1
|
Wu W, Kang Z, Mu D, Zhao H, Yang F. T2 mapping for quantitative assessment of ankle cartilage of weightlifters. Sci Rep 2023; 13:19160. [PMID: 37932324 PMCID: PMC10628267 DOI: 10.1038/s41598-023-46259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
The research into the prevention of sports injuries among the population, particularly juveniles, has become crucial due to the increasing participation in physical exercises like fitness. To assess the difference in T2 values of ankle talar cartilage between weightlifters and healthy volunteers using quantitative magnetic resonance imaging (MRI) technique T2 mapping. Study design: Prospective. Prospective evaluation of T2 values of ankle cartilage of 50 weightlifters (30 adults and 20 juveniles) and 100 healthy volunteers (80 adults and 20 juveniles) using Siemens 3.0 T MRI with PDWI, T1WI, and T2 mapping sequences. Three physicians manually divided the talar cartilage of the ankle joint into six regions of interest. Three physicians utilized the anterior and posterior cut edges of the tibial cartilage as markers to identify the corresponding anterior and posterior cut edges of the talar cartilage on the sagittal MRI images. The medial and lateral sides were defined as half of the talar articular surface on the coronal plane. Differences in T2 values in each cartilage region were compared using independent sample T test or Mann-Whitney U test. The T2 values of talar cartilage were significantly increased in the athlete group relative to the volunteer group (35.11 and 31.99, P < 0.001), with the most significant difference observed in the juvenile athlete group compared to the volunteer group (34.42 and 28.73, P < 0.001). There was a significant difference in the T2 value of ankle talar cartilage between weightlifters and healthy volunteers, and juveniles may be more vulnerable to overuse sports injuries. This study contributes to understanding the cartilage health of juvenile athletes and the prevention of sports injuries.
Collapse
Affiliation(s)
- Weibiao Wu
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China
| | - Zhuanzhuan Kang
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China
| | - Di Mu
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China
| | - Huiyu Zhao
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China
| | - Feng Yang
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China.
| |
Collapse
|
2
|
Baker ME, Kershaw LE, Carstens A, Daniel CR, Brown H, Roberts S, Taylor SE. T2 mapping of cartilage in the equine distal interphalangeal joint with corresponding histology using 0.27 T and 3.0 T magnetic resonance imaging. Equine Vet J 2023; 55:843-852. [PMID: 36397209 DOI: 10.1111/evj.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/10/2022] [Indexed: 08/09/2023]
Abstract
BACKGROUND Low-field magnetic resonance imaging (MRI) is widely available to equine veterinarians yet is insensitive at detecting cartilage damage in the distal interphalangeal joint (DIPJ). T2 mapping is a quantitative imaging technique that can detect cartilage damage before morphological change is apparent. OBJECTIVES Validation of a T2 mapping sequence on a low-field MR system. Correlation of the mean T2 relaxation time in sections of cartilage with varying levels of pathology using low- and high-field MRI. STUDY DESIGN Cross-sectional study. METHODS Eight phantoms with known (nominal) T2 values underwent low-field (0.27 T) MRI and 38 ex vivo DIPJs were imaged. A further 9 ex vivo DIPJs were imaged on both the low- and high-field MR systems. Immediately after imaging, the DIPJs were disarticulated and samples collected for histology. Histological sections were graded using the Osteoarthritis Research Society International (OARSI) scoring system. Fiji ImageJ software with the MRIAnalysisPak plugin was used to calculate T2 maps and draw the regions of interest (ROIs). RESULTS There was close agreement between the nominal and the measured T2 values in the phantom study. Spearman's rank correlation demonstrated significant positive correlation between low- and high-field T2 measurements, rho 0.644 (p < 0.001). The intrarater agreement for T2 measurements was excellent, intraclass correlation coefficient (ICC) = 0.99 (95% confidence interval [CI] = 0.99-1.00), the inter-rater agreement was excellent, ICC = 0.88 (95% CI = 0.82-0.92) and there was good intrarater agreement for OARSI scores (к = 0.76). MAIN LIMITATIONS Only a small number of histological samples were analysed. Both articular cartilage surfaces were measured within the ROI. There were no OARSI grade 0 control samples. CONCLUSIONS A T2 mapping sequence on a low-field 0.27 T MR system was validated. There was a positive correlation between low- and high-field T2 measurements. The findings suggest a higher mean T2 relaxation time in pathological cartilage tissue examined in this study compared to normal equine cartilage tissue.
Collapse
Affiliation(s)
- Melissa Eve Baker
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - Lucy Elizabeth Kershaw
- Edinburgh Imaging and Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Ann Carstens
- School of Animal, Environmental and Veterinary Sciences, Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Carola Riccarda Daniel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - Helen Brown
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - Steve Roberts
- Hallmarq Veterinary Imaging Ltd, Guildford, Surrey, UK
| | - Sarah Elizabeth Taylor
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Midlothian, UK
| |
Collapse
|
3
|
Cao G, Gao S, Xiong B. Application of quantitative T1, T2 and T2* mapping magnetic resonance imaging in cartilage degeneration of the shoulder joint. Sci Rep 2023; 13:4558. [PMID: 36941288 PMCID: PMC10027866 DOI: 10.1038/s41598-023-31644-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
To investigate and compare the values of 3.0 T MRI T1, T2 and T2* mapping quantification techniques in evaluating cartilage degeneration of the shoulder joint. This study included 123 shoulder joints of 119 patients, which were scanned in 3.0 T MRI with axial Fat Suppression Proton Density Weighted Image (FS-PDWI), sagittal fat suppression T2 Weighted Image (FS-T2WI), coronal T1Weighted Image (T1WI), FS-PDWI, cartilage-specific T1, T2 and T2* mapping sequences. Basing on MRI images, the shoulder cartilage was classified into grades 0 1, 2, 3 and 4 according to the International Cartilage Regeneration & Joint Preservation Society (ICRS). The grading of shoulder cartilage was based on MRI images with ICRS as reference, and did not involve arthroscopy or histology.The T1, T2 and T2* relaxation values in the superior, middle and inferior bands of shoulder articular cartilage were measured at all grades, and the differences in various indicators between groups were analyzed and compared using a single-factor ANOVA test. The correlation between T1, T2 and T2* relaxation values and MRI-based grading was analyzed by SPSS software. There were 46 shoulder joints with MRI-based grade 0 in healthy control group (n = 46), while 49 and 28 shoulder joints with grade 1-2 (mild degeneration subgroup) and grade 3-4 (severe degeneration subgroup) in patient group (n = 73), accounting for 63.6% and 36.4%, respectively. The T1, T2 and T2* relaxation values of the superior, middle and inferior bands of shoulder articular cartilage were significantly and positively correlated with the MRI-based grading (P < 0.01). MRI-basedgrading of shoulder cartilage was markedly associated with age (r = 0.766, P < 0.01). With the aggravation of cartilage degeneration, T1, T2 and T2* relaxation values showed an upward trend (all P < 0.01), and T1, T2 and T2* mapping could distinguish cartilage degeneration at all levels (all P < 0.01). The T1, T2 and T2* relaxation values were significantly different between normal group and mild degeneration subgroup, normal group and severe degeneration subgroup, mild degeneration subgroup and severe degeneration subgroup (all P < 0.05). Quantitative T1, T2 and T2* mapping can quantify the degree of shoulder cartilage degeneration. All these MRI mapping quantification techniques can be used as critical supplementary sequences to assess shoulder cartilage degeneration, among which T2 mapping has the highest value.
