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Hernandez PA, Bradford JC, Brahmachary P, Ulman S, Robinson JL, June RK, Cucchiarini M. Unraveling sex-specific risks of knee osteoarthritis before menopause: Do sex differences start early in life? Osteoarthritis Cartilage 2024; 32:1032-1044. [PMID: 38703811 DOI: 10.1016/j.joca.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Sufficient evidence within the past two decades have shown that osteoarthritis (OA) has a sex-specific component. However, efforts to reveal the biological causes of this disparity have emerged more gradually. In this narrative review, we discuss anatomical differences within the knee, incidence of injuries in youth sports, and metabolic factors that present early in life (childhood and early adulthood) that can contribute to a higher risk of OA in females. DESIGN We compiled clinical data from multiple tissues within the knee joint-since OA is a whole joint disorder-aiming to reveal relevant factors behind the sex differences from different perspectives. RESULTS The data gathered in this review indicate that sex differences in articular cartilage, meniscus, and anterior cruciate ligament are detected as early as childhood and are not only explained by sex hormones. Aiming to unveil the biological causes of the uneven sex-specific risks for knee OA, we review the current knowledge of sex differences mostly in young, but also including old populations, from the perspective of (i) human anatomy in both healthy and pathological conditions, (ii) physical activity and response to injury, and (iii) metabolic signatures. CONCLUSIONS We propose that to close the gap in health disparities, and specifically regarding OA, we should address sex-specific anatomic, biologic, and metabolic factors at early stages in life, as a way to prevent the higher severity and incidence of OA in women later in life.
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Affiliation(s)
- Paula A Hernandez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | | | - Priyanka Brahmachary
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Sophia Ulman
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Movement Science Laboratory, Scottish Rite for Children, Frisco, TX 75034, USA.
| | - Jennifer L Robinson
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195, USA; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA.
| | - Ronald K June
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg/Saar D-66421, Germany.
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Eckstein F, Wirth W, Putz R. Sexual dimorphism in articular tissue anatomy - Key to understanding sex differences in osteoarthritis? Osteoarthritis Cartilage 2024; 32:1019-1031. [PMID: 38871022 DOI: 10.1016/j.joca.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/06/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Osteoarthritis (OA) prevalence and incidence varies between women and men, but it is unknown whether this follows sex-specific differences in systemic factors (e.g. hormones) and/or differences in pre-morbid joint anatomy. We recognize that classifications of sex within humans cannot be reduced to female/male, but given the lack of literature on non-binary individuals, this review is limited to the sexual dimorphism of articular morphotypes. METHODS Based on a Pubmed search using relevant terms, and input from experts, we selected articles based on the authors' judgment of their relevance, interest, originality, and scientific quality; no "hard" bibliometric measures were used to evaluate their quality or importance. Focus was on clinical rather than pre-clinical studies, with most (imaging) data being available for the knee joint. RESULTS After introducing "sexual dimorphism", the specific literature on articular morphotypes is reviewed, structured by: radiographic joint space width (JSW), meniscus, ligaments, articular cartilage morphology, articular cartilage composition and deformation, and articular tissue response to treatment. CONCLUSIONS Sex-specific differences were clearly observed for JSW, meniscus damage, ligament size, and cartilage morphometry (volume, thickness, and surface areas) but not for cartilage composition. Ligament and cartilage measures were smaller in women even after matching for confounders. Taken together, the findings indicate that female (knee) joints may be structurally more vulnerable and at greater risk of OA. The "one size/sex fits all" approach must be abandoned in OA research, and all observational and interventional studies should report their results for sex-specific strata, at least in pre-specified secondary or post-hoc analyses.
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MESH Headings
- Humans
- Female
- Male
- Cartilage, Articular/pathology
- Cartilage, Articular/diagnostic imaging
- Sex Characteristics
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/pathology
- Knee Joint/diagnostic imaging
- Knee Joint/pathology
- Sex Factors
- Osteoarthritis/diagnostic imaging
- Osteoarthritis/pathology
- Menisci, Tibial/diagnostic imaging
- Menisci, Tibial/pathology
- Menisci, Tibial/anatomy & histology
- Radiography
- Ligaments, Articular/anatomy & histology
- Ligaments, Articular/pathology
- Ligaments, Articular/diagnostic imaging
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Affiliation(s)
- Felix Eckstein
- Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology, Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - Wolfgang Wirth
- Research Program for Musculoskeletal Imaging, Center for Anatomy and Cell Biology, Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany
| | - Reinhard Putz
- Anatomische Anstalt, Ludwig Maximilians Universität München, Munich, Germany
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Xin H, Li X, Zhang Y, Zeng C, Lei G, Yang T, Wei J. The mediation effects of malalignment on the relation of sex to the risk of incidence tibiofemoral osteoarthritis. Osteoarthritis Cartilage 2024; 32:1134-1140. [PMID: 38880429 DOI: 10.1016/j.joca.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/15/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To investigate to what extent the higher risk of tibiofemoral radiographic osteoarthritis (TFROA) in females vs. males can be explained by knee malalignment. DESIGN Using data from Multicenter Osteoarthritis Study (MOST) and Osteoarthritis Initiative (OAI), we examined the relation of sex to the incident medial and lateral TFROA and performed mediation analyses to assess to what extent varus and valgus malalignments account for sex differences in the incident medial or lateral TFROA. RESULTS Of the 3462 knees without medial and lateral TFROA in MOST, the 7-year risks of medial and lateral TFROA were 16.9% and 10.0% in females, and 15.8% and 4.2% in males, respectively. Females had 2.31-fold (95% confidence interval [95% CI]: 1.73 to 3.08) higher incident lateral TFROA than males, and the relative risk (RR) of the indirect effect of sex on lateral TFROA through valgus malalignment was 1.15 (95% CI: 1.09 to 1.20), accounting for 23% of its total effect on lateral TFROA. In OAI (n = 3095 knees), females had 1.54-fold (95% CI: 1.15 to 2.04) higher incident lateral TFROA than males, and RR of the indirect effect of sex on lateral TFROA through valgus malalignment was 1.10 (95% CI: 1.04 to 1.21), accounting for 26% of its total effect on lateral TFROA. No apparent sex difference in the incident medial TFROA was found in MOST (RR = 1.05, 95% CI: 0.89 to 1.25) or OAI (RR = 1.02, 95% CI: 0.84 to 1.19). CONCLUSION Females had a higher risk of developing lateral TFROA than males; however, valgus malalignment only modestly explained such a difference.
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Affiliation(s)
- Haoyu Xin
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital and The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Tuo Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China; Health Management Center, Xiangya Hospital and Central South University, Changsha 410008, China
| | - Jie Wei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China; FuRong Laboratory, Changsha 410078, Hunan, China.
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Meta F, Clark SC, Tagliero AJ, Hevesi M, Saris DBF, Krych AJ. Athlete-Specific Considerations of Cartilage Injuries. Sports Med Arthrosc Rev 2024; 32:60-67. [PMID: 38978199 DOI: 10.1097/jsa.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Cartilage injuries can present in a diverse setting of anatomic locations, with varying severity, and can impact athletes of all ages and competition levels. Moreover, the timing of when an injury presents introduces an additional dimension to treatment decision-making. Frequently, the level of competition, in conjunction with career trajectory and short-term and long-term athlete goals, will dictate whether a temporary or definitive treatment strategy is ideal. Although indicating the correct therapeutic regimen may prove challenging, understanding the athlete-specific considerations can be essential to meeting the goals of the athlete and other stakeholders involved in the athlete's career. The purpose of this review is to comprehensively present the deliberations a treating physician must consider in managing cartilage injuries within a spectrum of athletic levels ranging from youth to professional levels, with a secondary focus on the presentation of temporizing treatment strategies and associated outcomes.
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Affiliation(s)
- Fabien Meta
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Sean C Clark
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
- Department of Orthopedic Surgery, University Medical Center, Utrecht University, The Netherlands
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Di Martino A, Barile F, D'Agostino C, Castafaro V, Cerasoli T, Mora P, Ruffilli A, Traina F, Faldini C. Are there gender-specific differences in hip and knee cartilage composition and degeneration? A systematic literature review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1901-1910. [PMID: 38456943 PMCID: PMC11101511 DOI: 10.1007/s00590-024-03871-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
The aim of the present review is to systematically analyse the current literature about gender differences in hip or knee cartilage composition and degeneration, to help explaining how and why osteoarthritis affects women more often and more severely than men. A systematic review of the literature in English was performed. Eleven studies on 1962 patients (905 females and 787 males) that reported differences on cartilage composition between males and females were included. Nine evaluated the knee, one the hip, and one both. They were heterogeneous in their methods: one conducted histological analyses, and all the others evaluated cartilage characteristics (volume, width, and composition) through magnetic resonance imaging. All authors reported gender differences in both volume and morphology of the cartilage, from infancy to menopause. In fact, a study on 92 healthy children statistically showed significant gender differences in cartilage thickness at all sites, even after adjustment for age, body, and bone size. Gender differences become more evident after menopause, when women have a lower cartilage volume and a higher cartilage loss. Men show significantly higher knee and hip cartilage volumes than women, and women carry a significantly greater risk to develop osteoarthritis. This is in part due to body and bone size, but also depends on qualitative and quantitative differences in the composition of cartilage and its degeneration rate after menopause. Structural changes in cartilage that occur between genders during ageing have significance in the development of osteoarthritis.
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Affiliation(s)
- Alberto Di Martino
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.
- Ist Orthopedic Department, IRCCS - Istituto Ortopedico Rizzoli, Via G. Cesare Pupilli, 1, Bologna, Italy.
| | - Francesca Barile
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio D'Agostino
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Ist Orthopedic Department, IRCCS - Istituto Ortopedico Rizzoli, Via G. Cesare Pupilli, 1, Bologna, Italy
| | - Vanita Castafaro
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Ist Orthopedic Department, IRCCS - Istituto Ortopedico Rizzoli, Via G. Cesare Pupilli, 1, Bologna, Italy
| | - Tosca Cerasoli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Ist Orthopedic Department, IRCCS - Istituto Ortopedico Rizzoli, Via G. Cesare Pupilli, 1, Bologna, Italy
| | - Paolo Mora
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alberto Ruffilli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Ist Orthopedic Department, IRCCS - Istituto Ortopedico Rizzoli, Via G. Cesare Pupilli, 1, Bologna, Italy
| | - Francesco Traina
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Ist Orthopedic Department, IRCCS - Istituto Ortopedico Rizzoli, Via G. Cesare Pupilli, 1, Bologna, Italy
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Eckstein F, Wluka AE, Wirth W, Cicuttini F. 30 Years of MRI-based cartilage & bone morphometry in knee osteoarthritis: From correlation to clinical trials. Osteoarthritis Cartilage 2024; 32:439-451. [PMID: 38331162 DOI: 10.1016/j.joca.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/20/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The first publication on morphometric analysis of articular cartilage using magnetic resonance imaging (MRI) in 1994 set the scene for a game change in osteoarthritis (OA) research. The current review highlights milestones in cartilage and bone morphometry, summarizing the rapid progress made in imaging, its application to understanding joint (patho-)physiology, and its use in interventional clinical trials. METHODS Based on a Pubmed search of articles from 1994 to 2023, the authors subjectively selected representative work illustrating important steps in the development or application of magnetic resonance-based cartilage and bone morphometry, with a focus on studies in humans, and on the knee. Research on OA-pathophysiology is addressed only briefly, given length constraints. Compositional and semi-quantitative assessment are not covered here. RESULTS The selected articles are presented in historical order as well as by content. We review progress in the technical aspects of image acquisition, segmentation and analysis, advances in understanding tissue growth, physiology, function, and adaptation, and a selection of clinical trials examining the efficacy of interventions on knee cartilage and bone. A perspective is provided of how lessons learned may be applied to future research and clinical management. CONCLUSIONS Over the past 30 years, MRI-based morphometry of cartilage and bone has contributed to a paradigm shift in understanding articular tissue physiology and OA pathophysiology, and to the development of new treatment strategies. It is likely that these technologies will continue to play a key role in the development and (accelerated) approval of therapy, potentially targeted to different OA phenotypes.
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Affiliation(s)
- Felix Eckstein
- Department of Imaging & Functional Musculoskeletal Research, Center of Anatomy and Cell Biology, Paracelsus Medical University (PMU), Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Bavaria, Germany.
