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Willaume T, Ehlinger M, Favreau H, Weingertner N, Zorn PE, Dillenseger JP, Koch G, Velten M, Bierry G. Assessment of knee cartilage using accelerated 3 T MRI: Evaluation of an isotropic 3D fast spin-echo sequence (CUBE) with compressed sensing technique. Magn Reson Imaging 2025; 117:110321. [PMID: 39793772 DOI: 10.1016/j.mri.2025.110321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 12/19/2024] [Accepted: 01/02/2025] [Indexed: 01/13/2025]
Abstract
PURPOSE Compressed Sensing (CS) is an emerging technique to accelerate MRI acquisitions. The aim of this study was to assess the reliability and accuracy of cartilage thickness measurements in the knee using a CS-enabled isotropic 3D Fast Spin-Echo (FSE) sequence on a 3-T MRI scanner. METHODS Twenty-eight tibial condyle sections were collected from 14 adult patients who underwent total knee arthroplasty. An isotropic 3D PDw FSE with variable flip-angle (CUBE) sequence with CS was used to acquire MR images of the tibial condyle sections. Minimum cartilage thickness measurements were independently performed by two experienced readers (R1 and R2) on MR images and compared to corresponding anatomical sections measurements. Intraclass correlation coefficients (ICCs) and Bland-Altman analyses, were used to assess agreement between MR and anatomical measurements. RESULTS A total of 84 paired cartilage areas were analyzed [cartilage thickness measurements ranged from 0 to 3.40 mm at anatomical evaluation (mean, 1.08 mm ± 0.83)]. The agreements between MR and anatomical measurements were excellent (mean differences, 0.06 ± 0.31 mm for R1 and 0.03 ± 0.43 mm for R2) with respective ICC values of 0.93 and 0.88. Bland-Altman analyses revealed small differences between MR and anatomical measurements, with 95 % Limit of Agreements values falling within clinically acceptable ranges (-0.54 to 0.66 mm for R1, -0.87 to 0.80 mm for R2). CONCLUSION The 3D PDw FSE sequence with Compressed Sensing acceleration technique demonstrated reliable and accurate assessment of cartilage thickness of the tibial condyles within a timeframe suitable for routine clinical practice.
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Affiliation(s)
- Thibault Willaume
- Department of Radiology, University Hospital of Strasbourg, 1 Avenue Moliere, 67098 Strasbourg, France.
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg Cedex, France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098 Strasbourg Cedex, France
| | - Noëlle Weingertner
- Department of Pathology, University Hospital of Strasbourg, 67098 Strasbourg Cedex, France
| | - Pierre-Emmanuel Zorn
- Department of Radiology, University Hospital of Strasbourg, 1 Avenue Moliere, 67098 Strasbourg, France
| | - Jean-Philippe Dillenseger
- Department of Radiology, University Hospital of Strasbourg, 1 Avenue Moliere, 67098 Strasbourg, France; ICube - UMR 7357, CNRS, University of Strasbourg, 67000 Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1 Place de L'hôpital, 67000 Strasbourg, France
| | - Michel Velten
- Department of Epidemiology and Public Health, Bas-Rhin Cancer Registry, Inserm UMR-S1113, ICANS, University of Strasbourg, 67085 Strasbourg, France
| | - Guillaume Bierry
- Department of Radiology, University Hospital of Strasbourg, 1 Avenue Moliere, 67098 Strasbourg, France
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Mahendrakar P, Kumar D, Patil U. Comprehensive Study on Scoring and Grading Systems for Predicting the Severity of Knee Osteoarthritis. Curr Rheumatol Rev 2024; 20:133-156. [PMID: 37828677 DOI: 10.2174/0115733971253574231002074759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 10/14/2023]
Abstract
Knee Osteoarthritis (KOA) is a degenerative joint ailment characterized by cartilage loss, which can be seen using imaging modalities and converted into imaging features. The older population is the most affected by knee OA, which affects 16% of people worldwide who are 15 years of age and older. Due to cartilage tissue degradation, primary knee OA develops in older people. In contrast, joint overuse or trauma in younger people can cause secondary knee OA. Early identification of knee OA, according to research, may be a successful management tactic for the condition. Scoring scales and grading systems are important tools for the management of knee osteoarthritis as they allow clinicians to measure the progression of the disease's severity and provide suggestions on suitable treatment at identified stages. The comprehensive study reviews various subjective and objective knee evaluation scoring systems that effectively score and grade the KOA based on where defects or changes in articular cartilage occur. Recent studies reveal that AI-based approaches, such as that of DenseNet, integrating the concept of deep learning for scoring and grading the KOA, outperform various state-of-the-art methods in order to predict the KOA at an early stage.
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Affiliation(s)
- Pavan Mahendrakar
- Department of Computer Science and Engineering, B.L.D.E.A's V.P.Dr.P.G. Halakatti College of Engineering and Technology, Vijayapur, Karnataka, India
| | - Dileep Kumar
- Department of Computer Science and Engineering, Scientific Collaborations for Developing Markets United Imaging Healthcare, Shanghai, China
| | - Uttam Patil
- Jain College of Engineering, T.S Nagar, Hunchanhatti Road, Machhe, Belagavi, Karnataka, India
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A degenerative medial meniscus retains some protective effect against osteoarthritis-induced subchondral bone changes. Bone Rep 2020; 12:100271. [PMID: 32478143 PMCID: PMC7251536 DOI: 10.1016/j.bonr.2020.100271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/18/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022] Open
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Xie W, Li F, Han Y, Qin Y, Wang Y, Chi X, Xiao J, Li Z. Neuropeptide Y1 receptor antagonist promotes osteoporosis and microdamage repair and enhances osteogenic differentiation of bone marrow stem cells via cAMP/PKA/CREB pathway. Aging (Albany NY) 2020; 12:8120-8136. [PMID: 32381754 PMCID: PMC7244071 DOI: 10.18632/aging.103129] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022]
Abstract
Osteoporosis is a common metabolic bone disorder in the elderly population. The accumulation of bone microdamage is a critical factor of osteoporotic fracture. Neuropeptide Y (NPY) has been reported to regulated bone metabolism through Y1 receptor (Y1R). In this study the effects and mechanisms of Y1R antagonist on prevention for osteoporosis were characterized. In the clinical experiment, compared with osteoarthritis (OA), osteoporosis (OP) showed significant osteoporotic bone microstructure and accumulation of bone microdamage. NPY and Y1R immunoreactivity in bone were stronger in OP group, and were both correlated with bone volume fraction (BV/TV). In vivo experiment, Y1R antagonist significantly improved osteoporotic microstructure in the ovariectomized (OVX) rats. And Y1R antagonist promoted RUNX2, OPG and inhibit RANKL, MMP9 in bone marrow. In vitro cell culture experiment, NPY inhibited osteogenesis, elevated RANKL/OPG ratio and downregulated the expression of cAMP, p-PKAs and p-CREB in BMSCs, treated with Y1R antagonist or 8-Bromo-cAMP could inhibit the effects of NPY. Together, Y1R antagonist improved the bone microstructure and reduced bone microdamage in OVX rats. NPY-Y1R could inhibit osteoblast differentiation of BMSCs via cAMP/PKA/CREB pathway. Our findings highlight the regulation of NPY-Y1R in bone metabolism as a potential therapy strategy for the prevention of osteoporosis and osteoporotic fracture.