Collapse
Affiliation(s)
- Guijuan Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, 430022, Wuhan, Hubei, China
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shubo Gao
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, 430022, Wuhan, Hubei, China.
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
4
|
Han QX, Tong Y, Zhang L, Sun J, Ma J, Liu X, Zhang S, Jiang B, Li Y. Comparative efficacy of osteochondral autologous transplantation and microfracture in the knee: an updated meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2023; 143:317-328. [PMID: 34304280 DOI: 10.1007/s00402-021-04075-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/12/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION More than 19% of patients undergoing knee arthroscopies suffers from articular cartilage defects. The chondral or osteochondral lesion has negative impacts on the knee joints function and the life quality of patients. However, the treatment remains challenging as hyaline cartilage is not renewable. The purpose of this study was to systematically analyze the data of randomized controlled trials for comparing the postoperative outcomes between osteochondral autologous transplantation (OAT) and microfracture (MF) procedure. We hypothesized that the outcomes were better in OAT than MF procedure. MATERIALS AND METHODS A systematic literature search of the EMBASE, Pubmed, and Cochrane Library databases was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The outcome measures include: the rate of excellent or good results, the rate of return to sports, the failure rate, osteoarthritis rate, International Cartilage Repair Society (ICRS) score, Lysholm Knee Score, and Tegner scale. The statistical analysis was completed using Review Manager (RevMan, version 5.3) software. RESULTS The systematic search identified 7 studies with a total of 346 patients. The pooled result showed significant differences between the two groups in the rate of return to sports and failure. The following outcome scores showed significant improvement (pre- vs postoperatively): Lysholm score (p = 0.02), Tegner scale (p < 0.00001), and ICRS score (p < 0.00001). The differences were not significant in the excellent or good results and the rate of osteoarthritis. CONCLUSION The patients in OAT group may return to play quicker, even return to pre-injury level of activity compared to the MF group. OAT is better than MF procedure in accordance with Lysholm score, Tegner score, ICRS score, and the rate of failure. However, few studies have reported long-term outcomes and there has no uniform criteria for safe return to sports. Further research is needed. LEVEL OF EVIDENCE Level II, meta-analysis of randomized controlled trials.
Collapse
Affiliation(s)
- Qing-Xin Han
- Department of Arthroscopy and Sports Medicine, China Academy of Chinese Medical Sciences, Wangjing Hospital, Beijing, 100102, China.,Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yi Tong
- School of Humanities, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Lei Zhang
- Department of Arthroscopy and Sports Medicine, China Academy of Chinese Medical Sciences, Wangjing Hospital, Beijing, 100102, China.
| | - Jin Sun
- Department of Arthroscopy and Sports Medicine, China Academy of Chinese Medical Sciences, Wangjing Hospital, Beijing, 100102, China
| | - Jia Ma
- Department of Arthroscopy and Sports Medicine, China Academy of Chinese Medical Sciences, Wangjing Hospital, Beijing, 100102, China
| | - Xiaohua Liu
- Department of Arthroscopy and Sports Medicine, China Academy of Chinese Medical Sciences, Wangjing Hospital, Beijing, 100102, China
| | - Sheng Zhang
- Department of Arthroscopy and Sports Medicine, China Academy of Chinese Medical Sciences, Wangjing Hospital, Beijing, 100102, China
| | - Bo Jiang
- Department of Arthroscopy and Sports Medicine, China Academy of Chinese Medical Sciences, Wangjing Hospital, Beijing, 100102, China
| | - Yan Li
- Department of Arthroscopy and Sports Medicine, China Academy of Chinese Medical Sciences, Wangjing Hospital, Beijing, 100102, China
| |
Collapse
|
5
|
Ewertowski NP, Schleich C, Abrar DB, Hosalkar HS, Bittersohl B. Automated measurement of alpha angle on 3D-magnetic resonance imaging in femoroacetabular impingement hips: a pilot study. J Orthop Surg Res 2022; 17:370. [PMID: 35907886 PMCID: PMC9338591 DOI: 10.1186/s13018-022-03256-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) syndrome is an established pre-osteoarthritic condition. Diagnosis is based on both clinical and radiographic parameters. An abnormal manually calculated alpha angle in magnetic resonance imaging (MRI) is traditionally utilized to diagnose abnormal femoral head-neck offset. This pilot study aimed to assess the feasibility of automated alpha angle measurements in patients with FAI syndrome, and to compare automated with manual measurements data with regard to the time and effort needed in each method. METHODS Alpha angles were measured with manual and automated techniques, using postprocessing software in nineteen hip MRIs of FAI syndrome patients. Two observers conducted manual measurements. Intra- and inter-observer reproducibility and correlation of manual and automated alpha angle measurements were calculated using intra-class correlation (ICC) analysis. Both techniques were compared regarding the time taken (in minutes) and effort required, measured as the amount of mouse button presses performed. RESULTS The first observer's intra-observer reproducibility was good (ICC 0.77; p < 0.001) while the second observer's was good-to-excellent (ICC 0.93; p < 0.001). Inter-observer reproducibility between both observers in the first (ICC 0.45; p < 0.001) and second (ICC 0.56; p < 0.001) manual alpha angle assessment was moderate. The intra-class correlation coefficients between manual and automated alpha angle measurements were ICC = 0.24 (p = 0.052; observer 1, 1st measurement), ICC = 0.32 (p = 0.015; observer 1, 2nd measurement), ICC = 0.50 (p < 0.001; observer 2, 1st measurement), and ICC = 0.45 (p < 0.001; observer 2, 2nd measurement). Average runtime for automatic processing of the image data for the automated assessment was 16.6 ± 1.9 min. Automatic alpha angle measurements took longer (time difference: 14.6 ± 3.9 min; p < 0.001) but required less effort (difference in button presses: 231 ± 23; p < 0.001). While the automatic processing is running, the user can perform other tasks. CONCLUSIONS This pilot study demonstrates that objective and reliable automated alpha angle measurement of MRIs in FAI syndrome hips is feasible. Trial registration The Ethics Committee of the University of Düsseldorf approved our study (Registry-ID: 2017084398).
