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Uchio Y, Ishijima M, Ikeuchi M, Ikegawa S, Ishibashi Y, Omori G, Shiba N, Takeuchi R, Tanaka S, Tsumura H, Deie M, Tohyama H, Yoshimura N, Nakashima Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of Osteoarthritis of the knee - Secondary publication. J Orthop Sci 2024:S0949-2658(24)00139-8. [PMID: 39127581 DOI: 10.1016/j.jos.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/28/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University, Izumo, Japan.
| | | | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi University, Nankoku, Japan
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, Center for Integrated Medical Science (IMS), RIKEN, Tokyo, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoto Shiba
- Department of Orthopaedics, Kurume University School of Medicine, Fukuoka, Japan
| | - Ryohei Takeuchi
- Department of Joint Surgery Center, Yokohama Sekishinkai Hospital, Yokohama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University, Oita, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan
| | | | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, University of Tokyo, Tokyo, Japan
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Shimozaki K, Nakase J, Kanayama T, Yanatori Y, Ishida Y, Ohno N, Miyati T, Tsuchiya H. Extrusion of the medial meniscus under a weight-loading condition in early knee osteoarthritis: an investigation using special upright magnetic resonance imaging. BMC Musculoskelet Disord 2023; 24:680. [PMID: 37633935 PMCID: PMC10463466 DOI: 10.1186/s12891-023-06807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Whether the medial meniscus morphology and movement occur under upright loading conditions in early knee osteoarthritis (OA) or medial meniscus posterior root tear (MMPRT) remains unknown. This study aimed to evaluate the medial and anteroposterior extrusion of the medial meniscus under unloaded and upright-loaded conditions in patients with early knee OA. METHODS Twelve patients with early knee OA and 18 healthy adult volunteers participated in this study. Magnetic resonance imaging using special equipment was performed with the participants in the unloaded and upright-loaded conditions. Medial, anterior, and posterior extrusions of the medial meniscus against the tibial edge were evaluated and compared between the early knee OA and healthy adult control groups. Additionally, 12 patients in the early knee OA group were divided into 2 subgroups based on whether MMPRT was observed, and the extrusion of the medial meniscus was compared. RESULTS The amount of medial extrusion of the medial meniscus in both the unloaded and upright-loaded conditions was significantly greater in the early knee OA group than in the control group (unloaded: 2.6 ± 1.0 mm vs 0.7 ± 0.5 mm; upright-loaded: 3.7 ± 0.9 mm vs 1.8 ± 0.8 mm). Similarly, the anterior and posterior extrusion of the medial meniscus in the upright-loaded condition was significantly larger in the early knee OA group (anterior: 4.6 ± 1.0 mm vs 3.7 ± 1.1 mm; posterior: -3.4 ± 1.1 mm vs -4.6 ± 1.6 mm). However, no difference was observed in meniscal extrusion between unloaded and upright-loaded conditions. The posterior extrusion of the medial meniscus in the upright-loaded condition was significantly greater in MMPRT cases than in non-MMPRT cases in the early knee OA group (MMPRT: -2.7 ± 1.1 mm; non-MMPRT -4.1 ± 1.5 mm). CONCLUSIONS In early knee OA, significantly large meniscal extrusions of the medial meniscus in both unloaded and upright-loaded conditions were found compared with healthy adults. Among patients with early knee OA, those with MMPRT showed a large posterior extrusion of the medial meniscus in the upright-loaded condition compared with those without MMPRT. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Tomoyuki Kanayama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshihiro Ishida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-0942, Japan
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-0942, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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Murata S, Kijima H, Saito K, Saito H, Miura T, Akagawa M, Tsukamoto H, Sasaki K, Ebina T, Nozaka K, Miyakoshi N. Evaluation of Medial Meniscal Extrusion Using Radiography. J Clin Med 2023; 12:5268. [PMID: 37629311 PMCID: PMC10456070 DOI: 10.3390/jcm12165268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Recently, there has been increasing interest in medial meniscal extrusion (MME), but few reports have evaluated MME via X-ray. In this study, the amount of MME and meniscal height at the medial border of the tibia were measured via X-ray with gradation processing. The extrusion length divided by the meniscal height yields the meniscal extrusion ratio, which was used as an index. In addition, the medial meniscal length of the part protruding from the medial border of the tibia on MRI was measured as an absolute value. Then, the correlation between the meniscal extrusion ratio and the amount of MME on MRI was examined, and there was a strong correlation between the meniscal extrusion ratio via X-ray and the amount of MME on MRI (correlation coefficient 0.860, p < 0.0001). The cut-off value of the meniscal extrusion ratio via X-ray for positive meniscal extrusion on MRI was 0.50, with an AUC of 0.9825, sensitivity of 0.9063, and specificity of 0.8663. From the present study, it was possible to measure the extrusion length and meniscal height via gradation processing, with X-ray and without MRI, and to calculate the meniscal extrusion ratio, which strongly correlates with the amount of MME on MRI.
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Affiliation(s)
- Shohei Murata
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
- Department of Orthopedic Surgery, Kakunodate General Hospital, 3 Iwase, Senboku 014-0394, Japan
| | - Hiroaki Kijima
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Kimio Saito
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Hidetomo Saito
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Takanori Miura
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
| | - Manabu Akagawa
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
| | - Hiroaki Tsukamoto
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
| | - Kana Sasaki
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
| | - Toshihito Ebina
- Department of Orthopedic Surgery, Kakunodate General Hospital, 3 Iwase, Senboku 014-0394, Japan
| | - Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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Papalia GF, Za P, Saccone L, Franceschetti E, Zampogna B, Vasta S, Papalia R. Meniscal extrusion: risk factors and diagnostic tools to predict early osteoarthritis. Orthop Rev (Pavia) 2023; 15:74881. [PMID: 37197670 PMCID: PMC10184885 DOI: 10.52965/001c.74881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Meniscal extrusion (ME) is strongly correlated with cartilage wear and osteoarthritis (OA), be-cause of the altered kinematic and the decreased contact area between the tibia and femur. The aim of this narrative review is to analyze the process of ME, focusing on the possible causes, and to evaluate the correlation between ME and knee OA, in order to provide early diagnosis and treatments. Studies written in English that analyzed the causes of ME, provided indications re-garding diagnosis and treatment, and evaluated the relation between ME and early OA were in-cluded. Injuries, degeneration of the meniscal substance and meniscus root tears are associated with significantly increased ME. An extruded meniscus could be a manifestation of other pa-thologies such as disruption of coronary ligaments, cartilage loss, knee malalignment, ligament injuries, or OA. ME is strongly associated with osteoarthritis features, particularly with bone marrow lesion and cartilage damage. Magnetic resonance imaging represents the gold standard for the detection of ME. The severity of the medial meniscus extrusion may also affect healing af-ter repair, and meniscus extrusion is not completely reduced by meniscus posterior root tear re-pair. In this study, we proved that ME represents an important risk factor for early knee OA. We provided alternative theories of ME, such as meniscal fibers injury first and "dynamic extrusion of the menisci". The phenomenon of aging has been described as a new concept in the etiology of ME. Finally, we stated all the main techniques and characteristics of the diagnostic process, as well as the current knowledge in the therapeutic field.