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Affiliation(s)
- Weixin Xie
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.,Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Fan Li
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.,Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yi Han
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yi Qin
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yuan Wang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xiaoying Chi
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Jie Xiao
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Zhanchun Li
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
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Mezlini‐Gharsallah H, Youssef R, Uk S, Laredo JD, Chappard C. Three-dimensional mapping of the joint space for the diagnosis of knee osteoarthritis based on high resolution computed tomography: Comparison with radiographic, outerbridge, and meniscal classifications. J Orthop Res 2018; 36:2380-2391. [PMID: 29663495 PMCID: PMC6175338 DOI: 10.1002/jor.24015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/30/2018] [Indexed: 02/04/2023]
Abstract
One of the most important characteristic of knee osteoarthritis (OA) is the joint space (JS) width narrowing. Measurements are usually performed on two dimensional (2D) X-rays. We propose and validate a new method to assess the 3D joint space at the medial knee compartment using high resolution peripheral computed tomography images. A semi-automated method was developed to obtain a distance 3D map between femur an tibia with the following parameters: volume, minimum, maximum, mean, standard deviation, median, asymmetry, and entropy. We analyzed 71 knee specimens (mean age: 85 years), radiographs were performed for the Kellgren Lawrence (KL) score grading. In a subgroup of 41 specimens, the histopathological Outerbridge and meniscal classifications were performed and then cores were harvested from the tibial plateau in three different positions (posterior, central, and peripheral) and imaged at 10 µm of resolution to measure the cartilage thickness. Minimum, maximum, mean, and median were statistically lower and entropy higher between knee specimens classified as KL = 0 and KL = 3-4. Gr1 and 2 were statistically different from Gr3-4 for minimum, asymmetry, entropy using the Outerbridge classification and Gr1 was statistically different from Gr3-4 using the meniscal classification. Asymmetry, minimum, mean, median and entropy were significantly correlated with cartilage thickness. Parameters extracted from a 3D map of the medial joint space indicate local variations of JS and are related to local measurements of tibial cartilage thickness, and could be consequently useful to identify early OA. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:2380-2391, 2018.
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Affiliation(s)
- Houda Mezlini‐Gharsallah
- B2OA UMR 7052 CNRS Paris Diderot University10 Avenue de Verdun 75010 Paris,Sorbonne Paris CitéParisFrance
| | - Rabaa Youssef
- CEA Linklab Site El Ghazala Technopark 2088 Ariana TunisTunisia,COSIM, Carthage UniversityCarthageTunisia
| | - Stéphanie Uk
- B2OA UMR 7052 CNRS Paris Diderot University10 Avenue de Verdun 75010 Paris,Sorbonne Paris CitéParisFrance
| | - Jean D. Laredo
- B2OA UMR 7052 CNRS Paris Diderot University10 Avenue de Verdun 75010 Paris,Sorbonne Paris CitéParisFrance,Radiology Department Hospital Lariboisière2 Rue Ambroise Paré 75475 Paris Cédex 10, Sorbonne Paris CitéFrance
| | - Christine Chappard
- B2OA UMR 7052 CNRS Paris Diderot University10 Avenue de Verdun 75010 Paris,Sorbonne Paris CitéParisFrance
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Touraine S, Bouhadoun H, Engelke K, Laredo JD, Chappard C. Influence of meniscus on cartilage and subchondral bone features of knees from older individuals: A cadaver study. PLoS One 2017; 12:e0181956. [PMID: 28797093 PMCID: PMC5552215 DOI: 10.1371/journal.pone.0181956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 07/10/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Cartilage and subchondral bone form a functional unit. Here, we aimed to examine the effect of meniscus coverage on the characteristics of this unit in knees of older individuals. Methods We assessed the hyaline cartilage, subchondral cortical plate (SCP), and subchondral trabecular bone in areas covered or uncovered by the meniscus from normal cadaver knees (without degeneration). Bone cores harvested from the medial tibial plateau at locations uncovered (central), partially covered (posterior), and completely covered (peripheral) by the meniscus were imaged by micro-CT. The following were measured on images: cartilage volume (Cart.Vol, mm3) and thickness (Cart.Th, mm); SCP thickness (SCP.Th, μm) and porosity (SCP.Por, %); bone volume to total volume fraction (BV/TV, %); trabecular thickness (Tb.Th, μm), spacing (Tb.Sp, μm), and number (Tb.N, 1/mm); structure model index (SMI); trabecular pattern factor (Tb.Pf); and degree of anisotropy (DA). Results Among the 28 specimens studied (18 females) from individuals with mean age 82.8±10.2 years, cartilage and SCP were thicker at the central site uncovered by the meniscus than the posterior and peripheral sites, and Cart.Vol was greater. SCP.Por was highest in posterior samples. In the upper 1–5 mm of subchondral bone, central samples were characterized by higher values for BV/TV, Tb.N, Tb.Th, and connectivity (Tb.Pf), a more plate-like trabecular structure and lower anisotropy than with other samples. Deeper down, at 6–10 mm, the differences were slightly higher for Tb.Th centrally, DA peripherally and SMI posteriorly. Conclusions The coverage or not by meniscus in the knee of older individuals is significantly associated with Cart.Th, SCP.Th, SCP.Por and trabecular microarchitectural parameters in the most superficial 5 mm and to a lesser extent the deepest area of subchondral trabecular bone. These results suggest an effect of differences in local loading conditions. In subchondral bone uncovered by the meniscus, the trabecular architecture resembles that of highly loaded areas.