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wolfgang Wirth
- Department of Imaging & Functional Musculoskeletal Research, Center of Anatomy and Cell Biology, Paracelsus Medical University (PMU), Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Bavaria, Germany
| | - Flavia Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Salerno M, Andriolo L, Angelelli L, Buda R, Faldini C, Ferruzzi A, Vannini F, Zaffagnini S, Filardo G. Sex does not influence the long-term outcome of matrix-assisted autologous chondrocyte transplantation. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38372188 DOI: 10.1002/ksa.12068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Regenerative techniques for articular cartilage lesions demonstrated heterogeneous clinical results. Several factors may influence the outcome, with sex being one of the most debated. This study aimed at quantifying the long-term influence of sex on the clinical outcome obtained with a regenerative procedure for knee chondral lesions. METHODS Matrix-assisted autologous chondrocyte transplantation (MACT) was used to treat 235 knees which were prospectively evaluated with the International Knee Documentation Committee (IKDC), EuroQol visual analogue scale, and Tegner scores at 14-year mean follow-up. A multilevel analysis was performed with the IKDC subjective scores standardised according to the age/sex category of each patient and/or the selection of a match-paired subgroup to compare homogeneous men and women patients. RESULTS At 14 years, men and women showed a failure rate of 10.7% and 28.8%, respectively (p < 0.0005). An overall improvement was observed in both sexes. Women had more patellar lesions and men more condylar lesions (p = 0.001), and the latter also presented a higher preinjury activity level (p < 0.0005). Men had significantly higher IKDC subjective scores at all follow-ups (at 14 years: 77.2 ± 18.9 vs. 62.8 ± 23.1; p < 0.0005). However, the analysis of homogeneous match-paired populations of men and women, with standardised IKDC subjective scores, showed no differences between men and women (at 14 years: -1.6 ± 1.7 vs. -1.9 ± 1.6). CONCLUSION Men and women treated with MACT for knee chondral lesions presented a significant improvement and stable long-term results. When both sexes are compared with homogeneous match-paired groups, they have similar results over time. However, women present more often unfavourable lesion patterns, which proved more challenging in terms of long-term outcome after MACT. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Manuela Salerno
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucia Angelelli
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto Buda
- Clinica Ortopedica e Traumatologica, Ospedale SS Annunziata, Chieti, Italy
| | - Cesare Faldini
- Clinica Ortopedica e Traumatologica 1, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Ferruzzi
- Clinica Ortopedica e Traumatologica 1, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Vannini
- Clinica Ortopedica e Traumatologica 1, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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8
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Patel J, Chen S, Katzmeyer T, Pei YA, Pei M. Sex-dependent variation in cartilage adaptation: from degeneration to regeneration. Biol Sex Differ 2023; 14:17. [PMID: 37024929 PMCID: PMC10077643 DOI: 10.1186/s13293-023-00500-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
Despite acknowledgement in the scientific community of sex-based differences in cartilage biology, the implications for study design remain unclear, with many studies continuing to arbitrarily assign demographics. Clinically, it has been well-established that males and females differ in cartilage degeneration, and accumulating evidence points to the importance of sex differences in the field of cartilage repair. However, a comprehensive review of the mechanisms behind this trend and the influence of sex on cartilage regeneration has not yet been presented. This paper aims to summarize current findings regarding sex-dependent variation in knee anatomy, sex hormones' effect on cartilage, and cartilaginous degeneration and regeneration, with a focus on stem cell therapies. Findings suggest that the stem cells themselves, as well as their surrounding microenvironment, contribute to sex-based differences. Accordingly, this paper underscores the contribution of both stem cell donor and recipient sex to sex-related differences in treatment efficacy. Cartilage regeneration is a field that needs more research to optimize strategies for better clinical results; taking sex into account could be a big factor in developing more effective and personalized treatments. The compilation of this information emphasizes the importance of investing further research in sex differences in cartilage biology.
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Affiliation(s)
- Jhanvee Patel
- Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, 64 Medical Center Drive, PO Box 9196, Morgantown, WV, 26506-9196, USA
| | - Song Chen
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, 610083, Sichuan, China
| | - Torey Katzmeyer
- Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, 64 Medical Center Drive, PO Box 9196, Morgantown, WV, 26506-9196, USA
| | - Yixuan Amy Pei
- Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, 64 Medical Center Drive, PO Box 9196, Morgantown, WV, 26506-9196, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ming Pei
- Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, 64 Medical Center Drive, PO Box 9196, Morgantown, WV, 26506-9196, USA.
- WVU Cancer Institute, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV, 26506, USA.
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Fan T, Chen S, Zeng M, Li J, Wang X, Ruan G, Cao P, Zhang Y, Chen T, Ou Q, Wang Q, Wluka AE, Cicuttini F, Ding C, Zhu Z. Osteophytes mediate the associations between cartilage morphology and changes in knee symptoms in patients with knee osteoarthritis. Arthritis Res Ther 2022; 24:217. [PMID: 36076236 PMCID: PMC9454107 DOI: 10.1186/s13075-022-02905-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Aims To investigate whether the associations between cartilage defects and cartilage volumes with changes in knee symptoms were mediated by osteophytes. Methods Data from the Vitamin D Effects on Osteoarthritis (VIDEO) study were analyzed as a cohort. The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess knee symptoms at baseline and follow-up. Osteophytes, cartilage defects, and cartilage volumes were measured using magnetic resonance imaging at baseline. Associations between cartilage morphology and changes in knee symptoms were assessed using linear regression models, and mediation analysis was used to test whether these associations were mediated by osteophytes. Results A total of 334 participants (aged 50 to 79 years) with symptomatic knee osteoarthritis were included in the analysis. Cartilage defects were significantly associated with change in total knee pain, change in weight-bearing pain, and change in non-weight-bearing pain after adjustment for age, sex, body mass index, and intervention. Cartilage volume was significantly associated with change in weight-bearing pain and change in physical dysfunction after adjustment. Lateral tibiofemoral and patellar osteophyte mediated the associations of cartilage defects with change in total knee pain (49–55%) and change in weight-bearing pain (61–62%) and the association of cartilage volume with change in weight-bearing pain (27–30%) and dysfunction (24–25%). Both cartilage defects and cartilage volume had no direct effects on change in knee symptoms. Conclusions The significant associations between cartilage morphology and changes in knee symptoms were indirect and were partly mediated by osteophytes. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02905-8.
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Affiliation(s)
- Tianxiang Fan
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Shibo Chen
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Muhui Zeng
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jia Li
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoshuai Wang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Guangfeng Ruan
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Peihua Cao
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yan Zhang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Tianyu Chen
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qianhua Ou
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qianyi Wang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. .,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. .,Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Zhaohua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China. .,Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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10
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Hernandez PA, Moreno M, Barati Z, Hutcherson C, Sathe AA, Xing C, Wright J, Welch T, Dhaher Y. Sexual Dimorphism in the Extracellular and Pericellular Matrix of Articular Cartilage. Cartilage 2022; 13:19476035221121792. [PMID: 36069595 PMCID: PMC9459468 DOI: 10.1177/19476035221121792] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Women have a higher prevalence and burden of joint injuries and pathologies involving articular cartilage than men. Although knee injuries affecting young women are on the rise, most studies related to sexual dimorphism target postmenopausal women. We hypothesize that sexual dimorphism in cartilage structure and mechanics is present before menopause, which can contribute to sex disparities in cartilage pathologies. DESIGN Bovine knee was used as a model to study healthy adult cartilage. We compared elastic moduli under compression, abundances of extracellular and pericellular matrix (PCM) proteins using proteomics, and PCM constituency with tissue immunofluorescence. The gene expression of matrix-related genes under basal, anabolic, and catabolic conditions was assessed by quantitative polymerase chain reaction (qPCR). RESULTS The equilibrium modulus was higher in male cartilage compared with female cartilage. Proteoglycans were not associated with this biomechanical dimorphism. Proteomic and pathway analyses of tissue showed dimorphic enriched pathways in extracellular matrix (ECM)-related proteins in which male cartilage was enriched in matrix interconnectors and crosslinkers that strengthen the ECM network. Moreover, male and female tissue differed in enriched PCM components. Females had more abundance of collagen type VI and decorin, suggesting different PCM mechanics. Furthermore, the activation of regenerative and catabolic function in chondrocytes triggered sex-dependent signatures in gene expression, indicating dimorphic genetic regulation that is dependent on stimulation. CONCLUSIONS We provide evidence for sexual dimorphism in cartilage before menopause. Some differences are intrinsic to chondrocytes' gene expression defined by their XX versus XY chromosomal constituency.
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Affiliation(s)
- Paula A. Hernandez
- Department of Orthopedic Surgery,
University of Texas Southwestern Medical Center, Dallas, TX, USA,Paula A. Hernandez, Department of
Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry
Hines Blvd, Dallas, TX 75390, USA.
| | - Miranda Moreno
- Department of Orthopedic Surgery,
University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zahra Barati
- Department of Orthopedic Surgery,
University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Conner Hutcherson
- Department of Orthopedic Surgery,
University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adwait A. Sathe
- Eugene McDermott Center for Human
Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Chao Xing
- Eugene McDermott Center for Human
Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX,
USA,Department of Bioinformatics,
University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Population and Data
Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jamie Wright
- Department of Cardiovascular and
Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Tre Welch
- Department of Cardiovascular and
Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Yasin Dhaher
- Department of Orthopedic Surgery,
University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Physical Medicine &
Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX,
USA
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11
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Cartilage thickness and bone shape variations as a function of sex, height, body mass, and age in young adult knees. Sci Rep 2022; 12:11707. [PMID: 35810204 PMCID: PMC9271066 DOI: 10.1038/s41598-022-15585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/27/2022] [Indexed: 11/22/2022] Open
Abstract
The functional relationship between bone and cartilage is modulated by mechanical factors. Scarce data exist on the relationship between bone shape and the spatial distribution of cartilage thickness. The aim of the study was to characterise the coupled variation in knee bone morphology and cartilage thickness distributions in knees with healthy cartilage and investigate this relationship as a function of sex, height, body mass, and age. MR images of 51 knees from young adults (28.4 ± 4.1 years) were obtained from a previous study and used to train a statistical shape model of the femur, tibia, and patella and their cartilages. Five multiple linear regression models were fitted to characterise morphology as a function of sex, height, body mass, and age. A logistic regression classifier was fitted to characterise morphological differences between males and females, and tenfold cross-validation was performed to evaluate the models’ performance. Our results showed that cartilage thickness and its distribution were coupled to bone morphology. The first five shape modes captured over 90% of the variance and described coupled changes to the bone and spatial distribution of cartilage thickness. Mode 1 (size) was correlated to sex (p < 0.001) and height (p < 0.0001). Mode 2 (aspect ratio) was also correlated to sex (p = 0.006) and height (p = 0.017). Mode 4 (condylar depth) was correlated to sex only (p = 0.024). A logistic regression model trained on modes 1, 2, and 4 could classify sex with an accuracy of 92.2% (95% CI [81.1%, 97.8%]). No other modes were influenced by sex, height, body mass, or age. This study demonstrated the coupled relationship between bone and cartilage, showing that cartilage is thicker with increased bone size, diaphysis size, and decreased femoral skew. Our results show that sex and height influence bone shape and the spatial distribution of cartilage thickness in a healthy young adult population, but body mass and age do not.
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12
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Schadler P, Lohberger B, Thauerer B, Faschingbauer M, Kullich W, Stradner MH, Husic R, Leithner A, Steinecker-Frohnwieser B. Fatty Acid-Binding Protein 4 (FABP4) Is Associated with Cartilage Thickness in End-Stage Knee Osteoarthritis. Cartilage 2021; 13:1165S-1173S. [PMID: 34218665 PMCID: PMC8804752 DOI: 10.1177/19476035211011520] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is no single blood biomarker for the staging of knee osteoarthritis (KOA). The purpose of this study was to assess the relationship of obesity, serum biomarkers, the hip-knee-ankle angle (HKAA) with sonographic cartilage thickness. METHODS We conducted a cross-sectional study of n = 33 patients undergoing knee arthroplasty. Body mass index (BMI) was recorded, and patients were grouped based on BMI. Serum blood samples were collected, and the following biomarkers were measured using the ELISA technique (subgroup of n = 23): oxidized low-density lipoprotein (oxLDL), soluble receptor for advanced glycation end-products (sRAGE), fatty acid-binding protein 4 (FABP4), membrane-bound phospholipase A2 (PLA2G2A). The HKAA was analyzed on full-length limb standing x-ray images. Cartilage thickness was assessed on ultrasound images. Multivariable regression analysis was performed to account for confounding. RESULTS After adjusting for age, gender, and HKAA, obese patients had thicker medial femoral cartilage (β = 0.165, P = 0.041). Furthermore, lateral cartilage thickness was negatively correlated with FABP4 level after adjusting for of age, gender, BMI, and HKAA (β = -0.006, P = 0.001). Confirming previous studies, after adjustment, FABP4 level was associated with a higher BMI group (β = 42.99, P < 0.001). None of the other markers (oxLDL, PLA2G2A, and sRAGE) was associated with BMI or cartilage thickness. DISCUSSION Our results indicate that BMI has a weak, positive association with cartilage thickness in end-stage KOA patients. FABP4 levels were negatively associated with cartilage thickness. While our study is limited by a small sample size, these results further highlight the role of FABP4 as promising biomarkers of burden of disease in KOA.