Collapse
Affiliation(s)
- Nastassja Pamela Ewertowski
- Department for Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Harish S Hosalkar
- Paradise Valley Hospital, San Diego, CA, USA.,Tri-City Medical Center, Oceanside, CA, USA.,Sharp Grossmont Hospital, La Mesa, CA, USA.,Scripps Hospital, San Diego, CA, USA
| | - Bernd Bittersohl
- Department for Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
| |
Collapse
|
6
|
Lindner D, Chechik Y, Beer Y, Tal S, Lysyy O, Blumenfeld-Katzir T, Ben-Eliezer N, Agar G. T2 Mapping Values in Postmeniscectomy Knee Articular Cartilage after Running: Early Signs of Osteoarthritis? J Knee Surg 2022; 35:739-749. [PMID: 33111272 DOI: 10.1055/s-0040-1718596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Loading on the joints during running may have a deleterious effect on post-partial meniscectomy knee cartilage, leading to osteoarthritis. Utilizing T2-mapping measurements before and after running may enable the observation of changes in the articular cartilage of the postmeniscectomy knees compared with healthy knees. After medial partial meniscectomy, 12 volunteers underwent magnetic resonance imaging (MRI) of the both knees, before and immediately after 30 minutes of running. Quantitative assessment of articular cartilage was performed using a T2-mapping technique. In the medial compartment of the operated knees, significantly lower T2 values were found in anterior tibial plateau (pre- vs. postrun: 33.85 vs. 30.45 ms; p = 0.003) and central tibial plateau (33.33 vs. 30.63 ms; p = 0.007). Similar differences were found in lateral regions of central femur (post- vs. prerun: 35.86 vs. 40.35 ms; p = 0.015), posterior femur (34.89 vs. 37.73 ms; p = 0.001), and anterior tibia (24.66 vs. 28.70 ms, p = 0.0004). In lateral compartment, postrun values were significantly lower in operated compared with healthy knees, in central femur (34.89 vs. 37.59 ms; p = 0.043), posterior femoral (36.88 vs. 39.36 ms; p = 0.017), anterior tibia (24.66 vs. 30.20 ms; p = 0.009), and posterior tibia (28.84 vs. 33.17 ms; p = 0.006). No statistical difference was found while comparing postrun to prerun healthy knees. Lower T2 values were found in operated knees after 30 minutes of running. These changes were seen in medial and lateral compartments. We suspect that running may subject the articular cartilage to excessive loads in the post-partial meniscectomy knee, loads that in healthy knee do not cause any changes.
Collapse
Affiliation(s)
- Dror Lindner
- Department of Orthopedics, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yigal Chechik
- Department of Orthopedics, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftah Beer
- Department of Orthopedics, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Tal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Shamir Medical Center, Zerifin, Israel
| | - Oleg Lysyy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Shamir Medical Center, Zerifin, Israel
| | | | - Noam Ben-Eliezer
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - Gabriel Agar
- Department of Orthopedics, Shamir Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Song Y, Jorgensen C. Mesenchymal Stromal Cells in Osteoarthritis: Evidence for Structural Benefit and Cartilage Repair. Biomedicines 2022; 10:biomedicines10061278. [PMID: 35740299 PMCID: PMC9219878 DOI: 10.3390/biomedicines10061278] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 12/15/2022] Open
Abstract
Osteoarthritis (OA) presents a major clinical challenge to rheumatologists and orthopedists due to the lack of available drugs reducing structural degradation. Mesenchymal stromal cells (MSCs) may represent new therapeutic approaches in cartilage regeneration. In this review, we highlight the latest knowledge on the biological properties of MSC, such as their chondrogenic and immunomodulatory potential, and we give a brief overview of the effects of MSCs in preclinical and clinical studies of OA treatment and also compare different MSC sources, with the adipose tissue-derived MSCs being promising. Then, we focus on their structural benefit in treating OA and summarize the current evidence for the assessment of cartilage in OA according to magnetic resonance imaging (MRI) and second-look arthroscopy after MSC therapy. Finally, this review provides a brief perspective on enhancing the activity of MSCs.
Collapse
|
8
|
Schreiner MM, Raudner M, Szomolanyi P, Ohel K, Ben-Zur L, Juras V, Mlynarik V, Windhager R, Trattnig S. Chondral and Osteochondral Femoral Cartilage Lesions Treated with GelrinC: Significant Improvement of Radiological Outcome Over Time and Zonal Variation of the Repair Tissue Based on T 2 Mapping at 24 Months. Cartilage 2021; 13:604S-616S. [PMID: 32493044 PMCID: PMC8725372 DOI: 10.1177/1947603520926702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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 To prospectively assess the efficacy of GelrinC in the treatment of chondral and osteochondral femoral cartilage lesions using morphological (Magnetic Resonance Observation of Cartilage Repair Tissue [MOCART]) and quantitative (T2-mapping) magnetic resonance imaging (MRI). DESIGN This study was designed as a prospective single-arm, open label, multicenter study. Morphological magnetic resonance imaging (MRI) for MOCART assessment and T2 mapping was performed 1 week and 6, 12, 18, and 24 months after GelrinC implantation. Evaluation of T2 mapping was based on the assessment of global T2 indices (T2 of the repair tissue [RT] divided by T2 of healthy reference cartilage) and zonal variation. RESULTS Fifty-six (20 female) patients were prospectively enrolled. The mean MOCART score significantly increased from baseline to the 24-month follow-up with 88.8 (95% CI, 85.8-91.9; P < 0.001) for all lesions combined as well as 86.8 (95% CI, 83.0-90.6) for chondral lesions and 94.1 (95% CI, 68.55-100) for osteochondral lesions. Furthermore, based on T2 mapping, significant zonal variation of the RT was observed at 24 months (P = 0.039), which did not differ significantly from healthy reference cartilage (P = 0.6). CONCLUSION Increasing MOCART scores were observed throughout the follow-up period, indicative of maturation of the cartilage repair. Significant zonal variation of the RT at 24 months might indicate the transformation into hyaline cartilage-like RT. Slightly differing morphological outcome between chondral and osteochondral lesions, but similar global and zonal T2 indices at 24 months, support the potential of GelrinC as a treatment option for both lesion types.