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Affiliation(s)
- Sébastien Touraine
- B2OA, UMR CNRS 7052, University Paris Diderot, Paris, France
- Service de Radiologie Ostéo-Articulaire, Hôpital Lariboisière, Paris, France
| | - Hamid Bouhadoun
- B2OA, UMR CNRS 7052, University Paris Diderot, Paris, France
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jean Denis Laredo
- B2OA, UMR CNRS 7052, University Paris Diderot, Paris, France
- Service de Radiologie Ostéo-Articulaire, Hôpital Lariboisière, Paris, France
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Angthong C. Ankle fracture configuration following treatment with and without arthroscopic-assisted reduction and fixation. World J Orthop 2016; 7:258-264. [PMID: 27114933 PMCID: PMC4832227 DOI: 10.5312/wjo.v7.i4.258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 12/10/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To report ankle fracture configurations and bone quality following arthroscopic-assisted reduction and internal-fixation (ARIF) or open reduction and internal-fixation (ORIF). METHODS The patients of ARIF (n = 16) or ORIF (n = 29) to treat unstable ankle fracture between 2006 and 2014 were reviewed retrospectively. Baseline data, including age, sex, type of injury, immediate postoperative fracture configuration (assessed on X-rays and graded by widest gap and largest step-off of any intra-articular site), bone quality [assessed with bone mineral density (BMD) testing] and arthritic changes on X-rays following surgical treatments were recorded for each group. RESULTS Immediate-postoperative fracture configurations did not differ significantly between the ARIF and ORIF groups. There were anatomic alignments as 8 (50%) and 8 (27.6%) patients in ARIF and ORIF groups (P = 0.539) respectively. There were acceptable alignments as 12 (75%) and 17 (58.6%) patients in ARIF and ORIF groups (P = 0.341) respectively. The arthritic changes in follow-up period as at least 16 wk following the surgeries were shown as 6 (75%) and 10 (83.3%) patients in ARIF and ORIF groups (P = 0.300) respectively. Significantly more BMD tests were performed in patients aged > 60 years (P < 0.001), ARIF patients (P = 0.021), and female patients (P = 0.029). There was no significant difference in BMD test t scores between the two groups. CONCLUSION Ankle fracture configurations following surgeries are similar between ARIF and ORIF groups, suggesting that ARIF is not superior to ORIF in treatment of unstable ankle fractures.
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Xiao J, Yu W, Wang X, Wang B, Chen J, Liu Y, Li Z. Correlation between neuropeptide distribution, cancellous bone microstructure and joint pain in postmenopausal women with osteoarthritis and osteoporosis. Neuropeptides 2016; 56:97-104. [PMID: 26706183 DOI: 10.1016/j.npep.2015.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/11/2015] [Accepted: 12/07/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To explore the relationship between the distribution of neuropeptides, cancellous bone microstructure and joint pain in postmenopausal women with osteoarthritis (OA) and osteoporosis (OP). METHODS Cancellous bone of the femoral head was obtained at the time of hip arthroplasty from 20 postmenopausal women, 10 with OA and 10 with OP. Pain intensity was evaluated using the visual analog scale (VAS) before the operation. The microstructural parameters were measured with micro-CT and the neuropeptides of the cancellous bone were stained by an immunohistochemical method. RESULTS We observed that BV/TV, Tb.Th and Th.N values in the OP were significantly decreased compared to those in the OA. Immunohistochemical analysis revealed that the mean optical density (MOD) values for SP, CGRP, and VIP in the OA group were significantly higher than those in the OP, and the MOD value for NPY in the OA was significantly lower than that in the OP. We also observed that the MOD values for SP were positively correlated with AD, BV/TV, Tb.Th, Tb.N and Conn.D and negatively with MD, Tb.Sp and SMI in all patients. The MOD values for CGRP were positively correlated with AD, BV/TV and Tb.Th. MOD values for VIP were positively correlated with BV/TV and Tb.Th and negatively with SMI. The VAS score was correlated positively with the MOD values for SP, CGRP, VIP and negatively with NPY in all patients. CONCLUSIONS Neuropeptides play an important role in the pathogenesis of OA and OP, which may cause pain and influence the bone microstructure.
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Affiliation(s)
- Jie Xiao
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Weifeng Yu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xiangrui Wang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Bo Wang
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Jianwei Chen
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yue Liu
- Department of Human Anatomy, Histology and Embryology, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
| | - Zhanchun Li
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
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Anakwenze OA, Iyengar JJ, Ahmad CS. Treatment of Medial Collateral Ligament Injuries of the Elbow with Use of the "Tommy John" Operation: Indications and Results. JBJS Rev 2014; 2:01874474-201406000-00003. [PMID: 27500715 DOI: 10.2106/jbjs.rvw.m.00057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Oke A Anakwenze
- The San Diego Shoulder and Elbow Service at the Garfield Specialty Center, Kaiser Permanente, 5893 Copley Drive, San Diego, CA 92111
| | - Jaicharan J Iyengar
- Alpine Orthopaedic Medical Group, 2488 North California Street, Stockton, CA 95204
| | - Christopher S Ahmad
- Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University, 622 West 168th Street, PH-11, New York, NY 10032
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Kohl S, Evangelopoulos DS, Ahmad SS, Kohlhof H, Herrmann G, Bonel H, Eggli S. A novel technique, dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: a preliminary biomechanical study. Knee 2014; 21:477-80. [PMID: 24405792 DOI: 10.1016/j.knee.2013.11.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 10/30/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a common lesion. Current treatment emphasizes arthroscopic ACL reconstruction via a graft, although this approach is associated with potential drawbacks. A new method of dynamic intraligamentary stabilization (DIS) was subjected to biomechanical analysis to determine whether it provides the necessary knee stability for optimal ACL healing. METHODS Six human knees from cadavers were harvested. The patellar tendon, joint capsule and all muscular attachments to the tibia and femur were removed, leaving the collateral and the cruciate ligaments intact. The knees were stabilized and the ACL kinematics analyzed. Anterior-posterior (AP) stability measurements evaluated the knees in the following conditions: (i) intact ACL, (ii) ACL rupture, (iii) ACL rupture with primary stabilization, (iv) primary stabilization after 50 motion cycles, (v) ACL rupture with DIS, and (vi) DIS after 50 motion cycles. RESULTS After primary suture stabilization, average AP laxity was 3.2 mm, which increased to an average of 11.26 mm after 50 movement cycles. With primary ACL stabilization using DIS, however, average laxity values were consistently lower than those of the intact ligament, increasing from an initial AP laxity of 3.00 mm to just 3.2 mm after 50 movement cycles. CONCLUSIONS Dynamic intraligamentary stabilization established and maintained close contact between the two ends of the ruptured ACL, thus ensuring optimal conditions for potential healing after primary reconstruction. The present ex vivo findings show that the DIS technique is able to restore AP stability of the knee.
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Affiliation(s)
- Sandro Kohl
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland; Robert Mathys Foundation, Bettlach, Switzerland
| | - Dimitrios S Evangelopoulos
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland; 3rd Department of Orthopaedic Surgery, K.A.T. Hospital, University of Athens, Greece.
