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Patella-Posterior Turning Point of the Distal Femur Distance Is a Potential Indicator for Diagnosing Patella Alta in Recurrent Patellar Dislocation Population. Arthroscopy 2023; 39:602-610. [PMID: 36306890 DOI: 10.1016/j.arthro.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/12/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To introduce a simple patellar height measurement method (patella-posterior turning point of the distal femur [P-PTP] Distance) independent of patellar anatomy with standardized patient position, and tested the reliability, validity, and diagnostic accuracy compared with commonly used ratios in knee extension. METHODS We retrospectively reviewed 418 computed tomography (CT) images of the knee joint in a group of patients who were diagnosed recurrent patellar dislocation (RPD). With the three-dimensional (3D) CT reconstructed knee, patellar height was qualitatively assessed by the patellar engagement with the femoral trochlea in terminal knee extension to divide RPD population into case (patella alta) and control group. With digitally reconstructed lateral radiographs, patellar height was measured with P-PTP distance (perpendicular distances between the distal edge of patella articular surface and posterior turning point of distal femur), and four commonly used ratios: Caton-Deschamps index, Modified Insall-Salvati index, Blackburne-Peel index, and Insall-Salvati index. An unpaired t-test was conducted to determine significant differences between groups. Correlation coefficient, intra- and inter-observer reliability, receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were also calculated. RESULTS 198 knee images (198 patients) were included for final evaluation. Patella alta was present in 72 knees (36.3%) with RPD. The effect size was relatively large between the case and control group for P-PTP distance (d = -1.619; 95% CI, -1.948 to -1.286). P-PTP distance correlated moderately to strongly with four commonly used ratios (P < .001). Intraobserver and interobserver reliability was good for P-PTP distance. The AUC of the ROC curve was categorized as excellent for P-PTP distance, better than other measurements (P < .001), and the cutoff value was 4.2 mm with the highest sensitivity (86.11%) and specificity (84.92%). CONCLUSIONS The measurement method, P-PTP distance, showed good intra-observer and inter-observer reliability, well correlated with commonly used ratios, and presented best diagnostic accuracy among commonly used ratios for predicting RPD. P-PTP distance might be a potential indicator for identifying patella alta in RPD patients when supine and knee extended. CLINICAL RELEVANCE The measurement reported in this study may help in advancing clinical evaluation of patella alta, providing an alternative and simple method to measure patellar height. Standing or weight-bearing plain lateral radiographs obtained from the routine practice should be further assessed in the next step to further validate the method.
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Li JS, Tsai TY, Clancy MM, Lewis CL, Felson DT, Li G. Cartilage contact characteristics of the knee during gait in individuals with obesity. J Orthop Res 2022; 40:2480-2487. [PMID: 35076128 PMCID: PMC9309196 DOI: 10.1002/jor.25288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Obesity increases the risk of knee osteoarthritis (OA). Knee joint contact characteristics have been thought to provide insights into the pathogenesis of knee OA; however, the cartilage contact characteristics in individuals with obesity have not been fully described. We conducted cartilage-to-cartilage contact analyses through high-precision fluoroscopy imaging with subject-specific magnetic resonance cartilage models. Twenty-five individuals with obesity were recruited for this study, and previously published data consisted of eight nonobese individuals who were used as the comparator group. In both groups, knees were imaged by a dual fluoroscopic imaging system during treadmill walking, and the tibiofemoral cartilage contact locations were analyzed and described on the tibial plateau in the medial-lateral (ML) and anterior-posterior (AP) directions and on femoral condyle surfaces using contact angles in the sagittal plane and deviation angles in a plane perpendicular to the sagittal plane. On the medial tibial plateau, the ML contact locations in the individuals with obesity were located more medially than in the nonobese group throughout the stance phase. The medial plateau AP contact locations in individuals with obesity showed a different pattern compared with the nonobese group. The ML contact excursions on the medial plateau in the individuals with obesity were larger than in the nonobese group. These findings suggest that obesity affects the contact location mainly in the medial compartment, which explains, in part, the high prevalence of medial knee OA in the obese population.
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Affiliation(s)
- Jing-Sheng Li
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Margaret M. Clancy
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Cara L. Lewis
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David T. Felson
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
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Kondo T, Yagi Y, Saito H, Kanazawa T, Saito Y. [Evaluation of a Bone Coordinate System Constructed Using MR Image Composing]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:593-598. [PMID: 35466119 DOI: 10.6009/jjrt.2022-1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To evaluate the accuracy of a bone coordinate system constructed using MR image composing. METHOD A femoral coordinate system constructed using image composing of MR images of a whole bovine femur was evaluated using CT images. The MR images were acquired by moving the table and were processed with 3D distortion correction and composing. To evaluate the reproducibility of the measurements, the same operator repeated the construction of the femoral coordinate system. In addition, distortions in the MR images were evaluated in comparison with those in the CT images. RESULT The center position of the femoral coordinate system constructed using the MR image composing was 1.6±0.9 mm on the X-axis, 1.5±0.8 mm on the Y-axis, and 0.2±0.3 mm on the Z-axis, and the rotation of each axis was 1° or less. The distortion of the composed MR image was about 0.3%. CONCLUSION The femoral coordinate system constructed using MR image composing had the same accuracy as a system constructed with CT images. The effect of MR image composing on the construction of the femoral coordinate system was small.
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Affiliation(s)
- Tatsuya Kondo
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Yuta Yagi
- Division of Radiology, Niigata University Medical & Dental Hospital
| | - Hiroaki Saito
- Division of Radiology, Niigata University Medical & Dental Hospital
| | - Tsutomu Kanazawa
- Division of Radiology, Niigata University Medical & Dental Hospital
| | - Yutaro Saito
- Clinical Radiology Service, Tochigi Medical Center Shimotsuga
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Gustafson JA, Elias JJ, Fitzgerald GK, Tashman S, Debski RE, Farrokhi S. Combining advanced computational and imaging techniques as a quantitative tool to estimate patellofemoral joint stress during downhill gait: A feasibility study. Gait Posture 2021; 84:31-37. [PMID: 33264730 PMCID: PMC7902369 DOI: 10.1016/j.gaitpost.2020.11.016] [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: 02/17/2020] [Revised: 11/07/2020] [Accepted: 11/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The onset and progression of patellofemoral osteoarthritis (OA) has been linked to alterations in cartilage stress-a potential precursor to pain and subsequent cartilage degradation. A lack in quantitative tools for objectively evaluating patellofemoral joint contact stress limits our understanding of pathomechanics associated with OA. RESEARCH QUESTION Could computational modeling and biplane fluoroscopy techniques be used to discriminate in-vivo, subject-specific patellofemoral stress profiles in individuals with and without patellofemoral OA? METHODS The current study employed a discrete element modeling framework driven by in-vivo, subject-specific kinematics during downhill gait to discriminate unique patellofemoral stress profiles in individuals with patellofemoral OA (n = 5) as compared to older individuals without OA (n = 6). All participants underwent biplane fluoroscopy kinematic tracking while walking on a declined instrumented treadmill. Subject-specific kinematics were combined with high resolution geometrical models to estimate patellofemoral joint contact stress during 0%, 25 %, 50 %, 75 % and 100 % of the loading response phase of downhill gait. RESULTS Individuals with patellofemoral OA demonstrated earlier increases in patellofemoral stress in the lateral patellofemoral compartment during loading response as compared to OA-free controls (P = 0.021). Overall, both groups exhibited increased patellofemoral contact stress early in the loading response phase of gait as compared to the end of loading response. Results from this study show increased stress profiles in individuals with patellofemoral OA, indicating increasing joint loading in early phases of gait. SIGNIFICANCE This modeling framework-combining arthrokinematics with discrete element models-can objectively estimate changes in patellofemoral joint stress, with potential applications to evaluate outcomes from various treatment programs, including surgical and non-surgical rehabilitation treatments.