Collapse
Affiliation(s)
- Markus M. Schreiner
- Department of Orthopedics and Trauma
Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcus Raudner
- High Field MR Center, Department of
Biomedical Imaging and Image-Guided Therapy, CD Laboratory for Clinical Molecular MR
Imaging, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of
Biomedical Imaging and Image-Guided Therapy, CD Laboratory for Clinical Molecular MR
Imaging, Medical University of Vienna, Vienna, Austria
| | - Kitty Ohel
- Regentis Biomaterials Ltd., Or Akiva,
Israel
| | | | - Vladimir Juras
- High Field MR Center, Department of
Biomedical Imaging and Image-Guided Therapy, CD Laboratory for Clinical Molecular MR
Imaging, Medical University of Vienna, Vienna, Austria
| | - Vladimir Mlynarik
- High Field MR Center, Department of
Biomedical Imaging and Image-Guided Therapy, CD Laboratory for Clinical Molecular MR
Imaging, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma
Surgery, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- High Field MR Center, Department of
Biomedical Imaging and Image-Guided Therapy, CD Laboratory for Clinical Molecular MR
Imaging, Medical University of Vienna, Vienna, Austria,Siegfried Trattnig, High Field MR Centre,
Department of Biomedical Imaging and Image-Guided Therapy, CD Laboratory for
Clinical Molecular MR Imaging, Medical University of Vienna, Waehringer Guertel
18-20, Vienna, 1090 Vienna, Austria.
| |
Collapse
|
9
|
Shimomura K, Hamada H, Hart DA, Ando W, Nishii T, Trattnig S, Nehrer S, Nakamura N. Histological Analysis of Cartilage Defects Repaired with an Autologous Human Stem Cell Construct 48 Weeks Postimplantation Reveals Structural Details Not Detected by T2-Mapping MRI. Cartilage 2021; 13:694S-706S. [PMID: 33511856 PMCID: PMC8808920 DOI: 10.1177/1947603521989423] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to elucidate the efficacy of T2-mapping MRI and correlation with histology for the evaluation of tissue repair quality following the first-in-human implantation of an autologous tissue engineered construct. DESIGN We directly compared the results of T2-mapping MRI of cartilage repair tissue with the histology of a biopsy specimen from the corresponding area at 48 weeks postoperatively in 5 patients who underwent the implantation of a scaffold-free tissue-engineered construct generated from autologous synovial mesenchymal stem cells to repair an isolated cartilage lesion. T2 values and histological scores were compared at each of 2 layers of equally divided halves of the repair tissue (upper and lower zones). RESULTS Histology showed that the repair tissue in the upper zone was dominated by fibrous tissue and the ratio of hyaline-like matrix increased with the depth of the repair tissue. There were significant differences between upper and lower zones in histological scores. Conversely, there were no detectable statistically significant differences in T2 value detected among zones of the repair tissue, but zonal differences were detected in corresponding healthy cartilage. Accordingly, there were no correlations detected between histological scores and T2 values for each repair cartilage zone. CONCLUSION Discrepancies in the findings between T2 mapping and histology suggest that T2 mapping was limited in ability to detect details in the architecture and composition of the repair cartilage.
Collapse
Affiliation(s)
- Kazunori Shimomura
- Department of Orthopaedic Surgery, Osaka
University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical
Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - David A. Hart
- McCaig Institute for Bone & Joint
Health, University of Calgary, Calgary, Alberta, Canada
| | - Wataru Ando
- Department of Orthopaedic Medical
Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Nishii
- Department of Orthopaedic Surgery, Osaka
General Medical Center, Osaka, Japan
| | - Siegfried Trattnig
- High Field MR Center, Department of
Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna,
Austria,Christian Doppler Laboratory for
Clinical Molecular MR Imaging (MOLIMA), Department of Biomedical Imaging and
Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Nehrer
- Faculty of Health and Medicine,
Department for Health Sciences, Medicine and Research, Center for Regenerative
Medicine, Danube University Krems, Krems, Austria
| | - Norimasa Nakamura
- Department of Orthopaedic Surgery, Osaka
University Graduate School of Medicine, Osaka, Japan,Institute for Medical Science in Sports,
Osaka Health Science University, Osaka, Japan,Global Center for Medical Engineering
and Informatics, Osaka University, Osaka, Japan,Norimasa Nakamura, Institute for Medical
Science in Sports, Osaka Health Science University, 1-9-27, Tenma, Kita-ku,
Osaka City, Osaka, 530-0043, Japan.