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland
| | - Heindrik Kohlhof
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland
| | | | - Harald Bonel
- Department of Radiology, Inselspital, University of Bern, Switzerland
| | - Stefan Eggli
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland
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Li ZC, Dai LY, Jiang LS, Qiu S. Difference in subchondral cancellous bone between postmenopausal women with hip osteoarthritis and osteoporotic fracture: Implication for fatigue microdamage, bone microarchitecture, and biomechanical properties. ACTA ACUST UNITED AC 2012; 64:3955-62. [DOI: 10.1002/art.34670] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 08/07/2012] [Indexed: 12/31/2022]
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Osbahr DC, Dines JS, Rosenbaum AJ, Nguyen JT, Altchek DW. Does posteromedial chondromalacia reduce rate of return to play after ulnar collateral ligament reconstruction? Clin Orthop Relat Res 2012; 470:1558-64. [PMID: 22009711 PMCID: PMC3348298 DOI: 10.1007/s11999-011-2132-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical studies suggest ulnohumeral chondral and ligamentous overload (UCLO) explains the development of posteromedial chondromalacia (PMC) in throwing athletes with ulnar collateral ligament (UCL) insufficiency. UCL reconstruction reportedly allows 90% of baseball players to return to prior or a higher level of play; however, players with concomitant posteromedial chondromalacia may experience lower rates of return to play. QUESTIONS/PURPOSES The purpose of this investigation is to determine: (1) the rates of return to play of baseball players undergoing UCL reconstruction and posteromedial chondromalacia; and (2) the complications occurring after UCL reconstruction in the setting of posteromedial chondromalacia. METHODS We retrospectively reviewed 29 of 161 (18%) baseball players who were treated for the combined posteromedial chondromalacia and UCL injury. UCL reconstruction was accomplished with the docking technique, and the PMC was addressed with nothing or débridement if Grade 2 or 3 and with débridement or microfracture if Grade 4. The mean age was 19.6 years (range, 16-23 years). Most players were college athletes (76%) and pitchers (93%). We used a modified four-level scale of Conway et al. to assess return to play with 1 being the highest level (return to preinjury level of competition or performance for at least one season after UCL reconstruction). The minimum followup was 24 months (mean, 37 months; range, 24-52 months). RESULTS Return to play was Level 1 in 22 patients (76%), Level 2 in four patients (14%), Level 3 in two patients (7%), and Level 4 in one (3%) patient. CONCLUSIONS Our data suggest baseball players with concomitant PMC, may have lower rates of return to the same or a higher level of play compared with historical controls. LEVEL OF EVIDENCE Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daryl C. Osbahr
- Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD USA
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Menashe L, Hirko K, Losina E, Kloppenburg M, Zhang W, Li L, Hunter DJ. The diagnostic performance of MRI in osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2012; 20:13-21. [PMID: 22044841 PMCID: PMC3934362 DOI: 10.1016/j.joca.2011.10.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/02/2011] [Accepted: 10/03/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is currently diagnosed using clinical and radiographic findings. In recent years magnetic resonance imaging (MRI) use in OA has increasingly been studied. This study was conducted to determine the diagnostic utility of MRI in OA through a meta-analysis of published studies. METHODS A systematic literature search was undertaken to include studies that used MRI to evaluate or detect OA. MRI was compared to various reference standards: histology, arthroscopy, radiography, CT, clinical evaluation, and direct visual inspection. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) area under the curve (AUC) were calculated. Random-effects models were used to pool results. RESULTS Of 20 relevant studies identified from the literature, 16 reported complete data and were included in the meta-analysis, with a total of 1220 patients (1071 with OA and 149 without). Overall sensitivity from pooling data of all the included studies was 61% [95% confidence interval (CI) 53-68], specificity was 82% (95% CI 77-87), PPV was 85% (95% CI 80-88), and NPV was 57% (95% CI 43-70). The ROC showed an AUC of 0.804. There was significant heterogeneity in the above parameters (I(2)>83%). With histology as the reference standard, sensitivity increased to 74% and specificity decreased to 76% compared with all reference standards combined. When arthroscopy was used as the reference standard, sensitivity increased to 69% and specificity to 93% compared with all reference standards combined. CONCLUSION MRI can detect OA with an overall high specificity and moderate sensitivity when compared with various reference standards, thus lending more utility to ruling out OA than ruling it in. The sensitivity of MRI is below the current clinical diagnostic standards. At this time standard clinical algorithm for OA diagnosis, aided by radiographs appears to be the most effective method for diagnosing OA.
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Affiliation(s)
- Leo Menashe
- Tufts University School of Medicine, Boston MA ,Division of Research, New England Baptist Hospital, 125 Parker Hill
Ave Boston MA 02120.
| | - Kelly Hirko
- Division of Research, New England Baptist Hospital, 125 Parker Hill
Ave Boston MA 02120.
| | - Elena Losina
- Department of Orthopedic Surgery, Brigham and Women’s
Hospital, Department of Biostatistics, Boston University School of Public Health,
Boston, MA USA.
| | | | - Weiya Zhang
- Academic Rheumatology, the University of Nottingham, Clinical
Sciences Building, Nottingham City Hospital, Nottingham NG5, 1PB, United Kingdom
| | - Ling Li
- Division of Research, New England Baptist Hospital, 125 Parker Hill
Ave Boston MA 02120.
| | - David J. Hunter
- Division of Research, New England Baptist Hospital, 125 Parker Hill
Ave Boston MA 02120. ,Northern Clinical School, The University of Sydney, Sydney,
Australia.
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Martí Bonmatí L, Alberich-Bayarri A, García-Martí G, Sanz Requena R, Pérez Castillo C, Carot Sierra JM, Manjón Herrera JV. [Imaging biomarkers, quantitative imaging, and bioengineering]. RADIOLOGIA 2011; 54:269-78. [PMID: 21733539 DOI: 10.1016/j.rx.2010.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 12/13/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
Abstract
Imaging biomarkers define objective characteristics extracted from medical images that are related to normal biological processes, diseases, or the response to treatment. To develop an imaging biomarker, it is necessary to carry out a series of steps to validate its relation with the reality studied and to check its clinical and technical validity. This process includes defining tests for the concepts and mechanisms; obtaining standardized and optimized anatomic, functional, and molecular images; analyzing the data with computer models; displaying data appropriately; obtaining the appropriate statistic measures; and conducting tests on the principle, efficacy, and effectiveness. In this article, we aim to explain the steps that must be established to enable biomarkers to be correctly applied, from their theoretical conception to their clinical implementation. To this end, we use the evaluation of angiogenesis in articular cartilage as an example.
