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Rovedo P, Meine H, Hucker P, Taghizadeh E, Izadpanah K, Zaitsev M, Lange T. Time-Resolved Quantification of Patellofemoral Cartilage Deformation in Response to Loading and Unloading via Dynamic MRI With Prospective Motion Correction. J Magn Reson Imaging 2024; 60:175-183. [PMID: 37668040 DOI: 10.1002/jmri.28986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND In vivo cartilage deformation has been studied by static magnetic resonance imaging (MRI) with in situ loading, but knowledge about strain dynamics after load onset and release is scarce. PURPOSE To measure the dynamics of patellofemoral cartilage deformation and recovery in response to in situ loading and unloading by using MRI with prospective motion correction. STUDY TYPE Prospective. SUBJECTS Ten healthy male volunteers (age: [31.4 ± 3.2] years). FIELD STRENGTH/SEQUENCE T1-weighted RF-spoiled 2D gradient-echo sequence with a golden angle radial acquisition scheme, augmented with prospective motion correction, at 3 T. ASSESSMENT In situ knee loading was realized with a flexion angle of approximately 40° using an MR-compatible pneumatic loading device. The loading paradigm consisted of 2 minutes of unloaded baseline followed by a 5-minute loading bout with 50% body weight and an unloading period of 38 minutes. The cartilage strain was assessed as the mean distance between patellar and femoral bone-cartilage interfaces as a percentage of the initial (pre-load) distance. STATISTICAL TESTS Wilcoxon signed-rank tests (significance level: P < 0.05), Pearson correlation coefficient (r). RESULTS The cartilage compression and recovery behavior was characterized by a viscoelastic response. The elastic compression ([-12.5 ± 3.1]%) was significantly larger than the viscous compression ([-7.6 ± 1.5]%) and the elastic recovery ([10.5 ± 2.1]%) was significantly larger than the viscous recovery ([6.1 ± 1.8]%). There was a significant residual offset strain ([-3.6 ± 2.3]%) across the cohort. A significant negative correlation between elastic compression and elastic recovery was observed (r = -0.75). DATA CONCLUSION The in vivo cartilage compression and recovery time course in response to loading was successfully measured via dynamic MRI with prospective motion correction. The clinical relevance of the strain characteristics needs to be assessed in larger subject and patient cohorts. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Philipp Rovedo
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans Meine
- Medical Image Computing Group, Department of Informatics, University of Bremen, Bremen, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Patrick Hucker
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elham Taghizadeh
- Medical Image Computing Group, Department of Informatics, University of Bremen, Bremen, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Kaywan Izadpanah
- Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maxim Zaitsev
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lange
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Sinha U, Sinha S. Editorial for "Time-Resolved Quantification of Patellofemoral Cartilage Deformation in Response to Loading and Unloading via Dynamic MRI with Prospective Motion Correction". J Magn Reson Imaging 2024; 60:184-185. [PMID: 37670682 DOI: 10.1002/jmri.29001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Affiliation(s)
- Usha Sinha
- Department of Physics, San Diego State University, San Diego, California, USA
| | - Shantanu Sinha
- Muscle Imaging and Modeling Lab, Department of Radiology, University of California San Diego, San Diego, California, USA
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Cai X, Warburton C, Perez OF, Wang Y, Ho L, Finelli C, Ehlen QT, Wu C, Rodriguez CD, Kaplan L, Best TM, Huang CY, Meng Z. Hippo-PKCζ-NFκB signaling axis: A druggable modulator of chondrocyte responses to mechanical stress. iScience 2024; 27:109983. [PMID: 38827404 PMCID: PMC11140209 DOI: 10.1016/j.isci.2024.109983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/04/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Recent studies have implicated a crucial role of Hippo signaling in cell fate determination by biomechanical signals. Here we show that mechanical loading triggers the activation of a Hippo-PKCζ-NFκB pathway in chondrocytes, resulting in the expression of NFκB target genes associated with inflammation and matrix degradation. Mechanistically, mechanical loading activates an atypical PKC, PKCζ, which phosphorylates NFκB p65 at Serine 536, stimulating its transcriptional activation. This mechanosensitive activation of PKCζ and NFκB p65 is impeded in cells with gene deletion or chemical inhibition of Hippo core kinases LATS1/2, signifying an essential role of Hippo signaling in this mechanotransduction. A PKC inhibitor AEB-071 or PKCζ knockdown prevents p65 Serine 536 phosphorylation. Our study uncovers that the interplay of the Hippo signaling, PKCζ, and NFκB in response to mechanical loading serves as a therapeutic target for knee osteoarthritis and other conditions resulting from mechanical overloading or Hippo signaling deficiencies.
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Affiliation(s)
- Xiaomin Cai
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher Warburton
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Olivia F. Perez
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ying Wang
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lucy Ho
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Christina Finelli
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Quinn T. Ehlen
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chenzhou Wu
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carlos D. Rodriguez
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lee Kaplan
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
- Department of Orthopedics, University of Miami, Miami, FL, USA
- UHealth Sports Medicine Institute, University of Miami, Miami, FL, USA
| | - Thomas M. Best
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
- Department of Orthopedics, University of Miami, Miami, FL, USA
- UHealth Sports Medicine Institute, University of Miami, Miami, FL, USA
| | - Chun-Yuh Huang
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
- UHealth Sports Medicine Institute, University of Miami, Miami, FL, USA
| | - Zhipeng Meng
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
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Ivanov I, Ranchev S, Stoychev S. Experimental Ultrasound Approach for Studying Knee Intra-Articular Femur-Tibia Movements under Different Loads. J Funct Morphol Kinesiol 2023; 9:8. [PMID: 38249085 PMCID: PMC10801608 DOI: 10.3390/jfmk9010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
The purpose of the present study was to develop an experimental model for the study of intra-articular knee movements depending on the function of the knee joint and involved muscle groups under isometric stretching conditions with different loads. The experimental procedure included an ultrasound examination of a knee joint after isometric stretching in healthy men (n = 32). The changes (in millimeters) in the distances between the femur and tibia were measured using an ultrasound sonographer at three stages. The first stage was performed on ten (n = 10) healthy men in five different sitting and upright positions. In the second and third experimental model stages, lower limbs loading was applied to 22 participants. Our hypothesis, which was confirmed, was that as a result of increased loads on the participant's back, an intra-articular decrease in the femur-tibia cartilage surface distance would be observed. The accuracy of the created experimental model was improved over its three stages from 30% to 9%. Quantitative model data can help to create a mathematical model of the mechanical effects during the deformation of knee joint bone cartilage and it can also help outline some future tasks: increasing loading weights, enlarging participant groups, performing comparisons of men and women, and performing comparisons of healthy and pathological individuals.
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Affiliation(s)
- Ivan Ivanov
- National Sports Academy “Vassil Levski”, 1700 Sofia, Bulgaria
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
| | - Sergey Ranchev
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
| | - Stoyan Stoychev
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
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Cai X, Warburton C, Perez OF, Wang Y, Ho L, Finelli C, Ehlen QT, Wu C, Rodriguez CD, Kaplan L, Best TM, Huang CY, Meng Z. Hippo Signaling Modulates the Inflammatory Response of Chondrocytes to Mechanical Compressive Loading. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.06.09.544419. [PMID: 37662374 PMCID: PMC10473729 DOI: 10.1101/2023.06.09.544419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Knee osteoarthritis (KOA) is a degenerative disease resulting from mechanical overload, where direct physical impacts on chondrocytes play a crucial role in disease development by inducing inflammation and extracellular matrix degradation. However, the signaling cascades that sense these physical impacts and induce the pathogenic transcriptional programs of KOA remain to be defined, which hinders the identification of novel therapeutic approaches. Recent studies have implicated a crucial role of Hippo signaling in osteoarthritis. Since Hippo signaling senses mechanical cues, we aimed to determine its role in chondrocyte responses to mechanical overload. Here we show that mechanical loading induces the expression of inflammatory and matrix-degrading genes by activating the nuclear factor-kappaB (NFκB) pathway in a Hippo-dependent manner. Applying mechanical compressional force to 3-dimensional cultured chondrocytes activated NFκB and induced the expression of NFκB target genes for inflammation and matrix degradation (i.e., IL1β and ADAMTS4). Interestingly, deleting the Hippo pathway effector YAP or activating YAP by deleting core Hippo kinases LATS1/2 blocked the NFκB pathway activation induced by mechanical loading. Consistently, treatment with a LATS1/2 kinase inhibitor abolished the upregulation of IL1β and ADAMTS4 caused by mechanical loading. Mechanistically, mechanical loading activates Protein Kinase C (PKC), which activates NFκB p65 by phosphorylating its Serine 536. Furthermore, the mechano-activation of both PKC and NFκB p65 is blocked in LATS1/2 or YAP knockout cells, indicating that the Hippo pathway is required by this mechanoregulation. Additionally, the mechanical loading-induced phosphorylation of NFκB p65 at Ser536 is blocked by the LATS1/2 inhibitor Lats-In-1 or the PKC inhibitor AEB-071. Our study suggests that the interplay of the Hippo signaling and PKC controls NFκB-mediated inflammation and matrix degradation in response to mechanical loading. Chemical inhibitors targeting Hippo signaling or PKC can prevent the mechanoresponses of chondrocytes associated with inflammation and matrix degradation, providing a novel therapeutic strategy for KOA.
