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Nudelman H, Lőrincz A, Kassai T, Józsa G. Juvenile Osteochondritis Dissecans: A Case Report. Diagnostics (Basel) 2024; 14:1931. [PMID: 39272716 PMCID: PMC11394152 DOI: 10.3390/diagnostics14171931] [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: 08/01/2024] [Revised: 08/22/2024] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
(1) Background: This report aims to illustrate the development, progression, diagnosis, and treatment of chronically present articular surface lesions. (2) Methods: In this report, two patients are described from the point of the initial presentation of symptoms to surgical consultation based on radiologic findings. These patients underwent corrective surgery in the form of mosaicplasty to repair lesions present on the articular surface and the underlying subchondral bone. (3) Discussion: Diagnosing juvenile OCD remains challenging due to its variable clinical presentation and minute radiologic discoveries. X-rays are useful; however, the gold standard remains arthroscopy, which can be both diagnostic and therapeutic. Future prospects include the use of novel sonographic methods and the use of artificial intelligence within the given modalities. (4) Conclusions: The detailed imaging provided by MRI, combined with the insights from X-rays and potentially other modalities, allows for a nuanced understanding of this disease. This comprehensive approach ensures that treatment decisions are well-informed, optimising outcomes for young patients with this condition.
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Affiliation(s)
- Hermann Nudelman
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, 7624 Pécs, Hungary
- Division of Pediatric Surgery, Traumatology, Urology and Pediatric Otolaryngology, Department of Pediatrics, Medical School, University of Pécs, 7 József Attila Street, 7623 Pécs, Hungary
| | - Aba Lőrincz
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, 7624 Pécs, Hungary
- Division of Pediatric Surgery, Traumatology, Urology and Pediatric Otolaryngology, Department of Pediatrics, Medical School, University of Pécs, 7 József Attila Street, 7623 Pécs, Hungary
| | - Tamás Kassai
- Department of Pediatric Traumatology, Péterfy Hospital, Manninger Jenő National Trauma Center, 17 Fiumei Street, 1081 Budapest, Hungary
| | - Gergő Józsa
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, 7624 Pécs, Hungary
- Division of Pediatric Surgery, Traumatology, Urology and Pediatric Otolaryngology, Department of Pediatrics, Medical School, University of Pécs, 7 József Attila Street, 7623 Pécs, Hungary
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2
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Tóth F, Buko EO, Armstrong AR, Johnson CP. Relationship between the extent of vascular injury and the evolution of surgically induced osteochondrosis lesions in a piglet model. PLoS One 2024; 19:e0308641. [PMID: 39116161 PMCID: PMC11309495 DOI: 10.1371/journal.pone.0308641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open
Abstract
Ostechondritis dissecans (OCD) is an orthopaedic disease characterized by formation of osteochondral defects in developing joints. Epiphyseal cartilage necrosis (osteochondrosis [OC]) caused by focal failure of vascular supply is the known precursor lesion of OCD, but it remains to be established how the severity of vascular failure drives lesion healing or progression. In the current study we have implemented a novel piglet model of induced osteochondrosis of the lateral trochlear ridge of the femur to determine the role that the extent of ischemia plays in the development and progression of OC/OCD lesions. Ten 4-week-old Yorkshire piglets underwent surgical interruption of the vascular supply to the entirety (n = 4 pigs) or the distal half (n = 6 pigs) of the lateral trochlear ridge of the femur. At 2, 6, and 12 weeks postoperatively, distal femora were evaluated by magnetic resonance imaging (MRI) to determine the fate of induced OC lesions. At 12 weeks, piglets were euthanized, and the surgical sites were examined histologically. After complete devascularization, lesion size increased between the 6- and 12-week MRI by an average of 24.8 mm2 (95% CI: [-2.2, 51.7]; p = 0.071). During the same period, lesion size decreased by an average of 7.6 mm2 (95% CI: [-24.5, 19.4]; p = 0.83) in piglets receiving partial devascularization. At 12 weeks, average ± SD lesion size was larger (p<0.001) in piglets undergoing complete (73.5 ± 17.6 mm2) vs. partial (16.5 ± 9.8 mm2) devascularization. Our study demonstrates how the degree of vascular interruption determines lesion size and likelihood of healing in a large animal model of trochlear OC.
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Affiliation(s)
- Ferenc Tóth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Erick O. Buko
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Alexandra R. Armstrong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Casey P. Johnson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
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3
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Tóth F, Nissi MJ, Armstrong AR, Buko EO, Johnson CP. Epiphyseal cartilage vascular architecture at the distal humeral osteochondritis dissecans predilection site in juvenile pigs. J Orthop Res 2024; 42:737-744. [PMID: 37971288 PMCID: PMC10978299 DOI: 10.1002/jor.25732] [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: 05/21/2023] [Revised: 09/08/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Failure of endochondral ossification due to interruption of the vascular supply to the epiphyseal cartilage is a critical step in the development of osteochondritis dissecans (OCD). Herein we describe the vascular architecture of the distal humeral epiphyseal cartilage in pigs and identify characteristic features that have been associated with sites predisposed to OCD development across species. Distal humeral specimens were harvested from pigs (n = 5, ages = 1, 10, 18, 30, and, 42 days old) and imaged at 9.4T magnetic resonance imaging (MRI) using a 3D gradient recalled echo sequence. The MRI data were processed using a quantitative susceptibility mapping (QSM) pipeline to visualize the vascular architecture. Specimens were also evaluated histologically to identify the presence of ischemic epiphyseal cartilage necrosis (osteochondrosis [OC]-latens) and associated failure of endochondral ossification (OC-manifesta). The QSM data enabled visualization of two distinct vascular beds arising from the perichondrium at the lateral and medial aspects of the distal humeral epiphysis. Elongated vessels originating from these beds coursed axially to supply the lateral and medial thirds of epiphyseal cartilage. At 18 days of age and older, a shift from perichondrial to transosseous blood supply was noted axially, which appeared more pronounced on the lateral side. This shift coincided with histologic identification of OC-latens (30- and 42-day-old specimens) and OC-manifesta (18- and 42-day-old specimens) lesions in the corresponding regions. The vascular anatomy and its evolution at the distal humeral epiphysis closely resembles that previously reported at predilection sites of knee OCD, suggesting a shared pathophysiology between the knee and elbow joints.
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Affiliation(s)
- Ferenc Tóth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
| | - Mikko J Nissi
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Alexandra R Armstrong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
| | - Erick O Buko
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Casey P Johnson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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4
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Deichsel A, Palma Kries LK, Raschke MJ, Peez C, Briese T, Glasbrenner J, Herbst E, Kittl C. Refixation of a Large Osteochondral Fragment with Magnesium Compression Screws-A Case Report. Life (Basel) 2023; 13:life13051179. [PMID: 37240824 DOI: 10.3390/life13051179] [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: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Osteochondrosis dissecans (OCD) is a disease affecting the subchondral bone and the overlying articular cartilage. The etiology is most likely a combination of biological and mechanical factors. The incidence is highest in children >12 years old and it predominantly affects the knee. In high-grade OCD lesions, free osteochondral fragments usually are refixed via titanium screws or biodegradable screws or pins. In this case, headless compression screws made from magnesium were used for refixation. CASE REPORT A thirteen-year-old female patient with a two-year history of knee pain was diagnosed with an OCD lesion of the medial femoral condyle. After initial conservative treatment, displacement of the osteochondral fragment occurred. Refixation was performed using two headless magnesium compression screws. At the 6 months follow up, the patient was pain free, and the fragment showed progressive healing while the implants were biodegrading. DISCUSSION Existing implants for refixation of OCD lesions either require subsequent removal or show less stability and possible inflammatory reactions. The new generation of magnesium screws used in this case did not lead to a gas release, as described for previous magnesium implants, while maintaining stability during continuous biodegradation. CONCLUSIONS The data available to date on magnesium implants for the treatment of OCD are promising. However, the evidence on the magnesium implants in refixation surgery of OCD lesions is still limited. Further research needs to be conducted to provide data on outcomes and possible complications.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Lucas Klaus Palma Kries
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
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Lin KM, Gadinsky NE, Klinger CE, Kleeblad LJ, Shea KG, Dyke JP, Helfet DL, Rodeo SA, Green DW, Lazaro LE. Vascularity of the early post-natal human distal femoral chondroepiphysis: Quantitative MRI analysis. J Child Orthop 2022; 16:152-158. [PMID: 35620125 PMCID: PMC9127880 DOI: 10.1177/18632521221084179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 02/07/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Injury to or abnormality of developing distal femoral chondroepiphysis blood supply has been implicated in osteochondritis dissecans development. Progressive decrease in epiphyseal cartilage blood supply occurs in normal development; however, based on animal studies, it is hypothesized that there is greater decrease in regions more prone to osteochondritis dissecans lesions. We aimed to quantify differential regional perfusion of the immature distal femoral chondroepiphysis. We hypothesized there is decreased perfusion in the lateral aspect of the medial femoral condyle, the classic osteochondritis dissecans lesion location. METHODS Five fresh-frozen human cadaveric knees (0-6 months old) were utilized. The superficial femoral artery was cannulated proximally and contrast-enhanced magnetic resonance imaging performed using a previously reported protocol for quantifying osseous and soft tissue perfusion. Regions of interest were defined, and signal enhancement changes between pre- and post-contrast images, normalized to background muscle, were compared. RESULTS When comparing average normalized post-contrast signal enhancement of whole condyles, as well as distal, posterior, and inner (toward the notch) aspects of the medial and lateral condyles, no significant perfusion differences between condyles were found. In the medial condyle, no significant perfusion difference was found between the medial and lateral aspects. CONCLUSION We quantified immature distal femoral chondroepiphysis regional vascularity in the early post-natal knee. In specimens aged 0-6 months, no distinct watershed region was detected. Despite possible limitations, given small sample size, as well as resolution of magnetic resonance imaging and analysis, our results suggest the hypothesized vascular abnormality predisposing osteochondritis dissecans either does not occur universally or occurs after this developmental age.