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Affiliation(s)
- L Martí Bonmatí
- Servicio de Radiología, Hospital Quirón Valencia, Valencia, España.
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16
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Gadolinium-enhanced magnetic resonance imaging of the knee: an experimental approach. Skeletal Radiol 2010; 39:885-90. [PMID: 19357845 DOI: 10.1007/s00256-008-0645-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 11/27/2008] [Accepted: 12/26/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine gadolinium-enhanced magnetic resonance imaging (MRI) for monitoring cartilage degeneration. METHODS This is a proof-of-concept study in an animal model. Adult New Zealand rabbits were randomly stratified into five groups. Papain was injected intra-articularly in the right knee in four groups to establish the stages of cartilage degeneration. The left knee and group 5 served as controls. Bilateral MRI was performed 24 h after the initial injection of papain, and 1 week, 1 month, and 3 months following three papain injections. Injection of the contrast agent was followed by bilateral MRI examination immediately upon injection, and at 2 and 4 h post-injection. Signal intensities of articular cartilage and peripheral soft tissues were obtained before animals were sacrificed. Post-mortem bilateral cartilage specimens were studied histologically. RESULTS Histopathology results verified the staged degeneration of papain-treated articular cartilage. Differences in cartilage signal intensity were significant for the staged model using a special three-dimensional MRI method (P < 0.05) but not using ordinary MRI. No differences were observed within or between the control groups (P > 0.05). CONCLUSIONS Contrast-enhanced MRI examination may be a viable tool for early diagnosis of osteoarticular disease. Prospective studies are warranted to evaluate the potential for clinical application.
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Zhang ZM, Li ZC, Jiang LS, Jiang SD, Dai LY. Micro-CT and mechanical evaluation of subchondral trabecular bone structure between postmenopausal women with osteoarthritis and osteoporosis. Osteoporos Int 2010; 21:1383-90. [PMID: 19771488 DOI: 10.1007/s00198-009-1071-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 09/08/2009] [Indexed: 11/25/2022]
Abstract
SUMMARY An inverse relationship between osteoarthritis and osteoporosis has been debated over years. The microstructure of the femoral heads from postmenopausal osteoarthritic and osteoporotic women was evaluated with micro-CT. Significant differences were observed in microstructural parameters between them. Different microstructure might relate to the opposite bone defects in osteoarthritis and osteoporosis. INTRODUCTION This study was undertaken to verify the inverse relationship between osteoarthritis (OA) and osteoporosis (OP) by comparing the structural and mechanical indices. METHODS Femoral head specimens were obtained from 17 postmenopausal women (OA, n = 8; OP, n = 9) during hip surgery. The microstructural parameters were measured with micro-CT. Mechanical test was performed after bone cube scanning. RESULTS Significant difference in bone volume fraction (BV/TV) and trabecular thickness was noted between OA and OP groups. Structure model index decreased in OA, and increased in OP. The higher apparent density (AD) and lower material density (MD) were also shown in OA. Different from OP, positive correlation were noted between connectivity density and mechanical indices in OA. In OA group, BV/TV was associated with Young's modulus and AD, while trabecular number was the only parameter that correlated with MD. However, in OP group, only BV/TV correlated with yield strength, AD, and MD. CONCLUSIONS We observed the difference in microstructure between postmenopausal women with OA and OP, which might relate to the opposite bone defects in OA and OP. BV/TV might play an important role in mechanical properties of the subchondral bone in either OA or OP.
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Affiliation(s)
- Z-M Zhang
- Department of Orthopedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
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Sanz-Requena R, Martí-Bonmatí L, Hervás V, Vega M, Alberich-Bayarri A, García-Martí G, Carot JM. [Modification of longitudinal relaxation time (T1) as a biomarker of patellar cartilage degeneration]. RADIOLOGIA 2010; 52:221-7. [PMID: 20382403 DOI: 10.1016/j.rx.2010.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 12/27/2009] [Accepted: 01/11/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To study the viability of longitudinal relaxation time (T1) of patellar cartilage as a biomarker of the degree of degeneration. MATERIAL AND METHODS We included 15 subjects classified into three groups according to clinical criteria (pain, functional limitation, and duration of symptoms) and imaging criteria as follows: (a) normal (3 men, 2 women; age 30+/-14 years), (b) with initial degeneration of the patellar cartilage (3 men, 2 women; age 30+/-6 years), or (c) with advanced degeneration (3 men, 2 women; age 57+/-10 years). All underwent MRI examination using special echo-gradient sequences to segment the cartilage and calculate the T1 maps. We selected the entire cartilage and the regions of interest classified according to clinical and imaging criteria as normal, initial degeneration, and advanced degeneration. The T1 values of the cartilage were obtained pixel by pixel and were calculated as the mean for the entire cartilage or by subregions (normal, initial, advanced). Differences between groups for the entire cartilage and the regions were analyzed using Student-Newman-Keuls post-hoc ANOVA. Reproducibility was evaluated using the coefficient of variance. RESULTS No significant differences in the overall analysis of the entire cartilage were found between the three groups (normal: 1003+/-172 ms, initial: 1064+/-124 ms, advanced: 1041+/-308 ms, p=0.665). However, the analysis by regions revealed significant differences (normal: 908+/-53 ms, initial degeneration: 1057+/-157 ms, advanced degeneration: 1133+/-116 ms, p=0.029). The reproducibility analysis found variations of 1.3% for the overall calculation, 3.7% for the regional calculation, and 8.2% for the acquisition. CONCLUSION In this preliminary study, calculating the T1 of the cartilage enabled regions with different degrees of degeneration to be differentiated.
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Affiliation(s)
- R Sanz-Requena
- Servicio de Radiología, Hospital Quirón, Valencia, España.
