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Vujovic S, Henderson S, Presneau N, Odell E, Jacques TS, Tirabosco R, Boshoff C, Flanagan AM. Brachyury, a crucial regulator of notochordal development, is a novel biomarker for chordomas. J Pathol 2006; 209:157-65. [PMID: 16538613 DOI: 10.1002/path.1969] [Citation(s) in RCA: 371] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chordomas are malignant tumours that occur along the spine and are thought to derive from notochordal remnants. There is significant morphological variability between and within chordomas, with some showing prominent areas of chondroid differentiation. Our microarray data from a broad range of connective tissue neoplasms indicate that, at the transcriptional level, chordomas resemble cartilaginous neoplasms. Here we show that chordomas express many genes known to be involved in cartilage development, but they also uniquely express genes distinguishing them from chondroid neoplasms. The brachyury transcription factor, known to be involved in notochordal development, is only expressed by chordomas. Using a polyclonal antibody, we show that brachyury is expressed in the embryonic notochord and in all 53 chordomas analysed, labelling both chondroid and chordoid areas of these tumours. In contrast, the protein was not detected in over 300 neoplasms, including 163 chondroid tumours. Brachyury was not detected in the nucleus pulposus, arguing against the hypothesis that this tissue derives directly from the notochord. These data provide compelling evidence that chordomas derive from notochord and demonstrate that brachyury is a specific marker for the notochord and notochord-derived tumours.
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102
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Jones AO, Houang MTW, Low RS, Wood DG. Medial meniscus posterior root attachment injury and degeneration: MRI findings. ACTA ACUST UNITED AC 2006; 50:306-13. [PMID: 16884414 DOI: 10.1111/j.1440-1673.2006.01586.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The posterior root attachment of the medial meniscus is readily identifiable on MRI. Unless specifically reviewed, injuries involving this structure may be overlooked. Significant meniscal root pathology may cause functional incompetence of the meniscus, with consequent early onset cartilage degeneration and osteoarthritis. This review article emphasizes the importance of positive identification of an intact meniscal root and illustrates the known association of meniscal root injury or tear with medial extrusion of the medial meniscus by greater than 3 mm beyond the joint margin.
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Jungius KP, Schmid MR, Zanetti M, Hodler J, Koch P, Pfirrmann CWA. Cartilaginous defects of the femorotibial joint: accuracy of coronal short inversion time inversion-recovery MR sequence. Radiology 2006; 240:482-8. [PMID: 16801363 DOI: 10.1148/radiol.2401050077] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively assess the diagnostic performance of the short inversion time inversion-recovery (STIR) magnetic resonance (MR) sequence for depiction and classification of articular cartilaginous lesions in femorotibial joint, with arthroscopy as reference standard. MATERIALS AND METHODS Institutional review board did not require approval and informed consent for review of patients' records or images. All patients (and parents of underage patients) agreed to use of their data. Two musculoskeletal radiologists independently analyzed femorotibial cartilage on coronal STIR images from 84 knee MR examinations in 83 patients (48 male patients [49 knees], 35 female patients; mean age, 39.5 years). Slightly modified Outerbridge classification was used: grade 0, normal cartilage; grade 1, softening or swelling; grade 2, partial-thickness defect; grade 3, fissuring to the level of the subchondral bone; and grade 4, exposed subchondral bone. Arthroscopy performed within 15 weeks was the standard of reference. Classification for arthroscopy differed only in definition of grade 1 (softening or swelling of cartilage). Sensitivity, specificity, accuracy, positive and negative predictive values, and weighted kappa values were calculated to assess interobserver reliability. RESULTS At arthroscopy, 212 (63%) of 336 surfaces were classified as grade 0 (normal); 37 (11%), as grade 1 abnormalities; 30 (9%), as grade 2 lesions; 25 (7%), as grade 3 lesions; and 32 (10%), as grade 4 lesions. Grades 0 and 1 were considered normal; grades 2-4, as abnormal. For detection of contour defects of the cartilaginous surface, coronal STIR MR imaging had sensitivity values of 77% and 76%, specificity values of 96% and 89%, accuracy values of 91% and 85%, positive predictive values of 86% and 70%, and negative predictive values of 92% and 91% for readers 1 and 2, respectively. Weighted kappa value was 0.63. CONCLUSION Contour defects of femorotibial cartilage can be detected with reasonable accuracy with routine STIR sequence.