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Affiliation(s)
- Kenneth M Lin
- Hospital for Special Surgery/New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Naomi E Gadinsky
- Hospital for Special Surgery/New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Craig E Klinger
- Hospital for Special Surgery/New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA,Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA,Craig E Klinger, Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | | | - Kevin G Shea
- Stanford University Medical Center, Stanford, CA, USA
| | - Jonathan P Dyke
- Citigroup Biomedical Imaging Center and Weill Cornell Medicine, New York, NY, USA
| | - David L Helfet
- Hospital for Special Surgery/New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Scott A Rodeo
- Hospital for Special Surgery/New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Daniel W Green
- Hospital for Special Surgery/New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Lionel E Lazaro
- Miami Orthopedic & Sports Medicine Institute, Baptist Health South Florida, Miami, FL, USA
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6
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Johnson CP, Tóth F, Carlson CS, Armstrong AR, Zbýň Š, Wu B, Ellermann JM, Kim HKW. T1ρ and T2 mapping detect acute ischemic injury in a piglet model of Legg-Calvé-Perthes disease. J Orthop Res 2022; 40:484-494. [PMID: 33788301 PMCID: PMC8481332 DOI: 10.1002/jor.25044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
This study investigated the sensitivity of T1ρ and T2 relaxation time mapping to detect acute ischemic injury to the secondary ossification center (SOC) and epiphyseal cartilage of the femoral head in a piglet model of Legg-Calvé-Perthes disease. Six piglets underwent surgery to induce global right femoral head ischemia and were euthanized 48 h later. Fresh operated and contralateral-control femoral heads were imaged ex vivo with T1, T2, and T1ρ mapping using a 9.4T magnetic resonance imaging scanner. The specimens were imaged a second time after a freeze/thaw cycle and then processed for histology. T1, T2, and T1ρ measurements in the SOC, epiphyseal cartilage, articular cartilage, and metaphysis were compared between operated and control femoral heads using paired t tests. The effects of freeze/thaw, T1ρ spin-lock frequency, and fat saturation were also investigated. Five piglets with histologically confirmed ischemic injury were quantitatively analyzed. T1ρ was increased in the SOC (101 ± 15 vs. 73 ± 16 ms; p = 0.0026) and epiphyseal cartilage (84.9 ± 9.2 vs. 74.3 ± 3.6 ms; p = 0.031) of the operated versus control femoral heads. T2 was also increased in the SOC (28.7 ± 2.0 vs. 22.7 ± 1.7; p = 0.0037) and epiphyseal cartilage (57.4 ± 4.7 vs. 49.0 ± 2.7; p = 0.0041). No changes in T1 were detected. The sensitivities of T1ρ and T2 mapping in detecting ischemic injury were maintained after a freeze/thaw cycle, and T1ρ sensitivity was maintained after varying spin-lock frequency and applying fat saturation. In conclusion, T1ρ and T2 mapping are sensitive in detecting ischemic injury to the SOC and epiphyseal cartilage of the femoral head as early as 48 h after ischemia induction.
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Affiliation(s)
- Casey P. Johnson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN,Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Ferenc Tóth
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN
| | - Cathy S. Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN
| | | | - Štefan Zbýň
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN,Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Baolin Wu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Jutta M. Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN,Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Harry K. W. Kim
- Center for Excellence in Hip, Scottish Rite for Children, Dallas, TX,Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX
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Chau MM, Klimstra MA, Wise KL, Ellermann JM, Tóth F, Carlson CS, Nelson BJ, Tompkins MA. Osteochondritis Dissecans: Current Understanding of Epidemiology, Etiology, Management, and Outcomes. J Bone Joint Surg Am 2021; 103:1132-1151. [PMID: 34109940 PMCID: PMC8272630 DOI: 10.2106/jbjs.20.01399] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis. ➤ While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition. ➤ Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging. ➤ Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have had failure of conservative management or have unstable lesions. ➤ Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value.
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Affiliation(s)
- Michael M Chau
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Mikhail A Klimstra
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Kelsey L Wise
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Jutta M Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ferenc Tóth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Bradley J Nelson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- TRIA Orthopedic Center, Bloomington, Minnesota
| | - Marc A Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- TRIA Orthopedic Center, Bloomington, Minnesota
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8
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Sigurdsson SF, Olstad K, Ley CJ, Björnsdóttir S, Griffiths DJ, Fjordbakk CT. Radiological, vascular osteochondrosis occurs in the distal tarsus, and may cause osteoarthritis. Equine Vet J 2021; 54:82-96. [PMID: 33534938 DOI: 10.1111/evj.13432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Osteochondrosis occurs due to failure of the blood supply to growth cartilage. Osteochondrosis lesions have been identified in small tarsal bones and suggested to cause distal tarsal osteoarthritis; however, it has not been determined whether distal tarsal osteochondrosis lesions were the result of vascular failure. OBJECTIVES To perform post-mortem arterial perfusion and micro-computed tomography (CT) of the central (CTB) and third tarsal bones (TIII) of fetuses and foals up to 5 months old, to describe tarsal development and any lesions detected. STUDY DESIGN Descriptive, nonconsecutive case series. METHODS Twenty-three animals that died or were euthanased from 228 days of gestation to 5 months old were collected, comprising two fetuses and nine foals of miscellaneous breeds and 12 Icelandic Horse foals, a breed with high prevalence of distal tarsal osteoarthritis. One hindlimb from each foal was perfused arterially with barium, and the CTB and TIII were examined with micro-CT. RESULTS Perfusion yielded partial information from 41% of the animals. The CTB and TIII were supplied by nutrient arteries and perichondrial vessels with vertical, transverse and circumferential configurations. Fourteen of the 23 (61%) animals had focal defects in the ossification front, that is, radiological osteochondrosis. The majority of lesions matched the configuration and development of vertical vessels. Additionally, full-thickness, cylindrical defects matched transverse vessels, and the long axes of some dorsal lesions matched circumferential vessels. MAIN LIMITATIONS Lack of histological validation. CONCLUSIONS Post-mortem perfusion was poor for examination of the blood supply to the growth cartilage of the CTB and TIII. Radiological osteochondrosis lesions were compatible with vascular failure because they were focal, and because lesion geometry matched vessel configuration. The relationship between osteochondrosis and distal tarsal osteoarthritis warrants further investigation.