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Affiliation(s)
- Xiaomin Cai
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, FL
- These authors contributed equally to this work
| | - Christopher Warburton
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL
- These authors contributed equally to this work
| | - Olivia F. Perez
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL
- These authors contributed equally to this work
| | - Ying Wang
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, FL
- These authors contributed equally to this work
| | - Lucy Ho
- Department of Biomedical Engineering, University of Miami, FL
| | | | - Quinn T. Ehlen
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL
| | - Chenzhou Wu
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, FL
| | - Carlos D. Rodriguez
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, FL
| | - Lee Kaplan
- Department of Biomedical Engineering, University of Miami, FL
- Department of Orthopedics, University of Miami, Miami, FL
- UHealth Sports Medicine Institute, University of Miami, Miami, FL
| | - Thomas M. Best
- Department of Biomedical Engineering, University of Miami, FL
- Department of Orthopedics, University of Miami, Miami, FL
- UHealth Sports Medicine Institute, University of Miami, Miami, FL
| | - Chun-Yuh Huang
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL
- Department of Biomedical Engineering, University of Miami, FL
- UHealth Sports Medicine Institute, University of Miami, Miami, FL
| | - Zhipeng Meng
- Department of Molecular and Cellular Pharmacology, Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, FL
- USOAR Scholar Program, Medical Education, University of Miami Miller School of Medicine, Miami, FL
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Lee W, Miller EY, Zhu H, Luetkemeyer CM, Schneider SE, Neu CP. High frame rate deformation analysis of knee cartilage by spiral dualMRI and relaxation mapping. Magn Reson Med 2023; 89:694-709. [PMID: 36300860 PMCID: PMC10017275 DOI: 10.1002/mrm.29487] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Daily activities including walking impose high-frequency cyclic forces on cartilage and repetitive compressive deformation. Analyzing cartilage deformation during walking would provide spatial maps of displacement and strain and enable viscoelastic characterization, which may serve as imaging biomarkers for early cartilage degeneration when the damage is still reversible. However, the time-dependent biomechanics of cartilage is not well described, and how defects in the joint impact the viscoelastic response is unclear. METHODS We used spiral acquisition with displacement-encoding MRI to quantify displacement and strain maps at a high frame rate (25 frames/s) in tibiofemoral joints. We also employed relaxometry methods (T1 , T1ρ , T2 , T2 *) on the cartilage. RESULTS Normal and shear strains were concentrated on the bovine tibiofemoral contact area during loading, and the defected joint exhibited larger compressive strains. We also determined a positive correlation between the change of T1ρ in cartilage after cyclic loading and increased compressive strain on the defected joint. Viscoelastic behavior was quantified by the time-dependent displacement, where the damaged joint showed increased creep behavior compared to the intact joint. This technique was also successfully demonstrated on an in vivo human knee showing the gradual change of displacement during varus load. CONCLUSION Our results indicate that spiral scanning with displacement encoding can quantitatively differentiate the damaged from intact joint using the strain and creep response. The viscoelastic response identified with this methodology could serve as biomarkers to detect defects in joints in vivo and facilitate the early diagnosis of joint diseases such as osteoarthritis.
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Affiliation(s)
- Woowon Lee
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Emily Y. Miller
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
| | - Hongtian Zhu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Callan M. Luetkemeyer
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Stephanie E. Schneider
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Corey P. Neu
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
- Biomedical Engineering Program, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
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Frodl A, Lange T, Siegel M, Meine H, Taghizadeh E, Schmal H, Izadpanah K. Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction. J Pers Med 2022; 12:jpm12122049. [PMID: 36556269 PMCID: PMC9786691 DOI: 10.3390/jpm12122049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The influence of the MPFL graft in cases of patella instability with dysplastic trochlea is a controversial topic. The effect of the MPFL reconstruction as single therapy is under investigation, especially with severely dysplastic trochlea (Dejour types C and D). The purpose of this study was to evaluate the impact of trochlear dysplasia on patellar kinematics in patients suffering from low flexion patellar instability under weight-bearing conditions after isolated MPFL reconstruction. MATERIAL AND METHODS Thirteen patients were included in this study, among them were eight patients with mild dysplasia (Dejour type A and B) and five patients with severe dysplasia (Dejour type C and D). By performing a knee MRI with in situ loading, patella kinematics and the patellofemoral cartilage contact area could be measured under the activation of the quadriceps musculature in knee flexion angles of 0°, 15° and 30°. To mitigate MRI motion artefacts, prospective motion correction based on optical tracking was applied. Bone and cartilage segmentation were performed semi-automatically for further data analysis. Cartilage contact area (CCA) and patella tilt were the main outcome measures for this study. Pre- and post-surgery measures were compared for each group. RESULTS Data visualized a trending lower patella tilt after MPFL graft installation in both groups and flexion angles of the knee. There were no significant changes in patella tilt at 0° (unloaded pre-surgery: 22.6 ± 15.2; post-surgery: 17.7 ± 14.3; p = 0.110) and unloaded 15° flexion (pre-surgery: 18.9 ± 12.7; post-surgery: 12.2 ± 13.0; p = 0.052) of the knee in patients with mild dysplasia, whereas in patients with severe dysplasia of the trochlea the results happened not to be significant in the same angles with loading of 5 kg (0° flexion pre-surgery: 34.4 ± 12.1; post-surgery: 31.2 ± 16.1; p = 0.5; 15° flexion pre-surgery: 33.3 ± 6.1; post-surgery: 23.4 ± 8.6; p = 0.068). CCA increased in every flexion angle and group, but significant increase was seen only between 0°-15° (unloaded and loaded) in mild dysplasia of the trochlea, where significant increase in Dejour type C and D group was seen with unloaded full extension of the knee (0° flexion) and 30° flexion (unloaded and loaded). CONCLUSION This study proves a significant effect of the MPFL graft to cartilage contact area, as well as an improvement of the patella tilt in patients with mild dysplasia of the trochlea. Thus, the MPFL can be used as a single treatment for patient with Dejour type A and B dysplasia. However, in patients with severe dysplasia the MPFL graft alone does not significantly increase CCA.
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Affiliation(s)
- Andreas Frodl
- Department of Orthopedics and Traumatology, Freiburg University Hospital, 79106 Freiburg, Germany
- Correspondence:
| | - Thomas Lange
- Department of Radiology, Medical Physics, Freiburg University Hospital, 79106 Freiburg, Germany
| | - Markus Siegel
- Department of Orthopedics and Traumatology, Freiburg University Hospital, 79106 Freiburg, Germany
| | - Hans Meine
- Fraunhofer Institute for Digital Medicine, 28359 Freiburg, Germany
| | - Elham Taghizadeh
- Fraunhofer Institute for Digital Medicine, 28359 Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedic Surgery, University Hospital Odense, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Kaywan Izadpanah
- Department of Orthopedics and Traumatology, Freiburg University Hospital, 79106 Freiburg, Germany
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Teixeira Gonçalves Alves LF, Pinto Alves TD, Barros AS, Lopes Ferreira FA, Pereira Gutierres MA. Meniscal Bone Angle Is a Strong Predictor of Anterior Cruciate Ligament Injury. Arthrosc Sports Med Rehabil 2022; 4:e1993-e2003. [PMID: 36579050 PMCID: PMC9791884 DOI: 10.1016/j.asmr.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/27/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To evaluate the influence of lateral posterior tibial slope (LPTS) and meniscal bone angle (MBA) on primary anterior cruciate ligament (ACL) tear risk in an adult population through the LPTS-MBA ratio. Methods A retrospective case-control study was performed with patients from a tertiary hospital who underwent primary ACL surgery and had preoperative magnetic resonance imaging (MRI). These subjects were matched by age and sex in a 1:1 ratio to patients who had an MRI without ACL tear. LPTS and MBA were measured on MRI scan. Quantitative data are presented in the median ± interquartile range (IQR). Identification of independent risk factors for primary ACL tear was performed using multivariable logistic regression. Receiver operating characteristics curves detected any variable with strong discriminative capacity. Results In total, 95 patients with primary ACL tear confirmed on MRI were matched with 95 controls (N = 190). Nearly 80% were male subjects, with a median age of 26 years. In the ACL tear group, the median value of LPTS-MBA ratio was 0.20 (IQR 0.11-0.37) versus 0.12 (IQR 0.08-0.19) in the control group (P = .001). LPTS had a median value of 4.20° in the ACL tear group (IQR 2.05-7.35°) and 2.90° in the control group (IQR, 2.05-5.00°) (P = .026), whereas MBA was 19° (IQR, 16-24°) versus 26° (IQR, 24-30°) (P = .001), respectively. Logistic regression showed that LPTS (odds ratio 1.20, 95% confidence interval 1.03-1.42, P = .021) and MBA (odds ratio 0.78, 95% confidence interval 0.71-0.85, P = .001) were independent predictors. The area under the curve (AUC) of LPTS-MBA ratio was 0.69, greater than that of LPTS alone (AUC = 0.61) but lower than that for MBA (AUC = 0.82). Conclusions In this study, a reduced MBA was the strongest predictive variable associated with a primary ACL tear. A threshold of 22.35° of MBA was associated with an increased risk of ACL tear, with a sensitivity of 70% and specificity of 84%. A cut-off of 0.22 of LPTS-MBA was associated with an increased risk of ACL tear, with a sensitivity of 55% and specificity of 87%. Level of Evidence Level III, case-control study.
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Affiliation(s)
- Luís Filipe Teixeira Gonçalves Alves
- São João University Hospital Porto, Portugal,Address correspondence to Luís Filipe Teixeira Gonçalves Alves, M.D. Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
| | | | - António Sousa Barros
- UnIC@RISE – Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
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Jansen MP, Mastbergen SC, Eckstein F, van Heerwaarden RJ, Spruijt S, Lafeber FPJG. Comparison between 2D radiographic weight-bearing joint space width and 3D MRI non-weight-bearing cartilage thickness measures in the knee using non-weight-bearing 2D and 3D CT as an intermediary. Ther Adv Chronic Dis 2021; 12:20406223211037868. [PMID: 34434539 PMCID: PMC8381425 DOI: 10.1177/20406223211037868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: In knee osteoarthritis, radiographic joint space width (JSW) is frequently
used as a surrogate marker for cartilage thickness; however, longitudinal
changes in radiographic JSW have shown poor correlations with those of
magnetic resonance imaging (MRI) cartilage thickness. There are fundamental
differences between the techniques: radiographic JSW represents
two-dimensional (2D), weight-bearing, bone-to-bone distance, while on MRI
three-dimensional (3D) non-weight-bearing cartilage thickness is measured.
In this exploratory study, computed tomography (CT) was included as a third
technique, as it can measure bone-to-bone under non-weight-bearing
conditions. The objective was to use CT to compare the impact of
weight-bearing versus non-weight-bearing, as well as
bone-to-bone JSW versus actual cartilage thickness, in the
knee. Methods: Osteoarthritis patients (n = 20) who were treated with knee
joint distraction were included. Weight-bearing radiographs,
non-weight-bearing MRIs and CTs were acquired before and 2 years after
treatment. The mean radiographic JSW and cartilage thickness of the most
affected compartment were measured. From CT, the 3D median JSW was
calculated and a 2D projectional image was rendered, positioned similarly
and measured identically to the radiograph. Pearson correlations between the
techniques were derived, both cross-sectionally and longitudinally. Results: Fourteen patients could be analyzed. Cross-sectionally, all comparisons
showed moderate to strong significant correlations (R = 0.43–0.81; all
p < 0.05). Longitudinal changes over time were
small; only the correlations between 2D CT and 3D CT (R = 0.65;
p = 0.01) and 3D CT and MRI (R = 0.62;
p = 0.02) were statistically significant. Conclusion: The poor correlation between changes in radiographic JSW and MRI cartilage
thickness appears primarily to result from the difference in weight-bearing,
and less so from measuring bone-to-bone distance versus
cartilage thickness.