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Cuculi F, Brink T, Fischer A, Hadjeres L. [Thoracic pain, sudden sedimentation rate decline, microhematuria and a red ear--what the clinician should also consider!]. PRAXIS 2006; 95:917-8. [PMID: 16774052 DOI: 10.1024/0369-8394.95.22.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Eine 71-jährige Patientin wurde vom Hausarzt zur Abklärung von Dyspnoe und rechts-thorakalen Schmerzen zugewiesen. Sie wurde bis zur Einweisung während zwei Wochen wegen Verdachts auf Pneumonie mit drei verschiedenen Antibiotika erfolglos behandelt. Die Patientin hatte bei Eintritt erhöhte Entzündungsparameter (CRP 77 mg/l, BSG 90 mm/h) und beidseitige Pleuraergüsse im Röntgenbild. Am Folgetag klagte sie über Schmerzen im Bereich des linken Ohres, das gerötet, überwärmt und geschwollen war. Da das Ohrläppchen ausgespart war, wurde die Diagnose einer Perichondritis gestellt. Zusätzlich entwickelte die Patientin eine Episkleritis des rechten Auges, die BSG stieg auf über 100 mm/h an, das Kreatinin betrug 96 µmol/l und die Urinuntersuchung zeigte eine glomeruläre Mikrohämaturie und eine Proteinurie. Die c-ANCA-Serologie war mit einem Titer von 1:2560 deutlich positiv. Die Nierenbiopsie zeigte eine extrakapillär proliferative, pauciimmune Glomerulonephritis, vereinbar mit der Diagnose eines Morbus Wegeners. Unter kombinierter Immunosuppression mit Prednison (50 mg/Tag) und Endoxan (100 mg/Tag) war der Verlauf durch das Verschwinden der Perichondritis, Pleuritis, Episkleritis und durch eine Normalisierung der Nierenfunktion gekennzeichnet. Eine Perichondritis des Ohres ist ein seltenes, jedoch wichtiges Präsentationszeichen eines Morbus Wegeners.
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Abstract
The motivation for cartilage repair is the preservation of adequate joint motion. Repairing joint surface congruity and providing balanced load bearing are crucial for this. MRI can contribute to this goal by describing number, depth, size, and distribution of cartilage lesions throughout the different joint compartments. Essential to such a contribution are adequate spatial resolution at a reasonable SNR together with good contrast between both cartilage and the subchondral bone as well as the joint space. For TSE sequences, this is achieved using TEs between 30 and 50 ms. Diagnostic accuracy is optimal when a lesion is depicted in more than one plane. Short TE, high bandwidth, and the appropriate orientation of the frequency encoding direction contribute to minimizing metal artifacts. Besides internal alterations of the cartilage's matrix, moderately T2-weighted TSE sequences sensitively depict bone marrow edema such as signal alterations and joint effusion, both contributing to highlight even subtle cartilage lesions. T1-weighted FS/WE 3D GE sequences profit from their high spatial resolution to appreciate gradual erosion of the cartilage. In OD the interface to the surrounding bone, the integrity of the overlying cartilage, and associated cysts are used to determine stability. The presence of two or more findings increases diagnostic accuracy. Prognosis is associated with the size of the affected area.
