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Bradley PX, Thomas KN, Kratzer AL, Robinson AC, Wittstein JR, DeFrate LE, McNulty AL. The Interplay of Biomechanical and Biological Changes Following Meniscus Injury. Curr Rheumatol Rep 2023; 25:35-46. [PMID: 36479669 PMCID: PMC10267895 DOI: 10.1007/s11926-022-01093-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Meniscus injury often leads to joint degeneration and post-traumatic osteoarthritis (PTOA) development. Therefore, the purpose of this review is to outline the current understanding of biomechanical and biological repercussions following meniscus injury and how these changes impact meniscus repair and PTOA development. Moreover, we identify key gaps in knowledge that must be further investigated to improve meniscus healing and prevent PTOA. RECENT FINDINGS Following meniscus injury, both biomechanical and biological alterations frequently occur in multiple tissues in the joint. Biomechanically, meniscus tears compromise the ability of the meniscus to transfer load in the joint, making the cartilage more vulnerable to increased strain. Biologically, the post-injury environment is often characterized by an increase in pro-inflammatory cytokines, catabolic enzymes, and immune cells. These multi-faceted changes have a significant interplay and result in an environment that opposes tissue repair and contributes to PTOA development. Additionally, degenerative changes associated with OA may cause a feedback cycle, negatively impacting the healing capacity of the meniscus. Strides have been made towards understanding post-injury biological and biomechanical changes in the joint, their interplay, and how they affect healing and PTOA development. However, in order to improve clinical treatments to promote meniscus healing and prevent PTOA development, there is an urgent need to understand the physiologic changes in the joint following injury. In particular, work is needed on the in vivo characterization of the temporal biomechanical and biological changes that occur in patients following meniscus injury and how these changes contribute to PTOA development.
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Affiliation(s)
- Patrick X Bradley
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Karl N Thomas
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Avery L Kratzer
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Allison C Robinson
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Louis E DeFrate
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA.
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
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Jerban S, Kasibhatla A, Ma Y, Wu M, Chen Y, Guo T, Wan L, Szeverenyi N, Chang EY, Du J. Detecting Articular Cartilage and Meniscus Deformation Effects Using Magnetization Transfer Ultrashort Echo Time (MT-UTE) Modeling during Mechanical Load Application: Ex Vivo Feasibility Study. Cartilage 2021; 13:665S-673S. [PMID: 33289401 PMCID: PMC8808840 DOI: 10.1177/1947603520976771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Ultrashort echo time (UTE) magnetic resonance imaging (MRI) sequences have improved imaging of short T2 musculoskeletal (MSK) tissues. UTE-MRI combined with magnetization transfer modeling (UTE-MT) has demonstrated robust assessment of MSK tissues. This study aimed to investigate the variation of UTE-MT measures under mechanical loading in tibiofemoral cartilage and meniscus of cadaveric knee joints. DESIGN Fourteen knee joints from young (n = 8, 42 ± 12 years old) and elderly (n = 6, 89 ± 4 years old) donors were scanned on a 3-T scanner under 3 loading conditions: load = 300 N (Load1), load = 500 N (Load2), and load = 0 N (Unload). UTE-MT sequences were performed at each loading condition. Macromolecular proton fraction (MMF) was calculated from UTE-MT modeling. Wilcoxon rank sum test was used to examine the MRI data differences between loading conditions. RESULTS For young donors, MMF increased in all grouped regions of interest (meniscus [M], femoral articular cartilage [FAC], tibial articular cartilage [TAC], articular cartilage regions covered by meniscus [AC-MC], and articular cartilage regions uncovered by meniscus [AC-UC]) when the load increased from 300 to 500 N. The increases in MMF were significant for M (13.3%, P < 0.01) and AC-MC (9.2%, P = 0.04). MMF decreased in all studied regions after unloading, which was significant only for AC-MC (-8.9%, P = 0.01). For elderly donors, MRI parameters did not show significant changes by loading or unloading. CONCLUSION This study highlights the potential of the UTE-MT modeling combined with knee loading in differentiating between normal and abnormal knees. Average tissue deformation effects were likely higher and more uniformly distributed in the joints of young donors compared with elderly donors.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of
California, San Diego, CA, USA,Saeed Jerban, Department of Radiology,
University of California, 9500 Gilman Dr., San Diego, CA 92093, USA.