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Affiliation(s)
- Jonathan A. Gustafson
- Postdoctoral Research Fellow, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - John J. Elias
- Senior Research Scientist, Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
| | - G. Kelley Fitzgerald
- Professor & Director of the Physical Therapy Clinical and Translational Research Center, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Professor & Director of Biodynamics Laboratory, Department of Orthopedic Surgery, University of Texas Health Center, Houston, TX, USA
| | - Richard E. Debski
- Professor, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn Farrokhi
- Facility Research Director, DOD-VA Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, CA, USA
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Objective assessment of patellar maltracking with 3 T dynamic magnetic resonance imaging: feasibility of a robust and reliable measuring technique. Sci Rep 2020; 10:16770. [PMID: 33033292 PMCID: PMC7546634 DOI: 10.1038/s41598-020-72332-9] [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: 02/28/2020] [Accepted: 08/28/2020] [Indexed: 01/17/2023] Open
Abstract
Patellofemoral maltracking predisposes the patellofemoral joint to instability. The purpose of this study was to provide a reliable dynamic magnetic resonance imaging (MRI) measuring technique for patellofemoral maltracking, and to investigate the influence of anatomical risk factors (AF) on patellar maltracking. Ten patients (2 males,8 females, average 19 years) with clinical maltracking and 20 controls (10 males,10 females,average 28 years) were examined with a dynamic, multi-slice gradient-echo MRI sequence, during repetitive flexion(40°) and full extension, in an open-chain-active-movement. In a 30-s time frame three simultaneous transverse slices were acquired.
Dynamic mediolateral translation and dynamic tilt were measured at defined positions, by two independent examiners. Reproducibility was tested in a set of five knees. Common AFs for patellar maltracking (tibial-tuberosity-to-trochlear-groove-(TT-TG)-distances, trochlea-sulcus-angle, trochlea-sulcus-depth, lateral-trochlear-inclination and Caton-Deschamps-Index) were analyzed in consensus, using standard static MRI sequences. In patients, dynamic mediolateral translation was significantly greater in patients (12.4 ± 6.9 mm vs. − 0.1 ± 2.3 mm, p < 0.001) and the patella was positioned significantly more laterally (17.5 ± 6.9 mm vs. 3.1 ± 2.4 mm, p < 0.001) compared to controls. During movement, the patella tilted 16.3 ± 13.1° laterally in patients and 1.9 ± 4.3° medially in controls (dynamic tilt) (p < 0.002). All AFs were significantly different between patients and controls. Pathological TT-TG-distances, Caton-Deschamps-Indices and trochlea-sulcus-angles strongly correlated with dynamic patellar translation and dynamic patellar tilt (p < 0.001). In the patient population, the primary pathologies for maltracking were lateralized-tibial-tubercle (n = 5), trochlea dysplasia n = 2, patella alta (n = 3). Interrater-reliability for translation and tilt-measurement was excellent (0.971/0.976, 95% CIs 0.939–0.986/0.950–0.988). Dynamic MRI reliably differentiates between abnormal and physiological patellar tracking. Dynamic tracking and tilt strongly correlate with measurable AFs, which reinforces their clinical use and validates the presented technique.
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Biomechanik und Untersuchung des patellofemoralen Gelenks. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00388-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Makki K, Borotikar B, Garetier M, Acosta O, Brochard S, Ben Salem D, Rousseau F. 4D in vivo quantification of ankle joint space width using dynamic MRI. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2115-2118. [PMID: 31946318 DOI: 10.1109/embc.2019.8856687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spatio-temporal evolution of joint space width (JSW) during motion is of great importance to help with making early treatment plans for degenerative joint diseases like osteoarthritis (OA). These diseases can affect people of all ages leading to an acceleration of joint degeneration and to limitations in the activities of daily living. However, only a few studies have attempted to quantify the JSW from moving joints. In this paper, we present a generic pipeline to accurately determine the changes of the JSW during the joint motion cycle. The key idea is to combine spatial information of static MRI with temporal information of low-resolution (LR) dynamic MRI sequences via an intensity-based registration framework, leading to a high-resolution (HR) temporal reconstruction of the joint. This allows the temporal JSW to be measured in the HR domain using an Eulerian approach for solving partial differential equations (PDEs) inside a deforming inter-bone area where the HR reconstructed bone segmentations are considered as temporal Dirichlet boundaries. The proposed approach has been applied and evaluated on in vivo MRI data of five healthy children to non-invasively quantify the spatio-temporal evolution of the JSW of the ankle (tibiotalar joint) during the entire dorsi-plantar flexion motion cycle. Promising results were obtained, showing that this pipeline can be useful to perform large-scale studies containing subjects with OA for different joints like ankle and knee.
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Benavente S, Villagra J. Patellar calcar: morphometric analysis by knee magnetic resonance imaging and three-dimensional reconstruction software-assisted. Surg Radiol Anat 2019; 41:1483-1488. [PMID: 31529166 DOI: 10.1007/s00276-019-02337-1] [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: 07/12/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Patellar calcar corresponds to a greater trabecular bone density area in the patella lateral facet, whose morphometry is uncertain. This study aimed to describe patellar calcar morphometry by knee MRI and develop a 3D reconstruction software-assisted. MATERIALS AND METHODS Consecutive adult patients, submitted to knee MRI, between 2014 and 2017, were entered in IMPAX software. Exclusion criteria are history of patellar surgical intervention, trauma, chondromalacia, bone edema or bipartite patella. All MRI images were retrospectively reviewed by three readers. MRI patellar calcar measurements are height, width, thickness and posterior distance. 3D model protocol reconstruction: 3D Slicer software was used to design a preliminary model for each patient, and then all were automatically merged into one, which was finalized using the software segmentation tools. For 3D patellar calcar location, the transpolar axis was designed. RESULTS 250 MRI were analyzed, patellar calcar was present in 208 (83.2%); 101 men and 107 women. Mean age was 44.3 ± 15.6 years. MEASUREMENTS height 13.84 ± 2.42 mm (male: 14.50 ± 2.42; female: 13.21 ± 2.26) (p < 0.0001), width 12.21 ± 2.26 mm (male 13.14 ± 2.22; female 11.33 ± 1.93) (p < 0.0001). No statistically significant difference of thickness 0.56 ± 0.22 mm (male: 0.56 ± 0.25; female: 0.56 ± 0.20) and posterior distance 2.37 ± 0.80 mm (male: 2.46 ± 0.89; female: 2.29 ± 0.69) between genders was found. 3D model results: transpolar axis went through the patellar calcar in all the cases. CONCLUSIONS This study shows in a 3D model reconstruction, what was previously described in the literature, determining for the first time the patellar calcar morphometry in the knee MRI and identifying it as a regular finding in this imaging test.