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Affiliation(s)
- Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pierangelo Za
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luca Saccone
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sebastiano Vasta
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Oshima T, Putnis S, Grasso S, Lim YP, Oshima M, Parker DA. A balance between native footprint coverage and overlap of the anterolateral meniscal root in tibial tunnel positioning during anterior cruciate ligament reconstruction: A 3D MRI study. Knee 2023; 41:106-114. [PMID: 36642034 DOI: 10.1016/j.knee.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/13/2022] [Accepted: 12/08/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Tibial footprint of anterior cruciate ligament (ACL) is situated close to the anterior lateral meniscal root (ALMR) attachment. PURPOSE To investigate the impact of the size and location of the tibial tunnel for ACL reconstruction on the ACL footprint coverage and overlap to the ALMR. STUDY DESIGN Controlled laboratory study. METHODS Twenty knee MRI scans from twenty healthy subjects were recruited, and three-dimensional (3D) tibia models were created to show the tibial attachment sites of ACL and ALMR. Surgical simulation of the tibial tunnel drilling was performed on each 3D model, entering the joint at an angle set at 60 degrees from the tibial plateau plane and 55 degrees from the posterior tibial condylar axis, with analysis for six different drill sizes; 7.5, 8, 8.5, 9, 9.5 and 10 mm; and nine locations; the center of the ACL attachment and eight locations 2% of the tibial width apart surrounding it. The width of the tibial plateau, the distance between ACL and ALMR attachment centers, and the size and location of the potential tibial tunnel were evaluated to determine association with the area of the ACL footprint coverage and ALMR overlap using a linear mixed effects model. RESULTS A large tunnel (p <.001), a central and anterior location (p <.029), and small tibial width (p =.015) were all associated with larger coverage of the ACL footprint. A large tunnel (p <.001), posteriorly and laterally located (p ≤ 0.001), and a small distance between the ACL and ALMR centers (p =.001) were significantly associated with a larger ALMR overlap. The association of the tunnel size to ALMR overlap reduced with a medial tunnel location. CONCLUSIONS The short distance between the centers of the ALMR attachment and native ACL footprint suggests that the ALMR will always be susceptible to overlap when the tibial tunnel is drilled in ACL reconstruction. Small alterations in tunnel location can lead to a statistically significant alteration with the amount of ALMR overlap. To minimize this overlap, whilst maintaining acceptable coverage of the ACL footprint, a tibial tunnel positioned in a medial or anteromedial location from the center of the ACL footprint is recommended.
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Affiliation(s)
- Takeshi Oshima
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; Asanogawa General Hospital, Kanazawa, Ishikawa, Japan
| | - Sven Putnis
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; Bristol Royal Infirmary, University Hospitals Bristol & Weston NHS Foundation Trust, UK
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Yoong Ping Lim
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Megumi Oshima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - David Anthony Parker
- Sydney Orthopaedic Research Institute, Chatswood, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
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Slight cartilage damage in weight-bearing area of lateral femoral condyle do not compromise short-term outcomes of medial unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2022; 142:3949-3955. [PMID: 34816324 DOI: 10.1007/s00402-021-04254-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Medial unicompartmental knee arthroplasty (mUKA) requires full-thickness cartilage in the lateral compartment, but slight damage of the cartilage surface can be ignored. However, as this statement lacks literature support, we investigated whether slight cartilage damages in the weight-bearing area of the lateral femoral condyle would affect the outcome of mUKAs. MATERIALS AND METHODS Outerbridge grading was performed on the cartilage in the weight-bearing area of the lateral femoral condyle intraoperatively. The patients, grouped as normal or as having lateral condyle cartilage of Outerbridge grade 1-2 (slight cartilage damage), underwent mUKA. Full-length lower extremity radiographs were taken and hip-knee-ankle angles (HKAAs) were measured both preoperatively and postoperatively. Using magnetic resonance imaging, the lateral meniscal extrusion distance was also measured. In addition, the Oxford Knee Score (OKS) was assessed preoperatively and at the last follow-up, in addition to the patient satisfaction assessment. RESULTS We enrolled 152 knees of 142 patients proposed for mUKAs. The mean age of participants was 69.5 years (51-89 years) and they were followed up for a mean of 25.4 months (15-44 months). There was no significant difference in preoperative (p = 0.746) and postoperative (p = 0.202) mean OKS between the normal, Outerbridge grade 1 and Outerbridge grade 2 groups. While the normal group had a higher change in OKS than the group with cartilage damage, this difference was not significant (p = 0.910). The UKA corrected the patients' mean HKAA from 171.1° (preoperatively) to 176.1° (postoperatively). From all patients, only four had slight lateral meniscus extrusion with MEDs of ≤ 0.25 mm. With the exception of one patient with a poor outcome in normal group, the rest were satisfied with the outcome of mUKA. No patients had prosthesis-related complications or revision surgery. CONCLUSIONS Cartilage damage of Outerbridge grade 1 and grade 2 in the weight-bearing area of the lateral femoral condyle will not compromise the short-term outcome of medial mobile-bearing UKA.
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Falkowski AL, Jacobson JA, Cresswell M, Bedi A, Kalia V, Zhang B. Medial Meniscal Extrusion Evaluation With Weight-Bearing Ultrasound: Correlation With MR Imaging Findings and Reported Symptoms: Correlation With MR Imaging Findings and Reported Symptoms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2867-2875. [PMID: 35302664 PMCID: PMC9790463 DOI: 10.1002/jum.15975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 02/20/2022] [Accepted: 02/26/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To compare medial meniscal extrusion on weight-bearing ultrasound (US) with supine US and magnetic resonance (MR) imaging correlating with meniscal pathology and reported symptoms. METHODS IRB approved study with informed consent. Patients obtaining routine knee MR imaging for suspected knee pathology were prospectively evaluated with supine and weight-bearing US of the medial meniscus. Meniscal extrusion was measured independently by two fellowship-trained musculoskeletal radiologists. Correlation was made to presence or absence of meniscal degeneration or tear on MR imaging, as well as reported symptoms. Statistical significance was calculated via intraclass correlation coefficient (ICC) and analysis of variance (ANOVA). RESULTS Ninety-nine knees from 95 subjects (50 males, 45 females; mean age 45 ± 15 years) were included. Mean medial meniscal extrusion measured at US for a normal meniscus (n = 36) was 0.8 mm when supine, increasing to 1.6 mm on weight-bearing. Mean meniscal extrusion in subjects with mucoid degeneration (n = 20) and those with meniscal tears (n = 43) was 1.6 mm, increasing to 2.3 mm with weight bearing. Inter-reader reliability showed ICC values of 0.853 to 0.940. There was a significant difference in medial meniscal extrusion comparing subjects with a normal medial meniscus at magnetic resonance imaging (MRI) and subjects with either meniscal degeneration or tear. There was no significant difference in degree of meniscal extrusion between subjects with meniscal degeneration or tear. There was trend of worsening symptoms and increasing functional limitations moving from normal meniscus to meniscal degeneration to meniscal tear. CONCLUSIONS A normal meniscus shows lesser mobility between supine and upright position, than a pathologic meniscus. Both mucoid degeneration and meniscal tear demonstrate extrusion in the supine position, which increases with weight-bearing position.