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Affiliation(s)
- Sigurdur F Sigurdsson
- Faculty of Veterinary Medicine, Department of Companion Animal Clinical Sciences, Equine Section, Norwegian University of Life Sciences, Oslo, Norway
| | - Kristin Olstad
- Faculty of Veterinary Medicine, Department of Companion Animal Clinical Sciences, Equine Section, Norwegian University of Life Sciences, Oslo, Norway
| | - Charles J Ley
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - David J Griffiths
- Faculty of Veterinary Medicine, Department of Basic Sciences and Aquatic Medicine, Anatomy Section, Norwegian University of Life Sciences, Oslo, Norway
| | - Cathrine T Fjordbakk
- Faculty of Veterinary Medicine, Department of Companion Animal Clinical Sciences, Equine Section, Norwegian University of Life Sciences, Oslo, Norway
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9
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Ellerbrock RE, Canisso IF, Larsen RJ, Garrett KS, Stewart MC, Herzog KK, Kersh ME, Moshage SG, Podico G, Lima FS, Childs BA. Fluoroquinolone exposure in utero did not affect articular cartilage of resulting foals. Equine Vet J 2020; 53:385-396. [PMID: 32479667 DOI: 10.1111/evj.13295] [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: 11/13/2019] [Revised: 04/16/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent studies have shown that fluoroquinolones, specifically, enrofloxacin and its active metabolite (ciprofloxacin), cross the equine placenta without causing gross or histological lesions in the first and third trimester fetuses or resulting foal. However, it is possible that in utero exposure to fluoroquinolones may cause subtle lesions not detectable by standard means; thus, a more in-depth assessment of potential toxicity is warranted. OBJECTIVES To use quantitative magnetic resonance imaging (qMRI), biomechanical testing, and chondrocyte gene expression to evaluate the limbs of foals exposed to enrofloxacin during the third trimester of pregnancy. STUDY DESIGN In vivo and control terminal experiment. METHODS Healthy mares at 280 days gestation were assigned into three groups: untreated (n = 5), recommended therapeutic (7.5 mg/kg enrofloxacin, PO, SID, n = 6) or supratherapeutic (15 mg/kg, PO, SID, n = 6) doses for 14 days. Mares carried and delivered to term and nursed their foals for ~30 days. Two additional healthy foals born from untreated mares were treated post-natally with enrofloxacin (10 mg/kg PO, SID, for 5 days). By 30 days, foal stifles, hocks, elbows, and shoulders were radiographed, foals were subjected to euthanasia, and foal limbs were analysed by quantitative MRI, structural MRI, biomechanical testing and chondrocyte gene expression. RESULTS Osteochondral lesions were detected with both radiography and structural MRI in foals from both enrofloxacin-treated and untreated mares. Severe cartilage erosions, synovitis and joint capsular thickening were identified in foals treated with enrofloxacin post-natally. Median cartilage T2 relaxation times differed between joints but did not differ between treatment groups. MAIN LIMITATIONS A small sample size was assessed and there was no long-term follow-up. CONCLUSION While further research is needed to address long-term foal outcomes, no differences were seen in advanced imaging, biomechanical testing or gene expression by 30 days of age, suggesting that enrofloxacin may be a safe and useful antibiotic for select bacterial infections in pregnant mares.
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Affiliation(s)
- Robyn E Ellerbrock
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA.,Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA
| | - Igor F Canisso
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA.,Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA
| | - Ryan J Larsen
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | | | - Matthew C Stewart
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA
| | - Kalyn K Herzog
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA.,Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Sara G Moshage
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Giorgia Podico
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA.,Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA
| | - Fabio S Lima
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana Champaign, Urbana, IL, USA
| | - Bronwen A Childs
- Department of Small Animal Medicine, College of Veterinary Medicine, Athens, GA, USA
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10
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Tóth F, Johnson CP, Mills B, Nissi MJ, Nykänen O, Ellermann J, Ludwig KD, Tompkins M, Carlson CS. Evaluation of the Suitability of Miniature Pigs as an Animal Model of Juvenile Osteochondritis Dissecans. J Orthop Res 2019; 37:2130-2137. [PMID: 31115932 PMCID: PMC6739150 DOI: 10.1002/jor.24353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/14/2019] [Indexed: 02/04/2023]
Abstract
Juvenile osteochondritis dissecans (JOCD) is a developmental disease characterized by formation of intra-articular (osteo)chondral flaps or fragments. Evidence-based treatment guidelines for JOCD are currently lacking. An animal model would facilitate study of JOCD and evaluation of diagnostic and treatment approaches. The purpose of this study was to assess the suitability of miniature pigs as a model of JOCD at the distal femur. First, stifle (knee) joints harvested from three juvenile miniature pigs underwent magnetic resonance imaging (MRI) to establish the vascular architecture of the distal femoral epiphyseal cartilage. Second, vessels supplying the axial or abaxial aspects of the medial femoral condyle were surgically interrupted in four additional juvenile miniature pigs, and the developing epiphyseal cartilage lesions were monitored using three consecutive MRI examinations over nine weeks. The miniature pigs were then euthanized, and their distal femora were harvested for histological evaluation. Vascular architecture of the distal femoral epiphyseal cartilage in the miniature pigs was found to be nearly identical to that of juvenile human subjects, characterized by separate vascular beds supplying the axial and abaxial aspects of the condyles. Surgical interruption of the vascular supply to the abaxial aspect of the medial femoral condyle resulted in ischemic cartilage necrosis (a precursor lesion of JOCD) in 75% (3/4) of the miniature pigs. Cartilage lesions were identified during the first MRI performed 3 weeks post-operatively. No clinically apparent JOCD-like lesions developed. In conclusion, miniature pigs are suitable for modeling JOCD precursor lesions. Further investigation of the model is warranted to assess induction of clinically apparent JOCD lesions. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2130-2137, 2019.
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Affiliation(s)
- Ferenc Tóth
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN
| | - Casey P. Johnson
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Benigno Mills
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN
| | - Mikko J. Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Olli Nykänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Jutta Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Kai D. Ludwig
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Marc Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN
| | - Cathy S. Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN
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Olstad K, Wormstrand B, Kongsro J, Grindflek E. Osteochondrosis in the Distal Femoral Physis of Pigs Starts With Vascular Failure. Vet Pathol 2019; 56:732-742. [PMID: 31060473 DOI: 10.1177/0300985819843685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Articular osteochondrosis (OC) arises due to vascular failure and ischemic chondronecrosis. The aim of the study was to describe the histological and computed tomographic (CT) characteristics of changes in the distal femoral physis of pigs, to determine if they represented OC lesions and if the pathogenesis was the same as for articular OC. The material included 19 male Landrace pigs bred for predisposition to OC. One or 2 pigs were euthanized and CT-scanned at 2-week intervals from 82 to 180 days of age. Material from 10 pigs was available for histological validation. The CT scans revealed 31 lesions confirmed in 3 planes and 1 additional macroscopically visible lesion confirmed in 2 CT planes. Twelve of the lesions were histologically validated. All lesions were compatible with OC. Cartilage canal and eosinophilic streak morphological changes corresponded to failure of end arteries coursing from the epiphysis, toward the metaphysis. The location of lesions was compatible with failure at the point of vessel incorporation into bone. Vascular failure was associated with retention of viable hypertrophic chondrocytes and delayed ossification but not cartilage necrosis. Lesion width ranged from 1.1% to 45.6% of the physis. Several lesions were expected to resolve due to small size and evidence of CT-identifiable, reparative ossification. Angular limb deformity was not detected in any pig. The pathogenesis of physeal OC started with vascular failure that was morphologically identical to articular OC. The heritable predisposition may therefore be the same. The association between lesions and limb deformity should be studied further in older pigs in future.