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Affiliation(s)
- Sergio Benavente
- Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Joaquín Villagra
- Universidad Católica de la Santísima Concepción, Concepción, Chile.
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Freedman BR, Mooney DJ. Biomaterials to Mimic and Heal Connective Tissues. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1806695. [PMID: 30908806 PMCID: PMC6504615 DOI: 10.1002/adma.201806695] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/27/2019] [Indexed: 05/11/2023]
Abstract
Connective tissue is one of the four major types of animal tissue and plays essential roles throughout the human body. Genetic factors, aging, and trauma all contribute to connective tissue dysfunction and motivate the need for strategies to promote healing and regeneration. The goal here is to link a fundamental understanding of connective tissues and their multiscale properties to better inform the design and translation of novel biomaterials to promote their regeneration. Major clinical problems in adipose tissue, cartilage, dermis, and tendon are discussed that inspire the need to replace native connective tissue with biomaterials. Then, multiscale structure-function relationships in native soft connective tissues that may be used to guide material design are detailed. Several biomaterials strategies to improve healing of these tissues that incorporate biologics and are biologic-free are reviewed. Finally, important guidance documents and standards (ASTM, FDA, and EMA) that are important to consider for translating new biomaterials into clinical practice are highligted.
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Affiliation(s)
- Benjamin R Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
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3D laser scanning in conjunction with surface texturing to evaluate shift and reduction of the tibiofemoral contact area after meniscectomy. J Mech Behav Biomed Mater 2018; 88:41-47. [PMID: 30125786 DOI: 10.1016/j.jmbbm.2018.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/02/2018] [Accepted: 08/08/2018] [Indexed: 01/20/2023]
Abstract
Meniscectomy significantly change the kinematics of the knee joint by reducing the contact area between femoral condyles and the tibial plateau, but the shift in the contact area has been poorly described. The aim of our investigation was to measure the shift of the tibiofemoral contact area occurring after meniscectomy. We used laser scans combined to surface texturing for measuring the 3D position and area of the femoral and tibial surfaces involved in the joint. In particular, natural condyles (porcine model) were analysed and the reverse engineering approach was used for the interpretation of the results from compression tests and local force measurements in conjunction with staining techniques. The results suggested that laser scans combined to surface texturing may be considered as a powerful tool to investigate the stained contours of the contact area. Beside the largely documented reduction of contact area and local pressure increase, a shift of the centroid of the contact area toward the intercondylar notch was measured after meniscectomy. As a consequence of the contact area shift and pressure increase, cartilage degeneration close to the intercondylar notch may occur.
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Ali AA, Mannen EM, Rullkoetter PJ, Shelburne KB. In vivo comparison of medialized dome and anatomic patellofemoral geometries using subject-specific computational modeling. J Orthop Res 2018; 36:1910-1918. [PMID: 29411900 PMCID: PMC6081258 DOI: 10.1002/jor.23865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/15/2018] [Indexed: 02/04/2023]
Abstract
Successful outcome following total knee arthroplasty (TKA) with patella resurfacing is partly determined by the restoration of patellofemoral (PF) function and recovery of the quadriceps mechanism. The current study compared two patellar TKA geometries (medialized dome and anatomic) to determine their impact on PF mechanics and quadriceps function. In-vivo, subject-specific patellar mechanics were evaluated using a sequential experimental and modeling approach. First, stereo radiography, marker-based motion capture, and force plate data were collected for TKA patients (10 dome, 10 anatomic) performing a knee extension and lunge. Second, subject-specific, whole-body, musculoskeletal models, including 6 degrees-of-freedom (DOF) knee joint kinematics, were created for each subject and activity to predict quadriceps forces. Last, finite element models of each subject and activity were created to predict PF kinematics, patellar loading, moment arm, and patellar tendon angle. Differences in mechanics between dome and anatomic patients were highlighted during load-bearing (lunge) activity. Anatomic subjects demonstrated greater PF flexion angles (avg. 11 ± 3°) compared to dome subjects during lunge. Similar to the natural knee, contact locations on the patella migrated inferior to superior as the knee flexed in anatomic subjects, but remained relatively superior in dome subjects. Differences in kinematics and contact location likely contributed to altered mechanics with anatomic subjects presenting greater load transfer from the quadriceps to the patellar tendon in deep flexion (>75°), and dome subjects demonstrating larger contact forces during lunge. Although there was substantial patient variability, evaluations of PF mechanics suggested improved quadriceps function and more natural kinematics in the anatomic design. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1910-1918, 2018.
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Affiliation(s)
- Azhar A. Ali
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Erin M. Mannen
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | | | - Kevin B. Shelburne
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
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Vignos MF, Kaiser JM, Baer GS, Kijowski R, Thelen DG. American Society of Biomechanics Clinical Biomechanics Award 2017: Non-anatomic graft geometry is linked with asymmetric tibiofemoral kinematics and cartilage contact following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2018; 56:75-83. [PMID: 29852331 PMCID: PMC6004264 DOI: 10.1016/j.clinbiomech.2018.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abnormal knee mechanics may contribute to early cartilage degeneration following anterior cruciate ligament reconstruction. Anterior cruciate ligament graft geometry has previously been linked to abnormal tibiofemoral kinematics, suggesting this parameter may be important in restoring normative cartilage loading. However, the relationship between graft geometry and cartilage contact is unknown. METHODS Static MR images were collected and segmented for eighteen subjects to obtain bone, cartilage, and anterior cruciate ligament geometries for their reconstructed and contralateral knees. The footprint locations and orientation of the anterior cruciate ligament were calculated. Volumetric, dynamic MR imaging was also performed to measure tibiofemoral kinematics, cartilage contact location, and contact sliding velocity while subjects performed loaded knee flexion-extension. Multiple linear regression was used to determine the relationship between non-anatomic graft geometry and asymmetric knee mechanics. FINDINGS Non-anatomic graft geometry was related to asymmetric knee mechanics, with the sagittal plane graft angle being the best predictor of asymmetry. A more vertical sagittal graft angle was associated with greater anterior tibial translation (β = 0.11mmdeg, P = 0.049, R2 = 0.22), internal tibial rotation (β = 0.27degdeg, P = 0.042, R2 = 0.23), and adduction angle (β = 0.15degdeg, P = 0.013, R2 = 0.44) at peak knee flexion. A non-anatomic sagittal graft orientation was also linked to asymmetries in tibial contact location and sliding velocity on the medial (β = -4.2mmsdeg, P = 0.002, R2 = 0.58) and lateral tibial plateaus (β = 5.7mmsdeg, P = 0.006, R2 = 0.54). INTERPRETATION This study provides evidence that non-anatomic graft geometry is linked to asymmetric knee mechanics, suggesting that restoring native anterior cruciate ligament geometry may be important to mitigate the risk of early cartilage degeneration in these patients.
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Affiliation(s)
- Michael F Vignos
- Department of Mechanical Engineering, University of Wisconsin - Madison, 1513 University Avenue, Madison, WI 53706, USA.
| | - Jarred M Kaiser
- Department of Mechanical Engineering, University of Wisconsin - Madison, 1513 University Avenue, Madison, WI 53706, USA; Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA 02215, USA
| | - Geoffrey S Baer
- Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 1685 Highland Avenue, Madison, WI 53705, USA
| | - Richard Kijowski
- Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin - Madison, 1513 University Avenue, Madison, WI 53706, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 1685 Highland Avenue, Madison, WI 53705, USA; Department of Biomedical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA.