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Affiliation(s)
- Anna L. Falkowski
- Department of RadiologyUniversity of MichiganAnn ArborMI
- Department of Radiology and Nuclear Medicine, Cantonal Hospital WinterthurUniversity of ZurichWinterthur
| | - Jon A. Jacobson
- Department of RadiologyUniversity of CincinnatiCincinnatiOHUSA
| | - Mark Cresswell
- Department of Radiology, St Paul's HospitalUniversity of British ColumbiaVancouverBCCanada
| | - Asheesh Bedi
- Department of Orthopaedic SurgeryUniversity of Michigan, Domino's Farms, MedSportAnn ArborMIUSA
| | - Vivek Kalia
- Department of RadiologyUniversity of MichiganAnn ArborMI
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA
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Makiev KG, Vasios IS, Georgoulas P, Tilkeridis K, Drosos G, Ververidis A. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. Knee Surg Relat Res 2022; 34:35. [PMID: 35851067 PMCID: PMC9290229 DOI: 10.1186/s43019-022-00163-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/03/2022] [Indexed: 01/04/2023] Open
Abstract
The menisci are crescent-shaped, fibrocartilaginous structures that play a crucial role in the load transition and distribution of the contact forces along the tibiofemoral articulation. Meniscal extrusion (ME) is a radiological finding, especially in magnetic resonance imaging (MRI) scans, for which there has been growing interest in recent years. ME, in the coronary plane, is defined as the maximum distance of the most distal end of the meniscus from the border of the tibial plateau, where the tibial eminences are the most prominent, without taking into account the osteophytes. Although there is still controversy in the literature in respect of the optimal cutoff value, a threshold of 3 mm is considered significant. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. It is associated with either rapidly progressive knee osteoarthritis or early onset of knee osteoarthritis and increased morbidity. In this review, we delineate the clinical significance of ME in various knee pathologies, as well as when, why and how it should be managed. To the best of our knowledge, this is the first study to elaborate on these topics.
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Affiliation(s)
- Konstantinos G Makiev
- Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece.
| | - Ioannis S Vasios
- Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece
| | - Paraskevas Georgoulas
- Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece
| | - Konstantinos Tilkeridis
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Drosos
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Athanasios Ververidis
- Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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Ishibashi K, Sasaki E, Ota S, Oyama T, Chiba D, Yamamoto Y, Tsuda E, Uemura N, Sawada K, Ishibashi Y. Bone marrow lesion severity was associated with proximal tibial inclination in early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:668-679. [PMID: 33394079 DOI: 10.1007/s00167-020-06378-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to investigate the effect of tibial plateau (TP) inclination and serum bone metabolic markers on bone marrow lesion (BML) in the general Japanese population with early knee osteoarthritis (EKOA). METHODS A total of 441 female volunteers who participated in the Iwaki Health Promotion Project in 2017 were enrolled. Participants without radiographic abnormalities were divided into normal and EKOA groups according to the Luyten's classification criteria for EKOA. The medial proximal tibial angle (MPTA), growth plate-TP angle, and growth plate-medial tibial plateau (MTP) angle were measured on standing anteroposterior radiographs of the knees. BML severity on T2-weighted fat-suppressed magnetic resonance imaging (MRI) was scored using the Whole-Organ MRI Score method. Serum levels of N-telopeptide of type I collagen, tartrate-resistant acid phosphatase-5b (TRACP-5b), bone-specific alkaline phosphatase, procollagen type I N-terminal propeptide, pentosidine, and homocysteine were assessed. Linear regression analysis was conducted to investigate the relationship between proximal tibial inclination, BML, and serum bone metabolic markers. RESULTS The growth plate was observed in 309 (70%) participants, and 48 (16%) participants had EKOA. The mean MPTA, growth plate-TP angle, and growth plate-MTP angle were 86.1 ± 5.9°, 3.6 ± 1.1°, and 9.9 ± 2.6°, respectively. The MPTA was negatively correlated with the growth plate-TP and growth plate-MTP angles (p = 0.006, p < 0.001). Participants with EKOA who had BML exhibited greater growth plate-MTP angle than those who did not (p = 0.018). Regression analysis revealed that BML severity was positively associated with MPTA (p = 0.036) and a bone formation marker (p = 0.045). CONCLUSION BML severity was positively associated with proximal tibial inclination and serum TRACP-5b level in participants with EKOA and normal knees, respectively. Assessment of proximal tibial inclination may provide insight into potential BML risk. Residual medial tibial inclination may potentially result in knee pain and symptoms in EKOA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kyota Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Tetsushi Oyama
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Nozomi Uemura
- Department of QOL and Health Promotion, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kaori Sawada
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Shinohara I, Inui A, Mifune Y, Nishimoto H, Yamaura K, Mukohara S, Yoshikawa T, Kato T, Furukawa T, Hoshino Y, Matsushita T, Kuroda R. Motion Analysis of Triangular Fibrocartilage Complex by Using Ultrasonography Images: Preliminary Analysis. SENSORS 2022; 22:s22010345. [PMID: 35009887 PMCID: PMC8749810 DOI: 10.3390/s22010345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 02/01/2023]
Abstract
The triangular fibrocartilage complex (TFCC) is a significant stabilizer of the distal radioulnar joint. Diagnosing TFCC injury is currently difficult, but ultrasonography (US) has emerged as a low-cost, minimally invasive diagnostic tool. We aimed to quantitatively analyze TFCC by performing motion analysis by using US. Twelve healthy volunteers, comprising 24 wrists (control group), and 15 patients with TFCC Palmer type 1B injuries (injury group) participated. The US transducer was positioned between the ulnar styloid process and triquetrum and was tilted ulnarly 30° from the vertical line. The wrist was then actively moved from 10° of radial deviation to 20° of ulnar deviation in a 60-rounds-per-minute rhythm that was paced by a metronome. The articular disc displacement velocity magnitude was analyzed by using particle image velocimetry fluid measurement software. The mean area of the articular discs was larger on ulnar deviation in the control group. The mean articular disc area on radial deviation was larger in the injury group. The average articular disc velocity magnitude for the injury group was significantly higher than that for the control group. The results suggest that patients with TFCC injury lose articular disc cushioning and static stability, and subsequent abnormal motion can be analyzed by using US.