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12
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Tóth F, Tompkins MA, Shea KG, Ellermann JM, Carlson CS. Identification of Areas of Epiphyseal Cartilage Necrosis at Predilection Sites of Juvenile Osteochondritis Dissecans in Pediatric Cadavers. J Bone Joint Surg Am 2018; 100:2132-2139. [PMID: 30562294 PMCID: PMC6738538 DOI: 10.2106/jbjs.18.00464] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The pathogenesis of human juvenile osteochondritis dissecans (JOCD) remains poorly understood, with multiple factors implicated, including ischemia, repetitive trauma, and genetic predisposition. Similarities in the predilection site and the diagnostic and clinical features of JOCD to the well-characterized veterinary counterpart, osteochondrosis dissecans, suggest that, similar to the animal disease, the pathogenesis JOCD may also be initiated in the first few years of life, when disruption of blood supply to the epiphyseal growth cartilage leads to failure of endochondral ossification. To gather data in support of the hypothesis that JOCD and osteochondrosis dissecans have a shared pathogenesis, biopsy specimens obtained from predilection sites of JOCD in juvenile human cadavers were histologically examined to determine whether they contained lesions similar to those found in animals diagnosed with subclinical osteochondrosis dissecans. METHODS In this descriptive laboratory study, 59 biopsy specimens (6 mm in diameter) were harvested from the central aspect (i.e., the notch side) of the femoral condyles of 26 human cadavers (1 month to 11 years old). Specimens were histologically evaluated for the presence of areas of cartilage necrosis and the morphology of cartilage canal blood vessels. RESULTS Locally extensive areas of necrotic epiphyseal cartilage were identified in 4 specimens obtained from 3 donors (ages 2 to 4 years). Areas of cartilage necrosis accompanied by focal failure of endochondral ossification or surrounded by subchondral bone were identified in biopsy specimens from 4 donors (ages 4 to 9 years). CONCLUSIONS The identification of epiphyseal cartilage necrosis identical to that described in animals with subclinical osteochondrosis, found in biopsy specimens obtained from femoral predilection sites of JOCD in pediatric cadavers, suggests a shared pathogenesis of JOCD in humans and osteochondrosis dissecans in animals. CLINICAL RELEVANCE These findings imply that the pathogenesis of human JOCD likely starts 5 to 10 years prior to the development of clinical symptoms. Enhanced understanding of the temporal features of JOCD pathogenesis provides an opportunity for earlier diagnosis and treatment, likely resulting in improved outcomes for this condition in the future.
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Affiliation(s)
- Ferenc Tóth
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota
| | - Marc A Tompkins
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota
- TRIA Orthopedic Center, Minneapolis, Minnesota
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Jutta M Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota
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13
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Olstad K, Shea KG, Cannamela PC, Polousky JD, Ekman S, Ytrehus B, Carlson CS. Juvenile osteochondritis dissecans of the knee is a result of failure of the blood supply to growth cartilage and osteochondrosis. Osteoarthritis Cartilage 2018; 26:1691-1698. [PMID: 30248503 DOI: 10.1016/j.joca.2018.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 05/25/2018] [Accepted: 06/09/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Juvenile osteochondritis dissecans (JOCD) is similar to osteochondrosis dissecans (OCD) in animals, which is the result of failure of the cartilage canal blood supply, ischemic chondronecrosis and delayed ossification, or osteochondrosis. The aim of the current study was to determine if osteochondrosis lesions occur at predilection sites for JOCD in children. METHOD Computed tomographic (CT) scans of 23 knees (13 right, 10 left) from 13 children (9 male, 4 female; 1 month to 11 years old) were evaluated for lesions consisting of focal, sharply demarcated, uniformly hypodense defects in the ossification front. Histological validation was performed in 11 lesions from eight femurs. RESULTS Thirty-two lesions consisting of focal, uniformly hypodense defects in the ossification front were identified in the CT scans of 14 human femurs (7 left, 7 right; male, 7-11 years old). Defects corresponded to areas of ischemic chondronecrosis in sections from all 11 histologically validated lesions. Intra-cartilaginous secondary responses comprising proliferation of adjacent chondrocytes and vessels were detected in six and two lesions, whereas intra-osseous responses including accumulation of chondroclasts and formation of granulation tissue occurred in 10 and six lesions, respectively. One CT cyst-like lesion contained both a pseudocyst and a true cyst in histological sections. CONCLUSION Changes identical to osteochondrosis in animals were detected at predilection sites for JOCD in children, and confirmed to represent failure of the cartilage canal blood supply and ischemic chondronecrosis in histological sections.
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Affiliation(s)
- K Olstad
- Department of Companion Animal Clinical Sciences, Equine Section, Norwegian University of Life Sciences, Oslo, Norway.
| | - K G Shea
- Department of Orthopedics, St. Luke's Sports Medicine, Boise, ID, USA.
| | - P C Cannamela
- Department of Orthopedics, St. Luke's Sports Medicine, Boise, ID, USA.
| | - J D Polousky
- Children's Health Specialty Center Plano Campus, Andrews Institute/Children's Health, Plano, TX, USA.
| | - S Ekman
- Department of Biomedicine and Veterinary Public Health, Division of Pathology, Swedish University of Life Sciences, Uppsala, Sweden.
| | - B Ytrehus
- Terrestrial Department, Norwegian Institute for Nature Research, Trondheim, Norway.
| | - C S Carlson
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA.
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14
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Johnson CP, Wang L, Tóth F, Aruwajoye O, Carlson CS, Kim HKW, Ellermann JM. Quantitative MRI Helps to Detect Hip Ischemia: Preclinical Model of Legg-Calvé-Perthes Disease. Radiology 2018; 289:386-395. [PMID: 30063188 PMCID: PMC6209066 DOI: 10.1148/radiol.2018180497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/16/2018] [Accepted: 06/04/2018] [Indexed: 12/22/2022]
Abstract
Purpose To determine whether quantitative MRI relaxation time mapping techniques can help to detect ischemic injury to the developing femoral head. Materials and Methods For this prospective animal study conducted from November 2015 to February 2018, 10 male 6-week-old piglets underwent an operation to induce complete right femoral head ischemia. Animals were humanely killed at 48 hours (n = 2) or 4 weeks (n = 8) after the operation, and the operated and contralateral-control femoral heads were harvested and frozen. Thawed specimens were imaged at 9.4-T MRI by using T1, T2, T1 in the rotating frame (T1ρ), adiabatic T1ρ, relaxation along a fictitious field (RAFF), and T2* mapping and evaluated with histologic analysis. Paired relaxation time differences between the operated and control femoral heads were measured in the secondary ossification center (SOC), epiphyseal cartilage, articular cartilage, and metaphysis and were analyzed by using a paired t test. Results In the SOC, T1ρ and RAFF had the greatest percent increases in the operated versus control femoral heads at both 48 hours (112% and 72%, respectively) and 4 weeks (74% and 70%, respectively). In the epiphyseal and articular cartilage, T2, T1ρ, and RAFF were similarly increased at both points (range, 24%-49%). At 4 weeks, T2, T1ρ, adiabatic T1ρ, and RAFF were increased in the SOC (P = .004, .018, < .001, and .001, respectively), epiphyseal cartilage (P = .009, .008, .011, and .007, respectively), and articular cartilage (P = .005, .016, .033, and .018, respectively). Histologic assessment identified necrosis in SOC and deep layer of the epiphyseal cartilage at both points. Conclusion T2, T1 in the rotating frame, adiabatic T1 in the rotating frame, and relaxation along a fictitious field maps are sensitive in helping to detect ischemic injury to the developing femoral head. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Casey P. Johnson
- From the Center for Magnetic Resonance Research (C.P.J., L.W., J.M.E.) and Departments of Radiology (C.P.J., L.W., J.M.E.), Veterinary Population Medicine (F.T.), and Veterinary Clinical Sciences (C.S.C.), University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455; Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Tex (O.A., H.K.W.K.); and Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Tex (H.K.W.K.)
| | - Luning Wang
- From the Center for Magnetic Resonance Research (C.P.J., L.W., J.M.E.) and Departments of Radiology (C.P.J., L.W., J.M.E.), Veterinary Population Medicine (F.T.), and Veterinary Clinical Sciences (C.S.C.), University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455; Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Tex (O.A., H.K.W.K.); and Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Tex (H.K.W.K.)
| | - Ferenc Tóth
- From the Center for Magnetic Resonance Research (C.P.J., L.W., J.M.E.) and Departments of Radiology (C.P.J., L.W., J.M.E.), Veterinary Population Medicine (F.T.), and Veterinary Clinical Sciences (C.S.C.), University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455; Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Tex (O.A., H.K.W.K.); and Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Tex (H.K.W.K.)
| | - Olumide Aruwajoye
- From the Center for Magnetic Resonance Research (C.P.J., L.W., J.M.E.) and Departments of Radiology (C.P.J., L.W., J.M.E.), Veterinary Population Medicine (F.T.), and Veterinary Clinical Sciences (C.S.C.), University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455; Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Tex (O.A., H.K.W.K.); and Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Tex (H.K.W.K.)
| | - Cathy S. Carlson
- From the Center for Magnetic Resonance Research (C.P.J., L.W., J.M.E.) and Departments of Radiology (C.P.J., L.W., J.M.E.), Veterinary Population Medicine (F.T.), and Veterinary Clinical Sciences (C.S.C.), University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455; Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Tex (O.A., H.K.W.K.); and Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Tex (H.K.W.K.)
| | - Harry K. W. Kim
- From the Center for Magnetic Resonance Research (C.P.J., L.W., J.M.E.) and Departments of Radiology (C.P.J., L.W., J.M.E.), Veterinary Population Medicine (F.T.), and Veterinary Clinical Sciences (C.S.C.), University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455; Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Tex (O.A., H.K.W.K.); and Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Tex (H.K.W.K.)
| | - Jutta M. Ellermann
- From the Center for Magnetic Resonance Research (C.P.J., L.W., J.M.E.) and Departments of Radiology (C.P.J., L.W., J.M.E.), Veterinary Population Medicine (F.T.), and Veterinary Clinical Sciences (C.S.C.), University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455; Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Tex (O.A., H.K.W.K.); and Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Tex (H.K.W.K.)