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Affiliation(s)
- Paul Schadler
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Paul Schadler, Research Laboratory,
Department of Orthopaedics and Trauma, Medical University of Graz,
Auenbruggerplatz 5-7, Graz, 8036, Austria.
| | - Birgit Lohberger
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for
Arthritis and Rehabilitation, Saalfelden, Austria
| | - Bettina Thauerer
- Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Saalfelden, Austria
| | | | - Werner Kullich
- Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Saalfelden, Austria
| | - Martin Helmut Stradner
- Division of Rheumatology and
Immunology, Department of Internal Medicine, Medical University of Graz, Graz,
Austria
| | - Rusmir Husic
- Division of Rheumatology and
Immunology, Department of Internal Medicine, Medical University of Graz, Graz,
Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria
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13
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Tack A, Ambellan F, Zachow S. Towards novel osteoarthritis biomarkers: Multi-criteria evaluation of 46,996 segmented knee MRI data from the Osteoarthritis Initiative. PLoS One 2021; 16:e0258855. [PMID: 34673842 PMCID: PMC8530341 DOI: 10.1371/journal.pone.0258855] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/06/2021] [Indexed: 01/16/2023] Open
Abstract
Convolutional neural networks (CNNs) are the state-of-the-art for automated assessment of knee osteoarthritis (KOA) from medical image data. However, these methods lack interpretability, mainly focus on image texture, and cannot completely grasp the analyzed anatomies' shapes. In this study we assess the informative value of quantitative features derived from segmentations in order to assess their potential as an alternative or extension to CNN-based approaches regarding multiple aspects of KOA. Six anatomical structures around the knee (femoral and tibial bones, femoral and tibial cartilages, and both menisci) are segmented in 46,996 MRI scans. Based on these segmentations, quantitative features are computed, i.e., measurements such as cartilage volume, meniscal extrusion and tibial coverage, as well as geometric features based on a statistical shape encoding of the anatomies. The feature quality is assessed by investigating their association to the Kellgren-Lawrence grade (KLG), joint space narrowing (JSN), incident KOA, and total knee replacement (TKR). Using gold standard labels from the Osteoarthritis Initiative database the balanced accuracy (BA), the area under the Receiver Operating Characteristic curve (AUC), and weighted kappa statistics are evaluated. Features based on shape encodings of femur, tibia, and menisci plus the performed measurements showed most potential as KOA biomarkers. Differentiation between non-arthritic and severely arthritic knees yielded BAs of up to 99%, 84% were achieved for diagnosis of early KOA. Weighted kappa values of 0.73, 0.72, and 0.78 were achieved for classification of the grade of medial JSN, lateral JSN, and KLG, respectively. The AUC was 0.61 and 0.76 for prediction of incident KOA and TKR within one year, respectively. Quantitative features from automated segmentations provide novel biomarkers for KLG and JSN classification and show potential for incident KOA and TKR prediction. The validity of these features should be further evaluated, especially as extensions of CNN-based approaches. To foster such developments we make all segmentations publicly available together with this publication.
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Affiliation(s)
| | | | - Stefan Zachow
- Zuse Institute Berlin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Berlin, Germany
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14
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Mean femoral cartilage thickness is higher in athletes as compared with sedentary individuals. Knee Surg Sports Traumatol Arthrosc 2021; 29:1206-1214. [PMID: 32671433 DOI: 10.1007/s00167-020-06146-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/10/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE It is unclear how high-intensity physical activity (HIPA) affects the knee joint, specifically the femoral cartilage (FC). Therefore, the aims of this study were to evaluate FC thickness via ultrasound among elite athletes involved in different types of HIPA, and to determine whether there is a correlation between serum cartilage oligomeric matrix protein (sCOMP) and rectus femoris (RF) thickness. METHOD A total of 132 male individuals participated in this study and were assigned to two groups, the sedentary (n = 43, 23.9 ± 3.7) and athlete groups (n = 89, 22.7 ± 4.6), which did not significantly differ in age. The athletes were elite and performed HIPA during sports such as volleyball (n = 20), soccer (n = 21), basketball (n = 28), and weightlifting (n = 20). RF thickness and three (mid-point) measurements were obtained for each knee. The mean FC thickness for each knee was defined as the sum of the medial, lateral condyles, and intercondylar areas. Blood samples for sCOMP analyses were also obtained. RESULTS All the measurements of the FC of both knees were significantly higher in the athletes than in the sedentary individuals (p < 0.001 and p = 0.001). The mean right and left FC values were also higher in the athletes (p < 0.001). Multiple linear regression analysis showed that participation in sporting activities was a significant predictor associated with the right and left mean FC thickness (p < 0.001 for both). No significant differences in the sCOMP levels were found between the two groups. CONCLUSION It was found that the mean FC was higher among athletes than among sedentary individuals. As a result, it is suggested that sports' participation is an independent factor associated with the right and left mean FC thickness. LEVEL OF EVIDENCE III.
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15
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Miranda-Duarte A, Borgonio-Cuadra VM, González-Huerta NC, Rojas-Toledo EX, Ahumada-Pérez JF, Morales-Hernández E, Pérez-Hernández N, Rodríguez-Pérez JM, Vargas-Alarcón G. Are functional variants of the microRNA-146a gene associated with primary knee OA? Evidence in Mexican mestizo population. Mol Biol Rep 2021; 48:1549-1557. [PMID: 33590413 DOI: 10.1007/s11033-021-06207-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/29/2021] [Indexed: 01/10/2023]
Abstract
MicroRNA-146a (miR-146a) is an inflammatory response regulator whose expression is deregulated in osteoarthritis (OA); variations in the miR-146a gene could affect OA risk. This study aimed to analyze the association between two functional variants of the miR-146a gene and primary knee OA in Mexican mestizo population. Methods and Results. A case-control study was conducted with cases defined as individuals aged ≥ 40 years with primary knee OA grade ≥ 2, according to the Kellgren-Lawrence system. Controls were volunteers with no primary knee OA with radiographic grade < 2. TaqMan allelic discrimination assays genotyped the rs2910164 and rs57095329. Allelic and genotypic frequencies, as well as the Hardy-Weinberg equilibrium (HWE), were calculated. The genetic association was tested under codominant, dominant, and recessive models. Non-conditional logistic regressions were carried out to estimate the association magnitude. We included 310 cases and 379 controls. Despite rs2910164 being in HWE, there was no association under codominant, dominant, and recessive models. In women with OA grade 2, the codominant model found a trend between the CC genotype and increased risk [OR (95% CI) 1.6 (0.7-3.5)]; the same trend was found in OA grade 4 in the codominant and recessive models [1.8 (0.6-5.4) and 2.0 (0.7-5.9)]. Conversely, in men with OA grade 4, the CC genotype tended to be associated with a lower risk in the codominant and recessive models [0.6 (0.1-6.0) and 0.5 (0.1-5.1)]. Conclusion. Our results show that miR-146a gene variants are not significantly associated with primary knee OA in Mexican mestizos.
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Affiliation(s)
- Antonio Miranda-Duarte
- Departamento de Medicina Genómica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", México Xochimilco 289, Arenal de Guadalupe, Del. Tlalpan, CP 14389, Mexico City, Mexico.
| | - Verónica Marusa Borgonio-Cuadra
- Departamento de Medicina Genómica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", México Xochimilco 289, Arenal de Guadalupe, Del. Tlalpan, CP 14389, Mexico City, Mexico
| | - Norma Celia González-Huerta
- Departamento de Medicina Genómica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", México Xochimilco 289, Arenal de Guadalupe, Del. Tlalpan, CP 14389, Mexico City, Mexico
| | - Emma Xochitl Rojas-Toledo
- Departamento de Medicina Genómica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", México Xochimilco 289, Arenal de Guadalupe, Del. Tlalpan, CP 14389, Mexico City, Mexico
| | - Juan Francisco Ahumada-Pérez
- Departamento de Medicina Genómica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", México Xochimilco 289, Arenal de Guadalupe, Del. Tlalpan, CP 14389, Mexico City, Mexico
| | - Eugenio Morales-Hernández
- Servicio de Radiología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", México Xochimilco 289, Arenal de Guadalupe, Del. Tlalpan, CP 14389, Mexico City, Mexico
| | - Nonanzit Pérez-Hernández
- Departamento de Biología Molecular, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Col. Sección XVI, Del. Tlalpan, CP 14080, Mexico City, Mexico
| | - José Manuel Rodríguez-Pérez
- Departamento de Biología Molecular, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Col. Sección XVI, Del. Tlalpan, CP 14080, Mexico City, Mexico
| | - Gilberto Vargas-Alarcón
- Departamento de Biología Molecular, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Col. Sección XVI, Del. Tlalpan, CP 14080, Mexico City, Mexico
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16
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Sidharthan S, Yau A, Almeida BA, Shea KG, Greditzer HG, Jones KJ, Fabricant PD. Patterns of Articular Cartilage Thickness in Pediatric and Adolescent Knees: A Magnetic Resonance Imaging-Based Study. Arthrosc Sports Med Rehabil 2021; 3:e381-e390. [PMID: 34027446 PMCID: PMC8128992 DOI: 10.1016/j.asmr.2020.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To establish normative values for articular cartilage thickness in pediatric and adolescent knees using magnetic resonance imaging (MRI) and investigate for any associations with age and skeletal maturity. Methods MRI scans were analyzed in patients 7 to 18 years old without osteochondral lesions, chondral wear/pathology, intra-articular fractures, or history of knee surgery. Measurements of articular cartilage thickness at the patella (medial facet, lateral facet, median ridge), femur (medial condyle, lateral condyle, lateral trochlea), and tibia (medial plateau, lateral plateau) were made on axial, coronal, and sagittal MRI. Descriptive statistics were used to calculate mean cartilage thickness by age and sex. Analysis of variance with repeated measures, analysis of covariance, independent samples t test, and linear regression were performed to determine differences in mean cartilage thickness by anatomic location, sex, physeal status, and age, respectively. Results A total of 240 knee MRI scans were included. Articular cartilage was thickest at the patella and did not vary with age or skeletal maturity. On the femur, articular cartilage was thickest at the lateral trochlea with mean cartilage thickness of 4.4 ± 1.4 mm in male patients and 3.6 ± 1.3 mm in female patients (P < .001). Patients with open distal femoral physes had significantly thicker cartilage at the medial femoral condyle, lateral femoral condyle, and lateral trochlea compared to patients with closing/closed physes (P < .001). Linear regression analysis revealed a significant inverse association between cartilage thickness at the femur and age. Conclusions In pediatric and adolescent knees, articular cartilage is thickest at the patella, where it does not strongly correlate with age. In contrast, there is a strong inverse association between increasing age and articular cartilage thickness of the distal femoral condyles. Clinical Relevance The longitudinal reference data presented in this study can aid in pre-operative interpretation of knee cartilage under pathologic conditions in pediatric and adolescent patients.
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Affiliation(s)
- Sreetha Sidharthan
- Divisions of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Annie Yau
- Divisions of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Bryan Aristega Almeida
- Divisions of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kevin G Shea
- Stanford University School of Medicine, Stanford, California, U.S.A
| | - Harry G Greditzer
- Radiology & Imaging, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kristofer J Jones
- David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Peter D Fabricant
- Divisions of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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17
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Brenneman Wilson EC, Gatti AA, Maly MR. A new technique to evaluate the impact of running on knee cartilage deformation by region. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2021; 34:593-603. [PMID: 33387105 DOI: 10.1007/s10334-020-00896-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/16/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES When measuring changes in knee cartilage thickness in vivo after loading, mean values may not reflect local changes. The objectives of this investigation were: (1) use statistical parametric mapping (SPM) to determine regional deformation patterns of tibiofemoral cartilage in response to running; (2) quantify regional differences in cartilage thickness between males and females; and (3) explore the influence of sex on deformation. MATERIALS AND METHODS Asymptomatic males (n = 15) and females (n = 15) had MRI imaging of their right knee before and after 15 min of treadmill running. Medial and lateral tibial, and medial and lateral weight-bearing femoral cartilage were segmented. SPM was completed on cartilage thickness maps to test the main effects of Running and Sex, and their interaction. F-statistic maps were thresholded; clusters above this threshold indicated significant differences. RESULTS Deformation was observed in all four compartments; the lateral tibia had the largest area of deformation (p < 0.0001). Thickness differences between sexes were observed in all four compartments, showing females have thinner cartilage (p ≤ 0.009). The lateral tibia had small clusters indicating an interaction of sex on deformation (p ≤ 0.012). DISCUSSION SPM identified detailed spatial information on tibiofemoral cartilage thickness differences observed after running, and between sexes and their interaction.
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Affiliation(s)
| | - Anthony A Gatti
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,NeuralSeg, Ltd., Hamilton, ON, Canada
| | - Monica R Maly
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada. .,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada. .,Department of Kinesiology, University of Waterloo, 200 University Avenue West, Burt Matthews Hall, Rm 1036, Waterloo, ON, N2G3G1, Canada.
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18
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von Loga IS, Batchelor V, Driscoll C, Burleigh A, Chia SLL, Stott B, Miotla-Zarebska J, Riley D, Dell'Accio F, Vincent TL. Does Pain at an Earlier Stage of Chondropathy Protect Female Mice Against Structural Progression After Surgically Induced Osteoarthritis? Arthritis Rheumatol 2020; 72:2083-2093. [PMID: 32602242 DOI: 10.1002/art.41421] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 06/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Female C57BL/6 mice exhibit less severe chondropathy than male mice. This study was undertaken to test the robustness of this observation and explore underlying mechanisms. METHODS Osteoarthritis was induced in male and female C57BL/6 or DBA/1 mice (n = 6-15 per group) by destabilization of the medial meniscus (DMM) or partial meniscectomy (PMX). Some mice were ovariectomized (OVX) (n = 30). In vivo repair after focal cartilage defect or joint immobilization (sciatic neurectomy) following DMM was assessed. Histologic analysis, evaluation of gene expression in whole knees, and behavioral analysis using Laboratory Animal Behavior Observation Registration and Analysis System (LABORAS) and Linton incapacitance testing (n = 7-10 mice per group) were performed. RESULTS Female mice displayed less severe chondropathy (20-75% reduction) across both strains and after both surgeries. Activity levels after PMX were similar for male and female mice. Some repair-associated genes were increased in female mouse joints after surgery, but no repair differences were evident in vivo. Despite reduced chondropathy, female mice developed pain-like behavior at the same time as male mice. At the time of established pain-like behavior (10 weeks after PMX), pain-associated genes were significantly up-regulated in female mice, including Gdnf (mean ± SEM fold change 2.54 ± 0.30), Nrtn (6.71 ± 1.24), Ntf3 (1.92 ± 0.27), and Ntf5 (2.89 ± 0.48) (P < 0.01, P < 0.01, P < 0.05, and P < 0.001, respectively, versus male mice). Inflammatory genes were not regulated in painful joints in mice of either sex. CONCLUSION We confirm strong structural joint protection in female mice that is not due to activity or intrinsic repair differences. Female mice develop pain at the same time as males, but induce a distinct set of neurotrophins. We speculate that heightened pain sensitivity in female mice protects the joint by preventing overuse.