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19
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Sanz-Requena R, Martí-Bonmatí L, Hervás V, Vega M, Alberich-Bayarri Á, García-Martí G, Carot J. Modification of longitudinal relaxation time (T1) as a biomarker of patellar cartilage degeneration. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Experimental model to evaluate in vivo and in vitro cartilage MR imaging by means of histological analyses. Eur J Radiol 2009; 70:561-9. [DOI: 10.1016/j.ejrad.2008.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 02/26/2008] [Accepted: 02/29/2008] [Indexed: 11/21/2022]
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Shen Y, Zhang ZM, Jiang SD, Jiang LS, Dai LY. Postmenopausal women with osteoarthritis and osteoporosis show different ultrastructural characteristics of trabecular bone of the femoral head. BMC Musculoskelet Disord 2009; 10:35. [PMID: 19356253 PMCID: PMC2674588 DOI: 10.1186/1471-2474-10-35] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 04/09/2009] [Indexed: 12/02/2022] Open
Abstract
Background Osteoporosis (OP) and osteoarthritis (OA) are public health diseases affecting the quality of life of the elderly, and bring about a heavy burden to the society and family of patients. It has been debated whether or not there is an inverse relationship between these two disorders. Methods To compare the exact difference in bone tissue structure between osteoporosis and osteoarthritis, we observed the ultrastructure of trabecular bone from the femoral heads using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). A total of 15 femoral head specimens from postmenopausal women were collected during the procedures of total or hemi hip replacement (OP, n = 8; OA, n = 7). The morphologic structure of the trabecular bone, collagen fibers, resorption lacuna and osteoblasts were observed. Results Under SEM, osteoporotic trabeculae appeared to be thinning, tapering, breaking and perforating. A number of resorption lacunae of various shapes were seen on the surface of the trabeculum. The collagen fibers of lacuna were resorbed. On occasion, naked granular bone crystals could be found. In the OA group, the trabecular bone looked thick with integrated structure. Reticular and granular new bone could be found. The trabeculum was covered by well-arranged collagen fibers around the resorption lacuna. In the OP group, under TEM, marginal collagen fibers were observed to be aligned loosely with enlarged spaces. A few inactive osteoblasts and no inflammatory cells were seen. In the OA group, the collagen fibers inside the trabeculum were arranged in a dense manner with many active osteoblasts and inflammatory cells infiltrating the matrix. Conclusion We found significant differences in the trabecular bone, collagen fibers, lacunae and osteoblasts between postmenopausal women with OP and OA. These findings support the hypothesis that there is an inverse relationship between OP and OA.
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Affiliation(s)
- Yun Shen
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, PR China.
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22
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Saupe N, Pfirrmann CWA, Schmid MR, Schertler T, Manestar M, Weishaupt D. MR imaging of cartilage in cadaveric wrists: comparison between imaging at 1.5 and 3.0 T and gross pathologic inspection. Radiology 2007; 243:180-7. [PMID: 17312277 DOI: 10.1148/radiol.2431060294] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate prospectively the diagnostic accuracy of magnetic resonance (MR) imaging in the identification of cartilage abnormalities at 3.0 and 1.5 T in cadaveric wrists, with gross pathologic findings as the standard of reference. MATERIALS AND METHODS The study was approved by the hospital review board, and informed consent for scientific use of body parts had been provided by the subjects. Ten cadaveric wrists from nine subjects were evaluated (seven left wrists, three right; five women, four men; age range, 46-99 years; mean age, 80 years). All wrists were examined with MR imaging in a 1.5-T unit and a 3.0-T unit, with the same imaging protocol used with both systems. Imaging protocol included intermediate-weighted fast spin-echo sequences and three-dimensional gradient-recalled-echo sequences. Cartilage surfaces of the proximal and distal carpal row, including the scaphotrapeziotrapezoidal joint, were analyzed in blinded fashion by two musculoskeletal radiologists working independently and then in consensus. Open inspection of the wrists was used as the standard of reference. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. The McNemar test was used to assess differences in diagnostic assessment. Weighted kappa values were calculated for interobserver agreement. RESULTS One hundred seventy cartilage surfaces were graded. The sensitivity and specificity for cartilage lesions were 43%-52% and 82%-89%, respectively, at 1.5 T and 48%-52% and 82% at 3.0 T. Differences in assessment did not reach statistical significance (P > .99). Highest sensitivities were found in the proximal carpal row (67%-71%); lowest sensitivities were found in the distal carpal row (14%-24%). Interobserver agreement was higher for imaging at 3.0 T (kappa = 0.634) than at 1.5 T (kappa = 0.267). CONCLUSION The performance of MR imaging for the detection of articular cartilage abnormalities in the wrist depends on anatomic location. Interobserver agreement is higher for imaging at 3.0 than at 1.5 T, but diagnostic performances were not significantly different (P > .99) at either field strength.
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Affiliation(s)
- Nadja Saupe
- Department of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
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Lahm A, Kreuz PC, Oberst M, Haberstroh J, Uhl M, Maier D. Subchondral and trabecular bone remodeling in canine experimental osteoarthritis. Arch Orthop Trauma Surg 2006; 126:582-7. [PMID: 16331520 DOI: 10.1007/s00402-005-0077-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We wanted to test the hypothesis that quality changes occur in early-stage arthritic subchondral cancellous bone after acute subchondral damage. So far, not much attention has been paid to changes of the subchondral bone after traumatic subchondral lesions. MATERIALS AND METHODS With an established animal model, we produced pure subchondral damage without initial affection of the articular cartilage in 12 Beagle dogs under MRI and histological control. We utilized bone histomorphometry to evaluate bone turnover, its structure and the articular cartilage 6 months after the initial damage. RESULTS On follow-up, bone remodelling was indicated, e.g. by a significant increase in the trabecular bone volume and thickness, osteoblast number and osteoid surface and a decrease in the trabecular number in all 12 samples. Several other parameters showed a tendency, e.g. osteoblast surface and osteoclast number. Cartilage analysis showed degenerative changes in ten of 12 samples that had not shown any evidence of damage during the initial examination. DISCUSSION Our investigation indicates a significant deterioration in the architecture of the cancellous bone with degenerative changes of the overlying articular cartilage after subchondral lesions, which change the mechanical properties.
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Affiliation(s)
- A Lahm
- Department of Orthopaedic and Trauma Surgery, University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
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Lahm A, Uhl M, Edlich M, Erggelet C, Haberstroh J, Kreuz PC. An experimental canine model for subchondral lesions of the knee joint. Knee 2005; 12:51-5. [PMID: 15664878 DOI: 10.1016/j.knee.2004.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Revised: 01/08/2004] [Accepted: 01/20/2004] [Indexed: 02/02/2023]
Abstract
Aim of the study was to create an animal model for the investigation of the role of subchondral bone damage without initial cartilage lesion in the pathogenesis of osteoarthritis, the mechanical properties of the joints as well as its role in cartilage metabolism. Therefore, after cadaver studies an animal model was created to apply a transarticular load to the femoro-patellar joint under reproducible conditions and produce a pure subchondral damage without affecting the articular cartilage. Following the cadaver studies a first group of four dogs was impacted to identify forces to produce isolated subchondral fractures in the femoral condyle. Then a second group of 12 dogs knee joints was impacted under identical conditions with forces of approximately 2100 N to produce similar subchondral fractures without cartilage damage in one joint under MRI control: T1-weighted SE-sequences. T2-weighted TSE, fat suppressed TIRM-sequences and 3D-FLASH fat saturated sequences. FLASH 3D-sequences revealed intact cartilage after impact in all cases and TIRM-sequences showed subchondral fractures representing bleeding, microfractures and fragmented bone trabecules. Turbo spin echo sequences and T1-weighted images revealed other intact intraarticular structures such as ligaments and menisci. The proposed experimental animal model is suitable to investigate the effect of pure subchondral damage on the articular cartilage and on means of treatment of cartilage defects without surgical intervention and without initial cartilage damage.