| |
Collapse
|
10
|
Iida K, Hashimoto Y, Nishida Y, Yamasaki S, Nakamura H. Evaluation of regenerated cartilage using T2 mapping methods after opening-wedge high tibial osteotomy with microfracture at the cartilage defect: a preliminary study. J Exp Orthop 2021; 8:91. [PMID: 34655391 PMCID: PMC8520536 DOI: 10.1186/s40634-021-00413-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study evaluated the regenerated cartilage after opening-wedge high tibial osteotomy (OWHTO) with concomitant microfracture by second-look arthroscopy, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and magnetic resonance imaging (MRI) T2 mapping. It was hypothesised that cartilage regeneration can be achieved by HTO, but the quality of regenerated cartilage is not normal cartilage. METHODS OWHTO was performed in eight knees of seven patients (mean age, 57.6 ± 5.2 years). Microfracture for the cartilage defect was performed followed by OWHTO, and second-look arthroscopy was performed at the time of plate removal (14.1 ± 4.5 months after OWHTO). MRI was assessed at three months and one year after surgery. The status of articular cartilage regeneration was assessed by the ICRS grade, MOCART score and T2 value. RESULTS The number of subjects in ICRS grade 1/2/3/4 changed significantly from 0/0/4/4 preoperatively to 0/2/6/0 postoperatively in the medial femoral condyle (MFC) (P < 0.05) and 0/0/0/8 preoperatively to 0/0/7/1 postoperatively in the medial tibial plateau (MTP) (P < 0.05). Mean MOCART scores for MFC and MTP at one year after surgery exhibited significant increases compared with the results at three months after surgery. Mean T2 values for MFC and MTP did not differ at three months and one year after surgery. CONCLUSION The appearance and morphological evaluation by ICRS grade and MOCART score of regenerated cartilage were improved after OWHTO with concomitant microfracture. However, there were no significant qualitative differences in T2 values. This suggests that the regenerated cartilage tissue was likely to be insufficient cartilage. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Ken Iida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
11
|
Shoji T, Saka H, Inoue T, Kato Y, Fujiwara Y, Yamasaki T, Yasunaga Y, Adachi N. Preoperative T2 mapping MRI of articular cartilage values predicts postoperative osteoarthritis progression following rotational acetabular osteotomy. Bone Joint J 2021; 103-B:1472-1478. [PMID: 34465155 DOI: 10.1302/0301-620x.103b9.bjj-2021-0266.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Rotational acetabular osteotomy (RAO) has been reported to be effective in improving symptoms and preventing osteoarthritis (OA) progression in patients with mild to severe develomental dysplasia of the hip (DDH). However, some patients develop secondary OA even when the preoperative joint space is normal; determining who will progress to OA is difficult. We evaluated whether the preoperative cartilage condition may predict OA progression following surgery using T2 mapping MRI. METHODS We reviewed 61 hips with early-stage OA in 61 patients who underwent RAO for DDH. They underwent preoperative and five-year postoperative radiological analysis of the hip. Those with a joint space narrowing of more than 1 mm were considered to have 'OA progression'. Preoperative assessment of articular cartilage was also performed using 3T MRI with the T2 mapping technique. The region of interest was defined as the weightbearing portion of the acetabulum and femoral head. RESULTS There were 16 patients with postoperative OA progression. The T2 values of the centre to the anterolateral region of the acetabulum and femoral head in the OA progression cases were significantly higher than those in patients without OA progression. The preoperative T2 values in those regions were positively correlated with the narrowed joint space width. The receiver operating characteristic analysis revealed that the T2 value of the central portion in the acetabulum provided excellent discrimination, with OA progression patients having an area under the curve of 0.858. Furthermore, logistic regression analysis showed T2 values of the centre to the acetabulum's anterolateral portion as independent predictors of subsequent OA progression (p < 0.001). CONCLUSION This was the first study to evaluate the relationship between intra-articular degeneration using T2 mapping MRI and postoperative OA progression. Our findings suggest that preoperative T2 values of the hip can be better prognostic factors for OA progression than radiological measures following RAO. Cite this article: Bone Joint J 2021;103-B(9):1472-1478.
Collapse
Affiliation(s)
- Takeshi Shoji
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
12
|
Olivos Meza A, Cortés González S, Ferniza Garza JJ, Pérez Jiménez FJ, Enrique VC, Ibarra C. Arthroscopic Treatment of Patellar and Trochlear Cartilage Lesions with Matrix Encapsulated Chondrocyte Implantation versus Microfracture: Quantitative Assessment with MRI T2-Mapping and MOCART at 4-Year Follow-up. Cartilage 2021; 12:320-332. [PMID: 30943755 PMCID: PMC8236658 DOI: 10.1177/1947603519835909] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
METHODS Seventeen patients aged 18 to 55 years with symptomatic full-thickness cartilage lesions on either patella or trochlea were treated with matrix autologous chondrocyte implantation (MACI) or microfracture (MF). Both procedures combined with unloading/realigning techniques. Clinical assessment and T2-mapping were evaluated at 48-months. RESULTS Clinically results from pre-op to 48-months improved significantly in MACI and MF for Lysholm (p = 0.001, p = 0.001), IKDC-S (p = 0.001, p = 0.002), KOOS-P (p = 0.000, p = 0.002), KOOS-DLA (p = 0.002, p = 0.003), KOOS-Sports/Rec (p = 0.000, p = 0.004), KOOS-QoL (p = 0.000, p = 0.003), KOOS-symptoms (p = 0.001, p = 0.020), and Kujala (p = 0.000, p = 0.01), respectively. Tegner was significant between baseline and 48 months only for MACI (p < 0.008) compared with MF (p = 0.25). No significant difference was observed between groups for any score at 3, 12, 24, and 48-months (p > 0.05). T2-mapping values improved significantly over time in MACI compared with MF at 24 months (39.35 vs. 50.44, p = 0.007) and 48 months (36.54 vs. 48.37, p = 0.005). When comparing control values to MACI at 12-m (p = 0.714), 24-m (p = 0.175), and 48-m (p = 0.097), no significant difference was found. MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score comparison gave no statistical difference between groups. CONCLUSIONS Clinically both techniques improved significantly over time. However, quantitative assessment showed that only newly formed tissue with MACI technique improves significantly since 12-months and maintains stable values compared with native cartilage until 48-month follow-up. MF results were never comparable to those native values. Level of evidence II.
Collapse
Affiliation(s)
| | | | | | | | | | - Clemente Ibarra
- Instituto Nacional de Rehabilitacion, Mexico City, Mexico,Clemente Ibarra, Calzada Mexico Xochimilco 289, Mexico City 14389, Mexico.
| |
Collapse
|
13
|
DeFroda SF, ODonnell RM, Fadale PD, Owens BD, Fleming BC. The role of magnetic resonance imaging in evaluating postoperative ACL reconstruction healing and graft mechanical properties: a new criterion for return to play? PHYSICIAN SPORTSMED 2021; 49:123-129. [PMID: 32897799 PMCID: PMC8007665 DOI: 10.1080/00913847.2020.1820846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/02/2020] [Indexed: 01/13/2023]
Abstract
Background: Disruption of the anterior cruciate ligament (ACL) is a common injury. In active patients, it is routinely treated with ACL reconstruction surgery. Following reconstruction, one of the critical decisions that must be made is the optimal timing of return to sport. While many biomechanical, biological, and functional criteria have been proposed to determine return to play, these methods are limited at best.Reasoning: As criteria for return to play are multifactorial, there is a growing need for noninvasive technologies, such as magnetic resonance imaging (MRI), to objectively track graft healing, to better assess the graft itself. Measuring the changes in the strength of the healing ligament has been shown to be a reliable means of objectively documenting graft healing in preclinical studies. While the initial studies of MR-based modeling of ACL graft healing are promising, this technology is still in its infancy and requires optimization.Purpose: The goals of this review are: 1) to outline the shortcomings of current return to play criteria, 2) to highlight the ability of MRI to determine the status of ACL graft healing, and 3) to discuss the future of imaging technology to determine return to play and its potential role in the clinical evaluation of patientsConclusion: There continues to be a wide variabiltiy regarding adequate return to play criteria, most of which are subjective in nature.
