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Nakagawa Y, Mukai S, Sakai S, Nakamura R, Takahashi M, Nakagawa S. Preoperative diagnosis of knee cartilage, meniscal, and ligament injuries by magnetic resonance imaging. J Exp Orthop 2023; 10:47. [PMID: 37079120 PMCID: PMC10119346 DOI: 10.1186/s40634-023-00595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/07/2023] [Indexed: 04/21/2023] Open
Abstract
PURPOSE The purpose of the study was to report on the current accuracy measures specific to 1.5-Tesla MRI of the knee in the patient population prone to injuries of the anterior cruciate ligament (ACL), the menisci, and the articular cartilage. METHODS We accrued patients between January 2018 through August 2021 who underwent a preoperative MRI and were diagnosed with an articular cartilage injury either due to unevenness of articular cartilage in T2-weighted sequences or due to the irregularity of subchondral bone in T1-weighted sequences. All patients were treated arthroscopically. Sensitivity, specificity, and accuracy were calculated for the detection of ACL, meniscus, and cartilage injuries. A P-value of < 0.05 represented statistical significance. RESULTS One-hundred and forty-seven cases which included 150 knee joints were enrolled in this study. The mean age at the time of surgery was 42.9 years-old. The sensitivity in the diagnosis of ACL injuries was significantly greater than that in the diagnosis of cartilage injuries (P = 0.0083). The ratios of the equality of operative indication in 6 recipient sites were found to be between 90.0% and 96.0%. The diagnostic critical point was within a 1 cm in diameter. CONCLUSION The diagnostic sensitivity in cartilage injuries was significantly lower than ones of ACL and meniscal injuries. The ratios of the equality of operative indication was determined to be between 90.0% and 96.0%, if we consider the unevenness of articular cartilage or the irregularity of subchondral bone. LEVEL OF EVIDENCE Level III, Prospective diagnostic cohort study.
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Affiliation(s)
- Yasuaki Nakagawa
- Clinical Research Center, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-Cho, Fushimi-Ku, Kyoto, 612-8555, Japan.
- Department of Orthopaedic Surgery, Japan Baptist Medical Foundation, Kyoto, Japan.
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Sayako Sakai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ryota Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Motoi Takahashi
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Puhakka J, Salonius E, Paatela T, Muhonen V, Meller A, Vasara A, Kautiainen H, Kosola J, Kiviranta I. Comparison Between Arthroscopic and Histological International Cartilage Repair Society Scoring Systems in Porcine Cartilage Repair Model. Cartilage 2022; 13:19476035211069246. [PMID: 35098743 PMCID: PMC9137296 DOI: 10.1177/19476035211069246] [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] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The arthroscopic and histological International Cartilage Repair Society (ICRS) scores are designed to evaluate cartilage repair quality. Arthroscopic ICRS score can give a maximum score of 12 and the histological score can give values between 0% and 100% for each of its 14 subscores. This study compares these methods in an animal cartilage repair model. This study hypothesizes that there is a significant correlation between these methods. DESIGN A chondral defect was made in the medial femoral condyle of 18 pigs. Five weeks later, 9 pigs were treated with a novel recombinant human type III collagen/polylactide scaffold and 9 were left untreated to heal spontaneously. After 4 months, the medial condyles were evaluated with a simulated arthroscopy using the ICRS scoring system followed by a histological ICRS scoring. RESULTS This porcine cartilage repair model produced repaired cartilage tissue ranging from good to poor repair tissue quality. The mean arthroscopic ICRS total score was 6.8 (SD = 2.2). Histological ICRS overall assessment subscore was 38.2 (SD = 31.1) and histological ICRS average points were 60.5 (SD = 19.5). Arthroscopic ICRS compared with histological ICRS average points or its overall assessment subscore showed moderate correlation (r = 0.49 and r = 0.50, respectively). The interrater reliability with the intraclass correlation coefficients for arthroscopic ICRS total scores, histological ICRS overall assessment subscore, and ICRS average points showed moderate to excellent reliability. CONCLUSIONS Arthroscopic and histological ICRS scoring methods for repaired articular cartilage show a moderate correlation in the animal cartilage repair model.