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Affiliation(s)
- A Lahm
- Department of Orthopaedic Surgery, University Hospital Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
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25
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Batiste DL, Kirkley A, Laverty S, Thain LMF, Spouge AR, Gati JS, Foster PJ, Holdsworth DW. High-resolution MRI and micro-CT in an ex vivo rabbit anterior cruciate ligament transection model of osteoarthritis. Osteoarthritis Cartilage 2004; 12:614-26. [PMID: 15262241 DOI: 10.1016/j.joca.2004.03.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Accepted: 03/20/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the potential of using non-invasive, multi-modality imaging techniques to quantify disease progression in a rabbit model of experimentally induced osteoarthritis (OA). METHODS High-resolution 4-T magnetic resonance imaging (MRI) and micro-computed tomography (micro-CT) techniques were implemented and validated in an ex vivo rabbit anterior cruciate ligament transection (ACLT) model of OA. A three-dimensional (3-D) rigid body registration technique was executed and evaluated to allow combined MR-CT analysis in co-registered image volumes of the knee. RESULTS The 3-D MRI and micro-CT data formats made it possible to quantify cartilage damage, joint-space, and osseous changes in the rabbit ACLT model of OA. Spoiled gradient-recalled echo and fast-spin echo (FSE) sequences were jointly used to evaluate femorotibial cartilage and determine the sensitivity (78.3%) and specificity (95.3%) of 4-T MRI to detect clinically significant cartilage lesions. Overall precision error of the micro-CT technique for analysis of joint-space, volumetric bone mineral density (vBMD), and bone volume fraction (BV/TV) was 1.8%, 1.2%, and 2.0%, respectively. Co-registration of the 3-D data sets was achieved to within 0.36 mm for completed intermodality registrations, 0.22 mm for extrapolated intramodality registrations, and 0.50mm for extrapolated intermodality registrations. CONCLUSIONS These results indicate that high-resolution 4-T MRI and micro-CT can be used to accurately quantify cartilage damage and calcified tissue changes in the rabbit ACLT model of OA. In addition, image volumes can be successfully co-registered to facilitate a comprehensive multi-modality examination of localized changes in both soft tissue and bone within the rabbit femorotibial joint.
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Affiliation(s)
- Danika L Batiste
- Imaging Research Laboratories, Robarts Research Institute, P.O. Box 5015, 100 Perth Drive, London, Ontario, Canada N6A 5K8
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Nag D, Liney GP, Gillespie P, Sherman KP. Quantification of T2 relaxation changes in articular cartilage with in situ mechanical loading of the knee. J Magn Reson Imaging 2004; 19:317-22. [PMID: 14994300 DOI: 10.1002/jmri.20000] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To devise a method for producing in vivo MRI images of the knee under physiologically significant loading, and to compare and evaluate the changes in cartilage characteristics before and during in situ compression of the knee. MATERIAL AND METHODS A total of 26 asymptomatic subjects were imaged on a 1.5 Tesla Philips Intera scanner using a commercially available knee coil. Routine anatomical images were followed by T(2) map acquisition. These scans were repeated following in situ compression of the knee using a MR compatible loading jig. RESULTS Following loading to body weight, several regions of femoral cartilage show early alteration of T(2) relaxation time, most significantly in the medial and lateral peripheral zones. There were no significant changes in the tibial cartilage. CONCLUSIONS The results establish the feasibility of measuring changes on MRI with in situ axial loading.
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Affiliation(s)
- David Nag
- Centre for MR Investigations, Hull Royal Infirmary, Hull, UK
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McGibbon CA, Bencardino J, Palmer WE. Subchondral bone and cartilage thickness from MRI: effects of chemical-shift artifact. MAGMA (NEW YORK, N.Y.) 2003; 16:1-9. [PMID: 12695880 DOI: 10.1007/s10334-003-0001-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Magnetic resonance imaging (MRI) is the modality of choice for visualizing and quantifying articular cartilage thickness. However, difficulties persist in MRI of subchondral bone using spoiled gradient-echo (SPGR) and other gradient-echo sequences, primarily due to the effects of chemical-shift artifact. Fat suppression techniques are often used to reduce these artifacts, but they prevent measurement of bone thickness. In this report, we assess the magnitude of chemical-shift effects (phase-cancellation and misregistration artifacts) on subchondral bone and cartilage thickness measurements in human femoral heads using a variety of pulse sequence parameters. Phase-cancellation effects were quantified by comparing measurements from in-phase images (TE=13.5 ms) to out-of-phase images (TE=15.8 ms). We also tested the assumption of the optimal in-phase TE by comparing thickness measures at small variations on TE (13.0, 13.5 and 14.0 ms). Misregistration effects were quantified by comparing measurements from water+fat images (water-only+fat-only images) to the measurements from in-phase (TE=13.5) images. A correction algorithm was developed and applied to the in-phase measurements and then compared to measurements from water+fat images. We also compared thickness measurements at different image resolutions. Results showed that both phase-cancellation artifact and misregistration artifact were significant for bone thickness measurement, but not for cartilage thickness measurement. Using an in-phase TE and correction algorithm for misregistration artifact, the errors in bone thickness relative to water+fat images were non-significant. This information may be useful for developing pulse sequences for optimal imaging of both cartilage and subchondral bone.
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Affiliation(s)
- Chris A McGibbon
- Department of Orthopaedics, Massachusetts General Hospital, Ruth Sleeper Hall 010, 40 Parkman St, Boston, MA, 02114 USA.
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Link TM, Steinbach LS, Ghosh S, Ries M, Lu Y, Lane N, Majumdar S. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology 2003; 226:373-81. [PMID: 12563128 DOI: 10.1148/radiol.2262012190] [Citation(s) in RCA: 345] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To determine whether knee pain, stiffness, and limited function in patients with different stages of osteoarthritis correlate with the degree of disease assessed on magnetic resonance (MR) images and radiographs. MATERIALS AND METHODS Radiographs in 50 patients with varying degrees of osteoarthritis of the knee were assessed by using the the Western Ontario and McMaster University (WOMAC) osteoarthritis index and the Kellgren-Lawrence (KL) scale. MR images were obtained and analyzed by two readers for cartilage lesions, bone marrow edema pattern, and ligamentous and meniscal lesions. RESULTS Thirteen of 16 knees with a KL score of 4 showed full-thickness cartilage lesions and bone marrow edema pattern. Cruciate ligament tears were found in five of 12 knees with a KL score of 3 and in nine of 16 knees with a KL score of 4. While the KL score correlated significantly (P <.05) with the grade of cartilage lesions, and a substantially higher percentage of lesions with higher KL scores were found on MR images, the correlations between MR imaging findings and KL score versus clinical findings were not significant (P >.05). Significant differences between WOMAC scores were found only for the grades of cartilage lesions (P <.05). CONCLUSION Cartilage lesions, bone marrow edema pattern, and meniscal and ligamentous lesions were frequently demonstrated on MR images in patients with advanced osteoarthritis. Clinical findings showed no significant correlations with KL score and extent of findings at MR imaging.