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Is There a Biomechanical Link Between Patellofemoral Pain and Osteoarthritis? A Narrative Review. Sports Med 2018; 46:1797-1808. [PMID: 27142536 DOI: 10.1007/s40279-016-0545-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The patellofemoral (PF) joint is the knee compartment most commonly affected by osteoarthritis (OA). Even mild PF OA is associated with considerable pain and functional limitations. Despite its prevalence and impact, little is understood of the etiology or structural and functional features of PF OA. The clinical symptoms of PF OA, such as anterior knee pain during stair ambulation and squatting, share many similarities with PF pain in adolescents and young adults. PF joint OA is most commonly diagnosed in people aged >40 years, many of whom report a history of PF pain. As such, there is growing evidence that PF pain and PF OA form a continuum of disease. This review explores the possible relationship between the presence of PF pain and the development of PF OA. We review the evidence for altered neuromotor control and biomechanical factors that may be associated with altered PF loading in people with PF pain and PF OA. In doing so, we highlight similarities and differences that may evolve along the continuum. By improving our understanding of the neuromotor and biomechanical links between PF pain and PF OA, we may highlight potential targets for new rehabilitation strategies.
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Farr J. Editorial Commentary: Is Magnetic Resonance Imaging Imaged Knee Patellar Tracking Relevant in Assessing the Patient With Patellar Instability? Arthroscopy 2018; 34:734-735. [PMID: 29502693 DOI: 10.1016/j.arthro.2017.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 02/02/2023]
Abstract
Patellar pain and instability are common presentations to surgeons, yet assessment is more a static art than a dynamic science. In addition to resource-intensive gait laboratory, computed tomography (CT) and magnetic resonance imaging (MRI) have been used to measure patellar tracking. CT has the limitation of radiation and MRI has the limitation of software processing times. With an updated MRI protocol and software, it is now possible to dynamically view patellar tracking. Determining how this will be used to help in the diagnosis and treatment of patients will be the next goal.
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Burke CJ, Kaplan D, Block T, Chang G, Jazrawi L, Campbell K, Alaia M. Clinical Utility of Continuous Radial Magnetic Resonance Imaging Acquisition at 3 T in Real-time Patellofemoral Kinematic Assessment: A Feasibility Study. Arthroscopy 2018; 34:726-733. [PMID: 29273250 PMCID: PMC6080599 DOI: 10.1016/j.arthro.2017.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare patellar instability with magnetic resonance imaging analysis using continuous real-time radial gradient-echo (GRE) imaging in the assessment of symptomatic patients and asymptomatic subjects. METHODS Symptomatic patients with suspected patellofemoral maltracking and asymptomatic volunteers were scanned in real time by a radial 2-dimensional GRE sequence at 3 T in axial orientation at the patella level through a range of flexion-extension. The degree of lateral maltracking, as well as the associated tibial tubercle-trochlear groove distance and trochlea depth, was measured. Patellar lateralization was categorized as normal (≤2 mm), mild (>2 to ≤5 mm), moderate (>5 to ≤10 mm), or severe (>10 mm). The patellofemoral cartilage was also assessed according to the modified Outerbridge grading system. RESULTS The study included 20 symptomatic patients (13 women and 7 men; mean age, 36 ± 12.8 years) and 10 asymptomatic subjects (3 women and 7 men; mean age, 33.1 years). The mean time to perform the dynamic component ranged from 3 to 7 minutes. Lateralization in the symptomatic group was normal in 10 patients, mild in 1, moderate in 8, and severe in 1. There was no lateral tracking greater than 3 mm in the volunteer group. Lateral maltracking was significantly higher in symptomatic patients than in asymptomatic subjects (4.4 ± 3.7 mm vs 1.5 ± 0.71 mm, P = .007). Lateral tracking significantly correlated with tibial tubercle-trochlear groove distance (r = 0.48, P = .006). There was excellent agreement on lateral tracking between the 2 reviewers (intraclass correlation coefficient, 0.979; 95% confidence interval, 0.956-0.990). CONCLUSIONS The inclusion of a dynamic radial 2-dimensional GRE sequence is a rapid and easily performed addition to the standard magnetic resonance imaging protocol and allows dynamic quantitative assessment of patellar instability and lateral maltracking in symptomatic patients. With a paucity of reported data using this technique confirming that these results reach clinical significance, future work is required to determine how much lateral tracking is clinically significant. LEVEL OF EVIDENCE Level III, case control.
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Affiliation(s)
- Christopher J Burke
- Department of Radiology, NYU Hospital for Joint Diseases, New York, New York, U.S.A..
| | - Daniel Kaplan
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Tobias Block
- NYU Center for Biomedical Imaging, New York, New York, U.S.A
| | - Gregory Chang
- NYU Center for Biomedical Imaging, New York, New York, U.S.A
| | - Laith Jazrawi
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Kirk Campbell
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Michael Alaia
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
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Gulati A, McElrath C, Wadhwa V, Shah JP, Chhabra A. Current clinical, radiological and treatment perspectives of patellofemoral pain syndrome. Br J Radiol 2018; 91:20170456. [PMID: 29303366 DOI: 10.1259/bjr.20170456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Anterior knee pain in active young adults is commonly related to patellofemoral pain syndrome, which can be broadly classified into patellar malalignment and patellar maltracking. Imaging is performed to further elucidate the exact malalignment and maltracking abnormalities and exclude other differentials. This article details the role of the stabilizers of the patellofemoral joint, findings on conventional and multimodality imaging aiding in patellofemoral pain syndrome diagnosis and characterization, and current perspectives of various treatment approaches.
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Affiliation(s)
- Aishwarya Gulati
- 1 Department of Radiology, Dr Gulati Imaging Institute , Hauz Khas, New Delhi , India
| | - Christopher McElrath
- 2 Department of Orthopaedic Surgery, UT Southwestern Medical Center , Dallas, TX , United States
| | - Vibhor Wadhwa
- 3 Department of Radiology, University of Arkansas for Medical Sciences , Little Rock, AR , United States
| | - Jay P Shah
- 2 Department of Orthopaedic Surgery, UT Southwestern Medical Center , Dallas, TX , United States
| | - Avneesh Chhabra
- 2 Department of Orthopaedic Surgery, UT Southwestern Medical Center , Dallas, TX , United States.,4 Department of Radiology, UTSouthwestern Medical Center , Dallas, TX , United States
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17
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Borotikar B, Lempereur M, Lelievre M, Burdin V, Ben Salem D, Brochard S. Dynamic MRI to quantify musculoskeletal motion: A systematic review of concurrent validity and reliability, and perspectives for evaluation of musculoskeletal disorders. PLoS One 2017; 12:e0189587. [PMID: 29232401 PMCID: PMC5726646 DOI: 10.1371/journal.pone.0189587] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To report evidence for the concurrent validity and reliability of dynamic MRI techniques to evaluate in vivo joint and muscle mechanics, and to propose recommendations for their use in the assessment of normal and impaired musculoskeletal function. Materials and methods The search was conducted on articles published in Web of science, PubMed, Scopus, Academic search Premier, and Cochrane Library between 1990 and August 2017. Studies that reported the concurrent validity and/or reliability of dynamic MRI techniques for in vivo evaluation of joint or muscle mechanics were included after assessment by two independent reviewers. Selected articles were assessed using an adapted quality assessment tool and a data extraction process. Results for concurrent validity and reliability were categorized as poor, moderate, or excellent. Results Twenty articles fulfilled the inclusion criteria with a mean quality assessment score of 66% (±10.4%). Concurrent validity and/or reliability of eight dynamic MRI techniques were reported, with the knee being the most evaluated joint (seven studies). Moderate to excellent concurrent validity and reliability were reported for seven out of eight dynamic MRI techniques. Cine phase contrast and real-time MRI appeared to be the most valid and reliable techniques to evaluate joint motion, and spin tag for muscle motion. Conclusion Dynamic MRI techniques are promising for the in vivo evaluation of musculoskeletal mechanics; however results should be evaluated with caution since validity and reliability have not been determined for all joints and muscles, nor for many pathological conditions.