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106
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Li LP, Herzog W. Arthroscopic evaluation of cartilage degeneration using indentation testing--influence of indenter geometry. Clin Biomech (Bristol, Avon) 2006; 21:420-6. [PMID: 16457915 DOI: 10.1016/j.clinbiomech.2005.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 10/24/2005] [Accepted: 12/13/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND It has been suggested that the early onset of cartilage degeneration might be detected with a handheld indentation probe during knee arthroscopy, prior to any visible change on the articular surface. Collagen degradation has been considered as the first sign of cartilage degeneration. Therefore, it is important to consider the collagen network as a distinct constituent in the study of arthroscopic evaluation of cartilage degeneration. METHODS The tip of an arthroscopic probe (indenter) was modeled as rigid and in contact with a cartilage/bone disk of sufficiently large radius to simulate an indentation in a joint. A fibril-reinforced model of cartilage, including streaming potentials and distinct constitutive laws for the proteoglycan matrix and collagen network, was used to determine the contact mechanics of indenter and cartilage. The finite element package ABAQUS was employed to obtain numerical solutions. FINDINGS A spherical indenter produces a relatively uniform deformation in cartilage, but can easily slide on the articular surface. In contrast, a cylindrical indenter produces great deformation gradients for quick compression rates, but does not slide as easily on the articular surface as the spherical indenter. Small porous and large solid indenters should be used to evaluate the properties of the proteoglycan matrix and collagen network, respectively, in order to minimize or maximize the fluid pressure in the corresponding case. When the collagen network is substantially degraded, the gradients of fluid pressure and deformation are greatly reduced regardless of indenter geometry. INTERPRETATION The indenter geometry including its porosity is important to the material safety of articular cartilage in indentation and precise evaluation of cartilage degeneration.
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107
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Valera FCP, Tamashiro E, de Araújo MM, Sander HH, Küpper DS. Evaluation of the Efficacy of Supraglottoplasty in Obstructive Sleep Apnea Syndrome Associated With Severe Laryngomalacia. ACTA ACUST UNITED AC 2006; 132:489-93. [PMID: 16702563 DOI: 10.1001/archotol.132.5.489] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the clinical and polysomnographic evolution of patients with severe laryngomalacia who underwent supraglottoplasty. DESIGN Retrospective study. SETTING University hospital. PATIENTS Seven children with severe laryngomalacia. MAIN OUTCOME MEASURES The patients were evaluated with a questionnaire given to their parents and with polysomnographic examination before and 3 months after surgery. The clinical data of respiratory and swallowing symptoms as well as the parameters of minimum oxygen saturation and respiratory disturbance index were evaluated after bilateral supraglottoplasty and compared with the preoperative data. RESULTS Two patients had pharyngolaryngomalacia and required tracheotomy. Four patients had a marked improvement of respiratory and deglutition symptoms. Polysomnographic data showed a significant improvement in the respiratory disturbance index after surgery (P<.05) but not in the minimum oxygen saturation level. However, this improvement was only partially achieved in 3 patients, in whom there were associated airway or neurologic changes. No serious surgical complications were observed. CONCLUSION Supraglottoplasty led to a marked improvement in all 5 patients without pharyngolaryngomalacia, but the 2 patients with pharyngolaryngomalacia required tracheotomy.
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Kijowski R, Blankenbaker DG, Stanton PT, Fine JP, De Smet AA. Radiographic findings of osteoarthritis versus arthroscopic findings of articular cartilage degeneration in the tibiofemoral joint. Radiology 2006; 239:818-24. [PMID: 16641340 DOI: 10.1148/radiol.2393050584] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To retrospectively correlate radiographic findings of osteoarthritis of the tibiofemoral joint with arthroscopic findings of articular cartilage degeneration within the tibiofemoral joint in patients with chronic knee pain. MATERIALS AND METHODS The study was performed in compliance with HIPAA regulations. Approval from an institutional review board and a waiver of informed consent were obtained. The study group consisted of 125 patients with osteoarthritis of the tibiofemoral joint (66 men, 59 women; age range, 35-77 years; average age, 52 years) and 25 patients of similar age (14 men, 11 women; age range, 36-69 years; average age, 50 years) with no osteoarthritis of the tibiofemoral joint. All patients underwent standing anteroposterior radiography of the knee prior to arthroscopic knee surgery. Each articular surface of the tibiofemoral joint was graded at arthroscopy. Two radiologists retrospectively reviewed the knee radiographs to determine the presence of marginal osteophytes, joint space narrowing, subchondral sclerosis, and subchondral cysts. The sensitivity and specificity of the radiographic features of osteoarthritis for the detection of articular cartilage degeneration within the medial and lateral compartments of the tibiofemoral joint were determined. RESULTS The sensitivity of marginal osteophytes, joint space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration was 67%, 46%, 16%, and 10%, respectively, for the medial compartment and 49%, 7%, 6%, and 3%, respectively, for the lateral compartment. The specificity of marginal osteophytes, joint space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration was 73%, 95%, 100%, and 100%, respectively, for the medial compartment and 81%, 100%, 100%, and 100%, respectively, for the lateral compartment. CONCLUSION Marginal osteophytes were the most sensitive radiographic feature for the detection of osteoarthritis of the tibiofemoral joint. Joint space narrowing, subchondral sclerosis, and subchondral cysts were less sensitive radiographic features of osteoarthritis and rarely occurred in the absence of associated osteophyte formation.