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Affiliation(s)
| | - Vicky Batchelor
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Clare Driscoll
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Annika Burleigh
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Shi-Lu L Chia
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Bryony Stott
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | | | - David Riley
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | | | - Tonia L Vincent
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
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19
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Factors related to femoral bowing among Korean female farmers: a cross-sectional study. Ann Occup Environ Med 2020; 32:e23. [PMID: 32802339 PMCID: PMC7406743 DOI: 10.35371/aoem.2020.32.e23] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/17/2020] [Indexed: 11/20/2022] Open
Abstract
Background Female farmers have a high prevalence of knee osteoarthritis (KOA) in South Korea. Femoral bowing has been reported to be related to KOA by increasing load on the mechanical axis. This study aimed to investigate factors related to femoral bowing in Korean female farmers. Methods We analyzed the legs of 264 female farmers registered with the Korea farmers' knee cohort of Jeonnam Center for Farmers' Safety and Health. A structured questionnaire was used to determine sociodemographic variables, agricultural career, cumulative squatting working time (CSWT), and cumulative heavy lifting working time. Femoral bone density was measured and Kellgren-Lawrence (KL) grades were obtained from the knee radiographs. Mechanical axis angle (MAA), femoral bowing angle (FBA), anatomical lateral distal femoral angle (aLDFA), anatomical medial proximal tibial angle (aMPTA), and condylar-plateau angle (CPA) were measured. We examined the relationship between the FBA and related factors by using multiple linear regression. Results The proportion of individuals with radiographic KOA (≥ KL grade 2) in this study was 37.9%. As KL grades increased, MAA, FBA, and CPA increased, whereas aLDFA and aMPTA decreased. FBA increased with age. Multiple linear regression analyses using FBA as a dependent variable showed relationship with higher age, lower height, higher BMI, lower bone mineral density, longer CSWT, and longer agricultural careers. Conclusions The results of this study suggest that external factors related to agricultural work in female farmers was associated with femoral bowing, in addition to internal factors such as age, bone density, height, and obesity.
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Cai G, Jiang M, Cicuttini F, Jones G. Association of age, sex and BMI with the rate of change in tibial cartilage volume: a 10.7-year longitudinal cohort study. Arthritis Res Ther 2019; 21:273. [PMID: 31818318 PMCID: PMC6902563 DOI: 10.1186/s13075-019-2063-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/13/2019] [Indexed: 01/02/2023] Open
Abstract
Background To describe the association of age, sex and body mass index with the rate of change of tibial knee cartilage volume over 10.7 years in a community-based sample of older adults. Methods Four hundred and eighty-one participants (49% female, mean age 60.8 years [range 51.1–79.7], 49% had knee pain and 58% radiographic osteoarthritis) were included. Tibial cartilage volume of the right knee was assessed on T1-weighted fat-suppressed 1.5 T MRI at baseline and 10.7 years. Data analyses were performed using linear regression models. Results The average rate of loss of cartilage volume was 1.2%/year (range 0.2–3.9%) with all participants losing cartilage volume over the study period. There was a significant association between age and loss of tibial cartilage volume in the medial (0.023%/year, 95% confidence interval [CI] 0.010 to 0.036%, p < 0.001), lateral (0.013%/year, 95% CI 0.003 to 0.023%, p = 0.012) and total tibia (0.018%/year, 95% CI 0.009 to 0.026%, p < 0.001). Higher body mass index at baseline and increases in body mass index over time were associated with a greater tibial cartilage loss at the medial (body mass index at baseline 0.040%/year, 95% CI 0.022 to 0.058%, p < 0.001; increases in body mass index 0.055%/year, 95% CI 0.018 to 0.093%, p = 0.004) but not lateral compartment. No evidence of non-linear relationships was observed. Compared to males, females lost more lateral tibial cartilage with increasing age (0.023%/year, 95% CI 0.003 to 0.043%, p = 0.024 for interaction). Conclusions Tibial cartilage volume declines at a faster rate with increasing age and body mass index in both males and females, particularly in the medial compartment. In contrast to the low rate of change in radiographs, our findings suggest that cartilage loss at the tibia is universal in this age group.
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Affiliation(s)
- Guoqi Cai
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Matthew Jiang
- Department of Rheumatology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.
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Variation in the Thickness of Knee Cartilage. The Use of a Novel Machine Learning Algorithm for Cartilage Segmentation of Magnetic Resonance Images. J Arthroplasty 2019; 34:2210-2215. [PMID: 31445869 PMCID: PMC7251923 DOI: 10.1016/j.arth.2019.07.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The variation in articular cartilage thickness (ACT) in healthy knees is difficult to quantify and therefore poorly documented. Our aims are to (1) define how machine learning (ML) algorithms can automate the segmentation and measurement of ACT on magnetic resonance imaging (MRI) (2) use ML to provide reference data on ACT in healthy knees, and (3) identify whether demographic variables impact these results. METHODS Patients recruited into the Osteoarthritis Initiative with a radiographic Kellgren-Lawrence grade of 0 or 1 with 3D double-echo steady-state MRIs were included and their gender, age, and body mass index were collected. Using a validated ML algorithm, 2 orthogonal points on each femoral condyle were identified (distal and posterior) and ACT was measured on each MRI. Site-specific ACT was compared using paired t-tests, and multivariate regression was used to investigate the risk-adjusted effect of each demographic variable on ACT. RESULTS A total of 3910 MRI were included. The average femoral ACT was 2.34 mm (standard deviation, 0.71; 95% confidence interval, 0.95-3.73). In multivariate analysis, distal-medial (-0.17 mm) and distal-lateral cartilage (-0.32 mm) were found to be thinner than posterior-lateral cartilage, while posterior-medial cartilage was found to be thicker (0.21 mm). In addition, female sex was found to negatively impact cartilage thickness (OR, -0.36; all values: P < .001). CONCLUSION ML was effectively used to automate the segmentation and measurement of cartilage thickness on a large number of MRIs of healthy knees to provide normative data on the variation in ACT in this population. We further report patient variables that can influence ACT. Further validation will determine whether this technique represents a powerful new tool for tracking the impact of medical intervention on the progression of articular cartilage degeneration.
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Matada MS, Holi MS, Raman R, Jayaramu Suvarna ST. Visualization of Cartilage from Knee Joint Magnetic Resonance Images and Quantitative Assessment to Study the Effect of Age, Gender and Body Mass Index (BMI) in Progressive Osteoarthritis (OA). Curr Med Imaging 2019; 15:565-572. [DOI: 10.2174/1573405614666181018123251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 11/22/2022]
Abstract
Background:
Osteoarthritis (OA) is a degenerative disease of joint cartilage affecting
the elderly people around the world. Visualization and quantification of cartilage is very much essential
for the assessment of OA and rehabilitation of the affected people. Magnetic Resonance Imaging
(MRI) is the most widely used imaging modality in the treatment of knee joint diseases. But
there are many challenges in proper visualization and quantification of articular cartilage using
MRI. Volume rendering and 3D visualization can provide an overview of anatomy and disease
condition of knee joint. In this work, cartilage is segmented from knee joint MRI, visualized in 3D
using Volume of Interest (VOI) approach.
Methods:
Visualization of cartilage helps in the assessment of cartilage degradation in diseased
knee joints. Cartilage thickness and volume were quantified using image processing techniques in
OA affected knee joints. Statistical analysis is carried out on processed data set consisting of 110
of knee joints which include male (56) and female (54) of normal (22) and different stages of OA
(88). The differences in thickness and volume of cartilage were observed in cartilage in groups
based on age, gender and BMI in normal and progressive OA knee joints.
Results:
The results show that size and volume of cartilage are found to be significantly low in OA
as compared to normal knee joints. The cartilage thickness and volume is significantly low for
people with age 50 years and above and Body Mass Index (BMI) equal and greater than 25. Cartilage
volume correlates with the progression of the disease and can be used for the evaluation of the
response to therapies.
Conclusion:
The developed methods can be used as helping tool in the assessment of cartilage
degradation in OA affected knee joint patients and treatment planning.
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Affiliation(s)
| | - Mallikarjun Sayabanna Holi
- Department of Electrical Instrumentation, University B.D.T. College of Engineering, Constituent College of VTU, Belagavi, Davangere-577 004, Karnataka, India
| | - Rajesh Raman
- Department of Radiodiagnosis, J.S.S. Medical College and Hospital, J.S.S. Academy of Higher Education and Research, Mysuru-570015, India
| | - Sujana Theja Jayaramu Suvarna
- Department of Orthopedics, J.S.S. Medical College and Hospital, J.S.S. Academy of Higher Education and Research, Mysuru-570015, India
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MRI-detected osteophytes of the knee: natural history and structural correlates of change. Arthritis Res Ther 2018; 20:237. [PMID: 30352619 PMCID: PMC6235223 DOI: 10.1186/s13075-018-1734-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 09/25/2018] [Indexed: 01/08/2023] Open
Abstract
Backgroud The natural history of semi-quantitative magnetic resonance imaging (MRI)-detected osteophytes (MRI-detected OPs) has not been described and it is unknown whether knee structural abnormalities can predict MRI-detected OP change over time. Thus, the aim of current study is to describe the natural history of knee MRI-detected OP, and to determine if knee structural abnormalities are associated with change of MRI-detected OP in a longitudinal study of older adults. Methods Randomly selected older adults (n = 837, mean age 63 years) had MRI at baseline and 413 of them had MRI 2.6 years later to measure MRI-detected OP, cartilage defects, cartilage volume, bone marrow lesions (BMLs), meniscal extrusion, infrapatellar fat pad (IPFP) quality score/maximum area and effusion-synovitis. Results Over 2.6 years, average MRI-detected OP score increased significantly in all compartments. The total MRI-detected OP score remained stable in 53% of participants, worsened (≥ 1-point increase) in 46% and decreased in 1%. Baseline cartilage defects (RR, 1.25–1.35), BMLs (RR, 1.16–1.17), meniscal extrusion (RR, 1.22–1.33) and IPFP quality score (RR, 1.08–1.20) site-specifically and independently predicted an increase in MRI-detected OP (p values all ≤ 0.05), after adjustment for covariates. Presence of IPFP abnormality was significantly associated with increased MRI-detected OPs but became non-significant after adjustment for other structural abnormalities. Total (RR, 1.27) and suprapatellar pouch effusion-synovitis (RR, 1.22) were both associated with increased MRI-detected OPs in the lateral compartment only (both p < 0.04). Conclusion Knee MRI-detected OPs are common in older adults and are likely to progress. The association between baseline structural abnormalities and worsening MRI-detected OPs suggest MRI-detected OP could be a consequence of multiple knee structural abnormalities.
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Bone shape mediates the relationship between sex and incident knee osteoarthritis. BMC Musculoskelet Disord 2018; 19:331. [PMID: 30208910 PMCID: PMC6136224 DOI: 10.1186/s12891-018-2251-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/28/2018] [Indexed: 01/01/2023] Open
Abstract
Background Knee bone shape differs between men and women and the incidence of knee osteoarthritis (OA) is higher in women than in men. Therefore, the purpose of the present study was to determine whether the observed difference in the incidence of knee radiographic OA (ROA) between men and women is mediated by bone shape. Methods We randomly sampled 304 knees from the OAI with incident ROA (i.e., development of Kellgren/Lawrence grade ≥ 2 by month 48) and 304 knees without incident ROA. We characterized distal femur and proximal tibia shape on baseline radiographs using Statistical Shape Modeling. If a specific bone shape was associated with the risk of incident ROA, marginal structural models were generated to assess the mediation effect of that bone shape on the relation of sex and risk of incident knee ROA adjusting for baseline covariates. Results Case and control participants were similar by age, sex and race, but case knees were from higher body mass index (BMI) participants (29.4 vs. 27.0; p < 0.001). Women had 49% increased odds of incident knee ROA compared with men (adjusted odds ratio (OR) = 1.49, 95% Confidence Interval (C.I.): 1.04, 2.12). There was an inconsistent mediation effect for tibial mode 2 between sex and incident knee ROA, with an indirect effect OR of 0.96 (95% C.I.: 0.91–1.00) and a direct effect OR of 1.56 (95% C.I.: 1.08–2.27), suggesting a protective effect for this mode. Similar findings were also observed for the mediation effect of tibia mode 10 and femur mode 4. These shape modes primarily involved differences in the angular relation of the heads to the shafts of the femur and tibia. Conclusions Distal femur and proximal tibia bone shapes partially and inconsistently mediated the relationship between sex and incident knee OA. Women had a higher risk of incident ROA, and specific bone shapes modestly protected them from even higher risk of ROA. The clinical significance of these findings warrant further investigation.