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Affiliation(s)
- Jani Puhakka
- University of Helsinki, Helsinki, Finland,Jani Puhakka, University of Helsinki, Topeliuksenkatu 5, Helsinki 00260, Finland.
| | | | | | | | | | - Anna Vasara
- Helsinki University Hospital, Helsinki, Finland
| | | | - Jussi Kosola
- Kanta-Hämeen keskussairaala, Hameenlinna, Finland
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Yang BW, Brusalis CM, Fabricant PD, Greditzer HG. Articular Cartilage Repair in the Knee: Postoperative Imaging. J Knee Surg 2021; 34:2-10. [PMID: 32898909 DOI: 10.1055/s-0040-1716357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diagnostic and therapeutic advancements have improved clinical outcomes for patients with focal chondral injuries of the knee. An increased number and complexity of surgical treatment options have, in turn, resulted in a commensurate proliferation of patients requiring postoperative evaluation and management. In addition to patient-reported clinical outcomes, magnetic resonance imaging (MRI) offers clinicians with noninvasive, objective data to assist with postoperative clinical decision making. However, successful MRI interpretation in this setting is clinically challenging; it relies upon an understanding of the evolving and procedure-specific nature of normal postoperative imaging. Moreover, further research is required to better elucidate the correlation between MRI findings and long-term clinical outcomes. This article focuses on how specific morphologic features identified on MRI can be utilized to evaluate patients following the most commonly performed cartilage repair surgeries of the knee.
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Affiliation(s)
- Brian W Yang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Peter D Fabricant
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Harry G Greditzer
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Favreau H, Pijnenburg L, Seitlinger J, Fioretti F, Keller L, Scipioni D, Adriaensen H, Kuchler-Bopp S, Ehlinger M, Mainard D, Rosset P, Hua G, Gentile L, Benkirane-Jessel N. Osteochondral repair combining therapeutics implant with mesenchymal stem cells spheroids. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 29:102253. [PMID: 32619705 DOI: 10.1016/j.nano.2020.102253] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/05/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022]
Abstract
Functional articular cartilage regeneration remains challenging, and it is essential to restore focal osteochondral defects and prevent secondary osteoarthritis. Combining autologous stem cells with therapeutic medical device, we developed a bi-compartmented implant that could promote both articular cartilage and subchondral bone regeneration. The first compartment based on therapeutic collagen associated with bone morphogenetic protein 2, provides structural support and promotes subchondral bone regeneration. The second compartment contains bone marrow-derived mesenchymal stem cell spheroids to support the regeneration of the articular cartilage. Six-month post-implantation, the regenerated articular cartilage surface was 3 times larger than that of untreated animals, and the regeneration of the osteochondral tissue occurred during the formation of hyaline-like cartilage. Our results demonstrate the positive impact of this combined advanced therapy medicinal product, meeting the needs of promising osteochondral regeneration in critical size articular defects in a large animal model combining not only therapeutic implant but also stem cells.
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Affiliation(s)
- Henri Favreau
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpitaux universitaires de Strasbourg (HUS), Hôpital de Hautepierre, Service de rhumatologie, Service de chirurgie thoracique and Service de chirurgie orthopédique et de traumatologie, Université de Strasbourg, Strasbourg, France
| | - Luc Pijnenburg
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpitaux universitaires de Strasbourg (HUS), Hôpital de Hautepierre, Service de rhumatologie, Service de chirurgie thoracique and Service de chirurgie orthopédique et de traumatologie, Université de Strasbourg, Strasbourg, France
| | - Joseph Seitlinger
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpitaux universitaires de Strasbourg (HUS), Hôpital de Hautepierre, Service de rhumatologie, Service de chirurgie thoracique and Service de chirurgie orthopédique et de traumatologie, Université de Strasbourg, Strasbourg, France
| | - Florence Fioretti
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Laetitia Keller
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Dominique Scipioni
- Hôpital Erasme-Cliniques universitaires de Bruxelles, Université libre de Bruxelles (ULB), CHIREC-Hôpital Delta, Belgique
| | - Hans Adriaensen
- CHRU de Tours, Service de Chirurgie Orthopédique 2, Faculté de Médecine de Tours, and INRA de tours, Université François Rabelais, Tours, France
| | - Sabine Kuchler-Bopp
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Matthieu Ehlinger
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpitaux universitaires de Strasbourg (HUS), Hôpital de Hautepierre, Service de rhumatologie, Service de chirurgie thoracique and Service de chirurgie orthopédique et de traumatologie, Université de Strasbourg, Strasbourg, France
| | - Didier Mainard
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Hôpital central Nancy, Service d'Orthopédie, Nancy, France
| | - Phillippe Rosset
- CHRU de Tours, Service de Chirurgie Orthopédique 2, Faculté de Médecine de Tours, and INRA de tours, Université François Rabelais, Tours, France
| | - Guoqiang Hua
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Luca Gentile
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France
| | - Nadia Benkirane-Jessel
- INSERM (French Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France; Université de Strasbourg, Faculté de Chirurgie Dentaire, Strasbourg, France.