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Affiliation(s)
- Bhushan Borotikar
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- IMT Atlantique, Brest, France
- * E-mail:
| | - Mathieu Lempereur
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- CHRU de Brest, Hôpital Morvan, Service de Médecine Physique et de Réadaptation, Brest, France
| | | | - Valérie Burdin
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- IMT Atlantique, Brest, France
| | - Douraied Ben Salem
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- Université de Bretagne Occidentale, Brest, France
- CHRU de Brest, Neuroradiologie, Imagerie Médico-Légale, Brest, France
| | - Sylvain Brochard
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- CHRU de Brest, Hôpital Morvan, Service de Médecine Physique et de Réadaptation, Brest, France
- Université de Bretagne Occidentale, Brest, France
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18
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Kaiser JM, Vignos MF, Kijowski R, Baer G, Thelen DG. Effect of Loading on In Vivo Tibiofemoral and Patellofemoral Kinematics of Healthy and ACL-Reconstructed Knees. Am J Sports Med 2017; 45:3272-3279. [PMID: 28903010 PMCID: PMC5955618 DOI: 10.1177/0363546517724417] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although knees that have undergone anterior cruciate ligament reconstruction (ACLR) often exhibit normal laxity on clinical examination, abnormal kinematic patterns have been observed when the joint is dynamically loaded during whole body activity. This study investigated whether abnormal knee kinematics arise with loading under isolated dynamic movements. HYPOTHESIS Tibiofemoral and patellofemoral kinematics of ACLR knees will be similar to those of the contralateral uninjured control knee during passive flexion-extension, with bilateral differences emerging when an inertial load is applied. STUDY DESIGN Controlled laboratory study. METHODS The bilateral knees of 18 subjects who had undergone unilateral ACLR within the past 4 years were imaged by use of magnetic resonance imaging (MRI). Their knees were cyclically (0.5 Hz) flexed passively. Subjects then actively flexed and extended their knees against an inertial load that induced stretch-shortening quadriceps contractions, as seen during the load acceptance phase of gait. A dynamic, volumetric, MRI sequence was used to track tibiofemoral and patellofemoral kinematics through 6 degrees of freedom. A repeated-measures analysis of variance was used to compare secondary tibiofemoral and patellofemoral kinematics between ACLR and healthy contralateral knees during the passive and active extension phases of the cyclic motion. RESULTS Relative to the passive motion, inertial loading induced significant shifts in anterior and superior tibial translation, internal tibial rotation, and all patellofemoral degrees of freedom. As hypothesized, tibiofemoral and patellofemoral kinematics were bilaterally symmetric during the passive condition. However, inertial loading induced bilateral differences, with the ACLR knees exhibiting a significant shift toward external tibial rotation. A trend toward greater medial and anterior tibial translation was seen in the ACLR knees. CONCLUSION This study demonstrates that abnormal knee kinematic patterns in ACLR knees emerge during a simple, active knee flexion-extension task that can be performed in an MRI scanner. CLINICAL RELEVANCE It is hypothesized that abnormal knee kinematics may alter cartilage loading patterns and thereby contribute to increased risk for osteoarthritis. Recent advances in quantitative MRI can be used to detect early cartilage degeneration in ACLR knees. This study demonstrates the feasibility of identifying abnormal ACLR kinematics by use of dynamic MRI, supporting the combined use of dynamic and quantitative MRI to investigate the proposed link between knee motion, cartilage contact, and early biomarkers of cartilage degeneration.
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Affiliation(s)
- Jarred M. Kaiser
- Address correspondence to Jarred M. Kaiser, PhD, Department of Mechanical Engineering, University of Wisconsin–Madison, 1513 University Ave, Madison, WI 53706, USA ()
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Aksahin E, Aktekin CN, Kocadal O, Duran S, Gunay C, Kaya D, Hapa O, Pepe M. Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella. Knee Surg Sports Traumatol Arthrosc 2017; 25:3038-3045. [PMID: 27034088 DOI: 10.1007/s00167-016-4083-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/08/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE The aims of this study were to evaluate sagittal plane alignment in patients with chondromalacia patella via magnetic resonance imaging (MRI), analyse the relationships between the location of the patellar cartilaginous lesions and sagittal alignment and finally investigate the relationships between the sagittal plane malalignment and patellofemoral loadings using by finite element analysis. METHODS Fifty-one patients who were diagnosed with isolated modified Outerbridge grade 3-4 patellar chondromalacia based on MRI evaluation and 51 control subjects were evaluated. Chondromalacia patella patients were divided into three subgroups according to the chondral lesion location as superior, middle and inferior. The patella-patellar tendon angle (P-PT) was used for evaluation of sagittal alignment of patellofemoral joint. Each subgroup was compared with control group by using P-PT angle. To investigate the biomechanical effects of sagittal plane malpositioning on patellofemoral joint, bone models were created at 30°, 60° and 90° knee flexion by using mean P-PT angles, which obtained from patients with chondromalacia patellae and control subjects. The total loading and contact area values of the patellofemoral joints were investigated by finite element analysis. RESULTS The mean age of all participants was 52.9 ± 8.2 years. The mean P-PT angle was significantly lower in chondromalacia group (142.1° ± 3.6°) compared to control group (144.5° ± 5.3°) (p = 0.008). Chondral lesions were located in superior, middle and inferior zones in 16, 20 and 15 patients, respectively. The mean P-PT angles in patients with superior (141.8 ± 2.7) and inferior subgroups (139.2 ± 2.3) were significantly lower than the values in the control group (p < 0.05). The contact area values were detected higher in models with chondromalacia than in the control models at the same flexion degrees. There were increased loadings at 30° and 90° flexions in the sagittal patellar tilt models. CONCLUSION This study revealed that sagittal plain malpositioning of the patellofemoral joint might be related to chondromalacia, especially in the presence of lesions in the upper and lower part of the patella. This condition leads to supraphysiological loadings on the patellofemoral joint. Sagittal patellar tilt should be considered in the evaluation and management of patellar cartilage defects. Taking sagittal plane malalignment into consideration in patellofemoral joint evaluation will enable us to design new physical and surgical modalities. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ertugrul Aksahin
- Department of Orthopedics and Traumatology, Medical Park Hospital, Ankara, Turkey.