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Affiliation(s)
| | | | - Yutaka Mifune
- Correspondence: ; Tel.: +81-78-382-5111; Fax: +81-78-351-6944
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11
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Usefulness of ultrasonography for dynamic evaluation of medial meniscus hoop function in early knee osteoarthritis. Sci Rep 2021; 11:20091. [PMID: 34635735 PMCID: PMC8505604 DOI: 10.1038/s41598-021-99576-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 09/23/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the dynamics of the medial meniscus during knee flexion–extension by ultrasonography and compare them with MRI findings to confirm the usefulness of ultrasonography for evaluating early knee osteoarthritis (KOA). In total, 100 patients were diagnosed with early KOA using clinical and radiographical findings. Dynamic ultrasonographic evaluation and MRI were performed in all patients. Medial meniscal extrusion (MME) and medial meniscal tears were evaluated via ultrasonography and MRI. Abnormal MME was defined as MME > 2 mm on ultrasonography during knee extension. Patients with abnormal MME were divided into two groups: a decrease group (group D) and a non-decrease group (group N). Age, sex, absence or type of meniscus tear, and MME were compared between the two groups. Of the 100 patients, 75 demonstrated MME > 2 mm at knee extension. MME at all assessment positions using ultrasonography and MRI were significantly greater in group N (n = 34) than that in group D (n = 41). Medial meniscus posterior root tears or radial tears were observed in most cases in group N. A lack of decrease in MME from 0° to 90° of flexion on ultrasonography was a characteristic finding in patients with a loss of meniscal hoop function.
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Mochizuki T, Tanifuji O, Watanabe S, Sato T, Endo N. The postoperative shorter meniscal width was the risk factor of lateral meniscal extrusion in the middle portion for juvenile and adolescent knees with discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2021; 29:2857-2866. [PMID: 32734331 DOI: 10.1007/s00167-020-06188-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The study aim was to clarify the risk factors for postoperative meniscal extrusion in a middle portion in juvenile and adolescent knees with DLM. METHODS Forty-six patients with symptomatic DLM who underwent surgery were retrospectively assessed. Inclusion criteria were set as follows: (1) aged ≤ 17 years with an open growth plate, (2) preoperative and postoperative follow-up MRI, and 3) reshaping surgeries comprising of saucerization alone or with meniscal repair. Average (95%CI) age during surgery, body mass index (BMI), and follow-up duration were 12 years (11-13), 19.9 kg/m2 (18.7-21.0), and 26.4 months (19.5-33.3), respectively. Age, sex, sports activities, BMI, postoperative rehabilitation, preoperative shift of DLM by Ahn's classification, surgical procedures, postoperative meniscal width of all portions, and meniscal healing were analyzed. RESULTS Postoperatively, eight knees in the no-extrusion group and 38 knees in the extrusion group were observed. In the univariate logistic regression analysis, shorter meniscal width in a middle portion (OR = 1.580, p = 0.006), shorter minimum width of all portions (OR = 1.674, p = 0.024), and meniscal healing (OR = 0.160, p = 0.028) were the risk factors for meniscal extrusion in a middle portion. Multiple logistic regression analysis demonstrated that shorter meniscal width in a middle portion was the risk factor. CONCLUSIONS As the clinical relevance, to prevent postoperative meniscal extrusion of the middle portion with DLM, surgeons are necessary to pay attention to maintain the adequate meniscal width for juvenile and adolescent knees. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan.
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Satoshi Watanabe
- Department of Orthopaedic Surgery, Niigata Medical Center, 3-27-11, Kobari, Nishi-ku, Niigata, 950-2022, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Niigata Medical Center, 3-27-11, Kobari, Nishi-ku, Niigata, 950-2022, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata, Niigata, 951-8510, Japan
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13
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Relationship between abnormalities detected by magnetic resonance imaging and knee symptoms in early knee osteoarthritis. Sci Rep 2021; 11:15179. [PMID: 34312418 PMCID: PMC8313522 DOI: 10.1038/s41598-021-94382-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/06/2021] [Indexed: 12/30/2022] Open
Abstract
We investigated the prevalence of magnetic resonance imaging (MRI) findings and their relationship with knee symptoms in women without radiographic evidence of knee osteoarthritis (KOA). This cross-sectional cohort study included 359 Japanese women without radiographic evidence of KOA (Kellgren‒Lawrence grade < 2). All participants underwent T2-weighted fat-suppressed MRI of their knees. Structural abnormalities (cartilage damage, bone marrow lesions [BMLs], subchondral cysts, bone attrition, osteophytes, meniscal lesions, and synovitis) were scored according to the whole-organ MRI score method. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Score. Participants were divided into early and non-KOA groups based on early KOA classification criteria. Logistic regression analysis was performed to evaluate the relationship between MRI abnormalities and knee symptoms. Cartilage damage was the most common abnormality (43.5%). The prevalences of cartilage damage, BMLs, subchondral cysts, bone attrition, meniscal lesions, and synovitis were higher in patients with early KOA than in those without. Synovitis (odds ratio [OR] 2.254, P = 0.002) and meniscal lesions (OR 1.479, P = 0.031) were positively associated with the presence of early KOA. Synovitis was most strongly associated with knee pain and might be a therapeutic target in patients with early KOA.
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Saruga T, Sasaki E, Inoue R, Chiba D, Ota S, Iwasaki H, Uesato R, Nakaji S, Ishibashi Y. Usefulness of serum hyaluronic acid levels as a predictor of incidence of hand osteoarthritis analyzed by longitudinal analysis from the Iwaki cohort. Sci Rep 2021; 11:4074. [PMID: 33603120 PMCID: PMC7892545 DOI: 10.1038/s41598-021-83693-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
The factors predicting hand osteoarthritis (HOA) in patients remain unknown. We aimed to investigate the usefulness of serum hyaluronic acid (sHA) levels in predicting HOA progression from a 6-year longitudinal epidemiological study. A total of 417 participants in the Iwaki cohort were followed-up over 6 years. Hand and knee radiographs taken at baseline and follow-up were scored according to Kellgren–Lawrence grades and Kallman score. Participants were classified into the HOA group and the non-HOA group. sHA levels at baseline were determined by ELISA. Correlations between sHA levels, the number of involved joints, and Kallman score were estimated. Factors related to the incidence or progression of HOA over 6 years were analyzed. The prevalence of HOA was 19.9% at baseline, and 3.6 ± 2.1 joints were involved. sHA levels in the HOA group at baseline were significantly higher than in the non-HOA group (p < 0.001) and correlated with the number of involved joints (r = 0.399, p < 0.001) and Kallman score (r = 0.540, p < 0.001). The incidence rate was 14.5%, and the progression rate was 46.1% over 6 years. Higher sHA levels at baseline were the risk factor of HOA incidence. Thus, sHA levels predicted the incidence of HOA over 6 years.