Collapse
Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
| | - Ryan M ODonnell
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
| | - Paul D Fadale
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
| | - Brett D Owens
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, US
- School of Engineering, Brown University, Providence, RI, US
| |
Collapse
|
14
|
Dai X, Fang J, Wang S, Luo J, Xiong Y, Zhang M, Zhu S, Yu X. Short- to Midterm Clinical and Radiological Outcomes After Matrix-Associated Autologous Chondrocyte Implantation for Chondral Defects in Knees. Orthop J Sports Med 2021; 9:2325967120982139. [PMID: 33718499 PMCID: PMC7925944 DOI: 10.1177/2325967120982139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Matrix-associated autologous chondrocyte implantation (MACI) has been proven to provide favorable short-term results for chondral defects in knees. However, it remains unclear whether the clinical benefits of MACI persist in the longer term. Purpose: The purpose of this prospective study was to evaluate the clinical and radiological outcomes, at short- and midterm follow-up, for patients undergoing MACI for focal chondral defects of the knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 30 consecutive patients (31 knees) were treated using MACI between October 2010 and March 2018. There were 24 male patients and 6 female patients with an average age of 26 years (range, 12-48 years). The areas of the cartilage defect were consistently >2 cm2. All patients underwent MACI for a focal chondral defect of the femoral condyles or trochlea in the knee. These patients had been evaluated for up to 5 years, with an average follow-up of 44 months (range, 6-60 months) postoperatively. The International Knee Documentation Committee (IKDC) score, Lysholm score, and magnetic resonance imaging (MRI) with T2 mapping were used to assess the outcomes. Results: No patients were lost to follow-up. Mean IKDC scores improved from 58.6 (range, 40.2-80.5) to 79.1 (range, 39.1-94.3) at 12 months and up to 88.4 (range, 83.9-100) at 5 years; mean Lysholm scores improved from 67.3 (range, 46-95) to 90.6 (range, 71-100) at 12 months and up to 95.9 (range, 85-100) at 5 years. The MRI with T2 mapping value of the transplanted area was evaluated for 21 knees, which revealed no differences compared with the normal area at 12 months postoperatively. Conclusion: From the first year onward, the clinical outcome scores and MRI with T2 mapping values showed continuous and marked improvement, suggesting that MACI is a valid option for localized cartilage defects in the knee.
Collapse
Affiliation(s)
- Xuesong Dai
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China
| | - Jinghua Fang
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China
| | - Siheng Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China
| | - Jianyang Luo
- Department of Orthopaedic Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Yan Xiong
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China
| | - Miaofeng Zhang
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China
| | - Sunan Zhu
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China
| | - Xinning Yu
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China
| |
Collapse
|
15
|
Yang BW, Brusalis CM, Fabricant PD, Greditzer HG. Articular Cartilage Repair in the Knee: Postoperative Imaging. J Knee Surg 2021; 34:2-10. [PMID: 32898909 DOI: 10.1055/s-0040-1716357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diagnostic and therapeutic advancements have improved clinical outcomes for patients with focal chondral injuries of the knee. An increased number and complexity of surgical treatment options have, in turn, resulted in a commensurate proliferation of patients requiring postoperative evaluation and management. In addition to patient-reported clinical outcomes, magnetic resonance imaging (MRI) offers clinicians with noninvasive, objective data to assist with postoperative clinical decision making. However, successful MRI interpretation in this setting is clinically challenging; it relies upon an understanding of the evolving and procedure-specific nature of normal postoperative imaging. Moreover, further research is required to better elucidate the correlation between MRI findings and long-term clinical outcomes. This article focuses on how specific morphologic features identified on MRI can be utilized to evaluate patients following the most commonly performed cartilage repair surgeries of the knee.
Collapse
Affiliation(s)
- Brian W Yang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Peter D Fabricant
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Harry G Greditzer
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| |
Collapse
|
16
|
Dong X, Li C, Liu J, Huang P, Jiang G, Zhang M, Zhang W, Zhang X. The effect of running on knee joint cartilage: A systematic review and meta-analysis. Phys Ther Sport 2020; 47:147-155. [PMID: 33279802 DOI: 10.1016/j.ptsp.2020.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Although running causes inevitable stress to the joints, data regarding its effect on the cartilage of the knee are conflicting. This systematic review and meta-analysis aimed to evaluate the effect of running on knee joint cartilage. METHODS PubMed, EMBASE, SportDiscus, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) and cohort studies. The outcome indicators were cartilage oligomeric matrix protein (COMP), cartilage volume and thickness, and T2. RESULTS A total of two RCTs and 13 cohort studies were included. There was no significant difference in cartilage volume between the running and control groups (MD, -115.88 U/I; 95% CI, -320.03 to 88.27; p = 0.27). However, running would decrease cartilage thickness (MD, -0.09 mm; 95%CI, -0.18 to -0.01; p = 0.03) and T2 (MD, -2.78 ms; 95% CI, -4.12 to -1.45; p < 0.001). Subgroup analysis demonstrated that COMP immediately or at 0.5 h after running was significantly increased, but there were no significant changes at 1 h or 2 h. CONCLUSIONS Running has advantages in promoting nutrition penetrating into the cartilage as well as squeezing out the metabolic substance, such as water. Our study found that running had a short-term adverse effect on COMP and did not affect cartilage volume or thickness.
Collapse
Affiliation(s)
- Xueping Dong
- Department of Sports Medicine and Rehabilitation, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, 518036, PR China
| | - Canfeng Li
- Department of Sports Medicine and Rehabilitation, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, 518036, PR China
| | - Jiyi Liu
- Department of Sports Medicine and Rehabilitation, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, 518036, PR China
| | - Pengzhou Huang
- Department of Sports Medicine and Rehabilitation, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, 518036, PR China
| | - Guanwei Jiang
- Department of Sports Medicine and Rehabilitation, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, 518036, PR China
| | - Mengdi Zhang
- Department of Sports Medicine and Rehabilitation, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, 518036, PR China
| | - Wentao Zhang
- Department of Sports Medicine and Rehabilitation, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, 518036, PR China
| | - Xintao Zhang
- Department of Sports Medicine and Rehabilitation, National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, 518036, PR China.