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Puig L, Monllau JC, Corrales M, Pelfort X, Melendo E, Cáceres E. Factors affecting meniscal extrusion: correlation with MRI, clinical, and arthroscopic findings. Knee Surg Sports Traumatol Arthrosc 2006; 14:394-8. [PMID: 16163556 DOI: 10.1007/s00167-005-0688-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 04/14/2005] [Indexed: 10/25/2022]
Abstract
The existence of meniscal extrusion is well known in the natural history of the osteoarthritic knee. However, extruded menisci are also seen in non-pathologic knees. To ascertain the prevalence of meniscal extrusion in non-arthritic patients, the MRIs of 100 knees were prospectively studied. The data were correlated both with clinical and operative arthroscopic findings. The results showed 68.5% of the medial menisci to have some degree of extrusion, averaging at 28% of the meniscal size. While the lateral meniscus were extruded in 18.8% of cases at an average of 15% of the meniscal size. Furthermore, a relationship between the anterior insertion variant of the anterior medial meniscus and meniscal extrusion was found (P=0.001) in this series. The results suggest meniscal extrusion to be much more common in non-arthritic knees than previously estimated. The results also suggest that when the anterior horn of the medial meniscus inserts anteriorly in the tibial plateau, the meniscus tends to be extruded. It must be kept in mind that one of the limitations of this work is that the MRIs are taken in a non-weightbearing position.
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Murgu SD, Colt HG. A 68-Year-Old Man With Intractable Dyspnea and Wheezing 45 Years After a Pneumonectomy. Chest 2006; 129:1107-11. [PMID: 16608964 DOI: 10.1378/chest.129.4.1107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
The assessment of articular cartilage using magnetic resonance imaging has seen considerable advances in recent years. Cartilage morphologic characteristics can now be evaluated with a high degree of accuracy and reproducibility using dedicated pulse sequences, which are becoming standard at many institutions. These techniques detect clinically unsuspected traumatic cartilage lesions, allowing the physician to study their natural history with longitudinal evaluation and also to assess disease status in degenerative osteoarthritis. Magnetic resonance imaging also provides a more objective assessment of cartilage repair to augment the information obtained from more subjective clinical outcome instruments. Newly developed methods that provide detail at an ultrastructural level offer an important addition to cartilage evaluation, particularly in the detection of early alterations in the extracellular matrix. These methods have created an undeniably important role for magnetic resonance imaging in the reproducible, noninvasive, and objective evaluation and monitoring of cartilage. An overview of the advances, current techniques, and impact of magnetic resonance imaging in the setting of trauma, degenerative arthritides, and surgical treatment for cartilage injury is presented.