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Affiliation(s)
- Thomas M Link
- Department of Radiology, University of California, San Francisco, CA, USA.
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Patel V, Issever AS, Burghardt A, Laib A, Ries M, Majumdar S. MicroCT evaluation of normal and osteoarthritic bone structure in human knee specimens. J Orthop Res 2003; 21:6-13. [PMID: 12507574 DOI: 10.1016/s0736-0266(02)00093-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although trabecular bone structure has been evaluated, variation with knee compartment and depth from joint surface is not completely understood. Cadaver knees were evaluated with microcomputed tomography analysis for these variations. Objective differences were compared between: medial vs. lateral compartments; femoral vs. tibial bone; and normal vs. arthritic knees. Depth dependent changes in the parameters were observed for the first 6 mm of the cores in normal knees: BV/TV, Tb.N and Conn.D gradually decrease, while Tb.Sp and SMI increase. In the first 6 mm of the normal tibia BV/TV, Tb.N, and Tb.Th are greater than in the femur on both the medial and lateral compartments while Tb.Sp, SMI, and Conn.D are lower. The medial compartment values for BV/TV, Tb.N, Tb.Th and Conn.D are generally greater than for the lateral in both the femur and tibia while Tb.Sp and SMI are lower. In comparison of normal vs. arthritic knees significant differences are observed in the first 6 mm of the medial tibia. With arthritis BV/TV and Tb.Th are lower, while SMI and Tb.Sp are higher. Tb.N and Conn.D show no statistically significant difference. The bone structure variations are, thus, most prominent in the first 6 mm of depth and medial compartment bone is generally more structurally sound than lateral. Severely arthritic bone changes are most prominent in the medial compartment of the tibia and bone structure is less sound in severe arthritis.
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Affiliation(s)
- Vikas Patel
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143-1290, USA
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Vande Berg BC, Lecouvet FE, Poilvache P, Jamart J, Materne R, Lengele B, Maldague B, Malghem J. Assessment of knee cartilage in cadavers with dual-detector spiral CT arthrography and MR imaging. Radiology 2002; 222:430-6. [PMID: 11818610 DOI: 10.1148/radiol.2222010597] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess dual-detector spiral CT arthrography in the evaluation of the entire knee cartilage obtained from cadavers. MATERIALS AND METHODS Two independent observers characterized articular cartilage in 12 cadaver knees in which MR imaging and dual-detector spiral CT arthrography were performed and compared their findings to those found during macroscopic assessment. The sensitivity and specificity of MR imaging and spiral CT arthrography for detecting grade 2A or higher and grade 2B or higher cartilage lesions, the Spearman correlation coefficient between arthrographic and macroscopic grading, and kappa statistics for assessing interobserver reproducibility were determined. RESULTS At spiral CT arthrography, sensitivities and specificities ranged between 80% and 88% for the detection of grade 2A or higher cartilage lesions and ranged between 85% and 94% for the detection of grade 2B or higher cartilage lesions. At MR imaging, sensitivities and specificities ranged between 78% and 86% and between 76% and 91% for the detection of grade 2A or higher and grade 2B or higher cartilage lesions, respectively. Spearman correlation coefficients between spiral CT arthrography or MR imaging and macroscopic grading of articular surfaces were 0.797 and 0.702, respectively. CONCLUSION Dual-detector spiral CT arthrography of the knee is a valuable method for the assessment of open cartilage lesions of the entire knee.
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Affiliation(s)
- Bruno C Vande Berg
- Department of Radiology, Cliniques Universitaires St Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium.
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Glaser C, Faber S, Eckstein F, Fischer H, Springer V, Heudorfer L, Stammberger T, Englmeier KH, Reiser M. Optimization and validation of a rapid high-resolution T1-w 3D FLASH water excitation MRI sequence for the quantitative assessment of articular cartilage volume and thickness. Magn Reson Imaging 2001; 19:177-85. [PMID: 11358655 DOI: 10.1016/s0730-725x(01)00292-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In view of follow up, survey and development of therapeutic strategies for osteoarthritis where cartilage deterioration plays an important role, a non invasive, reliable and quantitative assessment of the articular cartilage is desirable. The currently available high resolution T(1)-weighted (T1-w) 3D FLASH pulse sequences with frequency selective fat suppression are very time consuming. We have 1) optimized a high resolution T1-w 3D FLASH water excitation (WE) sequence for short acquisition time and cartilage visualization, and 2) validated this sequence for cartilage volume and thickness quantification. The spectral fat presaturation was replaced by selective water excitation. The flip angle of the WE sequence was optimized for the contrast to noise (C/N(cart)) ratio of cartilage. Sagittal datasets (voxel size: 0.31 x 0.31 x 2 mm(3)) of the knees of nine healthy volunteers were acquired both, with the 3D FLASH WE (17.2/6.6/30 degrees ) sequence (WE) and a previously validated 3D FLASH fat saturated (42/11/30 degrees ) sequence (FS). For validation of the WE sequence, cartilage volume, mean and maximal cartilage thickness of the two sequences were compared. Reproducibility was assessed by calculating the coefficient of variation (COV %) of 4 consecutive WE data sets in the volunteers. The acquisition time was reduced from 16'30" (FS) down to 7'14" for the WE sequence. Image contrast and visualization of the cartilage was very similar, but delineation of the basal layer of the cartilage was slightly improved with the WE sequence. A flip angle of 30 degrees provided the best C/N(cart) ratios (WE). Reproducibility (COV) was between 1.9 and 5.9%. Cartilage volume and thickness agreed within 4% between FS and WE sequence. The WE sequence allows for rapid, valid and reproducible quantification of articular cartilage volume and thickness, prerequisites for follow-up examinations. The reduced acquisition time (50% of FS) enables routine clinical application and thus may contribute to a broader assessment of osteoarthritis.
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Affiliation(s)
- C Glaser
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München Marchioninistr. 15, D-81377 Münich, Germany.
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