Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy?

A prospective study
  • B. Friemert
  • Y. Oberländer
  • W. Schwarz
  • H. J. Häberle
  • W. Bähren
  • H. Gerngroß
  • B. Danz


The role of magnetic resonance tomography (MRI) for the diagnosis of chondral lesions of the knee joint is still unclear. The sensitivity of the method ranges from 15% to 96%. The scope of our daily experiences showed that there were considerable deviations between the tomographical and arthoscopical results, which vary from the results of experimental studies. Therefore we have conducted a prospective study to investigate the question of how MRI can replace arthroscopy (ASC) in the diagnosis of cartilage damages in the scope of daily routine. All 195 patients included in this study received a magnetic resonance tomography followed by an arthroscopy. A clear diagnosis of supposition had to be determined before the magnetic resonance tomography. The patients were divided into 3 Groups. Group A ( n =86) received a standard Military Hospital Ulm (MH) MRI — sagittal STIR TSE and PD TSE, coronal and transversal T2 FFE (TR=660 ms, TE=18 ms, FA=30°, 512 matrix). In addition, one sub-Group, AK (n =21) was examined with a special cartilage sequence of the cartilage fs T1 W FFE. Neither patients in Group AK nor in Group A as a whole received any contrast medium. Group B (n =88) was examined with an alternate MRI protocol (Radiological Joint Practice, Neu-Ulm — sagittal T1 SE, T2 SE and T2 FLASH (TR=608 ms, TE=18 ms, FA=20°, 256 matrix), coronal PD fs), employing gadolinium as a contrast medium. 156 cartilage lesions were found arthroscopically. In Group A the sensitivity was 33%, the specificity 99%, and the positive and negative prediction values 75% and 98% respectively. Group B reached a sensitivity of 53% and a specificity of 98%. The positive prediction value was 48% and the negative was 98%. Group AK showed a sensitivity of 38% and specificity of 98%; the positive and negative prediction values came to 50% and 97% respectively. In conclusion, our results indicate that the MRI examination techniques recommended in the literature at present are not able to replace the ASC for the diagnosis of cartilage damages of the knee joint. In view of the high specificity (97%–99%) and the high negative prediction value (97%–98%), MRI is suitable for the exclusion of cartilage lesions. For a negative MRI associated with a cartilage injury, a cautious attitude towards an operative cartilage treatment is therefore justified. Because the MRI can not replace the ASC for diagnostic of cartilage damage, the ASC still has to be seen as the method of choice for the evaluation of cartilage damage.