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Handl M, Filová E, Kubala M, Lánský Z, Kolácná L, Vorlícek J, Trc T, Pach M, Amler E. Fluorescent advanced glycation end products in the detection of factual stages of cartilage degeneration. Physiol Res 2006; 56:235-242. [PMID: 16555949 DOI: 10.33549/physiolres.930934] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients treated for knee disorders were included in this study. They were examined clinically (Lequesne and Tegner scores) and by standard X-ray investigation. Patients underwent a surgical procedure, either arthroscopy or knee replacement. At the initial phase of surgery, a sample of cartilage was taken for laboratory examination. Progression of the disorder and the clinical examination was correlated with the actual state of the cartilage using a novel fluorescence approach. The intrinsic fluorescence of cartilages was shown as a suitable and sensitive method for detection of the actual state of cartilages because the correlation with X-ray examination and clinical status was found. Intrinsic fluorescence properties of cartilages from patients with chondropathy and osteoarthritis were described and found to be age-dependent. We also observed a higher concentration of advanced glycation end products due to inflammatory and/or degenerative processes in the cartilage. In addition, acute pathological changes due to diseases such as meniscal lesions or anterior cruciate ligament rupture caused a significant increase of formation of advanced glycation end products even in the group of young patients. In fact, such an observation could be crucial and important for the detection of knee conditions suspected of early meniscal and/or ACL lesions especially among young patients.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Age Factors
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Knee
- Arthroscopy
- Cartilage Diseases/diagnosis
- Cartilage Diseases/diagnostic imaging
- Cartilage Diseases/metabolism
- Cartilage Diseases/surgery
- Cartilage, Articular/diagnostic imaging
- Cartilage, Articular/metabolism
- Cartilage, Articular/surgery
- Female
- Glycation End Products, Advanced/metabolism
- Humans
- Joint Diseases/diagnosis
- Joint Diseases/diagnostic imaging
- Joint Diseases/metabolism
- Joint Diseases/surgery
- Knee Injuries/diagnosis
- Knee Injuries/diagnostic imaging
- Knee Injuries/metabolism
- Knee Injuries/surgery
- Knee Joint/diagnostic imaging
- Knee Joint/metabolism
- Knee Joint/surgery
- Male
- Middle Aged
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/metabolism
- Predictive Value of Tests
- Radiography
- Sensitivity and Specificity
- Severity of Illness Index
- Spectrometry, Fluorescence
- Synovitis/diagnosis
- Synovitis/metabolism
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Shafi M, Kim YY, Lee HK, Kim JC, Han CW. Meniscal hematoma of the knee joint: a case report. Knee Surg Sports Traumatol Arthrosc 2006; 14:50-4. [PMID: 15875158 DOI: 10.1007/s00167-005-0628-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Accepted: 12/07/2004] [Indexed: 10/25/2022]
Abstract
We report here an unusual case of medial meniscal hematoma of the knee joint. A review of the literature has revealed only one case that was previously reported. The authors present the successful decompression of the posterior horn of a medial meniscal hematoma through the direct posterior-posterior triangulation arthroscopic visualization method. We present here the case report.
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Stanciu S, Cîrmaci M, Berghea F, Bugaru M, Ciobica L, Jurcuţ C, Cherecheş T, Blaj S. Vibroarthrography--a possible functional non-invasive method for early detection damaged cartilage joint. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2006; 44:471-476. [PMID: 18386624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The vibroacoustic signals emitted by the diarthrodial articulation during a normal movement differentiates a healthy case from a pathologic one, due to alteration in forms and contact surfaces. The differences are shown by a various dynamics of the vibroacoustic spectra. Parametric representation of the acquired signals, filtering and clinical interpretation of those allow classification and fast recognition of a normal/pathologic status of the investigated articulation by the physician. Our method of acquiring the sound and vibration signals is effectuated completely non-invasive, with a set of translators using Pulse - sounds and vibrations analyzers (a matrix of prepolarised microphones with measurement domain in infrasound scale and piezoelectric acceleration transducers). A comparative study of vibroacoustic and thermal spectra, with early alterations revealed by knee nuclear magnetic resonance, correlates vibroacoustic and thermic spectra alterations with morphological ones, by determining certain limits between normal and pathological morphofunctional patterns. This prospective comparative study will help us evaluate the method in terms of sensibility, specificity, negative and positive predictive value, indices that assure the diagnostic power to the method.
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Tsou IYY, Yegappan M, Ong WS, Goh POL, Tan JL, Chee TSG. Cartilage injury and repair: assessment with magnetic resonance imaging. Singapore Med J 2006; 47:80-7; quiz 88. [PMID: 16397729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Articular cartilage damage plays a major role in joint degeneration and dysfunction. Accurate assessment of the morphology and degree of cartilage wear is important in diagnosis, prognosis and management, particularly as many of these patients are young or participate in high-performance sports. Magnetic resonance imaging is able to directly evaluate such injuries, due to its high spatial resolution and excellent soft-tissue contrast resolution. This pictoral essay aims to demonstrate normal and damaged articular cartilage on MR imaging, as well as surgically-repaired cartilage.