| | - Cem Nuri Aktekin
- Department of Orthopedics and Traumatology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Onur Kocadal
- Orthopedics and Traumatology Department, Ankara Education and Research Hospital, Ankara, Turkey
| | - Semra Duran
- Radiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Cüneyd Gunay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Defne Kaya
- Department of Physical Therapy and Rehabilitation, Faculty of Health Science, University of Uskudar, Istanbul, Turkey
| | - Onur Hapa
- Department of Orthopedics and Traumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murad Pepe
- Orthopedics and Traumatology Department, Ankara Education and Research Hospital, Ankara, Turkey
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20
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Bae WC, Ruangchaijatuporn T, Chung CB. New Techniques in MR Imaging of the Ankle and Foot. Magn Reson Imaging Clin N Am 2017; 25:211-225. [PMID: 27888849 DOI: 10.1016/j.mric.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Foot and ankle disorders are common in everyday clinical practice. MR imaging is frequently required for diagnosis given the variety and complexity of foot and ankle anatomy. Although conventional MR imaging plays a significant role in diagnosis, contemporary management increasingly relies on advanced imaging for monitoring therapeutic response. There is an expanding need for identification of biomarkers for musculoskeletal tissues. Advanced imaging techniques capable of imaging these tissue substrates will be increasingly used in routine clinical practice. Radiologists should therefore become familiar with these innovative MR techniques. Many such techniques are already widely used in other organ systems.
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Affiliation(s)
- Won C Bae
- Radiology Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA; Department of Radiology, UCSD MSK Imaging Research Lab, University of California, San Diego, 9427 Health Sciences Drive, La Jolla, CA 92093-0997, USA
| | - Thumanoon Ruangchaijatuporn
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok 10400, Thailand
| | - Christine B Chung
- Radiology Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA; Department of Radiology, UCSD MSK Imaging Research Lab, University of California, San Diego, 9427 Health Sciences Drive, La Jolla, CA 92093-0997, USA.
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21
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Cooper BG, Lawson TB, Snyder BD, Grinstaff MW. Reinforcement of articular cartilage with a tissue-interpenetrating polymer network reduces friction and modulates interstitial fluid load support. Osteoarthritis Cartilage 2017; 25:1143-1149. [PMID: 28285000 PMCID: PMC5726233 DOI: 10.1016/j.joca.2017.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/12/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is associated with increased articular cartilage hydraulic permeability and decreased maintenance of high interstitial fluid load support (IFLS) during articulation, resulting in increased friction on the cartilage solid matrix. This study assesses frictional response following in situ synthesis of an interpenetrating polymer network (IPN) designed to mimic glycosaminoglycans (GAGs) depleted during OA. METHODS Cylindrical osteochondral explants containing various interpenetrating polymer concentrations were subjected to a torsional friction test under unconfined creep compression. Time-varying coefficient of friction, compressive engineering strain, and normalized strain values (ε/εeq) were calculated and analyzed. RESULTS The polymer network reduced friction coefficient over the duration of the friction test, with statistically significantly reduced friction coefficients (95% confidence interval 14-34% reduced) at equilibrium compressive strain upon completion of the test (P = 0.015). A positive trend was observed relating polymer network concentration with magnitude of friction reduction compared to non-treated tissue. CONCLUSION The cartilage-interpenetrating polymer treatment improves lubrication by augmenting the biphasic tissue's interstitial fluid phase, and additionally improves the friction dissipation of the tissue's solid matrix. This technique demonstrates potential as a therapy to augment tribological function of articular cartilage.
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Affiliation(s)
- B G Cooper
- Department of Chemistry, Boston University, Boston, MA, USA; Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - T B Lawson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Mechanical Engineering, Boston University, Boston, MA, USA.
| | - B D Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Biomedical Engineering, Boston University, Boston, MA, USA; Department of Medicine, Boston University, Boston, MA, USA; Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
| | - M W Grinstaff
- Department of Chemistry, Boston University, Boston, MA, USA; Department of Biomedical Engineering, Boston University, Boston, MA, USA; Department of Medicine, Boston University, Boston, MA, USA.
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Normalized patellofemoral joint reaction force is greater in individuals with patellofemoral pain. J Biomech 2017; 60:238-242. [PMID: 28755815 DOI: 10.1016/j.jbiomech.2017.06.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/05/2017] [Accepted: 06/13/2017] [Indexed: 11/23/2022]
Abstract
Patellofemoral pain is a disabling, highly prevalent pathology. Altered patellofemoral contact forces are theorized to contribute to this pain. Musculoskeletal modeling has been employed to better understand the etiology of patellofemoral pain. Currently, there are no data on the effective quadriceps moment arm for individuals with patellofemoral pain, forcing researchers to apply normative values when modeling such individuals. In addition, the ratio of patellofemoral reaction force to quadriceps force is often used as a surrogate for patellofemoral joint contact force, ignoring the fact that the quadriceps efficiency can vary with pathology and intervention. Thus, the purposes of this study were to: (1) quantify the effective quadriceps moment arm in individuals with patellofemoral pain and compare this value to a control cohort and (2) develop a novel methodology for quantifying the normalized patellofemoral joint reaction force in vivo during dynamic activities. Dynamic MR data were captured as subjects with patellofemoral pain (30F/3M) cyclically flexed their knee from 10° to 40°. Data for control subjects (29F/9M) were taken from a previous study. The moment arm data acquired across a large cohort of individuals with patellofemoral pain should help advance musculoskeletal modeling. The primary finding of this study was an increased mean normalized patellofemoral reaction force of 14.9% (maximum values at a knee angle of 10°) in individuals with patellofemoral pain. Understanding changes in the normalized patellofemoral reaction force with pathology may lead to improvements in clinical decision making, and consequently treatments, by providing a more direct measure of altered patellofemoral joint forces.
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Mazzoli V, Nederveen AJ, Oudeman J, Sprengers A, Nicolay K, Strijkers GJ, Verdonschot N. Water and fat separation in real-time MRI of joint movement with phase-sensitive bSSFP. Magn Reson Med 2016; 78:58-68. [DOI: 10.1002/mrm.26341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Valentina Mazzoli
- Biomedical NMR, Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
- Orthopaedic Research Lab; Radboud University Medical Center; Nijmegen The Netherlands
| | - Aart J. Nederveen
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Jos Oudeman
- Department of Radiology; Academic Medical Center; Amsterdam The Netherlands
| | - Andre Sprengers
- Orthopaedic Research Lab; Radboud University Medical Center; Nijmegen The Netherlands
- Laboratory of Biomechanical Engineering; University of Twente; Enschede The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
| | - Gustav J. Strijkers
- Biomedical NMR, Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Biomedical Engineering and Physics; Academic Medical Center; Amsterdam The Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Lab; Radboud University Medical Center; Nijmegen The Netherlands
- Laboratory of Biomechanical Engineering; University of Twente; Enschede The Netherlands
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Kaiser J, Monawer A, Chaudhary R, Johnson KM, Wieben O, Kijowski R, Thelen DG. Accuracy of model-based tracking of knee kinematics and cartilage contact measured by dynamic volumetric MRI. Med Eng Phys 2016; 38:1131-5. [PMID: 27387902 DOI: 10.1016/j.medengphy.2016.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 05/07/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to determine the accuracy of knee kinematics and cartilage contact measured by volumetric dynamic MRI. A motor-actuated phantom drove femoral and tibial bone segments through cyclic 3D motion patterns. Volumetric images were continuously acquired using a 3D radially undersampled cine spoiled gradient echo sequence (SPGR-VIPR). Image data was binned based on position measured via a MRI-compatible rotary encoder. High-resolution static images were segmented to create bone models. Model-based tracking was performed by optimally registering the bone models to the volumetric images at each frame of the SPGR-VIPR series. 3D tibiofemoral translations and orientations were reconstructed, and compared to kinematics obtained by tracking fiducial markers. Imaging was repeated on a healthy subject who performed cyclic knee flexion-extension. Cartilage contact for the subject was assessed by measuring the overlap between articular cartilage surfaces. Model-based tracking was able to track tibiofemoral angles and translations with precisions less than 0.8° and 0.5mm. These precisions resulted in an uncertainty of less than 0.5mm in cartilage contact location. Dynamic SPGR-VIPR imaging can accurately assess in vivo knee kinematics and cartilage contact during voluntary knee motion performed in a MRI scanner. This technology could facilitate the quantitative investigation of links between joint mechanics and the development of osteoarthritis.