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Ruan G, Xu J, Wang K, Wu J, Zhu Q, Ren J, Bian F, Chang B, Bai X, Han W, Ding C. Associations between knee structural measures, circulating inflammatory factors and MMP13 in patients with knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:1063-1069. [PMID: 29753949 DOI: 10.1016/j.joca.2018.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/25/2018] [Accepted: 05/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate cross-sectional associations between serum level of Matrix metalloproteinase (MMP)13 and knee structural measures and circulating inflammatory factors in patients with symptomatic knee osteoarthritis (OA). DESIGN A total of 149 subjects with symptomatic knee OA were included. Magnetic resonance imaging was used to measure infrapatellar fat pad (IPFP) volume, IPFP signal intensity alternation, cartilage volume and cartilage defects. Knee radiography was used to assess radiographic OA using the Kellgren-Lawrence (K-L) grading system. Enzyme-linked immunosorbent assay was used to measure the serum levels of inflammatory factors and MMP13. RESULTS In multivariable analyses, serum MMP13 was negatively associated with cartilage volume at patellar site (β: -32.94 mm3 per 10 ng/ml, P < 0.05), and positively associated with cartilage defect at medial femoral site (OR: 1.13 per 10 ng/ml, P < 0.05). Also, MMP13 was positively associated with K-L grading and IPFP signal intensity alteration (OR: 1.14 and 1.15 per 10 ng/ml, respectively, both P < 0.05), and negatively associated with IPFP volume (β: -0.34 cm3 per 10 ng/ml, P < 0.05). Furthermore, serum level of adiponectin was negatively associated serum MMP13 quartiles (OR: 0.66 per 10 μg/ml, P < 0.05), and serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-8 and IL-18 were positively associated with serum MMP13 quartiles (ORs: 1.01-1.18 per 10 pg/ml, all P < 0.05). CONCLUSIONS Serum level of MMP13 was associated with knee structural abnormalities as well as serum inflammatory factors. These suggest that systemic MMP13 may play a role in knee OA, and could be regulated by inflammatory factors.
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Affiliation(s)
- G Ruan
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - J Xu
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - K Wang
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - J Wu
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Q Zhu
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - J Ren
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - F Bian
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - B Chang
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - X Bai
- Translational Research Centre, Academy of Orthopaedics, Guangdong Province, China; School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
| | - W Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| | - C Ding
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopaedics, Guangdong Province, China; School of Basic Medical Sciences, Southern Medical University, Guangzhou, China; Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Roberts HM, Moore JP, Thom JM. The effect of aerobic walking and lower body resistance exercise on serum COMP and hyaluronan, in both males and females. Eur J Appl Physiol 2018. [PMID: 29536174 DOI: 10.1007/s00421-018-3837-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the serum cartilage oligomeric matrix protein (COMP) and hyaluronan (HA) response to walking (high-repetition loading) and resistance training exercise (low-repetition loading) in males and females. METHODS 15 males (age: 28 ± 6 years; BMI: 24 ± 2; mean ± SD) and 15 females (age: 26 ± 4 years; BMI: 23 ± 2) completed both a 40-min walk at 80% of maximum heart rate and a 40-min lower body resistance training protocol, separated by a minimum of 48 h. Serum COMP and HA were determined at rest, immediately post, and 30-min post exercise. Resting femoral cartilage thickness was also measured using ultrasonography. RESULTS COMP increased following walking (28.9%; P < 0.001) and resistance training exercise (26.0%; P < 0.001), remaining above baseline post-exercise following walking (mean difference: +28.3 ng/ml; 95% CI 3.8-52.8 ng/ml; P = 0.02). Although the exercise response did not differ for gender, COMP concentrations were higher in males than in females at all time points (all, P < 0.001). In contrast, HA concentrations did not change following either modality of exercise. However, females demonstrated higher HA pre-exercise (37.7 ± 17.8 vs 26.2 ± 12.8 ng/ml; P = 0.006) and immediately post exercise (38.0 ± 19.0 vs 28.2 ± 15.5 ng/ml; P = 0.033) compared to men. Finally, following adjustment for body size, femoral cartilage thickness was greater in men compared to women (notch: 2.66 vs 1.74 mm, P < 0.001). CONCLUSION The effect of a single bout of lower body exercise on serum COMP and HA is independent of exercise modality in healthy men and women. Furthermore, having thicker femoral cartilage and higher baseline COMP in males does not appear to influence how the cartilage responds to exercise.
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Affiliation(s)
- Harry M Roberts
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK.
- School of Biosciences and Medicine, University of Surrey, The Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK.
| | - Jonathan P Moore
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Jeanette M Thom
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
- School of Medical Sciences, University of New South Wales, Sydney, Australia
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Schmitz RJ, Harrison D, Wang HM, Shultz SJ. Sagittal-Plane Knee Moment During Gait and Knee Cartilage Thickness. J Athl Train 2018; 52:560-566. [PMID: 28653865 DOI: 10.4085/1062-2050-52.4.05] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Understanding the factors associated with thicker cartilage in a healthy population is important when developing strategies aimed at minimizing the cartilage thinning associated with knee osteoarthritis progression. Thicker articular cartilage is commonly thought to be healthier cartilage, but whether the sagittal-plane biomechanics important to gait are related to cartilage thickness is unknown. OBJECTIVE To determine the relationship of a weight-bearing region of the medial femoral condyle's cartilage thickness to sagittal gait biomechanics in healthy individuals. DESIGN Descriptive laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-eight healthy participants (15 women: age = 21.1 ± 2.1 years, height = 1.63 ± 0.07 m, weight = 64.6 ± 9.9 kg; 13 men: age = 22.1 ± 2.9 years, height = 1.79 ± 0.05 m, weight = 75.2 ± 9.6 kg). MAIN OUTCOME MEASURE(S) Tibiofemoral angle (°) was obtained via goniometric assessment, thickness of the medial femoral condyle cartilage (mm) was obtained via ultrasound imaging, and peak internal knee-extensor moment (% body weight · height) was measured during 10 trials of over-ground walking at a self-selected pace. We used linear regression to examine the extent to which peak internal knee-extensor moment predicted cartilage thickness after accounting for tibiofemoral angle and sex. RESULTS Sex and tibiofemoral angle (12.3° ± 3.2°) were entered in the initial step as control factors (R2 = 0.01, P = .872). In the final step, internal knee-extensor moment (1.5% ± 1.3% body weight · height) was entered, which resulted in greater knee-extensor moment being related to greater cartilage thickness (2.0 ± 0.3 mm; R2Δ = 0.31, PΔ = .003). CONCLUSION Individuals who walked with a greater peak internal knee-extensor moment during gait had a cartilage structure that is generally considered beneficial in a healthy population. Our study offers promising findings that a potentially modifiable biomechanical factor is associated with cartilage status in a healthy population. Establishing these baseline relationships in uninjured populations may help us to better understand potential factors related to maladaptive gait patterns that predispose a person to adverse changes in the cartilage environment.
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Affiliation(s)
- Randy J Schmitz
- Department of Kinesiology, University of North Carolina-Greensboro
| | - David Harrison
- Department of Kinesiology, University of North Carolina-Greensboro
| | - Hsin-Min Wang
- Department of Sports Medicine, China Medical University, Taiwan
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina-Greensboro
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Tummala S, Schiphof D, Byrjalsen I, Dam EB. Gender Differences in Knee Joint Congruity Quantified from MRI: A Validation Study with Data from Center for Clinical and Basic Research and Osteoarthritis Initiative. Cartilage 2018; 9:38-45. [PMID: 29219018 PMCID: PMC5724673 DOI: 10.1177/1947603516684590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective Gender is a risk factor in the onset of osteoarthritis (OA). The aim of the study was to investigate gender differences in contact area (CA) and congruity index (CI) in the medial tibiofemoral (MTF) joint in 2 different cohorts, quantified automatically from magnetic resonance imaging (MRI). Design The CA and CI markers were validated on 2 different data sets from Center for Clinical and Basic Research (CCBR) and Osteoarthritis Initiative (OAI). The CCBR cohort consisted of 159 subjects and the OAI subcohort consisted of 1,436 subjects. From the MTF joint, the contact area was located and quantified using Euclidean distance transform. Furthermore, the CI was quantified over the contact area by assessing agreement of the first- and second-order general surface features. Then, the gender differences between CA and CI values were evaluated at different stages of radiographic OA. Results Female CAs were significantly higher than male CAs after normalization, male CIs were significantly higher than female CIs after correcting with age and body mass index ( P < 0.05), consistent across the 2 data sets. For the OAI data set, the gender differences were present at all stages of radiographic OA. Conclusion This study demonstrated the gender differences in CA and CI in MTF joints. The higher normalized CA and lower CI values in female knees may be linked with the increased risk of incidence of radiographic OA in females. These differences may help further understand the gender differences and/or to establish gender specific treatment strategies.
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Affiliation(s)
- Sudhakar Tummala
- eScience Center, Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Erik B. Dam
- Biomediq A/S, Copenhagen, Denmark,The D-BOARD EU Consortium,Erik B. Dam, Biomediq A/S, Fruebjergvej 3, 2100 Copenhagen, Denmark.
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Bigham HJ, Flaxman TE, Smith AJJ, Benoit DL. Neuromuscular adaptations in older males and females with knee osteoarthritis during weight-bearing force control. Knee 2018; 25:40-50. [PMID: 29174844 DOI: 10.1016/j.knee.2017.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/07/2017] [Accepted: 06/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Females exhibit significantly greater incidence, prevalence, and severity of osteoarthritis (OA) compared to males. Despite known biological, morphological, and functional differences between males and females, there has been little sex-related investigation into sex-specific biomechanical and neuromuscular responses to OA. OBJECTIVE To identify sex-related differences in OA-affected adults and within-sex differences between healthy and OA-affected adults' muscular activation patterns during lower limb loading. METHODS Thirty adults with OA and 36 controls completed a standing ground reaction force (GRF) matching protocol requiring participants to expose equal body weight to each leg and modulate horizontal GRFs while maintaining constant joint positions. Electromyography was plotted as a function of GRF direction to depict muscle activation patterns. Muscles were classified as a general joint stabilizer, specific joint stabilizer or moment actuator by quantifying activation patterns with a test of asymmetry, specificity index and mean direction of activity. Lower limb kinematics and kinetics were also recorded. RESULTS In general, muscle roles as it relates to joint stability did not differ between groups. Compared to controls, both males and females with OA demonstrated greater rectus femoris activity and reduced knee rotation moments. Females with OA had significantly greater biceps femoris and gastrocnemius activity during respective lateral, and anterior-medial loading directions compared to males with OA. CONCLUSIONS We identified fundamental differences in muscular stabilization strategies in older adults with OA as well as sex-related changes in neuromuscular function that may influence joint loading conditions and provide insight into the greater incidence of knee OA in females.
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Affiliation(s)
| | - Teresa E Flaxman
- School of Rehabilitation Sciences, University of Ottawa, Canada.
| | | | - Daniel L Benoit
- School of Human Kinetics, University of Ottawa, Canada; School of Rehabilitation Sciences, University of Ottawa, Canada.
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Zhu Z, Laslett LL, Han W, Antony B, Pan F, Cicuttini F, Jones G, Ding C. Associations between MRI-detected early osteophytes and knee structure in older adults: a population-based cohort study. Osteoarthritis Cartilage 2017; 25:2055-2062. [PMID: 28935436 DOI: 10.1016/j.joca.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 09/01/2017] [Accepted: 09/11/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe prevalence of osteophytes (OPs) detected only by magnetic resonance imaging (MRI) but not by standard X-ray in older adults and to evaluate longitudinal associations with knee structural changes. METHODS 837 participants were randomly selected from the local community and had MRI scans to assess knee OPs and other structures. OPs detected only by MRI but not by standard X-ray were defined as MRI-detected early OPs (MRI-OPs for short). OPs detected by both MRI and X-ray were defined as established-OPs. RESULTS The prevalence of MRI-OPs was 50% while the prevalence of established-OPs was 10% and no-OPs was 40% at total tibiofemoral (TF) compartment at baseline. Compared with no-OPs, participants with MRI-OPs had greater risks of increased cartilage defects in all TF compartments (RR 1.37, 95%CI 1.07-1.74) and bone marrow lesions (BMLs) only in medial TF compartment (RR 1.49, 95%CI 1.06-2.11), after adjustment for age, sex, BMI, cartilage defects, BMLs and/or joint space narrowing; participants with established-OPs had greater cartilage volume loss at total (β -2.02, 95%CI -3.86, -0.17) and lateral tibial sites (β -5.63, 95%CI -9.93, -1.32), greater risks of increased cartilage defects in total (RR 1.66, 95%CI 1.15-2.40) and medial TF compartments (RR 1.49, 95%CI 1.20-1.69) and BMLs in all TF compartments (RR 1.88, 95%CI 1.22-2.89), after adjustment for covariates. CONCLUSION MRI-OPs were associated with changes in knee structures, and the associations were similar but not as prominent as those for established-OPs. These suggest MRI-OPs may have a role to play in knee early-stage osteoarthritic progression.
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Affiliation(s)
- Z Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - W Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopaedics, Guangdong Province, China
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopaedics, Guangdong Province, China; School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Lu M, Han W, Wang K, Zhu Z, Antony B, Cicuttini F, Yin Z, Jones G, Ding C. Associations between proximal tibiofibular joint (PTFJ) types and knee osteoarthritic changes in older adults. Osteoarthritis Cartilage 2017; 25:1452-1458. [PMID: 28583898 DOI: 10.1016/j.joca.2017.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/12/2017] [Accepted: 05/25/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the cross-sectional associations between proximal tibiofibular joint (PTFJ) type configurations and knee joint structural abnormalities in older adults. METHODS A total of 967 community-based participants were studied. T1-weighted fat-suppressed magnetic resonance image (MRI) with spoiled gradient recalled echo sequence was utilized to assess the PTFJ type configurations. Knee cartilage volume, cartilage defects, bone marrow lesions and osteophytes were measured. Linear regression and binary logistic regression analyses were used to examine the associations between PTFJ type configurations and knee joint cartilage volume as well as knee structural abnormalities, respectively, after adjustment for potential confounders. RESULTS Seven PTFJ types including plane (49.4%), trochoid (31.9%), double trochoid (4.3%), saddle (5.4%), condylar (5.3%), trochlear (3.5%) and ball & socket (0.2%) were observed. Plane type was used as the comparator. In multivariable analyses, irregular joint types (comprising the five uncommon joint types) were associated negatively with cartilage volume, and positively with knee cartilage defects, bone marrow lesions and osteophytes in the lateral (but not medial) compartments. In contrast, trochoid type was only associated with reduced femoral cartilage volume, but not with knee cartilage defects, bone marrow lesions and osteophytes. CONCLUSIONS Irregular PTFJ joint shapes are associated with osteoarthritic changes in the lateral, but not medial, tibiofemoral compartment in older adults. The causal relationship needs to be examined in future longitudinal studies.