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Brommer H, Laasanen MS, Brama PAJ, van Weeren PR, Helminen HJ, Jurvelin JS. Functional consequences of cartilage degeneration in the equine metacarpophalangeal joint: quantitative assessment of cartilage stiffness. Equine Vet J 2005; 37:462-7. [PMID: 16163950 DOI: 10.2746/042516405774480012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY No quantitative data currently exist on the relationship of the occurrence of cartilage degeneration and changes in site-specific biomechanical properties in the metacarpophalangeal (MCP) joint in the horse. OBJECTIVES To gain insight into the biomechanical consequences of cartilage deterioration at 2 differently loaded sites on the proximal articular surface of the proximal phalanx (P1). HYPOTHESIS Static and dynamic stiffness of articular cartilage decreases significantly in degenerated cartilage. METHODS Cartilage degeneration index (CDI) values were measured at the lateral dorsal margin (Site 1), lateral central fovea (Site 2) and entire joint surface of P1 (CDIP1) in 30 horses. Group 1 contained joints without (CDIP1 values <25 %, n = 22) and Group 2 joints with (CDIP1 values >25 %, n = 8) signs of cartilage degeneration. Cartilage thickness at Sites 1 and 2 was measured using ultrasonic and needle-probe techniques. Osteochondral plugs were drilled out from Sites 1 and 2 and subsequently tested biomechanically in indentation geometry. Young's modulus at equilibrium and dynamic modulus were determined. RESULTS Cartilage thickness values were not significantly different between the 2 groups and sites. Young's modulus at Site 1 was significantly higher in Group 1 than in Group 2; at Site 2, the difference was not significant. Dynamic modulus values were significantly higher in Group 1 than in Group 2 at both sites. CONCLUSIONS Degenerative cartilage changes are clearly related to loss of stiffness of the tissue. Absolute changes in cartilage integrity in terms of CDI are greatest at the joint margin, but concomitant changes are also present at the centre, with a comparable decrease of the biomechanical moduli at the 2 sites. Therefore, significant cartilage degradation at the joint margin not only reflects local deterioration of biomechanical properties, but is also indicative of the functional quality in the centre. POTENTIAL RELEVANCE These findings may be important for improving prognostication and developing preventative measures.
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Recht MP, Goodwin DW, Winalski CS, White LM. MRI of articular cartilage: revisiting current status and future directions. AJR Am J Roentgenol 2005; 185:899-914. [PMID: 16177408 DOI: 10.2214/ajr.05.0099] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review the current understanding of the MRI appearance of articular cartilage and its relationship to the microscopic and macroscopic structure of articular cartilage, the optimal pulse sequences to be used in imaging, the appearance of both degenerative and traumatic chondral lesions, the appearance of the most common cartilage repair procedures, and future directions and developments in cartilage imaging. CONCLUSION Articular cartilage plays an essential role in the function of the diarthrodial joints of the body but is frequently the target of degeneration or traumatic injury. The recent development of several surgical procedures that hold the promise of forming repair tissue that is hyaline or hyalinelike cartilage has increased the need for accurate, noninvasive assessment of both native articular cartilage and postoperative repair tissue. MRI is the optimal noninvasive method for assessment of articular cartilage.
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Boutry N, Flipo RM, Cotten A. MR imaging appearance of rheumatoid arthritis in the foot. Semin Musculoskelet Radiol 2005; 9:199-209. [PMID: 16247721 DOI: 10.1055/s-2005-921940] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although conventional radiographs remain the initial mainstay for imaging of the foot in patients with rheumatoid arthritis (RA), magnetic resonance (MR) imaging has afforded the ability to detect early signs of the disease (i.e., synovitis, tenosynovitis, bone lesions, and bursitis), especially at the forefoot. In addition, the relatively symmetric distribution of the imaging abnormalities depicted in the metatarsophalangeal joints and the frequent involvement of the retro-calcaneal bursitis are almost specific for RA. In more advanced stages of the disease, MR imaging is well suited to evaluation of the hindfoot joints and tendons as well as the musculoskeletal complications of RA (e.g., tendon disruption, rheumatoid nodules, sinus tarsi syndrome).