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Lu K, Gao YJ, Wang HZ, Li C, Zhou TT, Qian RX, Shan HQ, Dong QR. A comparison of the use of a suprapatellar Chinese Aircraft-shaped Sleeve System versus suprapatellar intramedullary nailing for tibial shaft fractures: Outcomes over a one-year follow-up. Injury 2020; 51:1069-1076. [PMID: 32061356 DOI: 10.1016/j.injury.2020.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study aimed to investigate the effectiveness and safety of the Chinese Aircraft-shaped Sleeve (CASS) system on the clinical outcomes of tibial intermedullary nailing using a suprapatellar approach for the treatment of tibial fractures in a cohort of adult Chinese patients over a minimum one-year follow-up. METHODS After institutional review board approval, skeletally mature patients with Orthopaedic Trauma Association (OTA) type 42 tibial shaft fractures were randomized into either a SP approach using CASS group or a conventional SP approach group after informed consent was obtained. The operations were performed by a single senior orthopaedic surgeon according to group assignments. A group of 33 patients were treated using the CASS system and the other group of 34 patients were treated using a conventional SP approach. Both groups fully complied with research requirements and completed 12 months of follow-up. Magnetic resonance images (MRI) were obtained for the evaluation of the patellofemoral joint (PFJ) and residual debris preoperatively, as well as one week and 12 months postoperatively. Radiographs were used to assess alignment and union, visual analog scores (VAS) were used to assess anterior knee pain, and range of motion (ROM) and the Lysholm knee scoring scales were used for evaluating the operated knee at the 12-month follow-up. RESULTS Differences in cartilage lesion changes observed by MRI between the two groups were statistically significant (P = 0.030 at 1 week postoperatively; P = 0.025 at 12 months postoperatively). No significant differences were evident with respect to debris residue, malalignments, nonunion, VAS, ROM and Lysholm knee scoring scale with the exception of stair climbing (P = 0.02). CONCLUSION Based on the data of this one-year clinical follow-up study, the SP approach using the CASS system offers the potential to benefit patients suffering from tibial shaft fractures, who will be treated with intramedullary nailing especially for smaller patients.
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Affiliation(s)
- Ke Lu
- Department of Orthopaedics, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu 215004, China; Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu 215300, China
| | - Yi-Jun Gao
- Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu 215300, China
| | - Hong-Zhen Wang
- Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu 215300, China
| | - Chong Li
- Department of Orthopaedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu 215300, China
| | - Ting-Ting Zhou
- Department of Radiology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu 215300, China
| | - Rong-Xun Qian
- Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu 215300, China
| | - Hui-Qiang Shan
- Department of Orthopaedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu 215300, China
| | - Qi-Rong Dong
- Department of Orthopaedics, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu 215004, China.
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MR imaging of cartilage repair surgery of the knee. Clin Imaging 2019; 58:129-139. [DOI: 10.1016/j.clinimag.2019.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 12/17/2022]
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Nejadnik H, Tseng J, Daldrup-Link H. Magnetic resonance imaging of stem cell-macrophage interactions with ferumoxytol and ferumoxytol-derived nanoparticles. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2019; 11:e1552. [PMID: 30734542 PMCID: PMC6579657 DOI: 10.1002/wnan.1552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 01/07/2023]
Abstract
"Off the shelf" allogeneic stem cell transplants and stem cell nano-composites are being used for the treatment of degenerative bone diseases. However, major and minor histocompatibility antigens of therapeutic cell transplants can be recognized as foreign and lead to their rejection by the host immune system. If a host immune response is identified within the first week post-transplant, immune modulating therapies could be applied to prevent graft failure and support engraftment. Ferumoxytol (Feraheme™) is an FDA approved iron oxide nanoparticle preparation for the treatment of anemia in patients. Ferumoxytol can be used "off label" as an magnetic resonance (MR) contrast agent, as these nanoparticles provide measurable signal changes on magnetic resonance imaging (MRI). In this focused review article, we will discuss three methods to localize and identify innate immune responses to stem cell transplants using ferumoxytol-enhanced MRI, which are based on tracking stem cells, tracking macrophages or detecting mediators of cell death: (a) monitor MRI signal changes of ferumoxytol-labeled stem cells in the presence or absence of innate immune responses, (b) monitor influx of ferumoxytol-labeled macrophages into stem cell implants, and (c) monitor apoptosis of stem cell implants with caspase-3 activatable nanoparticles. These techniques can detect transplant failure at an early stage, when immune-modulating interventions can potentially preserve the viability of the cell transplants and thereby improve bone and cartilage repair outcomes. Approaches 1 and 2 are immediately translatable to clinical practice. This article is categorized under: Diagnostic Tools > in vivo Nanodiagnostics and Imaging Nanotechnology Approaches to Biology > Cells at the Nanoscale Diagnostic Tools > Biosensing.