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Affiliation(s)
- Tatsuro Saruga
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ryo Inoue
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Chiba
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Seiya Ota
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hiroki Iwasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ryoko Uesato
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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15
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Abstract
PURPOSE OF REVIEW This narrative review summarizes the last 5 years of published, peer-reviewed research on the use of musculoskeletal ultrasound (US) in osteoarthritis (OA). RECENT FINDINGS Multiple features relevant to OA can be visualized on US, including synovitis, erosion, enthesitis, osteophytes, cartilage damage, meniscal extrusion, and popliteal cysts. US can be used to confirm a diagnosis of OA or make an alternate diagnosis in the clinical setting. When a standardized protocol is used, US is a reliable modality for assessment of the features of OA. Findings on US can predict progression and response to therapy in OA of the hand and knee and can allow characterization of risk factors in a cost-effective, non-invasive, repeatable manner. US is becoming more widely used in OA imaging and has clear value in addition to radiography and clinical assessment. US will likely prove useful in defining phenotypes and providing treatment guidance in OA.
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Affiliation(s)
- Amanda E Nelson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.
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16
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Determining a Threshold of Medial Meniscal Extrusion for Prediction of Knee Pain and Cartilage Damage Progression Over 4 Years: Data From the Osteoarthritis Initiative. AJR Am J Roentgenol 2020; 216:1318-1328. [PMID: 32755218 DOI: 10.2214/ajr.20.23864] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND. The extent of medial meniscal extrusion (MME) that is associated with structural and symptomatic progression of knee osteoarthritis has not been defined yet. OBJECTIVE. The purpose of our study was to investigate MRI-based thresholds of MME that are associated with structural progression of knee degenerative disease and symptoms over a period of 4 years. METHODS. We studied 328 knees of 235 participants that were randomly selected from the Osteoarthritis Initiative cohort. MME was quantified on coronal sections of intermediate-weighted MRI sequences obtained at 3 T. Knee pain and cartilage abnormalities were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and the cartilage whole-organ MRI score (WORMS). General estimating equations with logistic regression models were used to correlate baseline MME and changes in pain (WOMAC) and cartilage damage (WORMS). ROC analyses were performed to determine the area under the ROC curve (AUROC). Individual thresholds were determined by maximizing the product of sensitivity and specificity. RESULTS. The AUROC for predicting progression of knee pain, medial compartment cartilage damage, and medial tibial cartilage damage were 0.71, 0.70, and 0.72, respectively, and the individual thresholds for MME were 2.5, 2.7, and 2.8 mm. A single threshold of 2.5 mm was determined by maximizing the mean of the product of sensitivity and specificity of the three outcome variables (knee pain progression, medial compartmental cartilage damage progression, and medial tibial cartilage damage progression). CONCLUSION. MME was associated with knee pain and cartilage damage progression over 4 years. A single threshold of 2.5 mm was found to be the most useful threshold for predicting knee pain, medial compartment cartilage damage progression, and tibial cartilage damage progression over 4 years. CLINICAL IMPACT. This threshold could be used to standardize the diagnostic criterion of extrusion and to better characterize the risk for subsequent structural and symptomatic progression of knee osteoarthritis.
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Ishibashi K, Sasaki E, Ota S, Chiba D, Yamamoto Y, Tsuda E, Yoshikuni S, Ihara K, Ishibashi Y. Detection of synovitis in early knee osteoarthritis by MRI and serum biomarkers in Japanese general population. Sci Rep 2020; 10:12310. [PMID: 32704147 PMCID: PMC7378056 DOI: 10.1038/s41598-020-69328-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/08/2020] [Indexed: 01/16/2023] Open
Abstract
To investigate synovitis' influence on early knee osteoarthritis (EKOA) by serum biomarkers and magnetic resonance imaging (MRI) findings in Japanese women. We enrolled 255 women aged 30-70 without radiographic abnormalities (Kellgren-Lawrence grade ≥ 2). Knee injury, OA outcome scores (KOOS), clinical examinations, and standing radiograph were used for classification criteria of EKOA. Participants were classified into normal knee group and EKOA group. All participants underwent MRIs of their right knee. The amount of effusion-synovitis volume was quantified. We compared serum matrix metalloproteinases-3 levels (MMP-3), high-sensitivity C-reactive protein, interleukin-6, and adiponectin between the groups. The relationship between synovitis and EOKA was investigated using multiple linear regression. Fifty-four participants (21%) were classified as EKOA. Serum MMP-3 concentration and effusion-synovitis volume were higher in patients with EKOA (p = 0.025 and p = 0.001, respectively). Effusion-synovitis volume negatively correlated with all KOOS subscales and positively correlated with serum MMP-3 concentration. Serum MMP-3 concentration was associated with effusion-synovitis volume β = 0.60, p < 0.001). There was mildly active but definitive synovitis in EKOA. This was an observational study so that no conclusions can be drawn regarding cause-effect for synovitis and symptoms. Future studies should conduct follow-up of participants with synovitis to assess the progression of knee OA.
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Affiliation(s)
- Kyota Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sugimura Yoshikuni
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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18
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Valgus Correctability and Meniscal Extrusion Were Associated With Alignment After Unicompartmental Knee Arthroplasty. Clin Orthop Relat Res 2020; 478:1636-1644. [PMID: 32324667 PMCID: PMC7310375 DOI: 10.1097/corr.0000000000001260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Appropriate postoperative lower limb alignment is one important element of a successful unicompartmental knee arthroplasty (UKA). To predict postoperative alignment, it is important to investigate the association between preoperative imaging evaluations and lower limb alignment after medial UKA. QUESTIONS/PURPOSES (1) Do preoperative valgus stress radiographic and MRI measurements (% mechanical axis, hip-knee-ankle angle, medial meniscal extrusion distance, and osteophyte area at the medial femur and tibia) correlate with postoperative lower limb alignment after UKA; and (2) Can useful cutoffs be calculated in advance of surgery for those findings that were associated with coronal-plane overcorrection? METHODS We retrospectively analyzed 125 patients with medial knee pain who underwent UKA from January 2012 to October 2018. Valgus stress radiography and MRI were performed routinely to assess the knee. Valgus stress radiography was obtained with the patient supine with the knee in full extension and a firm manual valgus force applied to the knee. Full-length weightbearing radiography was performed 3 months after surgery. There were 12% (15) of patients who did not undergo MRI, and 4% (five) of patients who did not receive the postoperative full-length weightbearing radiograph and they were excluded, leaving 84% (105) of patients available for analysis. There were 27 men and 78 women with a mean (range) age of 77 years ± 6 years (60 to 87). The preoperative diagnosis was medial osteoarthritis in 99 patients and osteonecrosis of the medial femoral condyle in six. To investigate the associations, we routinely measured % mechanical axis using radiography, and also measured the medial meniscal extrusion distance and osteophyte area at the medial femur and tibia using MRI after surgery. Medial meniscus extrusion distance was defined as the distance from the outermost edge of the medial meniscus to a line connecting the femoral and tibial cortices. From these parameters, postoperative alignment was estimated using regression and receiver operating characteristic curve analyses. Variables with p < 0.05 were included. RESULTS The % mechanical axis on the valgus stress radiograph and medial meniscal extrusion distance were correlated with postoperative lower limb alignment after UKA (adjusted correlation coefficient 0.72; p < 0.001, adjusted correlation coefficient 0.2; p = 0.003, respectively). The estimated % mechanical axis on the postoperative weightbearing radiograph was equal to -0.27 + 0.86% (% mechanical axis on valgus stress radiograph) + 1.14 mm (medial meniscal extrusion distance). Using a cutoff point of 36%, the % mechanical axis on valgus stress radiograph was associated with overcorrection after UKA (area under the curve: 0.89; odds ratio 14 [95% CI 0.75 to 0.95]; p < 0.001, sensitivity 77.8%, specificity 80.9%). CONCLUSIONS The overcorrection of a varus knee on a valgus stress radiograph before UKA and the increased extrusion of the medial meniscus on preoperative MRI was associated with a greater likelihood of overcorrected alignment after UKA. Future studies should conduct long-term follow-up of malalignment patients to assess the possible complications. LEVEL OF EVIDENCE Level III, diagnostic study.