| |
Collapse
|
17
|
Sharafat-Vaziri A, Khorasani S, Darzi M, Saffarian Z, Alizadeh Z, Tahmasebi MN, Kazemnejad S. Safety and efficacy of engineered tissue composed of silk fibroin/collagen and autologous chondrocytes in two patients with cartilage defects: A pilot clinical trial study. Knee 2020; 27:1300-1309. [PMID: 33010742 DOI: 10.1016/j.knee.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/24/2020] [Accepted: 06/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this pilot clinical trial study was to evaluate safety and effectiveness of the newly engineered tissue composed of autologous chondrocytes and collagen/fibroin scaffold in repair of osteochondral defects. METHODS We implemented a pilot clinical study in two patients with knee osteochondral lesions using engineered tissue composed of scaffold and autologous chondrocytes. Patients were clinically evaluated using the International Repair Cartilage Society score and magnetic resonance imaging (MRI) for one year. RESULTS Improved clinical outcomes and objective scores indicated a normal or nearly normal knee in both patients. International Knee Documentation Committee score was upgraded from 34.5 at baseline to 72.4 in the first patient, and 28.7 to 81.6 in the second patient. Visual analogue scale, showing the suffering pain score, was lowered from 8 to 0 in both patients, Western Ontario and McMaster Universities Osteoarthritis Index score representing the physical ability of the patients was changed from 68.1 to 87.1 in Patient 1 and 58.3 to 87.1 in Patient 2, the knee function score, related to the functional ability of the knee, was improved from 70 to 100 in the first patient and from 45 to 91 in the second patient. MRI showed great coverage and integration of the graft in patients, with no effusion, decreased edema and cartilage formation signals. CONCLUSIONS The functional and clinical outcomes alongside MRI data showed promising results for regenerating osteochondral defects. A randomized clinical trial study is required to confirm feasibility of this novel engineered tissue in repair of osteochondral defects.
Collapse
Affiliation(s)
- Arash Sharafat-Vaziri
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Somayeh Khorasani
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Maryam Darzi
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Zahra Saffarian
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Zahra Alizadeh
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Mohammad Naghi Tahmasebi
- Orthopedic Surgery Department, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Somaieh Kazemnejad
- Nanobiotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran.
| |
Collapse
|
18
|
de Abreu MR. Imaging assessment of surgical repair of knee cartilage. Radiol Bras 2020; 53:IX. [PMID: 32904798 PMCID: PMC7458559 DOI: 10.1590/0100-3984.2020.53.4e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
19
|
Anz AW, Edison J, Denney TS, Branch EA, Walz CR, Brock KV, Goodlett MD. 3-T MRI mapping is a valid in vivo method of quantitatively evaluating the anterior cruciate ligament: rater reliability and comparison across age. Skeletal Radiol 2020; 49:443-452. [PMID: 31482257 DOI: 10.1007/s00256-019-03301-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE As biologic augmentation methods emerge, objective measures of soft tissues are necessary for developmental study. The purpose of this study was to develop a quantitative MRI mapping protocol for the ACL. The objectives were (1) to provide age-based T2 relaxation, T2* relaxation, and volume values in healthy individuals, (2) to establish the intra-rater and inter-rater reliability of ACL mapping, and (3) to determine whether 3-T or 7-T MRI is more appropriate for future clinical trials. MATERIALS AND METHODS Thirty healthy participants, aged 18-62, asymptomatic for knee pathology and without history of knee injury underwent both a 3-T and 7-T MRI. Manual image mapping of the anterior cruciate ligament was performed by two observers and processed to obtain T2, T2*, and volume values. Analysis of variance and two-way random effects model were used to calculate statistical significance and intraclass correlation coefficients. RESULTS Across all participants, 3-T and 7-T mean T2, T2* and volume values were 37.1 ± 7.9 and 39.7 ± 6.2 ms (p = 0.124), 10.9 ± 1.3 and 10.9 ± 0.9 ms (p = 0.981), and 2380 ± 602 and 2484 ± 736 mm3 (p = 0.551), respectively. The T2, T2*, and volume did not vary between age cohorts (p > 0.05). Excellent inter-rater and intra-rater reliability regarding T2 and T2* values was found. While ACL volume exhibited good inter-rater reliability and excellent intra-rater reliability. CONCLUSIONS T2 relaxation values and ACL volume do not vary with age and therefore can be used as a quantifiable, non-invasive method to assess ACL graft maturation. 7-T MRI analysis was not superior to 3-T MRI analysis, suggesting that 3-T MRI is practical and capable for future comparative studies.
Collapse
Affiliation(s)
- Adam W Anz
- Andrews Institute for Orthopaedics & Sports Medicine, 1040 Gulf Breeze Parkway, Gulf Breeze, FL, 32561, USA.
| | - Jos Edison
- Edward Via College of Osteopathic Medicine, 910 South Donahue Drive, Auburn, AL, 36832, USA
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, 200 Broun Hall, Auburn, AL, 36849, USA
| | - Eric A Branch
- Andrews Institute for Orthopaedics & Sports Medicine, 1040 Gulf Breeze Parkway, Gulf Breeze, FL, 32561, USA
| | - Christopher R Walz
- Department of Electrical and Computer Engineering, Auburn University, 200 Broun Hall, Auburn, AL, 36849, USA
| | - Kenny V Brock
- Edward Via College of Osteopathic Medicine, 910 South Donahue Drive, Auburn, AL, 36832, USA
| | - Michael D Goodlett
- Auburn University Athletics, Auburn Athletics Complex, 392 S Donahue Drive, Auburn, AL, 36849, USA
| |
Collapse
|
20
|
Aydın M, Yorubulut M, Başarır K, Arıkan M, Binnet MS. Matrix induced autologous chondrocyte implantation in the knee: Comparison between osteochondritis dissecans and osteonecrosis and effect of chondrocyte thickness on prognosis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:66-73. [PMID: 32175899 DOI: 10.5152/j.aott.2020.01.347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was compare the clinical success of treatments for avascular necrosis and osteochondritis dissecans in cases who underwent matrix autologous chondrocyte implantations, and evaluate cartilage thickness on the clinical outcomes after implantation. METHODS A total of 37 patients (29 men, and 8 women; mean age: 23.8 years (16-38)) were treated prospectively with a two-stage matrix autologous chondrocyte implantation (avascular necrosis, n=21; osteochondritis dissecans, n=18). Clinical improvements and follows-up were assessed based on the patients' International Cartilage Repair Society (ICRS) scores with simultaneous cartilage thickness measurement using short-TI inversion recovery magnetic resonance imaging. The patients were divided into four subgroups based on their clinical scores, as group D <65 points, Group C 65-83 points, Group B 84-90 and Group A ≥90. RESULTS The mean ICRS score was 28.33±7.14 in the preoperative period in the avascular necrosis group, which increased to 70.88±12.61 at 60 months; while the mean ICRS score increased from 29.75±7.15 preoperatively to 87.58±12.83 at 60 months in the osteochondritis dissecans group. A statistically significant difference in the ICRS scores was noted between the two groups, and also between the ICRS scores and cartilage thicknesses of the subgroups (p<0.05). CONCLUSION Our study results revealed that greater clinical improvement was achieved in patients with osteochondritis dissecans undergoing matrix autologous chondrocyte implantation than in those with avascular necrosis. In addition, cartilage thickness greater than 3.7 mm following an autologous chondrocyte transplantation showed excellent clinical improvement. LEVEL OF EVIDENCE Level III, Therapeutic Study.
