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