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15
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Wormstrand B, Østevik L, Ekman S, Olstad K. Septic Arthritis/Osteomyelitis May Lead to Osteochondrosis-Like Lesions in Foals. Vet Pathol 2018; 55:693-702. [DOI: 10.1177/0300985818777786] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Failure of the cartilage canal blood supply leads to ischemic chondronecrosis which causes osteochondrosis, and osteochondral lesions. Osteochondrosis is a disease with a heritable component and usually occurs under aseptic conditions. Because bacteria can bind to growth cartilage and disrupt the blood supply in pigs and chickens, we considered whether this might play a role in development of equine osteochondrosis. The aim of this study was to examine whether bacteria are present in canals in the growth cartilage of foals with septic arthritis/osteomyelitis, and whether this is associated with osteochondrosis. The material consisted of 7 foals aged 9-117 days euthanized because of septic arthritis/osteomyelitis. The 7 cases had 16 lesions in growth cartilage that were evaluated histologically. Bacteria were present in cartilage canals in foals with septic arthritis/osteomyelitis. Portions of necrotic canals adjacent to bacteria frequently contained neutrophils, termed acute septic canals; or granulation tissue with neutrophils, termed chronic septic canals. Acute and chronic septic canals were associated with ischemic chondronecrosis in the articular-epiphyseal cartilage complex (AECC) of 5 cases and in the physis of 2 cases, and ossification was focally delayed in 5 of those 7 cases. Lesions occurred with and without adjacent osteomyelitis. Bacteria were present in cartilage canals and were associated with focal chondronecrosis in both the AECC and the physis. This establishes sepsis as a plausible cause of some osteochondral lesions in horses. It is recommended that horses with sepsis-related osteochondral lesions may be used for breeding without increasing the prevalence of OCD-predisposing genes in the population.
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Affiliation(s)
| | - Liv Østevik
- Norwegian University of Life Sciences, Oslo, Norway
| | - Stina Ekman
- Swedish University of Agricultural Sciences, Uppsala, Sweden
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16
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Martel G, Crowley D, Olive J, Halley J, Laverty S. Ultrasonographic screening for subclinical osteochondrosis of the femoral trochlea in foals (28-166 days old): a prospective farm study. Equine Vet J 2017; 50:312-320. [DOI: 10.1111/evj.12772] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 10/11/2017] [Indexed: 11/25/2022]
Affiliation(s)
- G. Martel
- Comparative Orthopedic Research Laboratory; Department of Clinical Sciences; Faculty of Veterinary Medicine; University of Montreal; Saint-Hyacinthe Quebec Canada
| | - D. Crowley
- Fethard Equine Hospital; Fethard Ireland
| | - J. Olive
- Radiology, Department of Clinical Sciences; Faculty of Veterinary Medicine; University of Montreal; Saint-Hyacinthe Quebec Canada
| | - J. Halley
- Fethard Equine Hospital; Fethard Ireland
| | - S. Laverty
- Comparative Orthopedic Research Laboratory; Department of Clinical Sciences; Faculty of Veterinary Medicine; University of Montreal; Saint-Hyacinthe Quebec Canada
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17
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Finnøy A, Olstad K, Lilledahl MB. Non-linear optical microscopy of cartilage canals in the distal femur of young pigs may reveal the cause of articular osteochondrosis. BMC Vet Res 2017; 13:270. [PMID: 28830435 PMCID: PMC5568222 DOI: 10.1186/s12917-017-1197-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
Abstract
Background Articular osteochondrosis is a common cause of leg weakness in pigs and is defined as a focal delay in the endochondral ossification of the epiphysis. The first demonstrated steps in the pathogenesis consist of loss of blood supply and subsequent chondronecrosis in the epiphyseal growth cartilage. Blood vessels in cartilage are located in cartilage canals and become incorporated into the secondary ossification centre during growth. It has been hypothesized that vascular failure occurs during this incorporation process, but it is not known what predisposes a canal to fail. To obtain new information that may reveal the cause of vascular failure, the distal femur of 4 pigs aged 82–140 days was sampled and examined by non-linear optical microscopy. This novel technique was used for its ability to reveal information about collagen by second harmonic generation and cellular morphology by two-photon-excited fluorescence in thick sections without staining. The aims were to identify morphological variations between cartilage canal segments and to examine if failed cartilage canals could be followed back to the location where the blood supply ceased. Results The cartilage canals were shown to vary in their content of collagen fibres (112/412 segments), and the second harmonic and fluorescence signals indicated a variation in the bundling of collagen fibrils (245/412 segments) and in the calcification (30/412 segments) of the adjacent cartilage matrix. Failed cartilage canals associated with chondronecrosis were shown to enter the epiphyseal growth cartilage from not only the secondary ossification centre, but also the attachment site of the caudal cruciate ligament. Conclusion The variations between cartilage canal segments could potentially explain why the blood supply fails at the osteochondral junction in only a subset of the canals. Proteins linked to these variations should be examined in future genomic studies. Although incorporation can still be a major cause, it could not account for all cases of vascular failure. The role of the caudal cruciate ligament in the cause of osteochondrosis should therefore be investigated further.
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Affiliation(s)
- Andreas Finnøy
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Kristin Olstad
- Faculty of Veterinary Medicine and Biosciences, Equine Section, Norwegian University of Life Sciences, P.O. Box 8146, Oslo, Norway
| | - Magnus B Lilledahl
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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18
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Dymerska B, Bohndorf K, Schennach P, Rauscher A, Trattnig S, Robinson SD. In vivo phase imaging of human epiphyseal cartilage at 7 T. Magn Reson Med 2017; 79:2149-2155. [PMID: 28758241 DOI: 10.1002/mrm.26858] [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: 01/30/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess the potential clinical utility of in vivo susceptibility-weighted imaging and quantitative susceptibility mapping of growth cartilage in the juvenile human knee at 7 T. METHODS High-resolution gradient-echo images of the knees of six healthy children and adolescents aged 6 to 15 were acquired with a 28-channel coil at 7 T. Phase images from the coils were combined using a short echo-time reference scan method (COMPOSER). RESULTS Veins oriented perpendicular to the static B0 field appeared doubled in susceptibility-weighted imaging, but not quantitative susceptibility mapping. Veins and layers in the cartilage were visible in all children up to the age of 13. CONCLUSIONS Phase imaging using susceptibility-weighted imaging and quantitative susceptibility mapping allows the in vivo visualization of veins and layers in human growth cartilage. Magn Reson Med 79:2149-2155, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Barbara Dymerska
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Klaus Bohndorf
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Paul Schennach
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Alexander Rauscher
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Siegfried Trattnig
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Simon D Robinson
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
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19
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Tóth F, David FH, LaFond E, Wang L, Ellermann JM, Carlson CS. In vivo visualization using MRI T 2 mapping of induced osteochondrosis and osteochondritis dissecans lesions in goats undergoing controlled exercise. J Orthop Res 2017; 35:868-875. [PMID: 27283998 PMCID: PMC5458739 DOI: 10.1002/jor.23332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/05/2016] [Indexed: 02/04/2023]
Abstract
In vivo visualization of subclinical osteochondrosis (OC) lesions, characterized by necrosis of epiphyseal growth cartilage, is necessary to clarify the pathogenesis of this disease. Hence, our objectives were to demonstrate induced necrosis of the epiphyseal cartilage in vivo using MRI and to monitor progression or resolution of resulting lesions. We also aimed to improve the goat model of OC by introducing controlled exercise. Vascular supply to the epiphyseal cartilage was surgically interrupted in four 5-day-old goats to induce ischemic cartilage necrosis in a medial femoral condyle. Starting 3 weeks postoperatively, goats underwent daily controlled exercise until euthanasia at 6, 10, 11 (n = 2) weeks postoperatively. T2 maps of operated and control femora were obtained in vivo at 3 (n = 4), 6 (n = 4), 9 (n = 3), and 11 (n = 2) weeks postoperatively using a 3 T MR scanner. In vivo MRI findings were validated against MRI results obtained ex vivo at 9.4 T in three goats and compared to histological results in all goats. Surgical interruption of the vascular supply caused ischemic cartilage necrosis in three out of four goats. T2 maps obtained in vivo at 3 T identified regions of increased relaxation time consistent with discrete areas of cartilage necrosis 3-11 weeks postoperatively and demonstrated delayed progression of the ossification front at 9 (n = 1) and 11 (n = 2) weeks postoperatively. In vivo MRI findings were confirmed by ex vivo MRI at 9.4 T and by histology. Identification of cartilage necrosis in clinical patients in the early stages of OC using T2 maps may provide valuable insight into the pathogenesis of this condition. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:868-875, 2017.