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Affiliation(s)
- M Lu
- Department of Orthopaedics, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - W Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - K Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Z Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Z Yin
- Department of Orthopaedics, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Zhu Z, Laslett LL, Jin X, Han W, Antony B, Wang X, Lu M, Cicuttini F, Jones G, Ding C. Association between MRI-detected osteophytes and changes in knee structures and pain in older adults: a cohort study. Osteoarthritis Cartilage 2017; 25:1084-1092. [PMID: 28115233 DOI: 10.1016/j.joca.2017.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/14/2016] [Accepted: 01/12/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe cross-sectional and longitudinal associations between magnetic resonance imaging (MRI)-detected osteophytes (OPs) and knee structural abnormalities and knee pain in older adults. METHOD A prospective population-based cohort study of 895 participants aged 50-80 years (mean age 62 years, 50% female) was performed. T1-or T2-weighted fat suppressed MRI was used to assess knee OPs, cartilage volume, cartilage defects and bone marrow lesions (BMLs) at baseline and after 2.6 years. Radiographically-detected OPs were scored according to the Osteoarthritis Research Society International (OARSI) atlas. Knee pain was assessed using a self-administered questionnaire at baseline, 2.6 and 5 years later. RESULTS 85% of participants had MRI-detected OPs at baseline, while 10% of participants had radiographically-detected OPs. Cross-sectionally, higher gardes of MRI-detected OPs in all compartments were significantly, independently and site-specifically associated with higher prevalences of cartilage defects and BMLs, lower cartilage volume and higher prevalence of knee pain. Longitudinally, higher gardes of baseline MRI-detected OPs site-specifically predicted greater risks of any increase in cartilage defects or BMLs, and loss of cartilage volume in medial and lateral tibiofemoral (LTF) and total compartments over 2.6 years in multivariable analyses. These significant associations were similar in those without radiographically-detected OPs. MTF and total OP scores were significantly associated with change in total knee pain over 2.6 and 5 years but these became non-significant after adjustment for cartilage defects and BMLs. CONCLUSION MRI-detected knee OPs are common and appear to be clinically relevant to knee structural changes in older adults.
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Affiliation(s)
- Z Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - X Jin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - W Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopedics, Guangdong Province, China; School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong, China
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - X Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - M Lu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopedics, Guangdong Province, China; School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Boeth H, MacMahon A, Eckstein F, Diederichs G, Schlausch A, Wirth W, Duda GN. MRI findings of knee abnormalities in adolescent and adult volleyball players. J Exp Orthop 2017; 4:6. [PMID: 28224374 PMCID: PMC5319929 DOI: 10.1186/s40634-017-0080-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/10/2017] [Indexed: 01/08/2023] Open
Abstract
Background To longitudinally and cross-sectionally evaluate knee abnormalities by sex and age in adolescent and adult volleyball athletes over 2 years using magnetic resonance imaging (MRI). Methods Thirty-six high-level volleyball athletes (18 adolescents: 56% female, mean age 16.0 ± 0.8 years; and 18 adults: 50% female, mean age 46.8 ± 5.1 years) were imaged by MRI at BL and at 2-year follow-up (FU). Prevalence and severity of cartilage lesions, subarticular bone marrow lesions (BMLs), subarticular cysts, osteophytes, and ligament and meniscus integrity were evaluated by sex and by age cohort (adolescents and adults) using the whole-organ MRI score (WORMS). Results There were no significant longitudinal changes in any of the features within any of the sex or age groups. No significant differences were found in overall prevalence or severity of any of the features between males and females, although at FU, males had a significantly higher prevalence of osteophytes in the medial femorotibial joint (MFTJ) than females (p=0.044). Compared to adolescents, adult volleyball players had a significantly greater prevalence and severity of cartilage lesions (p<0.001 for both), BMLs (p=0.0153 and p=0.005), and osteophytes (p≤0.003 and p<0.001), and more severe meniscal lesions (p≤0.021). Conclusion We found significant differences in the prevalence and severity of knee abnormalities between adolescent and adult volleyball players, but no overall differences by sex. These findings lay the groundwork for further investigations with larger cohorts and longer FU times to determine whether or not these knee abnormalities are associated with the development of OA.
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Affiliation(s)
- Heide Boeth
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Aoife MacMahon
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Eckstein
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Diederichs
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Arne Schlausch
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Wirth
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Han W, Aitken D, Zhu Z, Halliday A, Wang X, Antony B, Cicuttini F, Jones G, Ding C. Hypointense signals in the infrapatellar fat pad assessed by magnetic resonance imaging are associated with knee symptoms and structure in older adults: a cohort study. Arthritis Res Ther 2016; 18:234. [PMID: 27729069 PMCID: PMC5059934 DOI: 10.1186/s13075-016-1130-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/20/2016] [Indexed: 02/07/2023] Open
Abstract
Background There are few clinical and epidemiological studies reporting the association between abnormal changes within the IPFP and knee osteoarthritic changes. This study aims to describe the associations between hypointense signals in the infrapatellar fat pad (IPFP) and knee structural change and symptoms in older adults. Methods Participants (n = 874) were selected randomly from local community and followed up 2.7 years later (range 2.6–3.3 years). T1- or T2-weighted fat-suppressed magnetic resonance imaging (MRI) was assessed for IPFP hypointense signal, cartilage volume, cartilage defects, and bone marrow lesions (BMLs). Knee pain was assessed by self-administered Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire. Radiographic osteoarthritis was assessed using the OARSI atlas. Results Cross-sectionally, hypointense signals in the IPFP were significantly associated with a higher risk of knee cartilage defects at all sites, tibiofemoral BMLs and knee pain in multivariable analyses. Longitudinally, baseline signal abnormalities were significantly and positively associated with increases in knee cartilage defects (OR: 2.27, 95 % CI: 1.61–3.21), BMLs (OR: 1.91, 95 % CI: 1.39–2.62), and knee pain (OR: 1.36, 95 % CI: 1.05–1.76) in multivariable analyses. The associations with cartilage defects remained significant after adjustment for BMLs, but the associations with BMLs and knee pain decreased in magnitude or became non-significant after further adjustment for cartilage defects. Conclusions Hypointense signals in the IPFP were associated primarily with increased knee cartilage defects and also with BMLs and knee symptoms in cross-sectional and longitudinal analyses, suggesting the abnormality represented by this signal has a potentially important role in osteoarthritis progression. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1130-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Weiyu Han
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia.,Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Zhaohua Zhu
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia.,Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Andrew Halliday
- Department of Radiology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Xia Wang
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia. .,Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Prediction of medial tibiofemoral compartment joint space loss progression using volumetric cartilage measurements: Data from the FNIH OA biomarkers consortium. Eur Radiol 2016; 27:464-473. [PMID: 27221563 DOI: 10.1007/s00330-016-4393-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Investigating the association between baseline cartilage volume measurements (and initial 24th month volume loss) with medial compartment Joint-Space-Loss (JSL) progression (>0.7 mm) during 24-48th months of study. METHODS Case and control cohorts (Biomarkers Consortium subset from the Osteoarthritis Initiative (OAI)) were defined as participants with (n=297) and without (n=303) medial JSL progression (during 24-48th months). Cartilage volume measurements (baseline and 24th month loss) were obtained at five knee plates (medial-tibial, lateral-tibial, medial-femoral, lateral-femoral and patellar), and standardized values were analysed. Multivariate logistic regression was used with adjustment for known confounders. Artificial-Neural-Network analysis was conducted by Multi-Layer-Perceptrons (MLPs) including baseline determinants, and baseline (1) and interval changes (2) in cartilage volumes. RESULTS Larger baseline lateral-femoral cartilage volume was predictive of medial JSL (OR: 1.29 (1.01-1.64)). Greater initial 24th month lateral-femoral cartilage volume-loss (OR: 0.48 (0.27-0.84)) had protective effect on medial JSL during 24-48th months of study. Baseline and interval changes in lateral-femoral cartilage volume, were the most important estimators for medial JSL progression (importance values: 0.191(0.177-0.204), 0.218(0.207-0.228)) in the ANN analyses. CONCLUSIONS Cartilage volumes (both at baseline and their change during the initial 24 months) in the lateral femoral plate were predictive of medial JSL progression. KEY POINTS • Baseline lateral femoral cartilage volume is directly associated with medial JSL progression. • 24-month lateral femoral cartilage loss is inversely associated with medial JSL progression. • Lateral femoral cartilage volume is most important in association with medial JSL progression.
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Rai MF, Sandell LJ, Zhang B, Wright RW, Brophy RH. RNA Microarray Analysis of Macroscopically Normal Articular Cartilage from Knees Undergoing Partial Medial Meniscectomy: Potential Prediction of the Risk for Developing Osteoarthritis. PLoS One 2016; 11:e0155373. [PMID: 27171008 PMCID: PMC4865200 DOI: 10.1371/journal.pone.0155373] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
Objectives (i) To provide baseline knowledge of gene expression in macroscopically normal articular cartilage, (ii) to test the hypothesis that age, body-mass-index (BMI), and sex are associated with cartilage RNA transcriptome, and (iii) to predict individuals at potential risk for developing “pre-osteoarthritis” (OA) based on screening of genetic risk-alleles associated with OA and gene transcripts differentially expressed between normal and OA cartilage. Design Healthy-appearing cartilage was obtained from the medial femoral notch of 12 knees with a meniscus tear undergoing arthroscopic partial meniscectomy. Cartilage had no radiographic, magnetic-resonance-imaging or arthroscopic evidence for degeneration. RNA was subjected to Affymetrix microarrays followed by validation of selected transcripts by microfluidic digital polymerase-chain-reaction. The underlying biological processes were explored computationally. Transcriptome-wide gene expression was probed for association with known OA genetic risk-alleles assembled from published literature and for comparison with gene transcripts differentially expressed between healthy and OA cartilage from other studies. Results We generated a list of 27,641 gene transcripts in healthy cartilage. Several gene transcripts representing numerous biological processes were correlated with age and BMI and differentially expressed by sex. Based on disease-specific Ingenuity Pathways Analysis, gene transcripts associated with aging were enriched for bone/cartilage disease while the gene expression profile associated with BMI was enriched for growth-plate calcification and OA. When segregated by genetic risk-alleles, two clusters of study patients emerged, one cluster containing transcripts predicted by risk studies. When segregated by OA-associated gene transcripts, three clusters of study patients emerged, one of which is remarkably similar to gene expression pattern in OA. Conclusions Our study provides a list of gene transcripts in healthy-appearing cartilage. Preliminary analysis into groupings based on OA risk-alleles and OA-associated gene transcripts reveals a subset of patients expressing OA transcripts. Prospective studies in larger cohorts are needed to assess whether these patterns are predictive for OA.
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Affiliation(s)
- Muhammad Farooq Rai
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes Jewish Hospital, St. Louis, Missouri, United States of America
- * E-mail:
| | - Linda J. Sandell
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes Jewish Hospital, St. Louis, Missouri, United States of America
- Department of Cell Biology and Physiology, Washington University School of Medicine at Barnes Jewish Hospital, St. Louis, Missouri, United States of America
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Bo Zhang
- Department of Developmental Biology, Center of Regenerative Medicine, Washington University School of Medicine at Barnes Jewish Hospital, St. Louis, Missouri, United States of America
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes Jewish Hospital, St. Louis, Missouri, United States of America
| | - Robert H. Brophy
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, Washington University School of Medicine at Barnes Jewish Hospital, St. Louis, Missouri, United States of America
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Han W, Aitken D, Zhu Z, Halliday A, Wang X, Antony B, Cicuttini F, Jones G, Ding C. Signal intensity alteration in the infrapatellar fat pad at baseline for the prediction of knee symptoms and structure in older adults: a cohort study. Ann Rheum Dis 2015; 75:1783-8. [PMID: 26612337 DOI: 10.1136/annrheumdis-2015-208360] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/01/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the associations between infrapatellar fat pad (IPFP) signal intensity alteration at baseline and knee symptoms and structural changes in older adults. METHODS A total of 874 subjects (mean 62.1 years, 50.1% female) selected randomly from local community were studied at baseline and 770 were followed up (only 357 had MRI at follow-up) over 2.6 years. T1-weighted or T2-weighted fat suppressed MRI was used to assess IPFP signal intensity alteration (0-3), cartilage volume, cartilage defects and bone marrow lesions (BMLs) at baseline and 2.6 years later. Knee pain was assessed by self-administered Western Ontario and McMaster Osteoarthritis Index questionnaire. Radiographic osteoarthritis (OA) was assessed. RESULTS In cross-sectional analyses, IPFP signal intensity alteration was significantly and positively associated with total knee pain as well as knee cartilage defects, BMLs and knee radiographic OA and negatively associated with patellar cartilage volume after adjustment for age, sex, body mass index and/or radiographic OA. Longitudinally, baseline signal intensity alteration within IPFP was significantly and positively associated with increases in knee pain when going upstairs/downstairs as well as increases in tibiofemoral cartilage defects and BMLs, and negatively associated with change in lateral tibial cartilage volume in multivariable analyses. CONCLUSIONS IPFP signal intensity alteration at baseline was associated with knee structural abnormalities and clinical symptoms cross-sectionally and longitudinally in older adults, suggesting that it may serve as an important imaging biomarker in knee OA.