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Affiliation(s)
- Mylène P Jansen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100 (G02.228), Utrecht 3584CX, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Felix Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
| | - Ronald J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Sander Spruijt
- Reinier Haga Orthopaedic Centre, Zoetermeer, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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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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11
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Truhn D, Zwingenberger KT, Schock J, Abrar DB, Radke KL, Post M, Linka K, Knobe M, Kuhl C, Nebelung S. No pressure, no diamonds? - Static vs. dynamic compressive in-situ loading to evaluate human articular cartilage functionality by functional MRI. J Mech Behav Biomed Mater 2021; 120:104558. [PMID: 33957568 DOI: 10.1016/j.jmbbm.2021.104558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 01/21/2023]
Abstract
Biomechanical Magnetic Resonance Imaging (MRI) of articular cartilage, i.e. its imaging under loading, is a promising diagnostic tool to assess the tissue's functionality in health and disease. This study aimed to assess the response to static and dynamic loading of histologically intact cartilage samples by functional MRI and pressure-controlled in-situ loading. To this end, 47 cartilage samples were obtained from the medial femoral condyles of total knee arthroplasties (from 24 patients), prepared to standard thickness, and placed in a standard knee joint in a pressure-controlled whole knee-joint compressive loading device. Cartilage samples' responses to static (i.e. constant), dynamic (i.e. alternating), and no loading, i.e. free-swelling conditions, were assessed before (δ0), and after 30 min (δ1) and 60 min (δ2) of loading using serial T1ρ maps acquired on a 3.0T clinical MRI scanner (Achieva, Philips). Alongside texture features, relative changes in T1ρ (Δ1, Δ2) were determined for the upper and lower sample halves and the entire sample, analyzed using appropriate statistical tests, and referenced to histological (Mankin scoring) and biomechanical reference measures (tangent stiffness). Histological, biomechanical, and T1ρ sample characteristics at δ0 were relatively homogenous in all samples. In response to loading, relative increases in T1ρ were strong and significant after dynamic loading (Δ1 = 10.3 ± 17.0%, Δ2 = 21.6 ± 21.8%, p = 0.002), while relative increases in T1ρ after static loading and in controls were moderate and not significant. Generally, texture features did not demonstrate clear loading-related associations underlying the spatial relationships of T1ρ. When realizing the clinical translation, this in-situ study suggests that serial T1ρ mapping is best combined with dynamic loading to assess cartilage functionality in humans based on advanced MRI techniques.
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Affiliation(s)
- Daniel Truhn
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Ken Tonio Zwingenberger
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Justus Schock
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany; Institute of Imaging and Computer Vision, RWTH Aachen University, D-52074, Aachen, Germany
| | - Daniel Benjamin Abrar
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Karl Ludger Radke
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany
| | - Manuel Post
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Kevin Linka
- Hamburg University of Technology, Department of Continuum and Materials Mechanics, D-21073, Hamburg, Germany
| | - Matthias Knobe
- Cantonal Hospital Lucerne, Department of Orthopaedic and Trauma Surgery, CH-6000, Lucerne, Switzerland
| | - Christiane Kuhl
- Aachen University Hospital, Department of Diagnostic and Interventional Radiology, D-52074, Aachen, Germany
| | - Sven Nebelung
- University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225, Düsseldorf, Germany.
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12
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Davis S, Roldo M, Blunn G, Tozzi G, Roncada T. Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects. Front Bioeng Biotechnol 2021; 9:603408. [PMID: 33585430 PMCID: PMC7873466 DOI: 10.3389/fbioe.2021.603408] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022] Open
Abstract
Articular cartilage is a highly specialised connective tissue of diarthrodial joints which provides a smooth, lubricated surface for joint articulation and plays a crucial role in the transmission of loads. In vivo cartilage is subjected to mechanical stimuli that are essential for cartilage development and the maintenance of a chondrocytic phenotype. Cartilage damage caused by traumatic injuries, ageing, or degradative diseases leads to impaired loading resistance and progressive degeneration of both the articular cartilage and the underlying subchondral bone. Since the tissue has limited self-repairing capacity due its avascular nature, restoration of its mechanical properties is still a major challenge. Tissue engineering techniques have the potential to heal osteochondral defects using a combination of stem cells, growth factors, and biomaterials that could produce a biomechanically functional tissue, representative of native hyaline cartilage. However, current clinical approaches fail to repair full-thickness defects that include the underlying subchondral bone. Moreover, when tested in vivo, current tissue-engineered grafts show limited capacity to regenerate the damaged tissue due to poor integration with host cartilage and the failure to retain structural integrity after insertion, resulting in reduced mechanical function. The aim of this review is to examine the optimal characteristics of osteochondral scaffolds. Additionally, an overview on the latest biomaterials potentially able to replicate the natural mechanical environment of articular cartilage and their role in maintaining mechanical cues to drive chondrogenesis will be detailed, as well as the overall mechanical performance of grafts engineered using different technologies.
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Affiliation(s)
- Sarah Davis
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Marta Roldo
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, United Kingdom
| | - Tosca Roncada
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom
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13
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Schad P, Wollenweber M, Thüring J, Schock J, Eschweiler J, Palm G, Radermacher K, Eckstein F, Prescher A, Kuhl C, Truhn D, Nebelung S. Magnetic resonance imaging of human knee joint functionality under variable compressive in-situ loading and axis alignment. J Mech Behav Biomed Mater 2020; 110:103890. [DOI: 10.1016/j.jmbbm.2020.103890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
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14
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Said O, Schock J, Krämer N, Thüring J, Hitpass L, Schad P, Kuhl C, Abrar D, Truhn D, Nebelung S. An MRI-compatible varus-valgus loading device for whole-knee joint functionality assessment based on compartmental compression: a proof-of-concept study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 33:839-854. [PMID: 32314105 PMCID: PMC8302563 DOI: 10.1007/s10334-020-00844-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Beyond static assessment, functional techniques are increasingly applied in magnetic resonance imaging (MRI) studies. Stress MRI techniques bring together MRI and mechanical loading to study knee joint and tissue functionality, yet prototypical axial compressive loading devices are bulky and complex to operate. This study aimed to design and validate an MRI-compatible pressure-controlled varus-valgus loading device that applies loading along the joint line. METHODS Following the device's thorough validation, we demonstrated proof of concept by subjecting a structurally intact human cadaveric knee joint to serial imaging in unloaded and loaded configurations, i.e. to varus and valgus loading at 7.5 kPa (= 73.5 N), 15 kPa (= 147.1 N), and 22.5 kPa (= 220.6 N). Following clinical standard (PDw fs) and high-resolution 3D water-selective cartilage (WATSc) sequences, we performed manual segmentations and computations of morphometric cartilage measures. We used CT and radiography (to quantify joint space widths) and histology and biomechanics (to assess tissue quality) as references. RESULTS We found (sub)regional decreases in cartilage volume, thickness, and mean joint space widths reflective of areal pressurization of the medial and lateral femorotibial compartments. DISCUSSION Once substantiated by larger sample sizes, varus-valgus loading may provide a powerful alternative stress MRI technique.
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Affiliation(s)
- Oliver Said
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Justus Schock
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Institute of Computer Vision and Imaging, RWTH University Aachen, Aachen, Germany
| | - Nils Krämer
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Johannes Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Lea Hitpass
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Philipp Schad
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
| | - Daniel Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany
- Institute of Computer Vision and Imaging, RWTH University Aachen, Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, University Dusseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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15
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Functional MRI Mapping of Human Meniscus Functionality and its Relation to Degeneration. Sci Rep 2020; 10:2499. [PMID: 32051526 PMCID: PMC7016001 DOI: 10.1038/s41598-020-59573-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/10/2020] [Indexed: 12/24/2022] Open
Abstract
Meniscus pathology may promote early osteoarthritis. This study assessed human meniscus functionality (i.e. its response to loading) ex vivo based on quantitative T1, T1ρ, and T2 mapping as a function of histological degeneration and loading. Forty-five meniscus samples of variable degeneration were harvested from the lateral meniscus body region of 45 patients during total knee arthroplasties. Samples underwent serial mapping on a 3.0-T MRI scanner (Achieva, Philips) using a force-controlled and torque-inducing compressive loading device. Samples were measured at three loading positions, i.e. unloaded, loaded to 2 bar (compression force 37 N) and 4 bar (69 N). Histology (Pauli classification) and biomechanics (Elastic Modulus) served as references. Based on histology, samples were trichotomized as grossly intact (n = 14), mildly degenerative (n = 16), and moderate-to-severely degenerative (n = 15) and analyzed using appropriate parametric and non-parametric tests. For T1, we found loading-induced decreases in all samples, irrespective of degeneration. For T1ρ, zonal increases in intact (apex) and decreases in degenerative samples (base) were found, while for T2, changes were ambiguous. In conclusion, force-controlled loading and serial MR imaging reveal response-to-loading patterns in meniscus. Zonal T1ρ response-to-loading patterns are most promising in differentiating degeneration, while T1 and T2 aren’t clearly related to degeneration.and may provide an imaging-based indication of functional tissue properties.
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16
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Jerban S, Chang EY, Du J. Magnetic resonance imaging (MRI) studies of knee joint under mechanical loading: Review. Magn Reson Imaging 2019; 65:27-36. [PMID: 31670237 DOI: 10.1016/j.mri.2019.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/17/2019] [Accepted: 09/15/2019] [Indexed: 02/07/2023]
Abstract
Osteoarthritis (OA) is a very common disease that affects the human knee joint, particularly the articular cartilage and meniscus components which are regularly under compressive mechanical loads. Early-stage OA diagnosis is essential as it allows for timely intervention. The primary non-invasive approaches currently available for OA diagnosis include magnetic resonance imaging (MRI), which provides excellent soft tissue contrast at high spatial resolution. MRI-based knee investigation is usually performed on joints at rest or in a non-weight-bearing condition that does not mimic the actual physiological condition of the joint. This discrepancy may lead to missed detections of early-stage OA or of minor lesions. The mechanical properties of degenerated musculoskeletal (MSK) tissues may vary markedly before any significant morphological or structural changes detectable by MRI. Recognizing distinct deformation characteristics of these tissues under known mechanical loads may reveal crucial joint lesions or mechanical malfunctions which result from early-stage OA. This review article summarizes the large number of MRI-based investigations on knee joints under mechanical loading which have been reported in the literature including the corresponding MRI measures, the MRI-compatible devices employed, and potential challenges due to the limitations of clinical MRI sequences.
