Clinical Evaluation of the Patient with a Chondral Injury

RAFFY MIRZAYAN

Chondral injuries are becoming more frequently recognized. They have an incidence of between 5% and 10% in patients who have experienced acute sporting injuries and present with an acute hemarthrosis.¹ In addition, 20% of anterior cruciate ligament (ACL)-injured knees chronically develop cartilage loss.² The diagnosis of a chondral injury is hard to make and is often delayed. It is usually a diagnosis of exclusion and is often made only arthroscopically. Current magnetic resonance imaging (MRI) techniques are not sophisticated enough to appreciate the chondral injuries. However, newer techniques are emerging and will aid in earlier diagnosis. The most important aspect in making an accurate and timely diagnosis is to have a high degree of suspicion.

History

Patients with osteochondral injury may present with a variety of symptoms. A detailed history from the patient usually reveals a single traumatic antecedent event associated with the onset of symptoms, which include pain, effusion, locking, and catching. If an acute injury has occurred, ligamentous or meniscal injury should also be suspected. Prior traumatic injuries are common, and a history of the number of traumatic events should be documented. Chondral wear injuries can occur over time due to malalignment of a joint or maltracking of the patella. In these cases, patients may not have a history of an acute injury. If the patient has had a previous surgery of the affected joint, it is crucial to gain as much information from that procedure as possible. It is extremely helpful to not only have the operative report, but to also obtain video or photographs from the surgery to evaluate the size and location of a cartilage lesion, as well as to assess the cruciate ligaments and menisci. If a partial menisectomy was performed, the photographs will help to determine how much was removed and if a meniscal transplant may be necessary. If the lesion is an osteochondral defect, the photographs can aid in determining the amount of bony defect.

Physical Examination