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Affiliation(s)
- Hossein Nejadnik
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, California
| | - Jessica Tseng
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, California
| | - Heike Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, California
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[Magnetic resonance imaging following cartilage repair of focal chondral lesions]. Radiologe 2019; 59:722-731. [PMID: 31168773 DOI: 10.1007/s00117-019-0552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Focal cartilage lesions are common pathologies of weight-bearing joints. Clinical presentation ranges from asymptomatic patients to severe, pain-related movement deficits. Moreover, focal chondral lesions are risk factors for the development of osteoarthritis. There are various treatment options involving both surgical and nonsurgical treatments. Musculoskeletal radiologists should be aware of the various surgical options as well as the postsurgical imaging characteristics to depict whether the encountered imaging findings reflect the normal postoperative course or are indicative of a treatment failure. OBJECTIVES We aim to describe the most common surgical procedures for the repair of focal cartilage lesions and their typical postsurgical appearance on MRI studies. MATERIALS AND METHODS The literature in PubMed was searched with the terms "focal articular cartilage lesions", "chondral lesions", "MOCART", "Microfracture", "Osteochondral Autograft Transfer", "mosaicplasty", "Osteochondral Allograft Transplantation", "OATS", "OCT", "Autologous Chondrocyte Implantation", "ACI", "Matrix-Assisted Chondrocyte Implantation", "Autologous Matrix-induced Chondrogenesis". RESULTS Surgical methods for the treatment of focal cartilage lesions as well as the MR imaging features are explained.
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Bulte JWM, Daldrup-Link HE. Clinical Tracking of Cell Transfer and Cell Transplantation: Trials and Tribulations. Radiology 2018; 289:604-615. [PMID: 30299232 PMCID: PMC6276076 DOI: 10.1148/radiol.2018180449] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/09/2018] [Accepted: 07/18/2018] [Indexed: 12/29/2022]
Abstract
Cell therapy has provided unprecedented opportunities for tissue repair and cancer therapy. Imaging tools for in vivo tracking of therapeutic cells have entered the clinic to evaluate therapeutic cell delivery and retention in patients. Thus far, clinical cell tracking studies have been a mere proof of principle of the feasibility of cell detection. This review centers around the main clinical queries associated with cell therapy: Have cells been delivered correctly at the targeted site of injection? Are cells still alive, and, if so, how many? Are cells being rejected by the host, and, if so, how severe is the immune response? For stem cell therapeutics, have cells differentiated into downstream cell lineages? Is there cell proliferation including tumor formation? At present, clinical cell tracking trials have only provided information on immediate cell delivery and short-term cell retention. The next big question is if these cell tracking tools can improve the clinical management of the patients and, if so, by how much, for how many, and for whom; in addition, it must be determined whether tracking therapeutic cells in every patient is needed. To become clinically relevant, it must now be demonstrated how cell tracking techniques can inform patient treatment and affect clinical outcomes.
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Affiliation(s)
- Jeff W. M. Bulte
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, Departments of Chemical & Biomolecular Engineering, Biomedical Engineering, and Oncology, The Johns Hopkins University School of Medicine, 217 Traylor Bldg, 720 Rutland Ave, Baltimore, MD 21205 (J.W.M.B.); and Departments of Radiology, Molecular Imaging Program at Stanford (MIPS) and Pediatrics, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Palo Alto, Calif (H.E.D.L.)
| | - Heike E. Daldrup-Link
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, Departments of Chemical & Biomolecular Engineering, Biomedical Engineering, and Oncology, The Johns Hopkins University School of Medicine, 217 Traylor Bldg, 720 Rutland Ave, Baltimore, MD 21205 (J.W.M.B.); and Departments of Radiology, Molecular Imaging Program at Stanford (MIPS) and Pediatrics, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Palo Alto, Calif (H.E.D.L.)