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Dong Z, Liu F, Pan Y, Wu S, Luo C. Clinical analysis of an anchor nail combined with a titanium cable in the treatment of lower patella fractures. J Int Med Res 2020; 48:300060519873505. [PMID: 31875753 PMCID: PMC7783265 DOI: 10.1177/0300060519873505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/09/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study was performed to evaluate the clinical effect of an anchor nail and titanium cable for lower patella fractures and identify an effective treatment. METHODS Thirty-five patients with lower patella fractures were treated using anchor nail and titanium cable technology. The anchor was fixed to the main part of the patella; the lower patella was then fixed. A bone tunnel was created, and the titanium cable was fixed. The fracture was allowed to heal without tension. Postoperative radiographs were obtained at regular follow-up evaluations. The Böstman function scores were used to assess postoperative complications. RESULTS All patients were followed for an average of 15 months. The fracture healing time ranged from 12 to 24 weeks. The postoperative Böstman function scores were as follows: average, 28.6 points; excellent and good scores in 28 and 7 patients, respectively (100% rate of excellent and good scores). At 6 and 12 months postoperatively, the maximum degree of active extension of the affected knee joint was comparable with that of the healthy contralateral joint. CONCLUSION The combination of an anchor nail and titanium cable for lower patella fractures is simple and clinically satisfactory, restores knee function well, and is a worthy orthopedic method.
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Affiliation(s)
- Zhijun Dong
- Department of Orthopaedics, Orthopaedic Hospital of
Guizhou Province, Guiyang, China
| | - Fuyao Liu
- Department of Orthopaedics, Orthopaedic Hospital of
Guizhou Province, Guiyang, China
| | - Yuan Pan
- Department of Orthopaedics, Orthopaedic Hospital of
Guizhou Province, Guiyang, China
| | - Shengzhong Wu
- Department of Orthopaedics, Orthopaedic Hospital of
Guizhou Province, Guiyang, China
| | - Chunshan Luo
- Department of Orthopaedics, Orthopaedic Hospital of
Guizhou Province, Guiyang, China
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Varus alignment increases medial meniscus extrusion and peak contact pressure: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2020; 28:1092-1098. [PMID: 31489460 DOI: 10.1007/s00167-019-05701-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Assessment of medial meniscus extrusion (MME) has become increasingly popular in clinical practice to evaluate the dynamic meniscus function and diagnose meniscus pathologies. The purpose of this biomechanical study was to investigate the correlation between MME and the changes in joint contact pressure in varus and valgus alignment. It was hypothesized that varus alignment would result in significantly higher MME along with a higher joint contact pressure in the medial compartment. METHODS Eight fresh-frozen human cadaveric knees were axially loaded, with a 750 N compressive load, in full extension with the mechanical axis shifted to intersect the tibial plateau at 30% and 40% (varus), 50% (neutral), 60% and 70% (valgus) of its width (TPW). Tibiofemoral peak contact pressure (PCP), mean contact pressure (MCP) and contact area (CA) were determined using pressure-sensitive films. MME was obtained via ultrasound at maximum load. RESULTS MME was significantly increased from valgus (1.32 ± 0.22 mm) to varus alignment (3.16 ± 0.24 mm; p < 0.001). Peak contact pressure at 30% TPW varus alignment was significantly higher compared to 60% TPW valgus (p = 0.018) and 70% TPW valgus (p < 0.01). MME significantly correlated with PCP (r = 0.56; p < 0.001) and MCP (r = 0.47, p < 0.01) but not with CA (r = 0.23; n.s.). CONCLUSION MME was significantly increased in varus alignment, compared to neutral or valgus alignment, with an intact medial meniscus. It was also significantly correlated with PCP and MCP within the medial compartment. However, valgus malalignment and neutral axis resulted in reduced MME and contact pressure. Lower limb alignment must be taken into account while assessing MME in clinical practice. LEVEL OF EVIDENCE Controlled laboratory study.
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US detection of medial meniscus extrusion can predict the risk of developing radiographic knee osteoarthritis: a 5-year cohort study. Eur Radiol 2020; 30:3996-4004. [PMID: 32140818 DOI: 10.1007/s00330-020-06749-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA) through a 5-year follow-up. METHODS Overall, 472 participants and 944 knees were eligible. MME (mm) was measured at the baseline, and KOA was radiographically evaluated at both baseline and 5-year follow-up by Kellgren-Lawrence grade (KLG). Radiographic KOA (ROA) was defined as the knee showing KLG ≥ 2. Incident ROA (iROA) was defined if the baseline KLG of 0-1 increased to KLG ≥ 2 in 5 years. Progressive ROA (pROA) was defined if the baseline KLG of 2-3 worsened to a higher grade in 5 years. Receiver operating characteristic (ROC) curve and generalized estimating equations were used for analysis. RESULTS Of 574 non-ROA knees at the baseline, 43 knees (7.5%) developed iROA; of 370 ROA knees, 47 knees (12.7%) developed pROA. Based on the ROC curves, 4 mm was the optimal cutoff to detect the risk of iROA (area under curve [AUC] 0.639 [right knee]; AUC 0.641 [left knee]) and that of pROA (AUC 0.750 [right knee]; AUC 0.863 [left knee]). Multiple regression analysis showed that the 4-mm cutoff of MME was significantly associated with both the prevalence of iROA (regression coefficient [B] 1.909; p ≤ 0.001; adjusted odds ratio [aOR] 6.746) and that of pROA (B 1.791; p ≤ 0.001; aOR 5.993). CONCLUSIONS On ultrasonography, the participants with more extruded medial meniscus showed a higher prevalence of both iROA and pROA. Ultrasonography could identify patients who had a risk of developing KOA. KEY POINTS • Through a 5-year follow-up, the current cohort study was conducted to clarify the relationship between the baseline value of medial meniscus extrusion (MME) and the radiographic change of knee osteoarthritis (KOA). • More extruded medial meniscus evaluated by ultrasonography was associated with the development of radiographic KOA. • Ultrasonography could identify the patients who had a risk of developing KOA, and the 4-mm cutoff of MME was optimal to detect this risk.