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Affiliation(s)
- Weiyu Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia Department of Orthopaedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Zhaohua Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew Halliday
- Department of Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Xia Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
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Zheng S, Xu J, Xu S, Zhang M, Huang S, He F, Yang X, Xiao H, Zhang H, Ding C. Association between circulating adipokines, radiographic changes, and knee cartilage volume in patients with knee osteoarthritis. Scand J Rheumatol 2015; 45:224-9. [PMID: 26505548 DOI: 10.3109/03009742.2015.1083053] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To explore the associations between serum adipokine levels, radiographic osteoarthritis (ROA) severity, and articular cartilage volume in patients with knee OA. METHOD A cross-sectional sample of 205 patients (aged 45-74 years) with knee OA were consecutively recruited to the Anhui Osteoarthritis (AHOA) study. ROA was assessed using the Kellgren-Lawrence (KL) grading system (grades 0-4). Knee cartilage volume was determined using fat-saturated T1-weighted magnetic resonance imaging (MRI). Serum levels of the adipokines leptin, adiponectin, and resistin were measured by using an enzyme-linked immunosorbent assay (ELISA). RESULTS Serum adiponectin, but not serum leptin or resitin, was significantly associated with reduced ROA severity in univariable analyses and this association remained significant after adjustment for age, sex, body mass index (BMI), and disease duration [β = -0.012, 95% confidence interval (CI) -0.021 to -0.002]. In ROA patients, leptin was significantly and positively associated with knee cartilage volume at patellar and medial tibial sites in both unadjusted and adjusted analyses (β = 0.006, 95% CI 0.02-0.010 for medial tibia and β = 0.009, 95% CI 0.001-0.018 for patella sites) but adiponectin and resistin had no significant associations with cartilage volume. In non-ROA patients, leptin, adiponectin, and resistin were not significantly associated with cartilage volume at any site. CONCLUSIONS Serum levels of leptin are independently associated with increased knee cartilage volume. In addition, serum adiponectin is significantly and negatively associated with ROA severity, suggesting a potentially protective effect.
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Affiliation(s)
- S Zheng
- a Department of Rheumatology and Immunology , First Affiliated Hospital of Anhui Medical University , Hefei , PR China
| | - J Xu
- a Department of Rheumatology and Immunology , First Affiliated Hospital of Anhui Medical University , Hefei , PR China
| | - S Xu
- a Department of Rheumatology and Immunology , First Affiliated Hospital of Anhui Medical University , Hefei , PR China
| | - M Zhang
- a Department of Rheumatology and Immunology , First Affiliated Hospital of Anhui Medical University , Hefei , PR China
| | - S Huang
- a Department of Rheumatology and Immunology , First Affiliated Hospital of Anhui Medical University , Hefei , PR China
| | - F He
- a Department of Rheumatology and Immunology , First Affiliated Hospital of Anhui Medical University , Hefei , PR China
| | - X Yang
- a Department of Rheumatology and Immunology , First Affiliated Hospital of Anhui Medical University , Hefei , PR China
| | - H Xiao
- a Department of Rheumatology and Immunology , First Affiliated Hospital of Anhui Medical University , Hefei , PR China
| | - H Zhang
- b Department of Radiology , First Affiliated Hospital of Anhui Medical University , Hefei , PR China
| | - C Ding
- c Menzies Institute of Medical Research , University of Tasmania , Australia.,d Department of Epidemiology and Preventive Medicine , Monash University Medical School , Tasmania , Australia
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Jung YH, Shin JS, Lee J, Kim MR, Park KB, Choi A, Shin D, Ha IH. Influence of parity-related factors adjusted for abortion on knee osteoarthritis in Korean women aged 50 or older: A cross-sectional study. Maturitas 2015. [DOI: 10.1016/j.maturitas.2015.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Cai J, Xu J, Wang K, Zheng S, He F, Huan S, Xu S, Zhang H, Laslett L, Ding C. Association Between Infrapatellar Fat Pad Volume and Knee Structural Changes in Patients with Knee Osteoarthritis. J Rheumatol 2015; 42:1878-84. [PMID: 26276969 DOI: 10.3899/jrheum.150175] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The function of the infrapatellar fat pad (IPFP) in knee osteoarthritis (OA) remains uncertain. This study aimed to examine cross-sectional associations between IPFP volume and knee structures in patients with knee OA. METHODS The study included 174 patients with clinical knee OA (mean age, 55.5 yrs). Fat-suppressed 3-D T1-weighted spoiled gradient recall magnetic resonance imaging (MRI) was used to measure the IPFP and cartilage volume. T2-weighted fast spin echo MRI was used to assess cartilage defects and bone marrow lesions (BML). Radiographic knee osteophytes and joint space narrowing (JSN) were assessed using the Osteoarthritis Research Society International atlas. RESULTS After adjustment for potential confounders, greater IPFP volume was associated with greater tibial and patellar cartilage volume (all p < 0.05), and fewer cartilage defects at all sites (OR 0.88-0.91, all p < 0.05). IPFP volume was associated with presence of BML at lateral tibial and medial femoral sites (OR 0.88-0.91, all p < 0.05) and osteophytes at lateral tibiofemoral compartment (OR 0.88, p < 0.05). IPFP volume was not significantly associated with JSN. CONCLUSION Greater IPFP volume was associated with greater knee cartilage volume and fewer structural abnormalities, suggesting a protective role of IPFP size in knee OA.
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Affiliation(s)
- Jingyu Cai
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania
| | - Jianhua Xu
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania
| | - Kang Wang
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania
| | - Shuang Zheng
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania
| | - Fan He
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania
| | - Shuting Huan
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania
| | - Shengqing Xu
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania
| | - Hui Zhang
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania
| | - Laura Laslett
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania
| | - Changhai Ding
- From the Department of Rheumatology and Immunology, Arthritis Research Institute, and the Department of Medical Images, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.J. Cai, MMed; J. Xu, MD; K. Wang, MD; S. Zheng, MMed; F. He, MMed; S. Huan, MMed; S. Xu, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; H. Zhang, MMed, Department of Medical Image, the First Affiliated Hospital of Anhui Medical University; L. Laslett, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University; C. Ding, MD, Department of Rheumatology and Immunology, Arthritis Research Institute, the First Affiliated Hospital of Anhui Medical University, and Menzies Institute for Medical Research, University of Tasmania.
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Anthropometric difference of the knee on MRI according to gender and age groups. Surg Radiol Anat 2015; 38:203-11. [PMID: 26253858 DOI: 10.1007/s00276-015-1536-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/01/2015] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to analyze the anthropometric data from MRI images that were obtained from the non-arthritic knees in Asian adults, and to identify the existence of morphologic differences between age groups. This cross-sectional study included knee MR images of 535 patients (273 males, 262 females) taken for the evaluation of soft-tissue injuries, excluding cases with cartilage defect and malalignment. The age, gender, height, and BMI were also assessed. The patients were grouped into three different 20-year age groups (20-39, 40-59, and 60-79). The MRI analysis was performed on the anthropometric parameters of distal femur and posterior tibial slope. Age-related differences were found in femoral width, distance from the distal and posterior cartilage surface to the medial/lateral epicondyle, medial posterior condylar offset (PCO), and posterior condylar angle (PCA) (all P < 0.001), but not in lateral PCO, and medial/lateral tibial slopes. In the analysis of covariance analyses, significant interaction between gender and age groups was found in most parameters, but not in PCA, distance from the posterior cartilage surface to the medial epicondyle, or medial tibial slope. We found anthropometric differences among age groups exist in most of distal femoral parameters, but not in posterior tibial slope. The results of this study can be used by manufacturers to modify prostheses to be suitable for the future Asian elderly population.
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Kumar D, Souza RB, Subburaj K, MacLeod TD, Singh J, Calixto NE, Nardo L, Link TM, Li X, Lane NE, Majumdar S. Are There Sex Differences in Knee Cartilage Composition and Walking Mechanics in Healthy and Osteoarthritis Populations? Clin Orthop Relat Res 2015; 473:2548-58. [PMID: 25716211 PMCID: PMC4488198 DOI: 10.1007/s11999-015-4212-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Women are at a greater risk for knee osteoarthritis (OA), but reasons for this greater risk in women are not well understood. It may be possible that differences in cartilage composition and walking mechanics are related to greater OA risk in women. QUESTIONS/PURPOSES (1) Do women have higher knee cartilage and meniscus T1ρ than men in young healthy, middle-aged non-OA and OA populations? (2) Do women exhibit greater static and dynamic (during walking) knee loading than men in young healthy, middle-aged non-OA and OA populations? METHODS Data were collected from three cohorts: (1) young active (<35 years) (20 men, 13 women); (2) middle-aged (≥35 years) without OA (Kellgren-Lawrence [KL] grade < 2) (43 men, 65 women); and (3) middle-aged with OA (KL>1) (18 men, 25 women). T1ρ and T2 relaxation times for cartilage in the medial knee, lateral knee, and patellofemoral compartments and medial and lateral menisci were quantified with 3.0-T MRI. A subset of the participants underwent three-dimensional motion capture during walking for calculation of peak knee flexion and adduction moments, flexion and adduction impulses, and peak adduction angle. Differences in MR, radiograph, and gait parameters between men and women were compared in the three groups separately using multivariate analysis of variance. RESULTS Women had higher lateral articular cartilage T1ρ (men=40.5 [95% confidence interval {CI}, 38.8-42.3] ms; women=43.3 [95% CI, 41.9-44.7] ms; p=0.017) and patellofemoral T1ρ (men=44.4 [95% CI, 42.6-46.3] ms; women=48.4 [95% CI, 46.9-50.0] ms; p=0.002) in the OA group; and higher lateral meniscus T1ρ in the young group (men=15.3 [95% CI, 14.7-16.0] ms; women=16.4 [95% CI, 15.6-17.2] ms; p=0.045). The peak adduction moment in the second half of stance was lower in women in the middle-aged (men=2.05 [95% CI, 1.76-2.34] %BW*Ht; women=1.66 [95% CI, 1.44-1.89] %BW*Ht; p=0.037) and OA (men=2.34 [95% CI, 1.76-2.91] %BW*Ht; women=1.42 [95% CI, 0.89-1.94] %BW*Ht; p=0.022) groups. Static varus from radiographs was lower in women in the middle-aged (men=178° [95% CI, 177°-179°]; women=180° [95% CI, 179°-181°]; p=0.002) and OA (men=176° [95% CI, 175°-178°]; women=180° [95% CI, 179°-181°]; p<0.001) groups. Women had lower varus during walking in all three groups (young: men=4° [95% CI, 3°-6°]; women=2° [95% CI, 0°-3°]; p=0.013; middle-aged: men=2° [95% CI, 1°-3°]; women=0° [95% CI, -1° to 1°]; p=0.015; OA: men=4° [95% CI, 2°-6°]; women=0° [95% CI, -2° to 2°]; p=0.011). Women had a higher knee flexion moment (men=4.24 [95% CI, 3.58-4.91] %BW*Ht; women 5.40 [95% CI, 4.58-6.21] %BW*Ht; p=0.032) in the young group. CONCLUSIONS These data demonstrate differences in cartilage composition and gait mechanics between men and women in young healthy, middle-aged healthy, and OA cohorts. Considering the cross-sectional nature of the study, longitudinal research is needed to investigate if these differences in cartilage composition and walking mechanics are associated with a greater risk of lateral tibiofemoral or patellofemoral OA in women. Future studies should also investigate the relative risk of lateral versus medial patellofemoral cartilage degeneration risk in women compared with men. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Deepak Kumar
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA , />Division of Physical Therapy, Department of Health Professions, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Room B309, Charleston, SC 29425 USA
| | - Richard B. Souza
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA , />Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, San Francisco, CA USA
| | - Karupppasamy Subburaj
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA , />Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Toran D. MacLeod
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA , />Department of Physical Therapy, California State University, Sacramento, CA USA
| | - Justin Singh
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Nathaniel E. Calixto
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Lorenzo Nardo
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Thomas M. Link
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Xiaojuan Li
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
| | - Nancy E. Lane
- />Center for Musculoskeletal Health, University of California at Davis Medical Center, Sacramento, CA USA
| | - Sharmila Majumdar
- />Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA USA
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Omoumi P, Michoux N, Roemer FW, Thienpont E, Vande Berg BC. Cartilage thickness at the posterior medial femoral condyle is increased in femorotibial knee osteoarthritis: a cross-sectional CT arthrography study (Part 2). Osteoarthritis Cartilage 2015; 23:224-31. [PMID: 25450850 DOI: 10.1016/j.joca.2014.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/26/2014] [Accepted: 08/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the thickness of cartilage at the posterior aspect of the medial and lateral condyle in Osteoarthritis (OA) knees compared to non-OA knees using computed tomography arthrography (CTA). DESIGN 535 consecutive knee CTAs (mean patient age = 48.7 ± 16.0; 286 males), were retrospectively analyzed. Knees were radiographically classified into OA or non-OA knees according to a modified Kellgren/Lawrence (K/L) grading scheme. Cartilage thickness at the posterior aspect of the medial and lateral femoral condyles was measured on sagittal reformations, and compared between matched OA and non-OA knees in the whole sample population and in subgroups defined by gender and age. RESULTS The cartilage of the posterior aspect of medial condyle was statistically significantly thicker in OA knees (2.43 mm (95% confidence interval (CI) = 2.36, 2.51)) compared to non-OA knees (2.13 mm (95%CI = 2.02, 2.17)) in the entire sample population (P < 0.001), as well as for all subgroups of patients over 40 years old (all P ≤ 0.01), except for females above 60 years old (P = 0.07). Increase in cartilage thickness at the posterior aspect of the medial condyle was associated with increasing K/L grade in the entire sample population, as well as for males and females separately (regression coefficient = 0.10-0.12, all P < 0.001). For the lateral condyle, there was no statistically significant association between cartilage thickness and OA (either presence of OA or K/L grade). CONCLUSIONS Cartilage thickness at the non-weight-bearing posterior aspect of the medial condyle, but not of the lateral condyle, was increased in OA knees compared to non-OA knees. Furthermore, cartilage thickness at the posterior aspect of the medial condyle increased with increasing K/L grade.