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MR imaging of BioCartilage augmented microfracture surgery utilizing 2D MOCART and KOOS scores. J Clin Orthop Trauma 2018; 9:146-152. [PMID: 29896018 PMCID: PMC5995692 DOI: 10.1016/j.jcot.2017.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 08/10/2017] [Accepted: 08/19/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES BioCartilage is a novel scaffold-based microfracture augmentation technique that has been shown to aid in chondrogenic differentiation of adult progenitor cells resulting in formation of more hyaline-like cartilage. As this cartilage repair technique becomes more commonplace, it is essential that the musculoskeletal radiologist and orthopedic surgeon gain familiarity with the surgical technique and its post-operative MR imaging findings. METHODS We present several case studies regarding MRI findings (modified clinical 2D MOCART) and clinical outcome (KOOS) scores in patients who have undergone this novel surgical procedure. For data analysis KOOS scores where dichotomized to scores greater or less than 80, and MOCART scores were dichotomized to scores greater or less than 50. A fisher exact test was then performed to determine if there was any correlation between parameters of the modified 2D MOCART and KOOS scores (Tables 2 and 3). RESULTS Marrow elements travel through the microfracture holes and interact with the scaffold created by BioCartilage, rather than creating their own fibrin scaffold, as is typically anticipated from a marrow stimulation procedure. Interestingly, the amount defect fill, presence of an intact surface, intact subchondral bone, or lack of effusion did not correlate with positive outcomes. Parameters that trended towards significance included presence of adhesions and subchondral lamina. Completeness of cartilage interface, homogeneity, and signal intensity also failed to reach statistical significance. In our experience, patients that demonstrated mild repair tissue surface irregularity, but with preservation of greater than 50% thickness compared to surrounding native cartilage, mild irregularity of subchondral plate, with vertical low signal intensity lines (sequela of prior microfracture surgery), and mild or no bone marrow edema pattern demonstrated higher KOOS scores. CONCLUSION Biocartilage in conjunction with microfracture is an encouraging cartilage restoration technique that promotes regeneration of more robust hyaline-like cartilage compared to the fibrocartilage formed after conventional microfracture. The T2 mapping properties of the repair tissue after successful BioCartilage augmented microfracture surgery are very similar to that of the adjacent native cartilage. Although there appear to be characteristic trends in a successful repair, further research is warranted to elucidate any correlations between specific characteristics of the repair and patient clinical outcomes.
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Guermazi A, Roemer FW, Alizai H, Winalski CS, Welsch G, Brittberg M, Trattnig S. State of the Art: MR Imaging after Knee Cartilage Repair Surgery. Radiology 2015; 277:23-43. [DOI: 10.1148/radiol.2015141146] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Madelin G, Poidevin F, Makrymallis A, Regatte RR. Classification of sodium MRI data of cartilage using machine learning. Magn Reson Med 2014; 74:1435-48. [PMID: 25367844 DOI: 10.1002/mrm.25515] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/07/2014] [Accepted: 10/10/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the possible utility of machine learning for classifying subjects with and subjects without osteoarthritis using sodium magnetic resonance imaging data. Theory: Support vector machine, k-nearest neighbors, naïve Bayes, discriminant analysis, linear regression, logistic regression, neural networks, decision tree, and tree bagging were tested. METHODS Sodium magnetic resonance imaging with and without fluid suppression by inversion recovery was acquired on the knee cartilage of 19 controls and 28 osteoarthritis patients. Sodium concentrations were measured in regions of interests in the knee for both acquisitions. Mean (MEAN) and standard deviation (STD) of these concentrations were measured in each regions of interest, and the minimum, maximum, and mean of these two measurements were calculated over all regions of interests for each subject. The resulting 12 variables per subject were used as predictors for classification. RESULTS Either Min [STD] alone, or in combination with Mean [MEAN] or Min [MEAN], all from fluid suppressed data, were the best predictors with an accuracy >74%, mainly with linear logistic regression and linear support vector machine. Other good classifiers include discriminant analysis, linear regression, and naïve Bayes. CONCLUSION Machine learning is a promising technique for classifying osteoarthritis patients and controls from sodium magnetic resonance imaging data.