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Affiliation(s)
- Saeed Jerban
- 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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17
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Lange T, Taghizadeh E, Knowles BR, Südkamp NP, Zaitsev M, Meine H, Izadpanah K. Quantification of patellofemoral cartilage deformation and contact area changes in response to static loading via high-resolution MRI with prospective motion correction. J Magn Reson Imaging 2019; 50:1561-1570. [PMID: 30903682 DOI: 10.1002/jmri.26724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Higher-resolution MRI of the patellofemoral cartilage under loading is hampered by subject motion since knee flexion is required during the scan. PURPOSE To demonstrate robust quantification of cartilage compression and contact area changes in response to in situ loading by means of MRI with prospective motion correction and regularized image postprocessing. STUDY TYPE Cohort study. SUBJECTS Fifteen healthy male subjects. FIELD STRENGTH 3 T. SEQUENCE Spoiled 3D gradient-echo sequence augmented with prospective motion correction based on optical tracking. Measurements were performed with three different loads (0/200/400 N). ASSESSMENT Bone and cartilage segmentation was performed manually and regularized with a deep-learning approach. Average patellar and femoral cartilage thickness and contact area were calculated for the three loading situations. Reproducibility was assessed via repeated measurements in one subject. STATISTICAL TESTS Comparison of the three loading situations was performed by Wilcoxon signed-rank tests. RESULTS Regularization using a deep convolutional neural network reduced the variance of the quantified relative load-induced changes of cartilage thickness and contact area compared to purely manual segmentation (average reduction of standard deviation by ∼50%) and repeated measurements performed on the same subject demonstrated high reproducibility of the method. For the three loading situations (0/200/400 N), the patellofemoral cartilage contact area as well as the mean patellar and femoral cartilage thickness were significantly different from each other (P < 0.05). While the patellofemoral cartilage contact area increased under loading (by 14.5/19.0% for loads of 200/400 N), patellar and femoral cartilage thickness exhibited a load-dependent thickness decrease (patella: -4.4/-7.4%, femur: -3.4/-7.1% for loads of 200/400 N). DATA CONCLUSION MRI with prospective motion correction enables quantitative evaluation of patellofemoral cartilage deformation and contact area changes in response to in situ loading. Regularizing the manual segmentations using a neural network enables robust quantification of the load-induced changes. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1561-1570.
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Affiliation(s)
- Thomas Lange
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elham Taghizadeh
- Medical Image Computing Group, Department of Informatics, University of Bremen, Germany.,Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Benjamin R Knowles
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Norbert P Südkamp
- Department of Orthopedic and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
| | - Maxim Zaitsev
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans Meine
- Medical Image Computing Group, Department of Informatics, University of Bremen, Germany.,Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Kaywan Izadpanah
- Department of Orthopedic and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
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18
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Evrard L, Audigié F, Bertoni L, Jacquet S, Denoix JM, Busoni V. Low field magnetic resonance imaging of the equine distal interphalangeal joint: Comparison between weight-bearing and non-weight-bearing conditions. PLoS One 2019; 14:e0211101. [PMID: 30689659 PMCID: PMC6349334 DOI: 10.1371/journal.pone.0211101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/08/2019] [Indexed: 11/28/2022] Open
Abstract
This descriptive study aimed to compare the magnetic resonance appearance of the distal interphalangeal joint articular cartilage between standing weight-bearing and non-weight-bearing conditions. Ten forefeet of live horses were scanned in a standing low-field magnetic resonance system (0.27 T). After euthanasia for reasons unrelated to the study, the non-weight-bearing isolated feet were scanned in a vertical positioning reproducing limb orientation in live horses. The same acquisition settings as during the weight-bearing examination were used. Thickness and cross-sectional area of the distal interphalangeal articular cartilage and joint space were measured on tridimensional T1-weighted gradient echo high resolution frontal and sagittal images at predetermined landmarks in both conditions and were compared using a linear mixed-effects model. Frontal images were randomized and submitted to 9 blinded readers with 3 different experience levels for identification of weight-bearing versus non-weight-bearing acquisitions based on cartilage appearance. Weight-bearing limbs had significantly thinner distal interphalangeal cartilage (p = 0.0001) than non-weight-bearing limbs. This change was greater in the distal phalanx cartilage than that of the middle phalanx. Blinded readers correctly identified 83% (range 65 to 95%) of the images as weight-bearing or non-weight-bearing acquisitions, with significantly different results observed among the different readers (p < 0.001) and groups (p < 0.001). These results indicate that distal interphalangeal articular cartilage and particularly cartilage of the distal phalanx thins when weight-bearing compared to the non-weight-bearing standing postmortem conditions and suggest that cartilage abnormalities may be more difficult to identify on weight-bearing standing magnetic resonance imaging.
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Affiliation(s)
- Laurence Evrard
- Department of Clinical Sciences of Companion Animals and Equids, Equine Division, Diagnostic Imaging Section, University of Liège, Liège, Belgium
- * E-mail:
| | - Fabrice Audigié
- Centre d’Imagerie et de Recherche sur les Affections Locomotrices Equines (CIRALE), Unité 957 BPLC, Ecole Nationale Vétérinaire d’Alfort, Normandie Equine Vallée, Goustranville, France
| | - Lélia Bertoni
- Centre d’Imagerie et de Recherche sur les Affections Locomotrices Equines (CIRALE), Unité 957 BPLC, Ecole Nationale Vétérinaire d’Alfort, Normandie Equine Vallée, Goustranville, France
| | - Sandrine Jacquet
- Centre d’Imagerie et de Recherche sur les Affections Locomotrices Equines (CIRALE), Unité 957 BPLC, Ecole Nationale Vétérinaire d’Alfort, Normandie Equine Vallée, Goustranville, France
| | - Jean-Marie Denoix
- Centre d’Imagerie et de Recherche sur les Affections Locomotrices Equines (CIRALE), Unité 957 BPLC, Ecole Nationale Vétérinaire d’Alfort, Normandie Equine Vallée, Goustranville, France
| | - Valeria Busoni
- Department of Clinical Sciences of Companion Animals and Equids, Equine Division, Diagnostic Imaging Section, University of Liège, Liège, Belgium
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19
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Parween R, Shriram D, Mohan RE, Lee YHD, Subburaj K. Methods for evaluating effects of unloader knee braces on joint health: a review. Biomed Eng Lett 2019; 9:153-168. [PMID: 31168421 DOI: 10.1007/s13534-019-00094-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/13/2018] [Accepted: 01/08/2019] [Indexed: 02/01/2023] Open
Abstract
The paper aims to provide a state-of-the-art review of methods for evaluating the effectiveness and effect of unloader knee braces on the knee joint and discuss their limitations and future directions. Unloader braces are prescribed as a non-pharmacological conservative treatment option for patients with medial knee osteoarthritis to provide relief in terms of pain reduction, returning to regular physical activities, and enhancing the quality of life. Methods used to evaluate and monitor the effectiveness of these devices on patients' health are categorized into three broad categories (perception-, biochemical-, and morphology-based), depending upon the process and tools used. The main focus of these methods is on the short-term clinical outcome (pain or unloading efficiency). There is a significant technical, research, and clinical literature gap in understanding the short- and long-term consequences of these braces on the tissues in the knee joint, including the cartilage and ligaments. Future research directions may complement existing methods with advanced quantitative imaging (morphological, biochemical, and molecular) and numerical simulation are discussed as they offer potential in assessing long-term and post-bracing effects on the knee joint.