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Affiliation(s)
- Ferenc Tóth
- Veterinary Population Medicine Department, University of Minnesota, St. Paul, MN, USA
| | - Frédéric H. David
- Veterinary Clinical Sciences Department, University of Minnesota, St. Paul, MN, USA
| | - Elizabeth LaFond
- Veterinary Clinical Sciences Department, University of Minnesota, St. Paul, MN, USA
| | - Luning Wang
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jutta M. Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Cathy S. Carlson
- Veterinary Population Medicine Department, University of Minnesota, St. Paul, MN, USA
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20
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Martel G, Couture CA, Gilbert G, Bancelin S, Richard H, Moser T, Kiss S, Légaré F, Laverty S. Femoral epiphyseal cartilage matrix changes at predilection sites of equine osteochondrosis: Quantitative MRI, second-harmonic microscopy, and histological findings. J Orthop Res 2016; 34:1743-1752. [PMID: 27734566 DOI: 10.1002/jor.23176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/21/2016] [Indexed: 02/04/2023]
Abstract
Osteochondrosis is an ischemic chondronecrosis of epiphyseal growth cartilage that results in focal failure of endochondral ossification and osteochondritis dissecans at specific sites in the epiphyses of humans and animals, including horses. The upstream events leading to the focal ischemia remain unknown. The epiphyseal growth cartilage matrix is composed of proteoglycan and collagen macromolecules and encases its vascular tree in canals. The matrix undergoes major dynamic changes in early life that could weaken it biomechanically and predispose it to focal trauma and vascular failure. Subregions in neonatal foal femoral epiphyses (n = 10 osteochondrosis predisposed; n = 6 control) were assessed for proteoglycan and collagen structure/content employing 3T quantitative MRI (3T qMRI: T1ρ and T2 maps). Site-matched validations were made with histology, immunohistochemistry, and second-harmonic microscopy. Growth cartilage T1ρ and T2 relaxation times were significantly increased (p < 0.002) within the proximal third of the trochlea, a site predisposed to osteochondrosis, when compared with other regions. However, this was observed in both control and osteochondrosis predisposed specimens. Microscopic evaluation of this region revealed an expansive area with low proteoglycan content and a hypertrophic-like appearance on second-harmonic microscopy. We speculate that this matrix structure and composition, though physiological, may weaken the epiphyseal growth cartilage biomechanically in focal regions and could enhance the risk of vascular failure with trauma leading to osteochondrosis. However, additional investigations are now required to confirm this. 3T qMRI will be useful for future non-invasive longitudinal studies to track the osteochondrosis disease trajectory in animals and humans. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1743-1752, 2016.
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Affiliation(s)
- Gabrielle Martel
- Comparative Orthopaedic Research Laboratory, Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada
| | | | | | | | - Hélène Richard
- Comparative Orthopaedic Research Laboratory, Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada
| | - Thomas Moser
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Québec, Canada
| | - Sabrina Kiss
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Québec, Canada
| | | | - Sheila Laverty
- Comparative Orthopaedic Research Laboratory, Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada.
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Ellington MD, Edmonds EW. Pediatric Elbow and Wrist Pathology Related to Sports Participation. Orthop Clin North Am 2016; 47:743-8. [PMID: 27637661 DOI: 10.1016/j.ocl.2016.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pediatric overuse injuries are becoming more prevalent in today's society with more children competitively playing year-round sports at a younger age. The importance of prompt diagnosis and treatment is paramount to the treatment for these injuries, second only to rest and activity modification. This article will focus on overuse injuries of the upper extremity, specifically: little league elbow, elbow osteochondritis dissecans, and gymnast wrist. It will also discuss the pathophysiology, diagnosis, imaging, and treatment of each of these entities.
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Affiliation(s)
- Matthew D Ellington
- Division of Orthopedic Surgery, Rady Children's Hospital, 3030 Children's Way Suite 410, San Diego, CA 92123, USA
| | - Eric W Edmonds
- Division of Orthopedic Surgery, Rady Children's Hospital, 3030 Children's Way Suite 410, San Diego, CA 92123, USA.
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22
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Ellermann J, Johnson CP, Wang L, Macalena JA, Nelson BJ, LaPrade RF. Insights into the Epiphyseal Cartilage Origin and Subsequent Osseous Manifestation of Juvenile Osteochondritis Dissecans with a Modified Clinical MR Imaging Protocol: A Pilot Study. Radiology 2016; 282:798-806. [PMID: 27631413 DOI: 10.1148/radiol.2016160071] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To retrospectively determine if a modified clinical magnetic resonance (MR) imaging protocol provides information on the origin of juvenile osteochondritis dissecans (JOCD) lesions and allows for staging on the basis of the proposed natural history of JOCD to better guide clinical management of the disease. Materials and Methods This institutional review board-approved, HIPAA-compliant, retrospective study was performed in 13 consecutive patients (mean age, 14.9 years; age range, 10-22 years; nine male and four female patients) and one additional comparative patient (a 44-year-old man), in which 19 knees with 20 JOCD lesions were imaged. Seventeen lesions occurred in the medial femoral condyle, two occurred in the lateral femoral condyle, and one occurred in the medial trochlea. The clinical 3-T MR imaging protocol was supplemented with a routinely available multiecho gradient-recalled-echo sequence with the shortest attainable echo time of approximately 4 msec (T2* mapping). Results At the earliest manifestation, the lesion was entirely cartilaginous (n = 1). Subsequently, primary cartilaginous lesions within the epiphyseal cartilage developed a rim calcification that originated from normal subjacent bone, which defined a clear cleft between the lesion progeny and the parent bone (n = 9). Secondarily, progeny lesions became ossified (n = 7) while at the same time forming varying degrees of osseous bridging and/or clefting with the parent bone. Two healed lesions with a linear bony scar and one detached lesion were identified. Conclusion The modified MR imaging protocol allowed for identification of the epiphyseal cartilage origin and subsequent stages of ossification in JOCD. The approach allows further elucidation of the natural history of the disease and may better guide clinical management. © RSNA, 2016.
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Affiliation(s)
- Jutta Ellermann
- From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.)
| | - Casey P Johnson
- From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.)
| | - Luning Wang
- From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.)
| | - Jeffrey A Macalena
- From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.)
| | - Bradley J Nelson
- From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.)
| | - Robert F LaPrade
- From the Department of Radiology and Center for Magnetic Resonance Research (J.E., C.P.J., L.W.) and Department of Orthopaedic Surgery (J.A.M., B.J.N.), University of Minnesota Medical Center, 2021 6th St SE, Minneapolis, MN 55455; and Complex Knee and Sports Medicine Surgery, The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colo (R.F.L.)