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Affiliation(s)
- Guillaume Madelin
- Department of Radiology, Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA
| | - Frederick Poidevin
- Departamento de Astrofísica, Instituto de Astrofísica de Canarias, La Laguna, Tenerife, Spain; Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Antonios Makrymallis
- Department of Physics & Astronomy, University College London, Kathleen Lonsdale Building, Gower Place, London, UK
| | - Ravinder R Regatte
- Department of Radiology, Center for Biomedical Imaging, New York University School of Medicine, New York, New York, USA
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Cartilage repair surgery: outcome evaluation by using noninvasive cartilage biomarkers based on quantitative MRI techniques? BIOMED RESEARCH INTERNATIONAL 2014; 2014:840170. [PMID: 24877139 PMCID: PMC4024422 DOI: 10.1155/2014/840170] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/25/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND New quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as outcome measures after cartilage repair. OBJECTIVE To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. METHODS Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. RESULTS Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), and diffusion weighted imaging (DWI) are applicable on most clinical 1.5 T and 3 T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. CONCLUSIONS A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair.
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Chang G, Xia D, Sherman O, Strauss E, Jazrawi L, Recht MP, Regatte RR. High resolution morphologic imaging and T2 mapping of cartilage at 7 Tesla: comparison of cartilage repair patients and healthy controls. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2013; 26:539-48. [PMID: 23657612 DOI: 10.1007/s10334-013-0379-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/20/2013] [Accepted: 04/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECT Our objective was to use 7 T MRI to compare cartilage morphology (thickness) and collagen composition (T2 values) in cartilage repair patients and healthy controls. MATERIALS AND METHODS We scanned the knees of 11 cartilage repair patients and 11 controls on a 7 T MRI scanner using a high-resolution, gradient-echo sequence to measure cartilage thickness and a multi-echo spin-echo sequence to measure cartilage T2 values. We used two-tailed t tests to compare cartilage thickness and T2 values in: repair tissue (RT) versus adjacent cartilage (AC); RT versus healthy control cartilage (HC); AC versus HC. RESULTS Mean thickness in RT, AC, HC were: 2.2±1.4, 3.6±1.1, 3.3±0.7 mm. Differences in thickness between RT-AC (p=0.01) and RT-HC (p=0.02) were significant, but not AC-HC (p=0.45). Mean T2 values in RT, AC, HC were: 51.6±7.6, 40.0±4.7, 45.9±3.7 ms. Differences in T2 values between RT-AC (p=0.0005), RT-HC (p=0.04), and AC-HC (p=0.004) were significant. CONCLUSION 7 T MRI allows detection of differences in morphology and collagen architecture in: (1) cartilage repair tissue compared to adjacent cartilage and (2) cartilage repair tissue compared to cartilage from healthy controls. Although cartilage adjacent to repair tissue may be normal in thickness, it can demonstrate altered collagen composition.
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Affiliation(s)
- Gregory Chang
- Department of Radiology, NYU Langone Medical Center, Center for Musculoskeletal Care, 333 East 38th Street, 6th Floor, Room 610, New York, NY, 10016, USA,
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Schmal H, Pestka JM, Salzmann G, Strohm PC, Südkamp NP, Niemeyer P. Autologous chondrocyte implantation in children and adolescents. Knee Surg Sports Traumatol Arthrosc 2013; 21:671-7. [PMID: 22552618 DOI: 10.1007/s00167-012-2036-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Autologous chondrocyte implantation (ACI) is a well-established treatment method for cartilage defects in knees. Age-related grouping was based on expression data of cartilage-specific markers. Specificities of ACI in the different populations were analysed. METHODS Two hundred and sixty-seven patients undergoing ACI in the knee between 2006 and 2010 were included in this analysis. Cell characteristics and expression data of cartilage-specific surface markers as CD44, aggrecan and collagen type II were statistically analysed for age association. Epidemiological data of the defined groups were compared. Course of treatment was evaluated using MRI. RESULTS A correlation analysis showed statistically significant associations between age and aggrecan or collagen type II expression in all patients <30 years. A cluster analysis could predict age-dependent expression of these markers separating groups with an average age of 18.1 ± 2.3 and 23.6 ± 4.2 years, respectively (p < 0.02). Discriminance analysis suggested the age border between adults and juveniles at about 20 years. There was no influence of age on cell characteristics or CD44 expression. In the 19 of 267 patients with an age ≤18 years, gender distribution was not different compared to adults, but patella was significantly more affected. Cartilage lesions were mainly caused by osteochondritis dissecans (OCD) and trauma. The Knee Osteoarthritis Scoring System in MRI reached 4.8 ± 2.3 points before, declining to 3.3 ± 2.3 points 6 and 12 months after the operation. CONCLUSIONS Age-related expression of cartilage-specific markers allows definition of adolescents in cartilage regenerating surgery. Chondromalacia in these patients is mainly caused by OCD or trauma. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- H Schmal
- Department of Orthopaedic Surgery, University of Freiburg Medical Centre, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Germany.
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