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Affiliation(s)
- Rizuwana Parween
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
| | - Duraisamy Shriram
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
| | - Rajesh Elara Mohan
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
| | - Yee Han Dave Lee
- 2Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
| | - Karupppasamy Subburaj
- 1Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372 Singapore
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20
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Han X, Hong G, Chen L, Zhao M, Guo Y, Xu L, Wu M, Leng X, Sun P. T1
ρ and T2
mapping for the determination of articular cartilage denaturalization with osteonecrosis of the femoral head: A prospective controlled trial. J Magn Reson Imaging 2018; 49:760-767. [PMID: 30461119 DOI: 10.1002/jmri.26267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 01/14/2023] Open
Affiliation(s)
- Xiaorui Han
- Department of Radiography; Guangzhou First People's Hospital, Second Affiliated Hospital of South China University of Technology; Guangzhou P.R. China
| | - Guoju Hong
- Department of Surgery; University of Alberta; Edmonton AB Canada
| | - Leilei Chen
- Orthopedic Department; First Affiliated Hospital of Guangzhou University of Chinese Medicine; Guangzhou P.R. China
| | - Man Zhao
- Department of Radiography; First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University; Guangzhou P.R. China
| | - Yuan Guo
- Department of Radiography; Guangzhou First People's Hospital, Second Affiliated Hospital of South China University of Technology; Guangzhou P.R. China
| | - Ling Xu
- Department of Ultrasound; Guangdong Women and Children Hospital; Guangzhou P.R. China
| | - Mei Wu
- Department of Radiography; Guangzhou First People's Hospital, Second Affiliated Hospital of South China University of Technology; Guangzhou P.R. China
| | - Xiaoming Leng
- Universal Medical Imaging Diagnostic Center; Guangzhou P.R. China
| | - Ping Sun
- Orthopedic Department; First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University; Guangzhou P.R. China
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21
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Ho KY, McClaren J, Sudweeks S. Acute Effects of Walking on the Deformation of Femoral Articular Cartilage in Older Adults. J Geriatr Phys Ther 2018. [PMID: 29533282 DOI: 10.1519/jpt.0000000000000185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Although discomfort during walking is a common complaint in individuals with knee osteoarthritis (OA), how an acute bout of walking affects femoral cartilage remains unclear. Current literature has suggested that frontal plane knee malalignment (ie, varus and valgus) is associated with the initiation and/or progression of knee OA. However, the association between knee alignment and femoral cartilage deformation after an acute bout of loading has not yet been investigated. This study was aimed to compare the acute effects of walking on femoral cartilage deformation between older adults with and without knee OA. We also examined the association between frontal plane knee alignment and loading-induced femoral cartilage deformation. METHODS Ten persons without OA (Kellgren Lawrence grading = 0 or 1; 5 females and 5 males; 55.0 [1.8] years of age; 78.8 [14.1] kg; 1.8 [0.2] m) and 9 persons with OA (Kellgren Lawrence grading ≥2; 4 females and 5 males; 55.6 [4.5] years of age; 97.4 [15.0] kg; 1.7 [0.1] m) participated. Each participant underwent magnetic resonance imaging before and immediately after 30 minutes of fast walking at 3 to 4 miles per hour. To obtain cartilage deformation postwalking, the medial and lateral femoral cartilage of the weight-bearing areas was segmented on participants' magnetic resonance imaging. Cartilage thickness was quantified by computing the average perpendicular distance between opposing voxels defining the edges of the femoral cartilage. Cartilage deformation of the medial and lateral femurs was defined as the percent changes in cartilage thickness after walking. Frontal plane knee alignment was obtained by measuring the angle between the long axes of femur and tibia. Independent t tests were used to compare cartilage deformation between the 2 groups. Pearson correlation coefficients were used to assess the association between cartilage deformation and knee alignment. RESULTS AND DISCUSSION There was no significant difference in cartilage deformation between the OA and control groups in lateral (P = .69) or medial (P = .87) femur. A significant correlation was found between lateral femoral cartilage deformation and increased knee valgus alignment (r = 0.497; P = .03). No difference was found between medial femoral cartilage deformation and frontal plane knee alignment (r = 273; P = .26). CONCLUSIONS This is the first study comparing the acute effects of walking on femoral cartilage deformation between older adults with and without knee OA. Although there was not a difference in walking-induced femoral cartilage deformation between the OA and control groups, knee valgus was related to lateral femoral cartilage deformation after walking. Our findings suggested that walking exercises may be used safely in older adults without knee malalignment.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas
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Harkey MS, Blackburn JT, Davis H, Sierra-Arévalo L, Nissman D, Pietrosimone B. The association between habitual walking speed and medial femoral cartilage deformation following 30minutes of walking. Gait Posture 2018; 59:128-133. [PMID: 29031137 DOI: 10.1016/j.gaitpost.2017.09.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 02/02/2023]
Abstract
Habitual walking speed is a key functional outcome that has implications for knee biomechanics that occur during gait. Lower extremity biomechanics during walking affects the loading of the femoral cartilage. Ultrasonography (US) can be used to assess resting femoral cartilage thickness and acute cartilage deformation in response to walking. The purpose of this study was to determine the association between habitual walking speed and both resting femoral cartilage thickness and deformation. Twenty-four healthy participants with no history of knee injury volunteered for this study. Habitual walking speed was assessed with a 20-m walk test. Femoral cartilage thickness was assessed with US in the medial condyle, lateral condyle, and intercondylar regions prior to and immediately following 30min of walking. Femoral cartilage deformation was calculated as the percent change in cartilage thickness acutely following the walking protocol. Separate Pearson product moment correlations were used to assess the association between habitual walking speed and each US cartilage variable. Slower habitual walking speed was significantly associated with greater medial femoral cartilage deformation (r=0.48, P=0.018), but not with lateral and intercondylar deformation. Habitual walking speed was not significantly associated with the resting cartilage thickness in any cartilage region. These findings highlight the in vivo association between walking speed and medial femoral cartilage deformation. When controlling for body mass index, the association between walking speed and medial cartilage deformation was weakened (Δr=-0.12). Future studies are needed to determine the extent to which BMI influences the association between walking speed and cartilage deformation.
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Affiliation(s)
- Matthew S Harkey
- Division of Rheumatology, Tufts Medical Center, Boston MA, United States.
| | - J Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill NC, United States
| | - Hope Davis
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill NC, United States; Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill NC, United States
| | - Leslie Sierra-Arévalo
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill NC, United States
| | - Daniel Nissman
- Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill NC, United States
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23
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Sato T, Sato N, Sasaki T, Sato K, Gorniak GC. Patterns of patellofemoral articular cartilage wear in Japanese cadavers. J ANAT SOC INDIA 2017. [DOI: 10.1016/j.jasi.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Liu B, Lad NK, Collins AT, Ganapathy PK, Utturkar GM, McNulty AL, Spritzer CE, Moorman CT, Sutter EG, Garrett WE, DeFrate LE. In Vivo Tibial Cartilage Strains in Regions of Cartilage-to-Cartilage Contact and Cartilage-to-Meniscus Contact in Response to Walking. Am J Sports Med 2017; 45:2817-2823. [PMID: 28671850 PMCID: PMC5629119 DOI: 10.1177/0363546517712506] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are currently limited human in vivo data characterizing the role of the meniscus in load distribution within the tibiofemoral joint. Purpose/Hypothesis: The purpose was to compare the strains experienced in regions of articular cartilage covered by the meniscus to regions of cartilage not covered by the meniscus. It was hypothesized that in response to walking, tibial cartilage covered by the meniscus would experience lower strains than uncovered tibial cartilage. STUDY DESIGN Descriptive laboratory study. METHODS Magnetic resonance imaging (MRI) of the knees of 8 healthy volunteers was performed before and after walking on a treadmill. Using MRI-generated 3-dimensional models of the tibia, cartilage, and menisci, cartilage thickness was measured in 4 different regions based on meniscal coverage and compartment: covered medial, uncovered medial, covered lateral, and uncovered lateral. Strain was defined as the normalized change in cartilage thickness before and after activity. RESULTS Within each compartment, covered cartilage before activity was significantly thinner than uncovered cartilage before activity ( P < .001). After 20 minutes of walking, all 4 regions experienced significant cartilage thickness decreases ( P < .01). The covered medial region experienced significantly less strain than the uncovered medial region ( P = .04). No difference in strain was detected between the covered and uncovered regions in the lateral compartment ( P = .40). CONCLUSION In response to walking, cartilage that is covered by the meniscus experiences lower strains than uncovered cartilage in the medial compartment. These findings provide important baseline information on the relationship between in vivo tibial compressive strain responses and meniscal coverage, which is critical to understanding normal meniscal function.
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Affiliation(s)
- Betty Liu
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA,Department of Biomedical Engineering, Duke University School of Medicine, Durham, NC USA
| | - Nimit K. Lad
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Amber T. Collins
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Pramodh K. Ganapathy
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Gangadhar M. Utturkar
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Amy L. McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA,Department of Pathology, Duke University School of Medicine, Durham, NC USA
| | | | - Claude T. Moorman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - E. Grant Sutter
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - William E. Garrett
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC USA,Department of Biomedical Engineering, Duke University School of Medicine, Durham, NC USA
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25
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Lad NK, Liu B, Ganapathy PK, Utturkar GM, Sutter EG, Moorman CT, Garrett WE, Spritzer CE, DeFrate LE. Effect of normal gait on in vivo tibiofemoral cartilage strains. J Biomech 2016; 49:2870-2876. [PMID: 27421206 DOI: 10.1016/j.jbiomech.2016.06.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/10/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
Altered cartilage loading is believed to be associated with osteoarthritis development. However, there are limited data regarding the influence of normal gait, an essential daily loading activity, on cartilage strains. In this study, 8 healthy subjects with no history of knee surgery or injury underwent magnetic resonance imaging of a single knee prior to and following a 20-min walking activity at approximately 1.1m/s. Bone and cartilage surfaces were segmented from these images and compiled into 3-dimensional models of the tibia, femur, and associated cartilage. Thickness changes were measured across a grid of evenly spaced points spanning the models of the articular surfaces. Averaged compartmental strains and local strains were then calculated. Overall compartmental strains after the walking activity were found to be significantly different from zero in all four tibiofemoral compartments, with tibial cartilage strain being significantly larger than femoral cartilage strain. These results provide baseline data regarding the normal tibiofemoral cartilage strain response to gait. Additionally, the technique employed in this study has potential to be used as a "stress test" to understand how factors including age, weight, and injury influence tibiofemoral cartilage strain response, essential information in the development of potential treatment strategies for the prevention of osteoarthritis.
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Affiliation(s)
- Nimit K Lad
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Betty Liu
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Pramodh K Ganapathy
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gangadhar M Utturkar
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - E Grant Sutter
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Claude T Moorman
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - William E Garrett
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Louis E DeFrate
- Duke Sports Medicine Center, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
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In Vivo Dynamic Deformation of Articular Cartilage in Intact Joints Loaded by Controlled Muscular Contractions. PLoS One 2016; 11:e0147547. [PMID: 26807930 PMCID: PMC4726761 DOI: 10.1371/journal.pone.0147547] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/05/2016] [Indexed: 11/23/2022] Open
Abstract
When synovial joints are loaded, the articular cartilage and the cells residing in it deform. Cartilage deformation has been related to structural tissue damage, and cell deformation has been associated with cell signalling and corresponding anabolic and catabolic responses. Despite the acknowledged importance of cartilage and cell deformation, there are no dynamic data on these measures from joints of live animals using muscular load application. Research in this area has typically been done using confined and unconfined loading configurations and indentation testing. These loading conditions can be well controlled and allow for accurate measurements of cartilage and cell deformations, but they have little to do with the contact mechanics occurring in a joint where non-congruent cartilage surfaces with different material and functional properties are pressed against each other by muscular forces. The aim of this study was to measure in vivo, real time articular cartilage deformations for precisely controlled static and dynamic muscular loading conditions in the knees of mice. Fifty and 80% of the maximal knee extensor muscular force (equivalent to approximately 0.4N and 0.6N) produced average peak articular cartilage strains of 10.5±1.0% and 18.3±1.3% (Mean ± SD), respectively, during 8s contractions. A sequence of 15 repeat, isometric muscular contractions (0.5s on, 3.5s off) of 50% and 80% of maximal muscular force produced cartilage strains of 3.0±1.1% and 9.6±1.5% (Mean ± SD) on the femoral condyles of the mouse knee. Cartilage thickness recovery following mechanical compression was highly viscoelastic and took almost 50s following force removal in the static tests.
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27
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Wang H, Koff MF, Potter HG, Warren RF, Rodeo SA, Maher SA. An MRI-compatible loading device to assess knee joint cartilage deformation: Effect of preloading and inter-test repeatability. J Biomech 2015; 48:2934-40. [PMID: 26303166 DOI: 10.1016/j.jbiomech.2015.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 06/30/2015] [Accepted: 08/05/2015] [Indexed: 01/23/2023]
Abstract
It has been suggested that the extent and location of cartilage deformation within a joint under compressive loading may be predictive of predisposition to further degeneration. To explore this relationship in detail requires the quantification of cartilage deformation under controlled loads on a per-patient basis in a longitudinal manner. Our objectives were (1) to design a device capable of applying controllable axial loads while ensuring repeatable within-patient tibiofemoral positioning during magnetic resonance imaging (MRI) scans and (2) to determine the duration for which load should be maintained prior to the image acquisition, for a reproducible measurement of cartilage deformation, within the restraints of a clinical setting. A displacement control loading device was manufactured from MRI-compatible materials and tested on four volunteers for the following five scans: an unloaded scan, two repeat immediate scans which were started immediately after the application of 50% body weight, and two repeat delayed scans started 12 min after load application. Outcome measures included within-patient changes in tibiofemoral position and cartilage deformation between repeat loaded scans. The differences in tibiofemoral position between repeat loaded scans were <1mm in translation and <2° in rotation. Cartilage deformations were more consistent in the delayed scans compared to the immediate scans. We conclude that our loading device can ensure repeatable tibiofemoral positioning to allow for longitudinal studies, and the delayed scan may enable us to obtain more reproducible measurements of cartilage deformation in a clinical setting.
