Articles on: Job Aids

Cartilage Defect Identification

Defect Code #1: Bruising

Discolored cartilage due to blood pooling under the tissue.
Result of trauma. Look for other signs of trauma on surrounding bone and soft tissue.
Affected area is typically faint/light red in color.
Deeper, more severe bruises will be darker in color (crimson, purple).

Always Mark.

Superficial Bruising

Deeper Bruising

Defect Code #2: Laceration

A deep, thin cut through the cartilage.
Usually the result of an errant scalpel during tissue recovery or processing.
Typically seen on femoral/humeral heads, and on the posterior aspect of femoral condyles.

Always Mark.

Laceration on a humeral head.

Laceration on the posterior of a hemicondyle.

Defect Code #3: Rough Area

Rough Areas present as an area of gritty texture or ‘feel’.
Normal “wear & tear” acquired through articulation. Top layer of cartilage intact.
In minor cases Rough Areas look identical to pristine cartilage. These areas do not need to be marked and should be graded as pristine.
As severity increases, light may reflect off the Rough Area differently than unaffected cartilage. These areas are plainly visible, the cartilage may appear wrinkled. Mark if plainly visible.

Mark only if plainly visible. Minor Rough Areas DO NOT need to be marked. If borderline/in-doubt, mark the affected area.

A minor Rough Area, appears identical to surrounding cartilge.

A more severe Rough Area with a wrinkled appearance.

Defect Code #4: Striations

Series of uniform parallel lines that run in the direction of a joint's articulation.
Normal “wear & tear” acquired through articulation. Top layer of cartilage intact.
In minor cases, Striations are faint 2D lines not perceptible by touch. These areas do not need to be marked and should be graded as pristine.
In more severe cases, Striations are easier to see, and present as 3D grooves that can be felt by lightly moving a probe perpendicular across them. Mark these striations.
Commonly seen on the talus, patella, and femoral trochlea.

Mark only if perceptible by touch. Minor Striations DO NOT need to be marked. If borderline/in-doubt, mark the affected area.

More severe Striations on a patella. Note the superior-inferior direction of the lines.

Minor Striations in the trochlear groove. Note the direction in which the lines run.

Defect Code #5: Cracks in Cartilage

Fissures that disrupt the cartilage surface.
Can appear irregular/random or radiating outward from another defect, unlike striations which are always uniform/parallel.
Deeper than striations. Perceptible by touch (with a probe if necessary).
Cracks can be fine, hair-thin lines or severe chasm-like grooves.

Always mark.

Hair-Line Cracks on a femoral condyle.

Cracks on a lateral hemicondyle

Moderate Cracks on a tibial plateau.

Defect Code #6: Soft Cartilage

Soft spots can be identified by gently pressing into the cartilage with a finger or probe. Soft cartilage does not resist or rebound from pressure, and probes may even ‘sink’ into soft spots.
Jelly-like texture
Areas of soft cartilage may be visually distinct, sometimes appearing darker than surrounding cartilage.

Always mark.

Soft Cartilage on a patella.

Defect Code #7: Pitting in Cartilage

Pitting can present as isolated pin-hole like abrasions in the cartilage surface. More common on distal tibias.
Pitting can also appear as shallow, smooth dents or dimpling, similar to the surface of a golf ball.
For dimpled pitting, if the affected area has irregular margins and is deeper/wider than a small indentation, this defect would be better classified as a lesion.

Always mark.

Isolated Pin-Hole Pitting on a Distal Tibia

Examples of Dimple Pitting.

This graft was marked as having Pitting, but this defect would be better classified as a Lesion.

Defect Code #8: Lesion

Used to describe any large, severe defect that eliminates the top layer of cartilage.
Lesions can present as large “pot-holes” in the cartilage that may not extend all the way down to bone.
Some lesions can extend through the entire cartilage layer down to the sub-chondral bone.
Lesions can occur on any cartilage surface, but are more common on the distal femur.
Presence of a lesion will usually preclude a graft from being output as-is. If possible, you’ll most likely attempt to harvest cores from a graft with a lesion.

Always Mark.

Full thickness Lesion that has progressed all the way to sub-chondral bone.

OCD Lesion on a femoral condyle.

Early stage OCD Lesion on a hemicondyle.

Areas on a femoral condyle where Lesions are most likely to occur. Posterior area of the lateral condyle (left) and lateral/interior edge of the medial condyle (right).

Growth Plates

Open epiphyseal plates found at either end of long bones.
Typically found in adolescent donors, though growth plates can sometimes be seen in young adults.
Generally, growth plates won’t present as an issue so long as the plate is a least 1cm from the cartilage surface.
Take photos that show the position of the plate relative to the cartilage.

Thinning

Thin cartilage can appear similar to bruising, since the bone visible underneath the thin cartilage can be darker in color.
Thinning generally affects a larger area. Will often present as a dark spot due to bone visible just beneath the surface.
Look for signs of trauma that suggest Bruising over Thinning.
More common on distal tibias and femoral/humeral heads.