Arthroscopy MRI Cartilage damage Routine Sensitivity 


  1. 1.
    Bashir A, Gray ML, Boutin RD, Burstein D (1997) Glycosaminoglycan in articular cartilage: in vivo assessment with delayed Gd(DTPA)(2-)-enhanced MR imaging. Radiology 205:551PubMedGoogle Scholar
  2. 2.
    Bassett LW, Grover JS, Seeger LL (1990) Magnetic resonance imaging of knee trauma. Skeletal Radiol 19:401PubMedGoogle Scholar
  3. 3.
    Bredella MA, Tirman PF, Peterfy CG, Zarlingo M et al (1999) 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 172:1073PubMedGoogle Scholar
  4. 4.
    Carmichael IW, MacLeod AM, Travlos J (1997) MRI can prevent unnecessary arthroscopy. J Bone Joint Surg Br 79:624CrossRefPubMedGoogle Scholar
  5. 5.
    Disler DG, McCauley TR, Kelman CG, Fuchs MD et al (1996) Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. AJR Am J Roentgenol 167:127PubMedGoogle Scholar
  6. 6.
    Disler DG, Peters TL, Muscoreil SJ, Ratner LM et al (1994) Fat-suppressed spoiled GRASS imaging of knee hyaline cartilage: technique optimization and comparison with conventional MR imaging. AJR Am J Roentgenol 163:887PubMedGoogle Scholar
  7. 7.
    Eckstein F, Sittek H, Gavazzeni A, Milz S et al (1995) Knee joint cartilage in magnetic resonance tomography. MR chondrovolumetry (MR-CVM) using fat-suppressed FLASH 3D sequence. Radiologe 35:87PubMedGoogle Scholar
  8. 8.
    Giovagnoni A, Valeri G, Ercolani P, Paci E et al (1995) Magnetic resonance arthrography in chondral disease of the knee. Radiol Med (Torino) 90:219Google Scholar
  9. 9.
    Glaser C, Faber S, Eckstein F, Fischer H et al (2001) Optimization and validation of a rapid high-resolution T1-w 3D FLASH water excitation MRI sequence for the quantitative assessment of articular cartilage volume and thickness. Magn Reson Imaging 19:177PubMedGoogle Scholar
  10. 10.
    Gold GE, Bergman AG, Pauly JM, Lang P et al (1998) Magnetic resonance imaging of knee cartilage repair. Top Magn Reson Imaging 9:377PubMedGoogle Scholar
  11. 11.
    Hayes CW, Sawyer RW, Conway WF (1990) Patellar cartilage lesions: in vitro detection and staging with MR imaging and pathologic correlation. Radiology 176:479PubMedGoogle Scholar
  12. 12.
    Hodler J, Berthiaume MJ, Schweitzer ME, Resnick D (1992) Knee joint hyaline cartilage defects: a comparative study of MR and anatomic sections. J Comput Assist Tomogr 16:597PubMedGoogle Scholar
  13. 13.
    Hodler J, Buess E, Rodriguez M, Imhoff A (1993) Magnetic resonance tomography (MRT) of the knee joint: meniscus, cruciate ligaments and hyaline cartilage. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 159:107PubMedGoogle Scholar
  14. 14.
    Ochi M, Sumen Y, Kanda T, Ikuta Y, Itoh K (1994) The diagnostic value and limitation of magnetic resonance imaging on chondral lesions in the knee joint. Arthroscopy 10:176PubMedGoogle Scholar
  15. 15.
    Peyron JG (1986) Osteoarthritis. The epidemiologic viewpoint. Clin Orthop 13Google Scholar
  16. 16.
    Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB (1998) Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging [see comments]. J Bone Joint Surg Am 80:1276PubMedGoogle Scholar
  17. 17.
    Recht MP, Kramer J, Marcelis S, Pathria MN et al (1993) Abnormalities of articular cartilage in the knee: analysis of available MR techniques. Radiology 187:473PubMedGoogle Scholar
  18. 18.
    Recht MP, Piraino DW, Paletta GA, Schils JP, Belhobek GH (1996) Accuracy of fat-suppressed three-dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities. Radiology 198:209PubMedGoogle Scholar
  19. 19.
    Recht MP, Resnick D (1994) MR imaging of articular cartilage: current status and future directions. AJR Am J Roentgenol 163:283PubMedGoogle Scholar
  20. 20.
    Ruehm S, Zanetti M, Romero J, Hodler J (1998) MRI of patellar articular cartilage: evaluation of an optimized gradient echo sequence (3D-DESS). J Magn Reson Imaging 8:1246PubMedGoogle Scholar
  21. 21.
    Schultz E (1995) Our Group has had some controversy about the best way to image cartilage particularly in MR examinations of the knee. AJR Am J Roentgenol 165:481Google Scholar
  22. 22.
    Speer KP, Spritzer CE, Goldner JL, Garrett WE Jr (1991) Magnetic resonance imaging of traumatic knee articular cartilage injuries. Am J Sports Med 19:396PubMedGoogle Scholar
  23. 23.
    Tervonen O, Dietz MJ, Carmichael SW, Ehman RL (1993) MR imaging of knee hyaline cartilage: evaluation of two- and three-dimensional sequences. J Magn Reson Imaging 3:663PubMedGoogle Scholar
  24. 24.
    Totterman S, Weiss SL, Szumowski J, Katzberg RW et al (1989) MR fat suppression technique in the evaluation of normal structures of the knee. J Comput Assist Tomogr 13:473Google Scholar
  25. 25.
    Uhl M, Ihling C, Allmann KH, Laubenberger J et al (1998) Human articular cartilage: in vitro correlation of MRI and histologic findings. Eur Radiol 8:1123CrossRefPubMedGoogle Scholar
  26. 26.
    Vallotton JA, Meuli RA, Leyvraz PF, Landry M (1995) Comparison between magnetic resonance imaging and arthroscopy in the diagnosis of patellar cartilage lesions: a prospective study. Knee Surg Sports Traumatol Arthrosc 3:157PubMedGoogle Scholar
  27. 27.
    Westhoff J, Eckstein F, Sittek H, Losch A et al (1997) Three-dimensional thickness and volume measurements of the knee joint cartilage by MR tomography: reproducibility in volunteers. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 167:585PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • B. Friemert
    • 1
  • Y. Oberländer
    • 1
  • W. Schwarz
    • 1
  • H. J. Häberle
    • 2
  • W. Bähren
    • 3
  • H. Gerngroß
    • 1
  • B. Danz
    • 3
  1. 1.Surgical DepartmentMilitary Hospital UlmUlmGermany
  2. 2.Radiological Joint PracticeNeu-UlmGermany
  3. 3.Radiological DepartmentMilitary Hospital UlmUlmGermany

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