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Affiliation(s)
- Hongsheng Wang
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021, United States; Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY 10021, United States
| | - Matthew F Koff
- Magnetic Resonance Imaging Laboratory, Hospital for Special Surgery, New York, NY 10021, United States
| | - Hollis G Potter
- Magnetic Resonance Imaging Laboratory, Hospital for Special Surgery, New York, NY 10021, United States
| | - Russell F Warren
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, United States
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY 10021, United States
| | - Suzanne A Maher
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021, United States; Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, NY 10021, United States.
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28
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Cotofana S, Buck R, Dreher D, Wirth W, Roemer F, Duryea J, Nevitt M, Eckstein F. Longitudinal (one-year) change in cartilage thickness in knees with early knee osteoarthritis: A within-person between-knee comparison. Arthritis Care Res (Hoboken) 2015; 66:636-41. [PMID: 24106150 DOI: 10.1002/acr.22172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/23/2013] [Accepted: 09/10/2013] [Indexed: 11/11/2022]
Abstract
Objective: To test the hypothesis that cartilage displays significant longitudinal thickening in the external subregions of the central medial (ecMF) and lateral (ecLF) femur in knees with early radiographic osteoarthritis (ROA) compared with contralateral knees without ROA, and to explore differences in change in other subregions and in radiographic joint space width (JSW). Methods: 50 participants (50% women; age 61.1±9.7y; BMI 27.7±4.7kg/m2 ) were identified from the Osteoarthritis Initiative cohort with definite femorotibial osteophytes but no JSN in one knee (early ROA), and no osteophytes or JSN in the contralateral knee (non-ROA). A longitudinal within-person, between-knee comparison was performed using measures of subregional cartilage thickness based on analyses of sagittal DESSwe MR images obtained at baseline and 1-year. Medial JSW was evaluated from fixed flexion radiographs. Results: The change between baseline and 1-year was -6±94µm in ecMF and +18±91µm in ecLF in early ROA (p=0.78) vs. -1±68µm and +4±76µm in non-ROA knees (p=0.38). The variability of cartilage thickness change tended to be greater in early ROA than in non-ROA knees. Greater cartilage thickness loss in the lateral tibia and a greater reduction in minimum medial JSW was observed in early ROA vs. non-ROA knees. Conclusion: There was no direct evidence of longitudinal cartilage thickening in external subregions of the central femur in knees with early ROA compared with contralateral non-ROA knees. The observed greater variability in longitudinal thickness change in early ROA knees (but not in non-ROA knees) might be due to cartilage thickening and thinning occurring simultaneously in these knees.
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Affiliation(s)
- Sebastian Cotofana
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria, and Chondrometrics GmbH, Ainring, Germany
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Eckstein F, Le Graverand MPH. Plain radiography or magnetic resonance imaging (MRI): Which is better in assessing outcome in clinical trials of disease-modifying osteoarthritis drugs? Summary of a debate held at the World Congress of Osteoarthritis 2014. Semin Arthritis Rheum 2015; 45:251-6. [PMID: 26142321 DOI: 10.1016/j.semarthrit.2015.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/23/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
Osteoarthritis (OA) is the most common disease of synovial joints and currently lacks treatment options that modify structural pathology. Imaging is ideally suited for directly evaluating efficacy of disease-modifying OA drugs (DMOADs) in clinical trials, with plain radiography and MRI being most often applied. The current article is based on a debate held on April 26, 2014, at the World Congress of Osteoarthritis: The authors were invited to contrast strengths and limitations of both methods, highlighting scientific evidence on reliability, construct-validity, and correlations with clinical outcome, and comparing their sensitivity to change in knee OA and sensitivity to DMOAD treatment. The authors concluded that MRI provides more comprehensive information on articular tissues pathology, and that implementation of radiography in clinical trials remains a challenge. However, neither technique has thus far been demonstrated to be strongly superior over the other; for the time being it therefore appears advisable to use both in parallel in clinical trials, to provide more evidence on their relative performance. Radiographic JSW strongly depends on adequate positioning; it is not specific to cartilage loss but also to the meniscus. MRI provides somewhat superior sensitivity to change compared with the commonly used non-fluoroscopic radiographic acquisition protocols, and has recently provided non-location-dependent measures of cartilage thickness loss and gain, which are potentially more sensitive in detecting DMOAD effects than radiographic JSW or region-specific MRI. Non-location-dependent measures of cartilage thickness change should thus be explored further in context of anabolic and anti-catabolic DMOADs.
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Affiliation(s)
- Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, A5020 Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
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Sturnick DR, Vacek PM, DeSarno MJ, Gardner-Morse MG, Tourville TW, Slauterbeck JR, Johnson RJ, Shultz SJ, Beynnon BD. Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females. Am J Sports Med 2015; 43:839-47. [PMID: 25583759 PMCID: PMC6607022 DOI: 10.1177/0363546514563277] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knee joint geometry has been associated with risk of suffering an anterior cruciate ligament (ACL) injury; however, few studies have utilized multivariate analysis to investigate how different aspects of knee joint geometry combine to influence ACL injury risk. HYPOTHESES Combinations of knee geometry measurements are more highly associated with the risk of suffering a noncontact ACL injury than individual measurements, and the most predictive combinations of measurements are different for males and females. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 88 first-time, noncontact, grade III ACL-injured subjects and 88 uninjured matched-control subjects were recruited, and magnetic resonance imaging data were acquired. The geometry of the tibial plateau subchondral bone, articular cartilage, and meniscus; geometry of the tibial spines; and size of the femoral intercondylar notch and ACL were measured. Multivariate conditional logistic regression was used to develop risk models for ACL injury in females and males separately. RESULTS For females, the best fitting model included width of the femoral notch at its anterior outlet and the posterior-inferior-directed slope of the lateral compartment articular cartilage surface, where a millimeter decrease in notch width and a degree increase in slope were independently associated with a 50% and 32% increase in risk of ACL injury, respectively. For males, a model that included ACL volume and the lateral compartment posterior meniscus to subchondral bone wedge angle was most highly associated with risk of ACL injury, where a 0.1 cm3 decrease in ACL volume (approximately 8% of the mean value) and a degree decrease in meniscus wedge angle were independently associated with a 43% and 23% increase in risk, correspondingly. CONCLUSION Combinations of knee joint geometry measurements provided more information about the risk of noncontact ACL injury than individual measures, and the aspects of geometry that best explained the relationship between knee geometry and the risk of injury were different between males and females. Consequently, a female with both a decreased femoral notch width and an increased posterior-inferior-directed lateral compartment tibial articular cartilage slope combined or a male with a decreased ACL volume and decreased lateral compartment posterior meniscus angle were most at risk for sustaining an ACL injury.
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Affiliation(s)
- Daniel R. Sturnick
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Pamela M. Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Michael J. DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Mack G. Gardner-Morse
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Timothy W. Tourville
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - James R. Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Robert J. Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA
| | - Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Bruce D. Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA., Address correspondence to Bruce D. Beynnon, PhD, McClure Musculoskeletal Research Center, Department of Orthopedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT 05405, USA
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Souza RB, Kumar D, Calixto N, Singh J, Schooler J, Subburaj K, Li X, Link TM, Majumdar S. Response of knee cartilage T1rho and T2 relaxation times to in vivo mechanical loading in individuals with and without knee osteoarthritis. Osteoarthritis Cartilage 2014; 22:1367-76. [PMID: 24792208 PMCID: PMC4184934 DOI: 10.1016/j.joca.2014.04.017] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/11/2014] [Accepted: 04/20/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the effects of mechanical loading on knee articular cartilage T1ρ and T2 relaxation times in patients with and without osteoarthritis (OA). DESIGN Magnetic resonance (MR) images were acquired from 137 subjects with and without knee OA under two conditions: unloaded and loaded at 50% body weight. Three sequences were acquired: a high-resolution 3D-CUBE, a T1ρ relaxation time, and a T2 relaxation time sequences. Cartilage regions of interest included: medial and lateral femur (MF, LF); medial and lateral tibia (MT, LT), laminar analysis (superficial and deep layers), and subcompartments. Changes in relaxation times in response to loading were evaluated. RESULTS In response to loading, we observed significant reductions in T1ρ relaxation times in the MT and LT. In both the MF and LF, loading resulted in significant decreases in the superficial layer and significant increases in the deep layer of the cartilage for T1ρ and T2. All subcompartments of the MT and LT showed significant reduction in T1ρ relaxation times. Reductions were larger for subjects with OA (range: 13-19% change) when compared to healthy controls (range: 3-13% change). CONCLUSIONS Loading of the cartilage resulted in significant changes in relaxation times in the femur and tibia, with novel findings regarding laminar and subcompartmental variations. In general, changes in relaxation times with loading were larger in the OA group suggesting that the collagen-proteoglycan matrix of subjects with OA is less capable of retaining water, and may reflect a reduced ability to dissipate loads.
