Modified Outerbridge grading of chondromalacia

Dr Henry Knipe and Assoc Prof Frank Gaillard et al.

The modified Outerbridge grading of chondromalacia is divided into four grades by MRI, typically using fat-saturated proton density sequences. This grading system was originally devised for arthroscopy initially for assessment of chondromalacia patellae, 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.

Article information

rID: 1120
Tag: cases
Synonyms or Alternate Spellings:
  • Outerbridge grading system
  • Modified Outerbridge grading system

ADVERTISEMENT: Supporters see fewers/no ads

Cases and figures

  • Figure 1: normal
    Drag here to reorder.
  • Figure 2: grade 1
    Drag here to reorder.
  • Figure 3: grade 2
    Drag here to reorder.
  • Figure 4: grade 3
    Drag here to reorder.
  • Figure 5: grade 4
    Drag here to reorder.
  • Case 1: grade III
    Drag here to reorder.
  • Case 2: grade IV
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.