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Effect of medial meniscus extrusion on arthroscopic surgery outcome in the osteoarthritic knee associated with medial meniscus tear: a minimum 4-year follow-up. Chin Med J (Engl) 2019; 132:2550-2558. [PMID: 31658160 PMCID: PMC6846261 DOI: 10.1097/cm9.0000000000000492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background: The potential benefit of arthroscopic surgery for osteoarthritic knee associated with medial meniscus tear is controversial. This study was conducted to determine the effect of pre-operative medial meniscus extrusion (MME) on arthroscopic surgery outcomes in the osteoarthritic knee associated with medial meniscus tear during a minimum 4-year follow-up. Methods: This was a retrospective review of a total of 131 patients diagnosed with osteoarthritic knee associated with medial symptomatic degenerative meniscus tear who underwent arthroscopic surgery from January 2012 to December 2014 and were observed for more than 4 years. Patients were classified into two groups: MME ≥3 mm (major MME group, n = 54) and MME <3 mm (non-major MME group, n = 77). Clinical assessments, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and radiographic assessments, including the Kellgren-Lawrence (K-L) grade and medial joint space width (JSW), were evaluated pre-operatively and at final follow-up. The longitudinal changes of clinical and radiographic parameters (WOMAC and the medial JSW change, K-L grade progression) were compared between groups unadjusted and adjusted for age, sex, and body mass index. Four-year survival rates (without progression to knee replacement [KR]) were also evaluated using a log-rank test and Cox proportional hazard regression model. Results: Major MME was present in 41% of patients. After a minimum 4-year follow-up, the mean WOMAC total and pain scores improved significantly in both groups. However, the medial JSW and K-L grade worsened significantly. Patients with pre-operative major MME worsened more in WOMAC total (adjusted mean difference [MD] 3.800, 95% confidence interval [CI]: 0.900, 11.400; P = 0.037) and function (adjusted MD 3.100, 95% CI: 0.700, 6.300; P = 0.038) scores than patients with pre-operative non-major MME, and no significant difference was observed in WOMAC pain and stiffness score between groups. The group with major MME had significantly higher joint space narrowing (adjusted MD −0.630, 95% CI: −1.250, −0.100; P = 0.021) and K-L rate progression (adjusted mean relative risk [RR] 1.310, 95% CI: 1.100, 1.600; P = 0.038) than the group with non-major MME. There was a significantly more KR progression in patients with major MME compared with those with non-major MME (adjusted RR 3.100, 95% CI: 1.100, 9.200; P = 0.042 and adjusted hazard ratio 3.500, 95% CI 1.100, 9.500; P = 0.022). Conclusions: Osteoarthritic knee patients associated with medial meniscus tear with non-major MME are more responsive to arthroscopic surgery in terms of the clinical and radiologic outcomes and survival for at least 4-year follow-up; however, in terms of pain relief, arthroscopic surgery in patients with major MME is also beneficial as well as in patients with non-major MME.
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Oshima T, Grasso S, Beach A, Fritsch B, Parker DA. Lateral location of the tibial tunnel increases lateral meniscal extrusion after anatomical single-bundle anterior cruciate ligament reconstruction. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Özdemir M, Turan A. Correlation Between Medial Meniscal Extrusion Determined by Dynamic Ultrasound and Magnetic Resonance Imaging Findings of Medial-Type Knee Osteoarthritis in Patients With Knee Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2709-2719. [PMID: 30828848 DOI: 10.1002/jum.14976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/16/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of our study was to investigate the relationship between medial meniscal extrusion (MME) determined by dynamic ultrasound (US) and magnetic resonance imaging findings of medial-type knee osteoarthritis (OA). METHODS Single knees of 102 patients with knee pain were assessed by radiography, dynamic US, and magnetic resonance imaging. All knee radiographs were interpreted and grouped according to the Kellgren-Lawrence (KL) scale. Medial meniscal extrusion in non-weight-bearing and weight-bearing positions and the difference of these values (ΔMME) were measured by dynamic US. The medial tibiofemoral compartments of all knees were evaluated and grouped according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Mean values of non-weight-bearing MME, weight-bearing MME, and ΔMME ± standard deviations for groups formed according to the KL scale and WORMS system were compared. RESULTS We demonstrated that different from non-weight-bearing MME, weight-bearing MME was significantly correlated with not only high grades but also lower grades of cartilage damage and subchondral bone marrow lesions in medial-type knee OA. Although the difference in non-weight-bearing MME between cartilage status groups 1 and 2 was not significant (P = .071), there were significant differences in of weight-bearing MME between groups 1 and 2, between groups 2 and 3, and between groups 3 and group 4 (P = .003, .002, and .032, respectively). CONCLUSIONS We found statistically significant associations between MME values and the severity of the OA findings according to both the KL scale and WORMS system. We offer dynamic US as an initial tool for the diagnosis and a screening method to estimate the severity of knee OA.