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Affiliation(s)
- R B Souza
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States; Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, United States.
| | - D Kumar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - N Calixto
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - J Singh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - J Schooler
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - K Subburaj
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - X Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - T M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - S Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
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Choi JH, Fahrig R, Keil A, Besier TF, Pal S, McWalter EJ, Beaupré GS, Maier A. Fiducial marker-based correction for involuntary motion in weight-bearing C-arm CT scanning of knees. Part I. Numerical model-based optimization. Med Phys 2014; 40:091905. [PMID: 24007156 DOI: 10.1118/1.4817476] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Human subjects in standing positions are apt to show much more involuntary motion than in supine positions. The authors aimed to simulate a complicated realistic lower body movement using the four-dimensional (4D) digital extended cardiac-torso (XCAT) phantom. The authors also investigated fiducial marker-based motion compensation methods in two-dimensional (2D) and three-dimensional (3D) space. The level of involuntary movement-induced artifacts and image quality improvement were investigated after applying each method. METHODS An optical tracking system with eight cameras and seven retroreflective markers enabled us to track involuntary motion of the lower body of nine healthy subjects holding a squat position at 60° of flexion. The XCAT-based knee model was developed using the 4D XCAT phantom and the optical tracking data acquired at 120 Hz. The authors divided the lower body in the XCAT into six parts and applied unique affine transforms to each so that the motion (6 degrees of freedom) could be synchronized with the optical markers' location at each time frame. The control points of the XCAT were tessellated into triangles and 248 projection images were created based on intersections of each ray and monochromatic absorption. The tracking data sets with the largest motion (Subject 2) and the smallest motion (Subject 5) among the nine data sets were used to animate the XCAT knee model. The authors defined eight skin control points well distributed around the knees as pseudo-fiducial markers which functioned as a reference in motion correction. Motion compensation was done in the following ways: (1) simple projection shifting in 2D, (2) deformable projection warping in 2D, and (3) rigid body warping in 3D. Graphics hardware accelerated filtered backprojection was implemented and combined with the three correction methods in order to speed up the simulation process. Correction fidelity was evaluated as a function of number of markers used (4-12) and marker distribution in three scenarios. RESULTS Average optical-based translational motion for the nine subjects was 2.14 mm (± 0.69 mm) and 2.29 mm (± 0.63 mm) for the right and left knee, respectively. In the representative central slices of Subject 2, the authors observed 20.30%, 18.30%, and 22.02% improvements in the structural similarity (SSIM) index with 2D shifting, 2D warping, and 3D warping, respectively. The performance of 2D warping improved as the number of markers increased up to 12 while 2D shifting and 3D warping were insensitive to the number of markers used. The minimum required number of markers for 2D shifting, 2D warping, and 3D warping was 4-6, 12, and 8, respectively. An even distribution of markers over the entire field of view provided robust performance for all three correction methods. CONCLUSIONS The authors were able to simulate subject-specific realistic knee movement in weight-bearing positions. This study indicates that involuntary motion can seriously degrade the image quality. The proposed three methods were evaluated with the numerical knee model; 3D warping was shown to outperform the 2D methods. The methods are shown to significantly reduce motion artifacts if an appropriate marker setup is chosen.
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Affiliation(s)
- Jang-Hwan Choi
- Department of Radiology, Stanford University, Stanford, California 94305, USA.
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Beynnon BD, Vacek PM, Sturnick DR, Holterman LA, Gardner-Morse M, Tourville TW, Smith HC, Slauterbeck JR, Johnson RJ, Shultz SJ. Geometric profile of the tibial plateau cartilage surface is associated with the risk of non-contact anterior cruciate ligament injury. J Orthop Res 2014; 32:61-8. [PMID: 24123281 PMCID: PMC6604060 DOI: 10.1002/jor.22434] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/14/2013] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine if geometry of the articular surfaces of the tibial plateau is associated with non-contact anterior cruciate ligament (ACL) injury. This was a longitudinal cohort study with a nested case-control analysis. Seventy-eight subjects who suffered a non-contact ACL tear and a corresponding number of controls matched by age, sex, and sport underwent 3 T MRI of both knees. Surface geometry of the tibial articular cartilage was characterized with polynomial equations and comparisons were made between knees on the same person and between ACL-injured and control subjects. There was no difference in surface geometry between the knees of the control subjects. In contrast, there were significant differences in the surface geometry between the injured and normal knees of the ACL-injured subjects, suggesting that the ACL injury changed the cartilage surface profile. Therefore, comparisons were made between the uninjured knees of the ACL-injured subjects and the corresponding knees of their matched controls and this revealed significant differences in the surface geometry for the medial (p < 0.006) and lateral (p < 0.001) compartments. ACL-injured subjects tended to demonstrate a posterior-inferior directed orientation of the articular surface relative to the long axis of the tibia, while the control subjects were more likely to show a posterior-superior directed orientation.
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Affiliation(s)
- Bruce D. Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Pamela M. Vacek
- Department of Medical Biostatistics, Unviversity of Vermont, Burlington, Vermont
| | - Daniel R. Sturnick
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Leigh Ann Holterman
- Department of Medical Biostatistics, Unviversity of Vermont, Burlington, Vermont
| | - Mack Gardner-Morse
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Timothy W. Tourville
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Helen C. Smith
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - James R. Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Robert J. Johnson
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina
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Marsh M, Souza RB, Wyman BT, Hellio Le Graverand MP, Subburaj K, Link TM, Majumdar S. Differences between X-ray and MRI-determined knee cartilage thickness in weight-bearing and non-weight-bearing conditions. Osteoarthritis Cartilage 2013; 21:1876-85. [PMID: 24091161 DOI: 10.1016/j.joca.2013.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/13/2013] [Accepted: 09/08/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Determine the effect of loading upon MRI-based mean medial femorotibial cartilage thickness (mMFT_th) and radiograph-based minimum joint space width (mJSW), and determine loading's effect on the relationship between these measures. METHODS MRI and radiographs were analyzed of 25 knees in weight-bearing and non-weight-bearing conditions. Eight subjects had a Kellgren-Lawrence (KL) grade of 0, indicating no evidence of radiographic OA. The rest were KL = 2 or KL = 3, indicating mild to moderate OA. The change from unloaded to loaded conditions was calculated. RESULTS Joint space measures decreased from unloaded to loaded conditions for both radiographs (mJSW = 3.29 mm unloaded to 3.16 mm loaded, P < 0.05) and MRI (mMFT_th = 2.70 mm unloaded to 2.55 mm loaded P < 0.001). The mean absolute difference measured from radiographs was larger for the OA group than the control group, at -0.20 mm for OA vs +0.01 mm for control. Loaded X-ray and loaded MRI joint space values from our study were no better correlated to one another than loaded X-ray and unloaded MRI. CONCLUSION Knee loading does not add a very significant value to the study of joint space on healthy knees, but loading may play a role in the study of OA knees. Unloaded MRI assessments of cartilage thickness are as correlated to loaded JSW as to loaded MRI measurements. More study is necessary to determine whether loaded MRI adds significant value to the study of OA progression.
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Affiliation(s)
- M Marsh
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
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Quantitative magnetic resonance imaging assessment of cartilage status: a comparison between young men with and without anterior cruciate ligament reconstruction. Arthroscopy 2013; 29:2012-9. [PMID: 24286800 DOI: 10.1016/j.arthro.2013.09.075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the cartilage status of the knee joints using magnetic resonance imaging at least 2 years after anterior cruciate ligament reconstruction (ACLR) in young adult men. METHODS Thirty young male patients with unilateral ACLR and 15 age-matched and body mass index--matched healthy men (controls) participated in this study. All participants underwent quantitative magnetic resonance imaging scans. Three-dimensional dual-echo steady-state sagittal images were segmented using solid model software to calculate the mean cartilage thickness, and multi-echo sagittal images were segmented with Siemens software (Siemens, Erlangen, Germany) to determine the T2 relaxation time of each cartilage plate. RESULTS There was no statistically significant difference in the mean thickness of each cartilage plate between the ACLR and control groups (P = .9616 for lateral femoral cartilage, P = .5962 for lateral tibial cartilage, P = .9328 for patellar cartilage, P = .9712 for trochlear cartilage, P = .4408 for medial femoral cartilage, and P = .1933 for medial tibial cartilage). The ACLR group had significantly higher T2 values than the control group in the lateral femoral cartilage (P < .001), lateral tibia (P = .0011), trochlea (P = .0028), medial femur (P < .001), and medial tibia (P < .001). In addition, the patella showed no difference in T2 values between the 2 groups (P = .2152). The medial compartment cartilage showed a much higher percentage change in cartilage T2 values in the ACLR group. CONCLUSIONS Although no difference in cartilage thickness was detected between the ACLR group and the control group, the mean T2 relaxation time in the ACLR patients was significantly longer than that in control subjects. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Acute cartilage loading responses after an in vivo squatting exercise in people with doubtful to mild knee osteoarthritis: a case-control study. Phys Ther 2013; 93:1049-60. [PMID: 23580627 DOI: 10.2522/ptj.20120491] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The effects of exercise on osteoarthritic cartilage remain elusive. OBJECTIVE The objective of this study was to investigate the effect of dynamic in vivo squatting exercise on the magnitude and spatial pattern of acute cartilage responses in people with tibiofemoral osteoarthritis (ie, Kellgren-Lawrence grades 1 and 2). DESIGN This investigation was a case-control study. METHODS Eighteen people with radiographic signs of doubtful to mild medial tibiofemoral osteoarthritis were compared with 18 people who were middle-aged and healthy (controls). Three-dimensional magnetic resonance imaging was used to monitor deformation and recovery on the basis of 3-dimensional cartilage volume calculations (ie, total volume and volumes in anterior, central, and posterior subregions) before and after a 30-repetition squatting exercise. Three-dimensional volumes were estimated after semiautomatic segmentation and were calculated at 4 time points (1 before and 3 after scans). Scans obtained after the exercise were separated by 15-minute intervals. RESULTS In both groups, significant deformation was noted in the medial compartment (-3.4% for the femur and -3.2% for the tibia in people with osteoarthritis versus -2.8% for the femur and -3.8% for the tibia in people in the control group). People with osteoarthritis had significant deformation in the lateral femur (-3.9%) and a tendency toward significant deformation in the lateral tibia (-3.1%). From 15 minutes after exercise cessation onward, volume changes were no longer significantly different from the baseline. At all time points, no significant between-group differences were revealed for volume changes. People with osteoarthritis showed a tendency toward slower recovery preceded by larger deformations in entire cartilage plates and subregions. Spatial subregional deformation patterns were similar between groups. LIMITATIONS Generalizability is limited to people with doubtful to mild osteoarthritis and low levels of pain. CONCLUSIONS Tibiofemoral cartilage deformation appeared similar in magnitude and spatial pattern in people who were middle-aged and either had or did not have tibiofemoral osteoarthritis (ie, Kellgren-Lawrence grades 1 and 2). Restoration of volumes required a 15-minute recovery, especially in the presence of osteoarthritic cartilage degeneration.