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Suan JC, Chhem RK, Gati JS, Norley CJ, Holdsworth DW. 4 T MRI of chondrocalcinosis in combination with three-dimensional CT, radiography, and arthroscopy: a report of three cases. Skeletal Radiol 2005; 34:714-21. [PMID: 16167133 DOI: 10.1007/s00256-005-0930-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 04/07/2005] [Accepted: 04/12/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe 4 T MRI techniques in imaging chondrocalcinosis within the knee and examine the results together with those demonstrated using three-dimensional (3D) computed tomography, conventional radiography, and arthroscopy. DESIGN AND PATIENTS From a larger clinical imaging study of early osteoarthritis, knee arthroscopy patients were imaged using high-field MRI and high-resolution 3D CT prior to their surgery. Retrospective review of the imaging data diagnosed three patients with chondrocalcinosis. Fat-suppressed 3D spoiled gradient (3D SPGR) and two-dimensional fat-suppressed fast spin echo (FSE) imaging was performed at 4 T. The MR images, multi-planar reformatted CT (MPR-CT) and maximum intensity projection CT (MIP-CT) images, and radiographs were examined by a musculoskeletal radiologist for the presence and location of chondrocalcinosis. The findings from arthroscopy were also included. RESULTS MRI showed 16 sites of punctate hypointense regions from 18 articular surfaces and five of six menisci with similar signal characteristics. Both meniscal chondrocalcinosis and meniscal tears were clearly visible using the 3D SPGR sequence. Only three sites were demonstrated to have calcification using MPR-CT and MIP-CT revealed an additional three. In articular cartilage surfaces showing surface disruption, arthroscopy demonstrated 11 sites with crystal deposition. Arthroscopy also revealed five menisci with calcification present. CONCLUSION Our preliminary findings suggest that imaging chondrocalcinosis using spoiled gradient 4 T MRI is superior and complementary to the other imaging modalities in the detection of crystal deposition in both articular cartilage and menisci.
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Takatoku K, Sekiya H, Hayashi M, Hoshino Y, Kariya Y. Influence of fat pad removal on patellar tendon length during growth. Knee Surg Sports Traumatol Arthrosc 2005; 13:706-13. [PMID: 16044338 DOI: 10.1007/s00167-005-0637-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 01/05/2005] [Indexed: 10/25/2022]
Abstract
During various knee operations, the changes caused by the surgical invasion to the infrapatellar fat pad (IPF) is still unknown. If any changes exist, it will have great influence especially on growing generations. Eighty-four Japanese white rabbits (6-month-old) were divided into three groups: the resection group involving resection of the IPF, the graft group involving resection and reimplantation of the IPF, and the no-surgery group. All these surgical procedures were done in right knees. In all left knees, only arthrotomy was performed, serving as the sham side. After 3, 6, 12, and 24 weeks of the operation, the rabbits were killed. Lengths of the patellar tendon and patellar were measured in lateral X-ray. In order to eliminate individual differences in the patellar height, we defined a new index as percent patellar height (PPH) which indicated the percentage of the patellar height of surgery side compared with that of the sham side. The PPH was 90.6% (3 weeks), 83.0% (6 weeks), 73.6% (12 weeks), and 74.7% (24 weeks) in the resection group, while it was 88.4% (6 weeks), and 88.9% (24 weeks) in the graft group. Postsurgical scar tissue formation occurring where the IPF was removed prevented the normal growth of the patellar tendon. Reimplantation of the IPF lessened the adhesion of the patellar tendon to the surrounding tissue, and better growth of the tendon. These results showed that preservation of the IPF in young individuals could be crucial for the normal growth of the patellar tendon, and critical as well for the prevention of the degeneration of the articular surface.
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Gillogly SD, Myers TH. Treatment of full-thickness chondral defects with autologous chondrocyte implantation. Orthop Clin North Am 2005; 36:433-46. [PMID: 16164949 DOI: 10.1016/j.ocl.2005.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Autologous chondrocyte implantation (ACI) is a reproducible treatment option for large full-thickness symptomatic chondral injuries with appropriate knowledge of technique and patient selection. It provides a cellular repair that offers a high percentage of good to excellent clinical results over a long follow-up period. It is applicable over a wide range of chondral injuries from simple to more complex lesions. It is essential that the intra-articular environment be as close to normal as possible for successful cartilage repair. Coexisting knee pathology must be aggressively treated. ACI does have a prolonged postoperative rehabilitation course necessitated by the biologic nature of the repair, and patients must be able to comply with the rehabilitation and temporary restrictions required for a successful outcome.