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Affiliation(s)
- Jarred Kaiser
- Department of Mechanical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Arezu Monawer
- Department of Mechanical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Rajeev Chaudhary
- Department of Biomedical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin - Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Oliver Wieben
- Department of Biomedical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA ; Department of Medical Physics, University of Wisconsin - Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Richard Kijowski
- Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA ; Department of Biomedical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA ; Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 1685 Highland Avenue, Madison, WI 53705, USA .
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Koli J, Multanen J, Kujala UM, Häkkinen A, Nieminen MT, Kautiainen H, Lammentausta E, Jämsä T, Ahola R, Selänne H, Kiviranta I, Heinonen A. Effects of Exercise on Patellar Cartilage in Women with Mild Knee Osteoarthritis. Med Sci Sports Exerc 2016; 47:1767-74. [PMID: 25668399 DOI: 10.1249/mss.0000000000000629] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This study aims to investigate the effects of exercise on patellar cartilage using T2 relaxation time mapping of magnetic resonance imaging in postmenopausal women with mild patellofemoral joint osteoarthritis (OA). METHODS Eighty postmenopausal women (mean age, 58 (SD, 4.2) yr) with mild knee OA were randomized to either a supervised progressive impact exercise program three times a week for 12 months (n = 40) or a nonintervention control group (n = 40). Biochemical properties of cartilage were estimated using T2 relaxation time mapping, a parameter sensitive to collagen integrity, collagen orientation, and tissue hydration. Leg muscle strength and power, aerobic capacity, and self-rated assessment with the Knee Injury and Osteoarthritis Outcome Score were also measured. RESULTS After intervention, full-thickness patellar cartilage T2 values had medium-size effect (d = 0.59; 95% confidence interval, 0.16 to 0.97; P = 0.018); the change difference was 7% greater in the exercise group compared with the control group. In the deep half of tissue, the significant exercise effect size was medium (d = 0.56; 95% confidence interval, 0.13 to 0.99; P = 0.013); the change difference was 8% greater in the exercise group compared with controls. Furthermore, significant medium-size T2 effects were found in the total lateral segment, lateral deep, and lateral superficial zones in favor of the exercise group. Extension force was 11% greater (d = 0.63, P = 0.006) and maximal aerobic capacity was 4% greater (d = 0.55, P = 0.028) in the exercise group than in controls. No changes in Knee Injury and Osteoarthritis Outcome Score emerged between the groups. CONCLUSIONS Progressively implemented high-impact and intensive exercise creates enough stimuli and exerts favorable effects on patellar cartilage quality and physical function in postmenopausal women with mild knee OA.
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Affiliation(s)
- Jarmo Koli
- 1Department of Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND; 2Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, FINLAND; 3Department of Diagnostic Radiology, Oulu University Hospital, Oulu, FINLAND; 4Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, FINLAND; 5Department of Radiology, University of Oulu, Oulu, FINLAND; 6Department of General Practice and Primary Healthcare, University of Helsinki, Helsinki, FINLAND; 7Unit of Primary Healthcare, Kuopio University Hospital, Kuopio, FINLAND; 8Department of Medical Technology, Institute of Biomedicine, University of Oulu, Oulu, Finland; 9LIKES Research Center, Jyväskylä, FINLAND; and 10Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, FINLAND
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Kaiser J, Vignos MF, Liu F, Kijowski R, Thelen DG. American Society of Biomechanics Clinical Biomechanics Award 2015: MRI assessments of cartilage mechanics, morphology and composition following reconstruction of the anterior cruciate ligament. Clin Biomech (Bristol, Avon) 2016; 34:38-44. [PMID: 27061359 PMCID: PMC4851865 DOI: 10.1016/j.clinbiomech.2016.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The pathogenesis of osteoarthritis following anterior cruciate ligament (ACL) reconstruction is currently unknown. The study purpose was to leverage recent advances in quantitative and dynamic MRI to test the hypothesis that abnormal joint mechanics within four years of reconstruction is accompanied by evidence of early compositional changes in cartilage. METHODS Static MR imaging was performed bilaterally on eleven subjects with an ACL reconstruction (1-4years post-surgery) and on twelve healthy subjects to obtain tibial cartilage thickness maps. Quantitative imaging (mcDESPOT) was performed unilaterally on all subjects to assess the fraction of bound water in the tibial plateau cartilage. Finally, volumetric dynamic imaging was performed to assess cartilage contact patterns during an active knee flexion-extension task. A repeated-measures ANOVA was used to test for the effects of surgical reconstruction and location on cartilage thickness, bound water fractions, and contact across the medial and lateral tibia plateaus. FINDINGS No significant differences in cartilage thickness were found between groups. However, there was a significant reduction in the fraction of water bound by proteoglycan in the ACL reconstructed knees, most notably along the anterior portion of the medial plateau and the weight-bearing lateral plateau. During movement, reconstructed knees exhibited greater contact along the medial spine in the medial plateau and along the posterior aspect of the lateral plateau, when compared with their healthy contralateral knees and healthy controls. INTERPRETATION This study provides evidence that abnormal mechanics in anterior cruciate ligament reconstructed knees are present coincidently with early biomarkers of cartilage degeneration.
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Affiliation(s)
- Jarred Kaiser
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, USA
| | - Michael F Vignos
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, USA
| | - Fang Liu
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Richard Kijowski
- Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI 537924, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, USA; Department of Biomedical Engineering, University of Wisconsin - Madison, 1415 Engineering Drive, Madison, WI 53706, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 1685 Highland Avenue, Madison, WI 53705, USA.
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Inter- and intra-rater reliability of patellofemoral kinematic and contact area quantification by fast spin echo MRI and correlation with cartilage health by quantitative T1ρ MRI. Knee 2016; 23:13-9. [PMID: 26746045 PMCID: PMC4762728 DOI: 10.1016/j.knee.2015.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/11/2015] [Accepted: 08/20/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellar maltracking is a leading cause of patellofemoral pain syndrome (PFPS). The aim of this study was to determine the inter- and intra-rater reliability of a semi-automated program for magnetic resonance imaging (MRI) based patellofemoral kinematics. METHODS Sixteen subjects (10 with PFPS [mean age 32.3; SD 5.2; eight females] and six controls without PFPS 19 [mean age 28.6; SD 2.8; three females]) participated in the study. One set of T2-weighted, fat-saturated fast spin-echo (FSE) MRIs were acquired from each subject in full extension and 30° of knee flexion. MRI including axial T1ρ relaxation time mapping sequences was also performed on each knee. Following image acquisitions, regions of interest for kinematic MRI, and patellar and trochlear cartilage were segmented and quantified with in-house designed spline- based MATLAB semi-automated software. RESULTS Intraclass Correlations Coefficients (ICC) of calculated kinematic parameters were good to excellent, ICC > 0.8 in patellar flexion, rotation, tilt, and translation (anterior -posterior, medial -lateral, and superior -inferior), and contact area translation. Only patellar tilt in the flexed position and motion from extended to flexed state was significantly different between PFPS and control patients (p=0.002 and p=0.006, respectively). No significant correlations were identified between patellofemoral kinematics and contact area with T1ρ relaxation times. CONCLUSIONS A semi-automated, spline-based kinematic MRI technique for patellofemoral kinematic and contact area quantification is highly reproducible with the potential to help better understand the role of patellofemoral maltracking in PFPS and other knee disorders. LEVEL OF EVIDENCE Level IV.