| | - Akhil Kasibhatla
- Department of Radiology, University of
California, San Diego, CA, USA
| | - Yajun Ma
- Department of Radiology, University of
California, San Diego, CA, USA
| | - Mei Wu
- Department of Radiology, University of
California, San Diego, CA, USA
| | - Yanjun Chen
- Department of Radiology, University of
California, San Diego, CA, USA
| | - Tan Guo
- Department of Radiology, University of
California, San Diego, CA, USA
| | - Lidi Wan
- Department of Radiology, University of
California, San Diego, CA, USA
| | | | - Eric Y. Chang
- Department of Radiology, University of
California, San Diego, CA, USA,Radiology Service, VA San Diego
Healthcare System, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of
California, San Diego, CA, USA
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Jerban S, Ma Y, Kasibhatla A, Wu M, Szeverenyi N, Guma M, Covey D, D'lima D, Ward SR, Sah RL, Chang EY, Du J, Chung CB. Ultrashort echo time adiabatic T 1ρ (UTE-Adiab-T 1ρ) is sensitive to human cadaveric knee joint deformation induced by mechanical loading and unloading. Magn Reson Imaging 2021; 80:98-105. [PMID: 33945858 PMCID: PMC10858706 DOI: 10.1016/j.mri.2021.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/13/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The development of ultrashort echo time (UTE) MRI sequences has led to improved imaging of tissues with short T2 relaxation times, such as the deep layer cartilage and meniscus. UTE combined with adiabatic T1ρ preparation (UTE-Adiab-T1ρ) is an MRI measure with low sensitivity to the magic angle effect. This study aimed to investigate the sensitivity of UTE-Adiab-T1ρ to mechanical load-induced deformations in the tibiofemoral cartilage and meniscus of human cadaveric knee joints. METHODS Eight knee joints from young (42 ± 12 years at death) donors were evaluated on a 3 T scanner using the UTE-Adiab-T1ρ sequence under four sequential loading conditions: load = 0 N (Load0), load = 300 N (Load1), load = 500 N (Load2), and load = 0 N (Unload). UTE-Adiab-T1ρ was measured in the meniscus (M), femoral articular cartilage (FAC), tibial articular cartilage (TAC), articular cartilage regions uncovered by meniscus (AC-UC), and articular cartilage regions covered by meniscus (AC-MC) within region of interests (ROIs) manually selected by an experienced MR scientist. The Kruskal-Wallis test, with corrected significance level for multiple comparisons, was used to examine the UTE-Adiab-T1ρ differences between different loading conditions. RESULTS UTE-Adiab-T1ρ decreased in all grouped ROIs under both Load1 and Load2 conditions (-18.7% and - 16.9% for M, -18.8% and - 12.6% for FAC, -21.4% and - 10.7% for TAC, -26.2% and - 13.9% for AC-UC, and - 16.9% and - 10.7% for AC-MC). After unloading, average UTE-Adiab-T1ρ increased across all ROIs and within a lower range compared with the average UTE-Adiab-T1ρ decreases induced by the two previous loading conditions. The loading-induced differences were statistically non-significant. CONCLUSIONS While UTE-Adiab-T1ρ reduction by loading is likely an indication of tissue deformation, the increase of UTE-Adiab-T1ρ within a lower range by unloading implies partial tissue restoration. This study highlights the UTE-Adiab-T1ρ technique as an imaging marker of tissue function for detecting deformation patterns under loading.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, CA, USA.
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA, USA
| | - Akhil Kasibhatla
- Department of Radiology, University of California, San Diego, CA, USA
| | - Mei Wu
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Monica Guma
- Department of Medicine, School of Medicine, University of California, San Diego, CA, USA
| | - Dana Covey
- Orthopaedic Service, VA San Diego Healthcare System, San Diego, CA, USA; Department of Orthopedic Surgery, University of California, San Diego, CA, USA
| | - Darryl D'lima
- Shiley Center for Orthopedic Research and Education at Scripps Clinic, CA, USA
| | - Samuel R Ward
- Department of Orthopedic Surgery, University of California, San Diego, CA, USA; Department of Bioengineering, University of California, San Diego, CA, USA
| | - Robert L Sah
- Department of Orthopedic Surgery, University of California, San Diego, CA, USA; Department of Bioengineering, University of California, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, CA, USA
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Schmitz A, Piovesan D. Development of an Open-Source, Discrete Element Knee Model. IEEE Trans Biomed Eng 2016; 63:2056-67. [DOI: 10.1109/tbme.2016.2585926] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kolaczek S, Hewison C, Caterine S, Ragbar M, Getgood A, Gordon K. Analysis of 3D strain in the human medial meniscus. J Mech Behav Biomed Mater 2016; 63:470-475. [DOI: 10.1016/j.jmbbm.2016.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
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Patel R, Eltgroth M, Souza RB, Zhang CA, Majumdar S, Link TM, Motamedi D. Loaded versus unloaded magnetic resonance imaging (MRI) of the knee: Effect on meniscus extrusion in healthy volunteers and patients with osteoarthritis. Eur J Radiol Open 2016; 3:100-7. [PMID: 27331081 PMCID: PMC4906039 DOI: 10.1016/j.ejro.2016.05.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 11/19/2022] Open
Abstract
Increased extrusion of the medial meniscus with loaded MRI compared to unloaded. No change in lateral meniscus extrusion between loaded and unloaded MRI. Increased extrusion of the medial meniscus with loaded MRI in those with tears.
Objective Assess the impact of knee joint loading on meniscal extrusion in normal individuals and those with varying degrees of osteoarthritis (OA). Methods 143 healthy volunteers and patients with OA underwent 3 T MRI of the knee under unloaded and loaded conditions. OA was graded with the Kellgren-Lawrence (KL) system. Menisci were evaluated for presence of tear. Descriptive statistics were expressed as mean ± standard deviation. Loaded and unloaded groups were compared using Student’s t-test. Statistic significance was defined for all calculations as p < 0.05. Results The cohort included 87 women and 56 men with an average age of 53 years +/− 9.7 years. Kellgren-Lawrence grade distribution was as follows: 56 with grade 0, 46 with grade 1, 25 with grade 2, 13 with grade 3, and 3 with grade 4. 23% had medial meniscus tears and 16% had lateral meniscus tears. Differences in medial meniscal extrusion between loading and unloading were significant in the entire cohort (p < 0.0001). Statistically significant difference in medial meniscus extrusion with loading and unloading were found for KL score group of 0, 1 and 3 (p < 0.001, p < 0.001 and p = 0.005). Interestingly, no significant differences in extrusion with loading and unloading were found for the lateral meniscus (p = 0.07). Conclusion Our study demonstrated that medial meniscal extrusion significantly increased during loading, specifically in those low KL scores (0 and 1) and in KL score of 3. Loaded MRI may more accurately determine the extent of medial meniscal extrusion in particular in those with no to minimal OA.
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Affiliation(s)
- Rina Patel
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Matthew Eltgroth
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Richard B. Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Chiyuan A. Zhang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Daria Motamedi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States
- Corresponding author.
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