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. 2020 May 18;54(4):518-525.
doi: 10.1007/s43465-020-00140-4. eCollection 2020 Jul.

Can Ellipsoid Sign be One of the Earliest Findings of the Medial Femoral Condyle Chondromalacia of Knee Antero Posterior X-Ray?

Sever Çaglar  1 , Cem Albay  2
Affiliations

Can Ellipsoid Sign be One of the Earliest Findings of the Medial Femoral Condyle Chondromalacia of Knee Antero Posterior X-Ray?

Sever Çaglar et al. Indian J Orthop. .

Abstract

Background/purpose of the study: Aim of the study was to investigate whether ellipsoid sign (ES) in the region corresponding to the cartilaginous facet of the medial femoral condyle (MFC) indicates early cartilage lesion. The finding has not been defined in the literature yet.

Methods: The study was performed retrospectively with 50 patients who underwent articular cartilage examination and arthroscopy between 2015 and 2018. Patients were divided into two according to the presence or absence of ES. There were 24 patients in case group (Group A) and 26 patients in controls (Group B). Weight-bearing cartilage areas of MFC in the region where ES was found in both groups were classified according to arthroscopic Outerbridge classification (OC) and compared statistically with each other.

Results: There was no significant difference in terms of age, gender and alignment between Group A and Group B (p > 0.05). All OC grades were higher in Group A (p < 0.001). Positive correlation between ES and MFC chondromalacia grade was detected (r: 0.671, t: 6.266, p < 0.05).

Conclusion: ES, which refers to the difference in bone density in MFC seen in antero-posterior (AP) X-Ray, is a result of changes in subchondral bone due to chronic cartilage loss. ES detected on AP X-Ray may help in early diagnosis of medial femoral articular cartilage chondromalacia, even at grade 0 or 1. We recommend searching for ES, as the earliest symptom of chondromalacia, which occurs even before MRI lesions. Future studies may reveal additional information about ES.

Keywords: Cartilage; Chondromalacia; Ellipsoid sign; Femoral condyle; Osteoarthritis.

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Conflict of interest statement

Conflict of interestAll authors approved the manuscript and all authors declare that are no conflicts of interest regarding the publication.

Figures

Fig. 1
Fig. 1
Ellipsoid finding seen on MFC at standing AP X-Ray in both knee medial site
Fig. 2
Fig. 2
Comparison of study group and control group according to Outerbridge Classification
Fig. 3
Fig. 3
a Ellipsoid finding. b Severe condromalacia. c Grade 2 degeneration of the medial meniscus and increased cartilage thickness. d Fat suppressed MRI image. e Fat suppressed MRI image
Fig. 4
Fig. 4
a Ellipsoid finding of both knees. b, c Normal 3 PDW fat suppressed MRI image of right knee
Fig. 5
Fig. 5
a, b Grade 1 chondromalacia in the weight bearing cartilage of MFC
Fig. 6
Fig. 6
a Prominent ellipsoid sign in MFC in left knee. b Arthroscopic images of the cartilage lesion in weight bearing area of ​​MFC
Fig. 7
Fig. 7
a Comparison of both knees with a chronic ACL rupture in left knee (prominent ellipsoid sign in left knee). b Grade 2 chondromalacia according to Outerbridge Classification
Fig. 8
Fig. 8
a Ellipsoid sign in MFC of the left knee. b Posterior rupture of the medial meniscus. c Grade 1 chondromalacia according to Outerbridge Classification
Fig. 9
Fig. 9
a AP X-Ray: No ellipsoid sign. b MRI: Medial meniscus rupture. c Anterior cruciate ligament rupture
Fig. 10
Fig. 10
a No chondromalacia in arthroscopy. b Anterior cruciate ligament rupture in arthroscopy. c Bucket handle medial meniscus rupture
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