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23
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Tóth F, Torrison JL, Harper L, Bussieres D, Wilson ME, Crenshaw TD, Carlson CS. Osteochondrosis prevalence and severity at 12 and 24 weeks of age in commercial pigs with and without organic-complexed trace mineral supplementation. J Anim Sci 2016; 94:3817-3825. [DOI: 10.2527/jas.2015-9950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Nissi MJ MJ, Salo EN, Tiitu V, Liimatainen T, Michaeli S, Mangia S, Ellermann J, Nieminen MT. Multi-parametric MRI characterization of enzymatically degraded articular cartilage. J Orthop Res 2016; 34:1111-20. [PMID: 26662555 PMCID: PMC4903086 DOI: 10.1002/jor.23127] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/08/2015] [Indexed: 02/04/2023]
Abstract
Several laboratory and rotating frame quantitative MRI parameters were evaluated and compared for detection of changes in articular cartilage following selective enzymatic digestion. Bovine osteochondral specimens were subjected to 44 h incubation in control medium or in collagenase or chondroitinase ABC to induce superficial collagen or proteoglycan (glycosaminoglycan) alterations. The samples were scanned at 9.4 T for T1 , T1 Gd (dGEMRIC), T2 , adiabatic T1 ρ , adiabatic T2 ρ , continuous-wave T1 ρ , TRAFF2 , and T1 sat relaxation times and for magnetization transfer ratio (MTR). For reference, glycosaminoglycan content, collagen fibril orientation and biomechanical properties were determined. Changes primarily in the superficial cartilage were noted after enzymatic degradation. Most of the studied parameters were sensitive to the destruction of collagen network, whereas glycosaminoglycan depletion was detected only by native T1 and T1 Gd relaxation time constants throughout the tissue and by MTR superficially. T1 , adiabatic T1 ρ , adiabatic T2 ρ , continuous-wave T1 ρ , and T1 sat correlated significantly with the biomechanical properties while T1 Gd correlated with glycosaminoglycan staining. The findings indicated that most of the studied MRI parameters were sensitive to both glycosaminoglycan content and collagen network integrity, with changes due to enzymatic treatment detected primarily in the superficial tissue. Strong correlation of T1 , adiabatic T1ρ , adiabatic T2 ρ , continuous-wave T1 ρ , and T1 sat with the altered biomechanical properties, reflects that these parameters were sensitive to critical functional properties of cartilage. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1111-1120, 2016.
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Affiliation(s)
- Mikko J. Nissi MJ
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland,CMRR, Department of Radiology, University of Minnesota, Minneapolis, MN, USA,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland,Corresponding author: Mikko J. Nissi, Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland, Telephone number: +358-50-5955517, Fax number: +358-17-162585
| | - Elli-Noora Salo
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Virpi Tiitu
- Institute of Biomedicine, Anatomy, University of Eastern Finland, Kuopio, Finland
| | - Timo Liimatainen
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland,Department of Biotechnology and Molecular Medicine, A. I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Shalom Michaeli
- CMRR, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Silvia Mangia
- CMRR, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jutta Ellermann
- CMRR, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Miika T. Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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25
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Ellermann JM, Donald B, Rohr S, Takahashi T, Tompkins M, Nelson B, Crawford A, Rud C, Macalena J. Magnetic Resonance Imaging of Osteochondritis Dissecans: Validation Study for the ICRS Classification System. Acad Radiol 2016; 23:724-9. [PMID: 26976624 DOI: 10.1016/j.acra.2016.01.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 01/16/2016] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES In this retrospective case series, we utilize arthroscopy as the gold standard to determine if magnetic resonance imaging (MRI) of the knee can predict osteochondritis dissecans (OCD) lesion stability, the most important information to guide patient treatment decisions. It is hypothesized that the classification system of the International Cartilage Repair Society (ICRS) will allow for improved assessment of lesion grade and stability in OCD. MATERIALS AND METHODS Routine MRI studies of 46 consecutive patients with arthroscopically proven OCD lesions (mean age: 23.7 years; 26 male, 16 female) were assessed by three radiologists who were blinded to arthroscopic results. Arthroscopic images were evaluated by two orthopedic surgeons in consensus. The OCD criteria of the ICRS were applied to arthroscopy and imaging interpretations. Inter-rater correlation statistics and accuracy of magnetic resonance (MR) grading with respect to arthroscopy were determined. RESULTS Only 56% of the available MR reports assigned a label of stable or unstable to the lesion description. Of these, 58% of the lesions were deemed unstable and 42% were stable. Accuracy was 53% when reports addressed stability. Utilizing the ICRS classification system, for all three readers combined, the respective sensitivity, specificity, and accuracy of MR imaging to determine lesion stability were 70%, 81%, and 76%. When compared to the original MRI report, the overall accuracy increased from 53% to 76% when readers were given the specific criteria of the OCD ICRS classification. However, inter-reader variability remained high, with Krippendorf's alpha ranging from 0.48 to 0.57. CONCLUSIONS In this paper, we utilize arthroscopy as the gold standard to determine if MRI can predict OCD lesion stability, the most important information to guide patient treatment decisions. To our surprise, the analysis of the existing radiology reports that addressed stability revealed an overall accuracy in defining OCD lesion stability of about 53%. The classification system of the ICRS, created by an international multidisciplinary, multi-expert consortium, did markedly improve the accuracy, but consistency among different readers was lacking. This retrospective study on OCD reporting and classification highlights the inadequacy of existing classification schemes, and emphasizes the critical need for improved diagnostic MRI protocols in musculoskeletal radiology in order to propel it toward evidence-based medicine.
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26
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Zhang J, Nissi MJ, Idiyatullin D, Michaeli S, Garwood M, Ellermann J. Capturing fast relaxing spins with SWIFT adiabatic rotating frame spin-lattice relaxation (T1ρ) mapping. NMR IN BIOMEDICINE 2016; 29:420-30. [PMID: 26811973 PMCID: PMC4805510 DOI: 10.1002/nbm.3474] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 11/20/2015] [Accepted: 11/28/2015] [Indexed: 05/18/2023]
Abstract
Rotating frame spin-lattice relaxation, with the characteristic time constant T1ρ, provides a means to access motion-restricted (slow) spin dynamics in MRI. As a result of their restricted motion, these spins are sometimes characterized by a short transverse relaxation time constant T2 and thus can be difficult to detect directly with conventional image acquisition techniques. Here, we introduce an approach for three-dimensional adiabatic T1ρ mapping based on a magnetization-prepared sweep imaging with Fourier transformation (MP-SWIFT) sequence, which captures signal from almost all water spin populations, including the extremely fast relaxing pool. A semi-analytical procedure for T1ρ mapping is described. Experiments on phantoms and musculoskeletal tissue specimens (tendon, articular and epiphyseal cartilages) were performed at 9.4 T for both the MP-SWIFT and fast spin echo (FSE) read outs. In the phantom with liquids having fast molecular tumbling and a single-valued T1ρ time constant, the measured T1ρ values obtained with MP-SWIFT and FSE were similar. Conversely, in normal musculoskeletal tissues, T1ρ values measured with MP-SWIFT were much shorter than the values obtained with FSE. Studies of biological tissue specimens demonstrated that T1ρ-weighted SWIFT provides higher contrast between normal and diseased tissues relative to conventional acquisitions. Adiabatic T1ρ mapping with SWIFT readout captures contributions from the otherwise undetected fast relaxing spins, allowing more informative T1ρ measurements of normal and diseased states.
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Affiliation(s)
- J Zhang
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - M J Nissi
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - D Idiyatullin
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - S Michaeli
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - M Garwood
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - J Ellermann
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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27
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Wang L, Nissi MJ, Toth F, Johnson CP, Garwood M, Carlson CS, Ellermann J. Quantitative susceptibility mapping detects abnormalities in cartilage canals in a goat model of preclinical osteochondritis dissecans. Magn Reson Med 2016; 77:1276-1283. [PMID: 27018370 DOI: 10.1002/mrm.26214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To use quantitative susceptibility mapping (QSM) to investigate changes in cartilage canals in the distal femur of juvenile goats after their surgical transection. METHODS Chondronecrosis was surgically induced in the right medial femoral condyles of four 4-day-old goats. Both the operated and control knees were harvested at 2, 3, 5, and 10 weeks after the surgeries. Ex vivo MRI scans were conducted at 9.4 Tesla using TRAFF (relaxation time along a fictitious field)-weighted fast spin echo imaging and QSM to detect areas of chondronecrosis and investigate cartilage canal abnormalities. Histological sections from these same areas stained with hematoxylin and eosin and safranin O were evaluated to assess the affected tissues. RESULTS Both the histological sections and the TRAFF -weighted images of the femoral condyles demonstrated focal areas of chondronecrosis, evidenced by pyknotic chondrocyte nuclei, loss of matrix staining, and altered MR image contrast. At increasing time points after surgery, progressive changes and eventual disappearance of abnormal cartilage canals were observed in areas of chondronecrosis by using QSM. CONCLUSION Abnormal cartilage canals were directly visualized in areas of surgically induced chondronecrosis. Quantitative susceptibility mapping enabled investigation of the vascular changes accompanying chondronecrosis in juvenile goats. Magn Reson Med 77:1276-1283, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Luning Wang
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Ferenc Toth
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
| | - Casey P Johnson
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Garwood
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cathy S Carlson
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
| | - Jutta Ellermann
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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Orth P, Peifer C, Goebel L, Cucchiarini M, Madry H. Comprehensive analysis of translational osteochondral repair: Focus on the histological assessment. ACTA ACUST UNITED AC 2015; 50:19-36. [PMID: 26515165 DOI: 10.1016/j.proghi.2015.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 12/15/2022]
Abstract
Articular cartilage guarantees for an optimal functioning of diarthrodial joints by providing a gliding surface for smooth articulation, weight distribution, and shock absorbing while the subchondral bone plays a crucial role in its biomechanical and nutritive support. Both tissues together form the osteochondral unit. The structural assessment of the osteochondral unit is now considered the key standard procedure for evaluating articular cartilage repair in translational animal models. The aim of this review is to give a detailed overview of the different methods for a comprehensive evaluation of osteochondral repair. The main focus is on the histological assessment as the gold standard, together with immunohistochemistry, and polarized light microscopy. Additionally, standards of macroscopic, non-destructive imaging such as high resolution MRI and micro-CT, biochemical, and molecular biological evaluations are addressed. Potential pitfalls of analysis are outlined. A second focus is to suggest recommendations for osteochondral evaluation.
