ROCK ATHROSCOPY CLASSIFICATION

1. ROCK Classification committee

2. 10 members: 18 months with monthly meetings/conference calls,

video conferences

3. Development of classification systems for MRI, Xray, Arthroscopy

4. Review, approval by ROCK Membership May 2011

ROCK ATHROSCOPY CLASSIFICATION

1. GROSS OCD LESION DESCRIPTION

2. ICRS CARTILAGE CLASSIFICATION

3. OCD ARTICULAR LESION CONTOUR

ATHROSCOPY CLASSIFICATION:

GROSS LESION DESCRIPTION– IMMOBILE and MOBILE

GROSS OCD LESION DESCRIPTION

1. Focus on appearance of lesion arthroscopically

2. Lesion stability may have strong relationship to healing

potential

3. 2 Main Categories based upon stability

1. Immobile (3)

2. Mobile (5)

GROSS LESION DESCRIPTION– IMMOBILE and MOBILE

IMMOBILE Lesions - No observed movement of progeny fragment with respect to the surrounding parent surface upon probing

0. No abnormality detectable arthroscopically (Cue Ball)

1. Cartilage is intact and subtly demarcated (possibly under low light), (Subtle Shadow)

2. Cartilage is demarcated with a fissure, buckle, and/or wrinkle (Wrinkle in the Rug)

MOBILE Lesions -- Observed movement of progeny fragment with respect to the surrounding parent surface upon probing

3.  Cartilage is intact (Trampoline)

4.  Cartilage fissuring at periphery, unable to hinge open (Locked Door)

5.  Cartilage fissuring at periphery, able to hinge open (Trap Door)

6.  Circumferential fissuring and complete separation, but lesion in situ (Manhole Cover)

7.  Exposed sub-chondral bone defect (Crater)

Arthroscopic ImageIllustration

GROSS OCD LESION DESCRIPTION – CUE BALL

0 - No abnormality detectable arthroscopically

IMMOBILE Lesion

Need image

1 - Cartilage is intact and demarcated, but not mobile or ballotable with probing. This may be seen best under low light conditions, or tangential views.

IMMOBILE LESION

Arthroscopic ImageIllustration

GROSS OCD LESION DESCRIPTION – Shadow

Need image Need image

2 - Cartilage is demarcated with a fissure, buckle, and/or wrinkle, but not mobile or ballotable with probing (Wrinkle in the Rug)

IMMOBILE LESION

Arthroscopic ImageIllustration

GROSS OCD LESION DESCRIPTION – Wrinkle in Rug

Need image Need imageNeed Drawing

Arthroscopic ImageIllustration

3 - Cartilage is intact and demarcated, but mobile or ballotable with probing

MOBILE LESION

GROSS OCD LESION DESCRIPTION – Trampoline

Need image

Arthroscopic ImageIllustration

4 - Cartilage fissuring at periphery, but unable to hinge

MOBILE LESION

GROSS OCD LESION DESCRIPTION – Locked Door

Need image

Video ImageIllustration

4 - Cartilage fissuring at periphery, but unable to hinge

MOBILE LESION

GROSS OCD LESION DESCRIPTION – Locked Door

Need image Need image

Arthroscopic ImageIllustration

5 - Cartilage fissuring at periphery, with intact hinge (red arrows)

GROSS OCD LESION DESCRIPTION – Trap Door

Need image

Video ImageIllustration

5 - Cartilage fissuring at periphery, with intact hinge (red arrows)

MOBILE LESION

GROSS OCD LESION DESCRIPTION – Locked Door

Need image Need image

Arthroscopic ImageIllustration

6 - Circumferential fissuring, (highlighted by the red arrows) lesion in situ, but can be entirely displaced with a probe.

MOBILE LESION

GROSS OCD LESION DESCRIPTION – Manhole Cover

Need image

Arthroscopic Image

7 - Exposed sub-chondral bone defect

Congruent = fragment fits into crater without modifications

Incongruent = fragment fits into crater with modifications

GROSS OCD LESION DESCRIPTION – Crater

1 - Congruent2 - Incongruent3 - Fragmented4 - Absent

Illustration

1 - Congruent2 - Incongruent3 - Fragmented4 - Absent

Need image Need image

GROSS LESION DESCRIPTION– IMMOBILE and MOBILE

IMMOBILE Lesions - No observed movement of progeny fragment with respect to the surrounding parent surface upon probing

0. No abnormality detectable arthroscopically (Cue Ball)

1. Cartilage is intact and subtly demarcated (possibly under low light), (Subtle Shadow)

2. Cartilage is demarcated with a fissure, buckle, and/or wrinkle (Wrinkle in the Rug)

MOBILE Lesions -- Observed movement of progeny fragment with respect to the surrounding parent surface upon probing

3.  Cartilage is intact (Trampoline)

4.  Cartilage fissuring at periphery, unable to hinge open (Locked Door)

5.  Cartilage fissuring at periphery, able to hinge open (Trap Door)

6.  Circumferential fissuring and complete separation, but lesion in situ (Manhole Cover)

7.  Exposed sub-chondral bone defect (Crater)

GROSS LESION DESCRIPTION– IMMOBILE and MOBILE

IMMOBILE Lesions - No observed movement of progeny fragment with respect to the surrounding parent surface upon probing

0. No abnormality detectable arthroscopically (Cue Ball)

1. Cartilage is intact and subtly demarcated (possibly under low light), (Subtle Shadow)

2. Cartilage is demarcated with a fissure, buckle, and/or wrinkle (Wrinkle in the Rug)

MOBILE Lesions -- Observed movement of progeny fragment with respect to the surrounding parent surface upon probing

3.  Cartilage is intact (Trampoline)

4.  Cartilage fissuring at periphery, unable to hinge open (Locked Door)

5.  Cartilage fissuring at periphery, able to hinge open (Trap Door)

6.  Circumferential fissuring and complete separation, but lesion in situ (Manhole Cover)

7.  Exposed sub-chondral bone defect (Crater)

A. Congruent = fragment fits into crater without modifications

B. Incongruent = fragment fits into crater with modifications

C. Fragmented

D. Absent