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Affiliation(s)
- P Omoumi
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - N Michoux
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
| | - F W Roemer
- Department of Radiology, Klinikum Augsburg, Augsburg, Germany
| | - E Thienpont
- Department of Orthopedic Surgery, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
| | - B C Vande Berg
- Department of Radiology, Cliniques Universitaires St Luc - UC Louvain, Hippocrate Avenue 10/2942, B-1200 Brussels, Belgium
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Han W, Cai S, Liu Z, Jin X, Wang X, Antony B, Cao Y, Aitken D, Cicuttini F, Jones G, Ding C. Infrapatellar fat pad in the knee: is local fat good or bad for knee osteoarthritis? Arthritis Res Ther 2014; 16:R145. [PMID: 25008048 PMCID: PMC4227074 DOI: 10.1186/ar4607] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 06/25/2014] [Indexed: 12/30/2022] Open
Abstract
Introduction Recent studies regarding the infrapatellar fat pad (IPFP) mainly focus on the roles of the cells derived from the IPFP. There have been few clinical or epidemiological studies reporting on the association between the IPFP and knee osteoarthritis (OA). Our objective is to generate hypotheses regarding the associations between IPFP maximum area and knee OA measures in older adults. Methods A total of 977 subjects between 50 and 80 years of age (mean, 62.4 years) participated in the study. Radiographic knee osteophyte and joint space narrowing (JSN) were assessed using the Osteoarthritis Research Society International atlas. T1- or T2-weighted fat suppressed magnetic resonance imaging (MRI) was utilized to assess IPFP maximum area, cartilage volume, cartilage defects, and bone marrow lesions (BMLs). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire. Results After adjustment for potential confounders, IPFP maximum area was significantly associated with joint space narrowing (odds ratio (OR): 0.75, 95% confidence interval (CI): 0.62 to 0.91 (medial), 0.77, 95% CI: 0.62 to 0.96 (lateral)) and medial osteophytes (OR: 0.52, 95% CI: 0.35 to 0.76), knee tibial and patellar cartilage volume (β: 56.9 to 164.9 mm3/cm2, all P <0.001), tibial cartilage defects (OR: 0.58, 95% CI: 0.41 to 0.81 (medial), 0.53, 95% CI: 0.40-0.71 (lateral)), any BMLs (OR: 0.77, 95% CI: 0.63 to 0.94), and knee pain on a flat surface (OR: 0.79, 95% CI: 0.63 to 0.98). IPFP maximum area was negatively, but not significantly, associated with femoral cartilage defects, lateral tibiofemoral BMLs, and total knee pain or other knee pain subscales. Conclusion IPFP maximum area is beneficially associated with radiographic OA, MRI structural pathology and knee pain on a flat surface suggesting a protective role for IPFP possibly through shock absorption. Consequently, we must pay special attention to IPFP in the clinical settings, avoiding resection of normal IPFP in knee surgery.
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Pan F, Han W, Wang X, Liu Z, Jin X, Antony B, Cicuttini F, Jones G, Ding C. A longitudinal study of the association between infrapatellar fat pad maximal area and changes in knee symptoms and structure in older adults. Ann Rheum Dis 2014; 74:1818-24. [PMID: 24833783 DOI: 10.1136/annrheumdis-2013-205108] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/16/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The infrapatellar fat pad (IPFP) is of uncertain significance for knee osteoarthritis. The aim of this study was to describe the longitudinal associations between baseline IPFP maximal area and changes in knee pain, knee cartilage volume and cartilage defects in older adults. METHODS 356 community-dwelling male and female adults aged 50-80 years were measured at baseline and approximately 2.6 years later. T1-weighted or T2-weighted fat-suppressed MRI was used to assess maximal IPFP area, cartilage volume and cartilage defects at baseline and/or follow-up. Knee pain was assessed by the self-administered Western Ontario McMaster Osteoarthritis Index questionnaire. RESULTS After adjustment for confounders, IPFP maximal area in women was significantly and negatively associated with changes in knee pain (β: -0.18 to -0.86 for total knee pain, pain at night while in bed, pain when sitting/lying and pain when standing upright, all p<0.05) but not with other knee pain subscales. IPFP maximal area in women was beneficially associated with change in tibial cartilage volume per annum (β: +1.56% per cm(2) at medial site; +0.86% per cm(2) at lateral site, both p<0.05), but not with change in patellar cartilage volume. Further, it was significantly associated with reduced risks of increases in medial cartilage defects (relative risk: 0·46 at tibial site, relative risk: 0.59 at femoral site; both p<0.05) but not with increases at other sites in women. No significant associations were found in men. CONCLUSIONS While the associations are not fully consistent, IPFP maximal area appears to have a protective role for knee symptoms and cartilage damage in older female adults.
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Affiliation(s)
- Faming Pan
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Weiyu Han
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xia Wang
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Zhenhua Liu
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xingzhong Jin
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Benny Antony
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Graeme Jones
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Changhai Ding
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Cartilage signal intensity on T1-weighted MRI: association with risk factors and measures of knee osteoarthritis. Clin Rheumatol 2013; 33:359-68. [DOI: 10.1007/s10067-013-2447-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
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Filardo G, Kon E, Andriolo L, Vannini F, Buda R, Ferruzzi A, Giannini S, Marcacci M. Does patient sex influence cartilage surgery outcome? Analysis of results at 5-year follow-up in a large cohort of patients treated with Matrix-assisted autologous chondrocyte transplantation. Am J Sports Med 2013; 41:1827-34. [PMID: 23857885 DOI: 10.1177/0363546513480780] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sexual dimorphism in humans has already been documented at different levels, and preliminary findings also suggest the importance of patient sex on clinical outcome in the treatment of cartilage lesions. PURPOSE To document and analyze the influence of sex on clinical outcome in a large cohort of patients treated with a cartilage regenerative procedure for knee chondral lesions and prospectively followed at midterm follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 250 knees were treated with matrix-assisted autologous chondrocyte transplantation (MACT) and prospectively evaluated with International Knee Documentation Committee (IKDC), EuroQol visual analog scale (EQ-VAS), and Tegner scores at 1-, 2-, and minimum 5-year follow-ups to compare results obtained in men and women. The lesions were focal International Cartilage Repair Society grade III-IV chondral knee defects involving femoral condyles, trochleae, and patellae. Two homogeneous groups of 56 male patients and 56 female patients were then selected by a blinded statistician for a matched-pair analysis. RESULTS A statistically significant improvement in all the scores in both men and women was observed in the general population. The IKDC subjective score showed better results for men at all follow-up times: at 5 years, the mean IKDC subjective score was 79.5 ± 18.6 versus 64.3 ± 20.2 for men and women, respectively (P < .0005), and the same trend was confirmed with the EQ-VAS and Tegner scores. The matched-pair analysis confirmed the difference of final results achieved (74.1 ± 19.8 vs 63.7 ± 20.2, respectively; P = .006). However, men and women started with different preoperative levels, and the analysis of the improvement obtained was not significantly different. Finally, when scores were standardized for each patient, according to the mean score typical for the corresponding age and sex category in a healthy population, a sex-related difference was not confirmed at any of the follow-ups. Etiological factors, lesion site, and preinjury activity level differed in women and men of the general population and were the confounding factors responsible for the different outcome not confirmed by the analysis of homogeneous cohorts of patients. CONCLUSION Women have a different knee chondral lesion pattern and more often have unfavorable conditions related to the cause of injury, site, and activity level, and they also have lower raw, not standardized, scores. However, a matched-pair analysis with data standardized for the specific patient categories showed that, on equal terms, women have the same possibilities for successful outcome as men after surgical treatment for knee cartilage regeneration.
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Affiliation(s)
- Giuseppe Filardo
- Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136 Bologna, Italy.
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Carlos KP, Belli BDS, Alfredo PP. Efeito do ultrassom pulsado e do ultrassom contínuo associado a exercícios em pacientes com osteoartrite de joelho: estudo piloto. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000300014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A osteoartrite (OA) é uma doença crônica associada à morbidade significante. O objetivo deste estudo foi comparar o exercício isolado ao ultrassom pulsado (USP) e contínuo (USC) associados a exercício na redução da dor, melhora da amplitude de movimento (ADM), força muscular (FM), qualidade de vida (QV) e funcionalidade de pacientes com OA de joelhos. Trinta indivíduos, 50 a 75 anos, OA grau 2-4, foram randomizados: Grupo USC (USC + exercícios), Grupo USP (USP + exercícios) e Grupo EXE (exercícios). Os grupos foram avaliados antes e após o tratamento. A intervenção foi realizada três vezes por semana durante oito semanas: nas quatro primeiras foi aplicado USC ou USP e, nas demais foram realizados os exercícios. O Grupo EXE realizou exercícios durante oito semanas. Para análises intragrupos, utilizou-se o teste de Wilcoxon e, intergrupos, o teste de Kruskall-Walis. Na comparação intragrupos, o Grupo USC apresentou melhora significativa (p<0,05) nas variáveis da Western Ontario and McMaster Universities Osteoarthritis (WOMAC) dor, função e escore total; o Grupo USP na dor repouso, ADM, FM e nas variáveis da WOMAC dor, função e escore total; já, o Grupo EXE na mobilidade e ADM. Na comparação intergrupos, o Grupo USC apresentou melhora significativa (p<0,05) quando comparado aos demais grupos na dor repouso, ADM, escores função e total da WOMAC e o Grupo EXE na dor da WOMAC. A associação do USC a exercícios foi mais efetiva na melhora da dor, ADM, função e QV em pacientes com OA de joelho.
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Wang Y, Wluka AE, Jones G, Ding C, Cicuttini FM. Use magnetic resonance imaging to assess articular cartilage. Ther Adv Musculoskelet Dis 2012; 4:77-97. [PMID: 22870497 PMCID: PMC3383521 DOI: 10.1177/1759720x11431005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) enables a noninvasive, three-dimensional assessment of the entire joint, simultaneously allowing the direct visualization of articular cartilage. Thus, MRI has become the imaging modality of choice in both clinical and research settings of musculoskeletal diseases, particular for osteoarthritis (OA). Although radiography, the current gold standard for the assessment of OA, has had recent significant technical advances, radiographic methods have significant limitations when used to measure disease progression. MRI allows accurate and reliable assessment of articular cartilage which is sensitive to change, providing the opportunity to better examine and understand preclinical and very subtle early abnormalities in articular cartilage, prior to the onset of radiographic disease. MRI enables quantitative (cartilage volume and thickness) and semiquantitative assessment of articular cartilage morphology, and quantitative assessment of cartilage matrix composition. Cartilage volume and defects have demonstrated adequate validity, accuracy, reliability and sensitivity to change. They are correlated to radiographic changes and clinical outcomes such as pain and joint replacement. Measures of cartilage matrix composition show promise as they seem to relate to cartilage morphology and symptoms. MRI-derived cartilage measurements provide a useful tool for exploring the effect of modifiable factors on articular cartilage prior to clinical disease and identifying the potential preventive strategies. MRI represents a useful approach to monitoring the natural history of OA and evaluating the effect of therapeutic agents. MRI assessment of articular cartilage has tremendous potential for large-scale epidemiological studies of OA progression, and for clinical trials of treatment response to disease-modifying OA drugs.
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Abstract
BACKGROUND Gender-specific differences in knee and hip anatomy have been well documented. Although it has been accepted these differences exist, there is controversy regarding if and how these differences should be addressed with gender-specific implant designs. QUESTIONS/PURPOSES (1) What are the anatomic and morphologic differences, if any, in the knee and hip between men and women? (2) Do gender-specific TKA designs provide better clinical functioning, survivorship, and improved fit in women? (3) How have anatomic differences in the hip been addressed, if at all, by THA? METHODS We conducted a systematic review of the MEDLINE database to identify all articles reviewing basic science and clinical outcomes of gender-specific total knee and total hip implants. From these, we reviewed 253 studies. RESULTS The anatomic studies elucidated multiple differences in the anatomy of knees and hips between men and women. All reviewed studies report similar clinical function and satisfaction scores between men and women for gender-specific TKA and no improvement in these scores when comparing gender-specific TKA to unisex TKA. Current modularity in THA appears to accommodate any anatomic differences in the hip. CONCLUSIONS Based on the available literature, there is no difference in the outcome of patients with a gender-specific knee arthroplasty versus a unisex arthroplasty. It does not appear gender-specific THAs would provide any benefit over current systems.
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Affiliation(s)
- Aaron J. Johnson
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Christopher R. Costa
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Michael A. Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
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