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Diaz R, Kidwell M, Albright J, Dolan L. Knee cartilage defect documentation: computer assistance in quantification of cartilage defects. Orthopedics 2005; 28:s1275-6. [PMID: 16235454 DOI: 10.3928/0147-7447-20051002-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In order to determine the potential for a computer-assisted program to allow accurate and reproducible measurements of joint surface defects, area measurements were repeated 10 times by three observers for two complex lesions of predetermined size. The results indicate that this system offers a significant improvement over the surgeon's freehand method of assessment and that further development is indeed warranted.
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Wang Y, Ding C, Wluka AE, Davis S, Ebeling PR, Jones G, Cicuttini FM. Factors affecting progression of knee cartilage defects in normal subjects over 2 years. Rheumatology (Oxford) 2005; 45:79-84. [PMID: 16188947 DOI: 10.1093/rheumatology/kei108] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Cartilage defects are present in subjects with knee osteoarthritis (OA). Although they are often present in healthy subjects, there is little data on the natural history of cartilage defects. The aim of this study was to examine the change in cartilage defects over 2 yr and to identify factors associated with this change. METHODS One hundred and twenty-four healthy subjects underwent magnetic resonance imaging of their dominant knee at baseline and follow-up. Cartilage defects were scored (0-4) at five sites. Bone size was determined at medial and lateral tibial plateau and patella. Height, weight, body mass index and physical activity were measured by standard protocols. RESULTS Eighty-six subjects completed the study. The mean cartilage defect score of each tibiofemoral compartment increased over time. However, medial and lateral tibiofemoral defect score decreased in 5% of the subjects. Cartilage defects were more likely to progress in males than females in each individual compartment (P<0.001 for medial tibiofemoral, P=0.005 for lateral tibiofemoral and P=0.01 for patellar cartilage). Baseline cartilage defect score was negatively associated with the progression of cartilage defects in each compartment (all P<0.001). CONCLUSION Although knee cartilage defects progressed over time in the majority of normal subjects, those of the highest severity tended to regress. Male gender and baseline cartilage defect score were the main factors associated with the progression of cartilage defects. Larger studies will be required to identify factors associated with the progression and regression of lesions.
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Blankenbaker DG, De Smet AA, Fine JP. Is intra-articular pathology associated with MCL edema on MR imaging of the non-traumatic knee? Skeletal Radiol 2005; 34:462-7. [PMID: 15940487 DOI: 10.1007/s00256-005-0931-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 04/04/2005] [Accepted: 04/12/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Edema surrounding the medial collateral ligament (MCL) is seen on MR imaging in patients with MCL injuries and in patients with radiographic osteoarthritis in the non-traumatic knee. Because we noted MCL edema in patients without prior trauma or osteoarthritis, we studied the association between intra-articular pathology and MCL edema in patients without knee trauma. DESIGN AND PATIENTS We evaluated the MR examinations of 247 consecutive patients (121 male, 126 female with a mean age of 44 years) without recent trauma for the presence of edema surrounding the MCL, meniscal and ACL tears, medial meniscal extrusion, medial compartment chondromalacia, and osteoarthritis. The percentages of patients illustrating MCL edema with and without each type of pathology were compared using Fisher's exact test to determine if there was a statistically significant association. RESULTS We found MCL edema in 60% of 247 patients. MCL edema was present in 67% of patients with medial meniscal tears, 35% with lateral meniscal tears, 100% with meniscal extrusion of 3 mm or more, 78% with femoral chondromalacia, 82% with tibial chondromalacia, and 50% with osteoarthritis. The percentage of patients with edema increased with the severity of the chondromalacia. These associations were all statistically significant (p <0.02). The mean age of those with MCL edema was 49.7 years compared with 34.9 years without MCL edema ( p <0.001). Patient gender and ACL tear did not correlate with MCL edema. Nine (4%) of the 247 patients had MCL edema without intra-articular pathology. None of these 9 patients had MCL tenderness or joint laxity on physical examination. CONCLUSIONS We confirmed that MCL edema is associated with osteoarthritis, but is also associated with meniscal tears, meniscal extrusion, and chondromalacia. In addition, MCL edema can be seen in patients without intra-articular pathology, recent trauma or MCL abnormality on physical examination.
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