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Freedman BR, Sheehan FT, Lerner AL. MRI-based analysis of patellofemoral cartilage contact, thickness, and alignment in extension, and during moderate and deep flexion. Knee 2015; 22. [PMID: 26213361 PMCID: PMC5536899 DOI: 10.1016/j.knee.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several factors are believed to contribute to patellofemoral joint function throughout knee flexion including patellofemoral (PF) kinematics, contact, and bone morphology. However, data evaluating the PF joint in this highly flexed state have been limited. Therefore, the purpose of this study was to evaluate patellofemoral contact and alignment in low (0°), moderate (60°), and deep (140°) knee flexion, and then correlate these parameters to each other, as well as to femoral morphology. METHODS Sagittal magnetic resonance images were acquired on 14 healthy female adult knees (RSRB approved) using a 1.5 T scanner with the knee in full extension, mid-flexion, and deep flexion. The patellofemoral cartilage contact area, lateral contact displacement (LCD), cartilage thickness, and lateral patellar displacement (LPD) throughout flexion were defined. Intra- and inter-rater repeatability measures were determined. Correlations between patellofemoral contact parameters, alignment, and sulcus morphology were calculated. RESULTS Measurement repeatability ICCs ranged from 0.94 to 0.99. Patellofemoral cartilage contact area and thickness, LCD, and LPD were statistically different throughout all levels of flexion (p<0.001). The cartilage contact area was correlated to LPD, cartilage thickness, sulcus angle, and epicondylar width (r=0.47-0.72, p<0.05). DISCUSSION This study provides a comprehensive analysis of the patellofemoral joint throughout its range of motion. CONCLUSIONS This study agrees with past studies that investigated patellofemoral measures at a single flexion angle, and provides new insights into the relationship between patellofemoral contact and alignment at multiple flexion angles. CLINICAL RELEVANCE The study provides a detailed analysis of the patellofemoral joint in vivo, and demonstrates the feasibility of using standard clinical magnetic resonance imaging scanners to image the knee joint in deep flexion.
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Affiliation(s)
- Benjamin R. Freedman
- Department of Biomedical Engineering, University of Rochester,Department of Bioengineering, University of Pennsylvania
| | | | - Amy L. Lerner
- Department of Biomedical Engineering, University of Rochester
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Hoechel S, Schulz G, Müller-Gerbl M. Insight into the 3D-trabecular architecture of the human patella. Ann Anat 2015; 200:98-104. [PMID: 25835353 DOI: 10.1016/j.aanat.2015.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/19/2015] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
The subchondral bone plate (SBP), a dynamic component of the osteochondral unit, shows functional adaptation to long-term loading by distribution of the mineral content in a manner best serving the mechanical demands. Since the received joint-load is transmitted into the trabecular system, the spongy bone also exhibits differences in strain energy density which models it for optimal support. To evaluate the regional variations in trabecular architecture, in accordance with the density distribution of the SBP revealing its long-term load intake, CT- and μCT-datasets of ten physiologic patellae were analysed for defined parameters of bony structure. For the SBP, the density distributions as well as area measurements were used. The trabecular architecture was described using parameters of bone morphology comprising the first 5mm (examined in 1mm steps) below the SBP. The obtained measurements are: Bone volume fraction (BV/TV); Bone surface density (BS/TV); Trabecular number (Tb.N); Trabecular separation (Tb.Sp); Trabecular thickness (Tb.Th); structure model index (SMI); and the Degree of anisotropy (DA). The evaluated architectural parameters varied within the trabecular system and showed an inhomogeneous distribution pattern. It proved to be distinctive with maxima of material and stability situated below areas of the highest long-term load intake. With increasing depth, the pattern of distribution was persistent but lessened in intensity. The parameters significantly correlated with the density distribution of the SBP within the first and second millimetres. With increasing depth down to the fifth millimetre, the coefficients of correlation decreased for all values. The trabecular network adapts to its mechanical needs and is therefore not homogenously built. Dependent upon the long-term load intake, the trabecular model optimizes the support with significant correlation to the density distribution of the SBP.
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Affiliation(s)
- Sebastian Hoechel
- Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, 4056 Basel, Switzerland.
| | - Georg Schulz
- Biomaterials Science Center, University of Basel, Schanzenstrasse 46, 4056 Basel, Switzerland
| | - Magdalena Müller-Gerbl
- Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, 4056 Basel, Switzerland
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Yao J, Yang B, Niu W, Zhou J, Wang Y, Gong H, Ma H, Tan R, Fan Y. In vivo measurements of patellar tracking and finite helical axis using a static magnetic resonance based methodology. Med Eng Phys 2014; 36:1611-7. [DOI: 10.1016/j.medengphy.2014.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 08/19/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
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Demehri S, Thawait GK, Williams AA, Kompel A, Elias JJ, Carrino JA, Cosgarea AJ. Imaging Characteristics of Contralateral Asymptomatic Patellofemoral Joints in Patients with Unilateral Instability. Radiology 2014; 273:821-30. [DOI: 10.1148/radiol.14140295] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Neu CP. Functional imaging in OA: role of imaging in the evaluation of tissue biomechanics. Osteoarthritis Cartilage 2014; 22:1349-59. [PMID: 25278049 PMCID: PMC4185127 DOI: 10.1016/j.joca.2014.05.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/06/2014] [Accepted: 05/17/2014] [Indexed: 02/02/2023]
Abstract
Functional imaging refers broadly to the visualization of organ or tissue physiology using medical image modalities. In load-bearing tissues of the body, including articular cartilage lining the bony ends of joints, changes in strain, stress, and material properties occur in osteoarthritis (OA), providing an opportunity to probe tissue function through the progression of the disease. Here, biomechanical measures in cartilage and related joint tissues are discussed as key imaging biomarkers in the evaluation of OA. Emphasis will be placed on the (1) potential of radiography, ultrasound, and magnetic resonance imaging to assess early tissue pathomechanics in OA, (2) relative utility of kinematic, structural, morphological, and biomechanical measures as functional imaging biomarkers, and (3) improved diagnostic specificity through the combination of multiple imaging biomarkers with unique contrasts, including elastography and quantitative assessments of tissue biochemistry. In comparison to other modalities, magnetic resonance imaging provides an extensive range of functional measures at the tissue level, with conventional and emerging techniques available to potentially to assess the spectrum of preclinical to advance OA.
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Affiliation(s)
- C P Neu
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
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