pensy RA, Mulligan ME, Hatem S. Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression. Am J Roentgenol 2002; 179 (05) 1159-1166
    CrossrefPubMedGoogle Scholar
  • 11 Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am 1998; 80 (09) 1276-1284
    CrossrefPubMedGoogle Scholar
  • 12 Broderick LS, Turner DA, Renfrew DL, Schnitzer TJ, Huff JP, Harris C. Severity of articular cartilage abnormality in patients with osteoarthritis: evaluation with fast spin-echo MR vs arthroscopy. AJR Am J Roentgenol 1994; 162 (01) 99-103
    CrossrefPubMedGoogle Scholar
  • 13 Stephens T, Diduch DR, Balin JI, Gaskin CM. The cartilage black line sign: an unexpected MRI appearance of deep cartilage fissuring in three patients. Skeletal Radiol 2011; 40 (01) 113-116
    CrossrefPubMedGoogle Scholar
  • 14 Winalski CS, Gupta KB. Magnetic resonance imaging of focal articular cartilage lesions. Top Magn Reson Imaging 2003; 14 (02) 131-144
    CrossrefPubMedGoogle Scholar
  • 15 Wissman RD, Ingalls J, Nepute J. et al. The trochlear cleft: the “black line” of the trochlear trough. Skeletal Radiol 2012; 41 (09) 1121-1126
    CrossrefPubMedGoogle Scholar
  • 16 Markhardt BK, Kijowski R. The clinical significance of dark cartilage lesions identified on MRI. AJR Am J Roentgenol 2015; 205 (06) 1251-1259
    CrossrefPubMedGoogle Scholar
  • 17 Wissman RD, England E, Mehta K. et al. The trochlear cleft: initial experience in elite athletes. J Comput Assist Tomogr 2014; 38 (04) 499-502
    CrossrefPubMedGoogle Scholar
  • 18 Markhardt BK, Chang EY. Hypointense signal lesions of the articular cartilage: a review of current concepts. Clin Imaging 2014; 38 (06) 785-791
    CrossrefPubMedGoogle Scholar
  • 19 Pfirrmann CWA, Duc SR, Zanetti M, Dora C, Hodler J. MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement. Radiology 2008; 249 (01) 236-241
    CrossrefPubMedGoogle Scholar
  • 20 Schwaiger BJ, Gersing AS, Mbapte Wamba J, Nevitt MC, McCulloch CE, Link TM. Can signal abnormalities detected with MR imaging in knee articular cartilage be used to predict development of morphologic cartilage defects? 48-month data from the Osteoarthritis Initiative. Radiology 2016; 281 (01) 158-167
    CrossrefPubMedGoogle Scholar
  • 21 Horga LM, Hirschmann AC, Henckel J. et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol 2020; 49 (07) 1099-1107
    CrossrefPubMedGoogle Scholar
  • 22 Kaplan LD, Schurhoff MR, Selesnick H, Thorpe M, Uribe JW. Magnetic resonance imaging of the knee in asymptomatic professional basketball players. Arthroscopy 2005; 21 (05) 557-561
    CrossrefPubMedGoogle Scholar
  • 23 Walczak BE, McCulloch PC, Kang RW, Zelazny A, Tedeschi F, Cole BJ. Abnormal findings on knee magnetic resonance imaging in asymptomatic NBA players. J Knee Surg 2008; 21 (01) 27-33
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Kane PW, Tucker BS, Frederick R, Ciccotti MG, Freedman KB. Cartilage restoration of the patellofemoral joint. JBJS Rev 2017; 5 (10) e7
    CrossrefPubMedGoogle Scholar
  • 25 Yoshioka H, Stevens K, Genovese M, Dillingham MF, Lang P. Articular cartilage of knee: normal patterns at MR imaging that mimic disease in healthy subjects and patients with osteoarthritis. Radiology 2004; 231 (01) 31-38
    CrossrefPubMedGoogle Scholar
  • 26 Beltran J, Marty-Delfaut E, Bencardino J. et al. Chondrocalcinosis of the hyaline cartilage of the knee: MRI manifestations. Skeletal Radiol 1998; 27 (07) 369-374
    CrossrefPubMedGoogle Scholar
  • 27 Bedi A, Feeley BT, Williams III RJ. Management of articular cartilage defects of the knee. J Bone Joint Surg Am 2010; 92 (04) 994-1009
    CrossrefPubMedGoogle Scholar
  • 28 Gersing AS, Schwaiger BJ, Nevitt MC. et al. Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative. Radiology 2017; 284 (02) 508-520
    CrossrefPubMedGoogle Scholar