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Affiliation(s)
- Meltem Özdemir
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Health Application and Research Center, Ankara, Turkey
| | - Aynur Turan
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Health Application and Research Center, Ankara, Turkey
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Goto N, Okazaki K, Akiyama T, Akasaki Y, Mizu-Uchi H, Hamai S, Nakamura S, Nakashima Y. Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development. Knee Surg Sports Traumatol Arthrosc 2019; 27:2617-2623. [PMID: 30456569 DOI: 10.1007/s00167-018-5286-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 11/07/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Varus alignment is known as one of the major causes of medial compartment osteoarthritis (OA). Medial meniscus extrusion also plays a critical role in the in the development of OA. However, studies on the exact relationship between alignment parameters and medial meniscus extrusion are limited. Therefore, this study aimed to investigate this relationship in patients with knee OA. METHODS Based on a retrospective analysis of the outpatient magnetic resonance imaging (MRI) database, 190 knees were identified to be examined using weight-bearing, whole-leg radiographs and MRIs within 3 months from the first consultation. Subsequently, various parameters of lower leg alignment were measured, which affected the knee varus in radiographs. Finally, a statistical analysis was performed to assess the relationships between the OA grade, distance of medial meniscus extrusion (MME), and alignment parameters; hip-knee-ankle angle (HKAA), percentage of mechanical axis (% MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). The subjects were divided according to the presence or absence of MME (Group A: MME distance below 3 mm, Group B: MME distance 3 mm and above) to assess the differences in each alignment parameter correlated with MME distance between the groups. RESULTS MME distance significantly increased with OA grade progression. HKAA, % MA, MPTA, and JLCA significantly correlated with medial meniscus extrusion distance (r = - 0.21, - 0.23, - 0.16, 0.3, respectively). Multiple regression analysis of each significant alignment combined with age, sex, and body mass index revealed that HKAA, % MA, MPTA, and JLCA were significant independent factors of MME distance (P = 0.008, 0.0026, 0.011, 0.0001, respectively). These significant findings were reinforced in group B. In contrast, the correlation between alignment parameters and medial meniscus extrusion distance was not significant in group A. CONCLUSION Varus alignment factors are related to MME distance especially in extruded meniscus knees, as the OA grade progressed. Therefore, the coexistence of varus alignment and MME can be the risk factors for OA progression. As the low MPTA was an independent alignment factor for generating varus alignment, patients with osteoarthritis of the knee with both, low MPTA and MME could be the appropriate candidates for early intervention by high tibial osteotomy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Norio Goto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takenori Akiyama
- Akiyama clinic, 4-17-1 Midorigahama, Kasuya Gun, Shingu Cho, Fukuoka, 811-0119, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shunsuke Nakamura
- Akiyama clinic, 4-17-1 Midorigahama, Kasuya Gun, Shingu Cho, Fukuoka, 811-0119, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Oshima T, Leie M, Grasso S, Parker DA. Relationship between anterior cruciate ligament and anterolateral meniscal root bony attachment: High-resolution 3-T MRI analysis. Knee 2019; 26:537-544. [PMID: 31103414 DOI: 10.1016/j.knee.2019.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/24/2019] [Accepted: 04/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The tibial bony attachments of the anterior cruciate ligament (ACL) and the anterolateral meniscal root (ALMR) are very close, and drilling the tibial tunnel in ACL reconstruction may damage the ALMR attachment. This study investigated the relationship between the tibial attachment of the ACL and ALMR using high-resolution 3-T magnetic resonance imaging (MRI). METHODS Twenty healthy subjects (35.8 ± 13.0 years) had 20 knees scanned using high resolution 3-T MRI. The tibial bony attachments of ACL, ALMR, and the tibia were segmented and three-dimensional models were created. The shape, area, and location of each attachment were evaluated using this model. RESULTS The ACL tibial attachment was elliptical in nine knees (45%), C-shaped in nine knees (45%) and triangle in two knees (10%). The mean values of the ACL vs ALMR tibial attachments were as follows: area, 106.2 ± 21.3 vs 56.2 ± 21.3 mm2; length, 16.8 ± 2.0 vs 11.0 ± 1.8 mm; and width, 6.9 ± 1.3 vs 6.6 ± 1.0 mm. The location of the ACL vs ALMR attachment centres was 46.5 ± 1.7% vs 56.5 ± 1.9% in the medial-lateral direction and 36.3 ± 3.6% vs 36.7 ± 3.5% in the anterior-posterior direction. The distance between the ACL and ALMR centres was 8.1 ± 1.3 mm. CONCLUSIONS ACL and ALMR tibial attachments were individually distinguished using high resolution 3-T MRI. The short distance between both centres of the attachments may suggest that ALMR can be damaged when the tibial tunnel is drilled in ACL reconstruction.
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Affiliation(s)
- Takeshi Oshima
- Sydney Orthopaedic Research Institute, Sydney, Australia.
| | - Murilo Leie
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - David A Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia; The University of Sydney, Sydney, Australia
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Ota S, Chiba D, Sasaki E, Kumagai G, Yamamoto Y, Nakaji S, Tsuda E, Ishibashi Y. Symptomatic bone marrow lesions induced by reduced bone mineral density in middle-aged women: a cross-sectional Japanese population study. Arthritis Res Ther 2019; 21:113. [PMID: 31060629 PMCID: PMC6501306 DOI: 10.1186/s13075-019-1900-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 04/18/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The etiology of bone marrow lesions (BMLs) without knee osteoarthritis (KOA) and their association with bone fragility are unclear. We aimed to investigate the association between BMLs, bone mineral density (BMD), and bone markers in women without radiographic evidence of KOA. METHODS This single-center cross-sectional study in a Japanese population included 266 women without radiographic evidence of KOA, which was defined as a Kellgren-Lawrence grade < 2. All participants underwent coronal and sagittal T2-weighted fat-suppressed magnetic resonance imaging of their right knee. BML severity was scored according to the Whole-Organ MRI Scoring method. BMD was measured by dual-energy X-ray absorptiometry of the forearm. Levels of bone markers (bone-alkaline phosphatase [BAP], type I procollagen N-terminal propeptide [PINP], cross-linked N-telopeptide of type I collagen [NTx], and tartrate-resistant acid phosphatase-5b [TRACP-5b]), pentosidine, and homocysteine were assessed in the serum. Knee symptoms were evaluated on the basis of the Knee injury and Osteoarthritis and Outcome Score (KOOS). Participants were divided into symptomatic knee and asymptomatic knee groups on the basis of their KOOS according to the classification criteria for early KOA. Multiple linear regression analysis was performed to evaluate the relationship between BMLs, BMD, and bone markers. RESULTS The prevalence of BML was 35.3%. Age and some bone marker levels (BAP, PINP, NTx, and TRACP-5b) were higher, and all KOOS subscale scores and BMD were lower in participants with BMLs than in those without BMLs. On multiple linear regression analysis, BMD was negatively associated with BMLs (p = 0.014) in participants with symptomatic knees. There was no such association in participants with asymptomatic knees (p = 0.918). Among the bone markers, BAP (p = 0.006) and PINP (p = 0.043) were positively associated with BMLs in participants with symptomatic knees, while BAP (p = 0.038) and TRACP-5b (p = 0.011) were positively associated with BMLs in participants with asymptomatic knees. CONCLUSIONS In symptomatic Japanese women without radiographic evidence of KOA, BMD is negatively associated and some bone markers are positively associated with BMLs after adjustment for age and BMI. Thus, maintaining systemic bone metabolism could contribute to BML prevention in patients with pre-radiographic KOA.
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Affiliation(s)
- Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan. .,Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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28
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Osteoarthritis year in review 2018: imaging. Osteoarthritis Cartilage 2019; 27:401-411. [PMID: 30590194 DOI: 10.1016/j.joca.2018.12.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a narrative review of the most relevant original research published in 2017/2018 on osteoarthritis imaging. METHODS The PubMed database was used to recover all relevant articles pertaining to osteoarthritis and medical imaging published between 1 April 2017 and 31 March 2018. Review articles, case studies and in vitro or animal studies were excluded. The original publications were subjectively sorted based on relevance, novelty and impact. RESULTS AND CONCLUSIONS The publication search yielded 1,155 references. In the assessed publications, the most common imaging modalities were radiography (N = 708) and magnetic resonance imaging (MRI) (355), followed by computed tomography (CT) (220), ultrasound (85) and nuclear medicine (17). An overview of the most important publications to the osteoarthritis (OA) research community is presented in this narrative review. Imaging studies play an increasingly important role in OA research, and have helped us to understand better the pathophysiology of OA. Radiography and MRI continue to be the most applied imaging modalities, while quantitative MRI methods and texture analysis are becoming more popular. The value of ultrasound in OA research has been demonstrated. Several multi-modality predictive models have been developed. Deep learning has potential for more automatic and standardized analyses in future OA imaging research.
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