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Affiliation(s)
- Patrick Orth
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
| | - Carolin Peifer
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
| | - Lars Goebel
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
| | - Henning Madry
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37, D-66421 Homburg/Saar, Germany.
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Multiparametric MRI of Epiphyseal Cartilage Necrosis (Osteochondrosis) with Histological Validation in a Goat Model. PLoS One 2015; 10:e0140400. [PMID: 26473611 PMCID: PMC4608749 DOI: 10.1371/journal.pone.0140400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/24/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate multiple MRI parameters in a surgical model of osteochondrosis (OC) in goats. METHODS Focal ischemic lesions of two different sizes were induced in the epiphyseal cartilage of the medial femoral condyles of goats at 4 days of age by surgical transection of cartilage canal blood vessels. Goats were euthanized and specimens harvested 3, 4, 5, 6, 9 and 10 weeks post-op. Ex vivo MRI scans were conducted at 9.4 Tesla for mapping the T1, T2, T1ρ, adiabatic T1ρ and TRAFF relaxation times of articular cartilage, unaffected epiphyseal cartilage, and epiphyseal cartilage within the area of the induced lesion. After MRI scans, safranin O staining was conducted to validate areas of ischemic necrosis induced in the medial femoral condyles of six goats, and to allow comparison of MRI findings with the semi-quantitative proteoglycan assessment in corresponding safranin O-stained histological sections. RESULTS All relaxation time constants differentiated normal epiphyseal cartilage from lesions of ischemic cartilage necrosis, and the histological staining results confirmed the proteoglycan (PG) loss in the areas of ischemia. In the scanned specimens, all of the measured relaxation time constants were higher in the articular than in the normal epiphyseal cartilage, consistently allowing differentiation between these two tissues. CONCLUSIONS Multiparametric MRI provided a sensitive approach to discriminate between necrotic and viable epiphyseal cartilage and between articular and epiphyseal cartilage, which may be useful for diagnosing and monitoring OC lesions and, potentially, for assessing effectiveness of treatment interventions.
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30
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Tóth F, Nissi MJ, Ellermann JM, Wang L, Shea KG, Polousky J, Carlson CS. Novel Application of Magnetic Resonance Imaging Demonstrates Characteristic Differences in Vasculature at Predilection Sites of Osteochondritis Dissecans. Am J Sports Med 2015; 43:2522-7. [PMID: 26286878 PMCID: PMC4766866 DOI: 10.1177/0363546515596410] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Understanding the pathogenesis of osteochondrosis/osteochondritis dissecans and other developmental orthopaedic diseases that are thought to occur secondary to defects in vascular supply to growth/epiphyseal cartilage has been hampered by the inability to image the vasculature in this tissue. This is particularly true in human beings due to limitations of current imaging techniques and the lack of availability of appropriate cadaveric samples for histological studies. HYPOTHESIS Susceptibility-weighted imaging, an MRI sequence, allows identification of characteristic differences in the vascular architecture in species that are affected by osteochondrosis/osteochondritis dissecans on the femoral condyle (humans and pigs) versus a species that is free of the disease (goat). STUDY DESIGN Controlled laboratory study. MATERIALS Distal femora from cadavers of juvenile humans (n = 5), pigs (n = 3), and goats (n = 3) were scanned in a 9.4-T MRI scanner using susceptibility-weighted imaging. Three-dimensional reconstructions were created, and minimum intensity projections were calculated in 3 planes to enhance visualization of the vascular architecture. RESULTS Susceptibility-weighted imaging allowed clear visualization of the epiphyseal vasculature in all species. Vascular architecture, with vessels primarily arising from the perichondrium, was similar in humans and pigs, which are predisposed to osteochondrosis/osteochondritis dissecans, and was starkly different from that present in goats, a species in which there are no reports of osteochondrosis/osteochondritis dissecans. Furthermore, vessels in the distal femoral predilection site disappeared with age in humans in a pattern similar to that reported previously in pigs. CONCLUSION Nearly identical vascular architecture at the shared primary predilection site of osteochondrosis/osteochondritis dissecans in the femoral condyles in human beings and pigs suggests that vascular failure, which is known to be central to the pathogenesis of this disease in pigs, may also play a role in humans. CLINICAL RELEVANCE This assumption of a shared pathogenesis is supported by the pattern of disappearance of vessels with age at the primary predilection site of osteochondritis dissecans in humans, which is essentially identical to that which has been reported in pigs. Susceptibility-weighted imaging will likely help further elucidate this potential relationship in the future.
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Affiliation(s)
- Ferenc Tóth
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, USA,Correspondence to: Ferenc Toth, 435H AnSci/VetMed, 1988 Fitch Avenue, St. Paul, MN 55108, USA; Tel.: 1-612-624-7727;
| | - Mikko J. Nissi
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA,Department of Radiology, Institute of Diagnostics, University of Oulu, Oulu, Finland,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Jutta M. Ellermann
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Luning Wang
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Kevin G. Shea
- St Lukes Health System, Boise, ID,Department of Orthopedics, University of Utah, Salt Lake City, UT
| | - John Polousky
- The Rocky Mountain Hospital for Children, Denver, CO
| | - Cathy S. Carlson
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, USA
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Abstract
Osteochondrosis is defined as a focal disturbance in endochondral ossification. The cartilage superficial to an osteochondrosis lesion can fracture, giving rise to fragments in joints known as osteochondrosis dissecans (OCD). In pigs and horses, it has been confirmed that the disturbance in ossification is the result of failure of the blood supply to epiphyseal growth cartilage and associated ischemic chondronecrosis. The earliest lesion following vascular failure is an area of ischemic chondronecrosis at an intermediate depth of the growth cartilage (osteochondrosis latens) that is detectable ex vivo, indirectly using contrast-enhanced micro- and conventional computed tomography (CT) or directly using adiabatic T1ρ magnetic resonance imaging. More chronic lesions of ischemic chondronecrosis within the ossification front (osteochondrosis manifesta) are detectable by the same techniques and have also been followed longitudinally in pigs using plain CT. The results confirm that lesions sometimes undergo spontaneous resolution, and in combination, CT and histology observations indicate that this occurs by filling of radiolucent defects with bone from separate centers of endochondral ossification that form superficial to lesions and by phagocytosis and intramembranous ossification of granulation tissue that forms deep to lesions. Research is currently aimed at discovering the cause of the vascular failure in osteochondrosis, and studies of spontaneous lesions suggest that failure is associated with the process of incorporating blood vessels into the advancing ossification front during growth. Experimental studies also show that bacteremia can lead to vascular occlusion. Future challenges are to differentiate between causes of vascular failure and to discover the nature of the heritable predisposition for osteochondrosis.
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Affiliation(s)
- K. Olstad
- Faculty of Veterinary Medicine and Biosciences, Institute of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - S. Ekman
- Swedish University of Agricultural Sciences, Uppsala, Sweden
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