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Garnov N, Busse H, Gründer W. Angle-sensitive MRI for quantitative analysis of fiber-network deformations in compressed cartilage. Magn Reson Med 2013; 70:225-31. [PMID: 23716388 DOI: 10.1002/mrm.24795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 04/11/2013] [Accepted: 04/14/2013] [Indexed: 11/10/2022]
Abstract
PURPOSE To demonstrate the feasibility of a novel experimental method to quantitatively analyze fiber-network deformation in compressed cartilage by angle-sensitive magnetic resonance imaging (MRI) of cartilage. METHODS Three knee cartilage samples of an adult sheep were imaged in a high-resolution MRI scanner at 7 T. Main fiber orientation and its "offset" from the direction perpendicular to the bone-cartilage boundary were derived from MR images taken at different orientations with respect to B0. Bending of the collagen fibers was determined from weight-bearing MRI with the load (up to 1.0 MPa) applied over the whole sample surface. A "fascicle" model of the cartilage ultrastructure was assumed to analyze characteristic intensity variations in T2-weighted images under load. RESULTS T2-weighted MR images showed a strong variation of the signal intensities with sample orientation. In the T2-weighted weight-bearing series, regions of high signal intensity underwent shifts from the lateral to the central parts in all three cartilage samples. The bending of the collagen fibers was determined to be 27.2°, 35.4°, and 40.0° per MPa, respectively. CONCLUSION Assuming a "fascicle" model, the presented MRI method provides quantitative measures of structural adjustments in compressed cartilage. Our preliminary analysis suggests that cartilage fiber deformation includes both bending and crimping.
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Affiliation(s)
- Nikita Garnov
- Department of Diagnostic and Interventional Radiology Leipzig University Hospital Liebigstrasse 20 Leipzig Germany.
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Guermazi A, Hayashi D, Eckstein F, Hunter DJ, Duryea J, Roemer FW. Imaging of Osteoarthritis. Rheum Dis Clin North Am 2013; 39:67-105. [DOI: 10.1016/j.rdc.2012.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Cotofana S, Buck R, Wirth W, Roemer F, Duryea J, Nevitt M, Eckstein F. Cartilage thickening in early radiographic knee osteoarthritis: a within-person, between-knee comparison. Arthritis Care Res (Hoboken) 2013; 64:1681-90. [PMID: 22556039 DOI: 10.1002/acr.21719] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether the presence of definite osteophytes (in the absence of joint space narrowing [JSN]) on radiographs is associated with (subregional) increases in cartilage thickness in a within-person, between-knee cross-sectional comparison of participants in the Osteoarthritis Initiative. Based on previous results, the external weight-bearing medial femoral condyle (ecMF) and external weight-bearing lateral femoral condyle (ecLF) subregions were selected as primary end points. METHODS Both knees of 61 Osteoarthritis Initiative participants (n = 4,796) displayed definite tibial or femoral marginal osteophytes and no JSN in 1 knee, and no signs of radiographic osteoarthritis (OA) in the contralateral knee; this was confirmed by an expert central reader. In these participants, cartilage thickness was measured in 16 femorotibial subregions of each knee, based on sagittal double-echo steady-state with water excitation magnetic resonance images. Location-specific joint space width from fixed-flexion radiographs was determined using dedicated software. Location-specific associations of osteophytes with cartilage thickness were evaluated using paired t-tests and mixed-effects models. RESULTS Of the 61 participants, 48% had only medial osteophytes, 36% only lateral osteophytes, and 16% bicompartmental osteophytes. The knees with osteophytes had significantly thicker cartilage than contralateral knees without osteophytes in the ecMF (mean ± SD +71 ± 223 μmoles, equivalent to an increase of +5.5%; P = 0.015) and ecLF (mean ± SD +64 ± 195 μmoles, +4.1%; P = 0.013). No significant differences between knees were noted in other subregions or in joint space width. Cartilage thickness in the ecMF and ecLF was significantly associated with tibial osteophytes in the same (medial or lateral) compartment (P = 0.003). CONCLUSION The knees with early radiographic OA display thicker cartilage than (contralateral) knees without radiographic findings of OA, specifically in the external femoral subregions of compartments with marginal osteophytes.
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Diurnal variations in articular cartilage thickness and strain in the human knee. J Biomech 2012; 46:541-7. [PMID: 23102493 DOI: 10.1016/j.jbiomech.2012.09.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/26/2012] [Accepted: 09/28/2012] [Indexed: 11/21/2022]
Abstract
Due to the biphasic viscoelastic nature of cartilage, joint loading may result in deformations that require times on the order of hours to fully recover. Thus, cartilaginous tissues may exhibit cumulative strain over the course of each day. The goal of this study was to assess the magnitude and spatial distribution of strain in the articular cartilage of the knee with daily activity. Magnetic resonance (MR) images of 10 asymptomatic subjects (six males and four females) with mean age of 29 years were obtained at 8:00 AM and 4:00 PM on the same day using a 3T magnet. These images were used to create 3D models of the femur, tibia, and patella from which cartilage thickness distributions were quantified. Cartilage thickness generally decreased from AM to PM in all areas except the patellofemoral groove and was associated with significant compressive strains in the medial condyle and tibial plateau. From AM to PM, cartilage of the medial tibial plateau exhibited a compressive strain of -5.1±1.0% (mean±SEM) averaged over all locations, while strains in the lateral plateau were slightly lower (-3.1±0.6%). Femoral cartilage showed an average strain of -1.9±0.6%. The findings of this study show that human knee cartilage undergoes diurnal changes in strain that vary with site in the joint. Since abnormal joint loading can be detrimental to cartilage homeostasis, these data provide a baseline for future studies investigating the effects of altered biomechanics on diurnal cartilage strains and cartilage physiology.
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Li H, Hosseini A, Li JS, Gill TJ, Li G. Quantitative magnetic resonance imaging (MRI) morphological analysis of knee cartilage in healthy and anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 2012; 20:1496-502. [PMID: 22037812 PMCID: PMC3740362 DOI: 10.1007/s00167-011-1723-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 10/11/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze the morphological change in the cartilage of the knee after anterior cruciate ligament (ACL) injury by comparing with that of the intact contralateral knee. METHODS A total of 22 participants (12 male and 10 female patients) who had unilateral ACL injury underwent MRI scan of both the injured and intact contralateral knees. Sagittal plane images were segmented using a modeling software to determine cartilage volume and cartilage thickness in each part of the knee cartilage that were compared between the ACL-injured and the intact contralateral knees. Furthermore, the male and female patients' data were analyzed in subgroups. RESULTS The ACL-injured knees had statistically significant lower total knee cartilage volume than the intact contralateral knees (P = 0.0020), but had similar mean thickness of total knee cartilage (not significant: n.s.). In the male subgroup, there was no significant difference in cartilage volume and thickness between normal and ACL-injured knees. In the female subgroup, the ACL-injured knees demonstrated statistically significant difference in total knee cartilage volume (P = 0.0004) and thickness (P = 0.0024) compared with the normal knees. The percentage change in the cartilage thickness in women was significantly greater than that in men. CONCLUSION Cartilage volume was significantly smaller in the ACL-injured knees than in the contralateral intact knees in this cohort. Women tended to display greater cartilage volume and thickness change after ACL injury than men. These findings indicated that women might be more susceptible to cartilage alteration after ACL injuries. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hong Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ 1215, Boston, MA 02114, USA. Department of Sports Medicine, Huashan Hospital, Shanghai, People’s Republic of China
| | - Ali Hosseini
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ 1215, Boston, MA 02114, USA
| | - Jing-Sheng Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ 1215, Boston, MA 02114, USA
| | - Thomas J. Gill
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ 1215, Boston, MA 02114, USA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ 1215, Boston, MA 02114, USA
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In vivo three-dimensional motion analysis of osteoarthritic knees. Mod Rheumatol 2012; 23:646-52. [PMID: 22772489 DOI: 10.1007/s10165-012-0703-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
Abstract
AIM The purpose of this study is to investigate the three-dimensional (3D) kinematics of preoperative osteoarthritic (OA) knees, and to clarify the validity of the findings in comparison with previous studies of kinematics in normal and OA knees. MATERIALS AND METHODS Fifteen preoperative OA knees were scanned by 3D computed tomography (CT) at three positions. We created 3D bone models and quantitatively evaluated motion of the knee joint using a markerless volume-based registration technique. Assessment categories comprised rotation angles and anterior-posterior (AP) translation. The Pearson correlation test was used to analyze correlations between rotational angle and femorotibial angle. RESULTS From maximum extension to 90° flexion, 11 femurs displayed internal rotation relative to the tibia. In 10 knees, the sulcus moved >1 mm more backward than the lateral epicondyle. Significant differences were apparent between movement of the sulcus and lateral epicondyle. A correlation of -0.42 was found between the rotational angle and femorotibial angle. CONCLUSIONS The kinematics of OA knees differed from that of normal knees in that femurs did not present external rotation with flexion. One reason for this movement is that the medial condyle of the femur tended to move backward in knee flexion due to disruption of the tibial joint surface.
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Sitoci K, Hudelmaier M, Eckstein F. Nocturnal Changes in Knee Cartilage Thickness in Young Healthy Adults. Cells Tissues Organs 2012; 196:189-94. [DOI: 10.1159/000333456] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2011] [Indexed: 11/19/2022] Open
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Wenger A, Englund M, Wirth W, Hudelmaier M, Kwoh K, Eckstein F. Relationship of 3D meniscal morphology and position with knee pain in subjects with knee osteoarthritis: a pilot study. Eur Radiol 2011; 22:211-20. [PMID: 21842432 DOI: 10.1007/s00330-011-2234-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 07/06/2011] [Accepted: 08/01/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To explore whether quantitative, three-dimensional measurements of meniscal position and size are associated with knee pain using a within-person, between-knee study design. METHODS We studied 53 subjects (19 men, 34 women) from the Osteoarthritis Initiative, with identical radiographic OA grades in both knees, but frequent pain in one and no pain in the other knee. The tibial plateau and menisci were analyzed using coronally reconstructed double echo steady-state sequence with water excitation (DESSwe) MRI. RESULTS The medial meniscus covered a smaller proportion of the tibial plateau (-5%) and displayed greater extrusion of the body (+15%) in painful than in painless knees (paired t-test; p < 0.05). The external margin of the lateral meniscus showed greater extrusion of the body in painful knees (+22%; p = 0.03), but no significant difference in the position of its internal margin or tibial coverage. Medial or lateral extrusion ≥3 mm was more frequent in painful (n = 23) than in painless knees (n = 12; McNemar's test; p = 0.02). No significant association was observed between meniscal size and knee pain. CONCLUSIONS These data suggest a relationship between extrusion of the meniscal body, as measured with quantitative MRI, and knee pain in subjects with knee OA. Further studies need to confirm these findings and their clinical relevance.
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Affiliation(s)
- Andrea Wenger
- Institute of Anatomy & Musculoskeletal Research, Paracelsus Medical University (PMU), Strubergasse 21, A5020 Salzburg, Austria.
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