Chondromalacia grading

Chondromalacia can be divided into 4 grades by MRI, typically using fat saturated proton density sequences. This grading system is the modified Outerbridge grading system, which was devised for arthroscopy initially for assessment of chondromalacia patella, but then modified and extended for all chondral surfaces 1.

  • grade I
    • focal areas of hyperintensity with normal contour 
    • arthroscopically: softening or swelling of cartilage
  • grade II
    • blister-like swelling/fraying of articular cartilage extending to surface
    • arthroscopically: fragmentation and fissuring within soft areas of articular cartilage
  • grade III
    • partial thickness cartilage loss with focal ulceration
    • arthroscopically: partial thickness cartilage loss with fibrillation (crab-meat appearance)
  • grade IV
    • full thickness cartilage loss with underlying bone reactive changes
    • arthroscopically: cartilage destruction with exposed subchondral bone

 This is not to be confused with the osteochondral injury staging system or osteochondritis dissecans surgical staging system.

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