Collapse
Affiliation(s)
- Murat Aydın
- Department of Orthopedics and Traumatology, Amasya Merzifon Public Hospital Medicine, Amasya, Turkey
| | - Mehmet Yorubulut
- Department of Radiology, Primer Medical Imaging Center, Ankara, Turkey
| | - Kerem Başarır
- Department of Orthopaedics and Traumatology, Ankara University, School of Medicine, Ankara, Turkey
| | - Murat Arıkan
- Department of Orthopaedics and Traumatology, Oncology Training and Research Hospital, Ankara, Turkey
| | - Mehmet Serdar Binnet
- Department of Orthopaedics and Traumatology, Ankara University, School of Medicine, Ankara, Turkey
| |
Collapse
|
21
|
Solheim E, Hegna J, Inderhaug E. Long-Term Survival after Microfracture and Mosaicplasty for Knee Articular Cartilage Repair: A Comparative Study Between Two Treatments Cohorts. Cartilage 2020; 11:71-76. [PMID: 29926745 PMCID: PMC6921956 DOI: 10.1177/1947603518783482] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate survival of cartilage repair in the knee by microfracture (MFX; n = 119) or mosaicplasty osteochondral autograft transfer (OAT; n = 84). DESIGN For survival analyses, "failure" was defined as the event of a patient reporting a Lysholm score <65 or undergoing an ipsilateral knee replacement. The Kaplan-Meier method was used for construction of a survival functions plot for the event "failure." Log rank (Mantel-Cox) test was used for comparison of survival distributions in the 2 groups. RESULTS The long-term failure rate (62% overall) was significantly higher in the MFX group (66%) compared with the OAT group (51%, P = 0.01). Furthermore, the mean time to failure was significantly shorter (P < 0.001) in the MFX group, 4.0 years (SD 4.1) compared with the OAT group, 8.4 years (SD 4.8). In the OAT group, the survival rate stayed higher than 80% for the first 7 years, and higher than 60% for 15 years, while the survival rate dropped to less than 80% within 12 months, and to less than 60% within 3 years in the MFX group, log rank (Mantel-Cox) 20.295 (P < 0.001). The same pattern was found in a subgroup of patients (n = 134) of same age (<51 years) and size of treated lesion (<500 mm2), log rank (Mantel-Cox) 10.738 (P = 0.001). The nonfailures (48%) were followed for median 15 yeas (1-18 years). CONCLUSIONS MFX articular cartilage repairs failed more often and earlier than the OAT repairs, both in the whole cohort and in a subgroup of patients matched for age and size of treated lesion, indicating that the OAT repair is the more durable. LEVEL OF EVIDENCE Therapeutic study, Level III.
Collapse
Affiliation(s)
- Eirik Solheim
- Department of Orthopedics, Deaconess
University Hospital, Bergen, Norway,Department of Orthopedics, Aleris
Nesttun Hospital, Bergen, Norway,Department of Clinical Medicine, Faculty
of Medicine and Dentistry, University of Bergen, Bergen, Norway,Eirik Solheim, Department of Orthopaedics,
Deaconess University Hospital, Haraldsplass, PB 6165, 5152 Bergen, Norway.
| | - Janne Hegna
- Department of Orthopedics, Aleris
Nesttun Hospital, Bergen, Norway
| | - Eivind Inderhaug
- Department of Orthopedics, Deaconess
University Hospital, Bergen, Norway
| |
Collapse
|
22
|
Abstract
OBJECTIVE. For many years, MRI of the musculoskeletal system has relied mostly on conventional sequences with qualitative analysis. More recently, using quantitative MRI applications to complement qualitative imaging has gained increasing interest in the MRI community, providing more detailed physiologic or anatomic information. CONCLUSION. In this article, we review the current state of quantitative MRI, technical and software advances, and the most relevant clinical and research musculoskeletal applications of quantitative MRI.
Collapse
|
23
|
Shoji T, Yamasaki T, Izumi S, Sawa M, Akiyama Y, Yasunaga Y, Adachi N. Evaluation of articular cartilage following rotational acetabular osteotomy for hip dysplasia using T2 mapping MRI. Skeletal Radiol 2018; 47:1467-1474. [PMID: 29704036 DOI: 10.1007/s00256-018-2943-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/05/2018] [Accepted: 04/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rotational acetabular osteotomy (RAO) is one of the surgical treatments for acetabular dysplasia, and satisfactory results have been reported. We evaluated the postoperative changes of articular cartilage and whether the pre-operative condition of the articular cartilage influences the clinical results using T2 mapping MRI. METHODS We reviewed 31 hips with early stage osteoarthritis in 31 patients (mean age, 39.6 years), including three men and 28 women who underwent RAO for hip dysplasia. Clinical evaluations including Japanese Orthopedic Association (JOA) score and Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ), and radiographical evaluations on X-ray were performed. Longitudinal qualitative assessment of articular cartilage was also performed using 3.0-T MRI with T2 mapping technique preoperatively, 6 months, and at 1 and 2 years postoperatively. RESULTS There was no case with progression of osteoarthritis. The mean JOA score improved from 70.1 to 93.4 points, the mean postoperative JHEQ score was 68.8 points, and radiographical data also improved postoperatively. We found that the T2 values of the cartilage at both femoral head and acetabulum increased at 6 months on coronal and sagittal views. However, they significantly decreased 1 and 2 years postoperatively. The T2 values of the center to anterolateral region of acetabulum negatively correlated with postoperative JHEQ score, particularly in pain score. CONCLUSIONS This study suggests that biomechanical and anatomical changes could apparently cause decreased T2 values 1-2 years postoperatively compared with those preoperatively. Furthermore, preoperative T2 values of the acetabulum can be prognostic factors for the clinical results of RAO.
Collapse
Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Soutaro Izumi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mikiya Sawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuji Akiyama
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-Hiroshima, 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| |
Collapse
|
24
|
Solheim E, Hegna J, Strand T, Harlem T, Inderhaug E. Randomized Study of Long-term (15-17 Years) Outcome After Microfracture Versus Mosaicplasty in Knee Articular Cartilage Defects. Am J Sports Med 2018; 46:826-831. [PMID: 29253350 DOI: 10.1177/0363546517745281] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few comparative randomized long-term studies on microfracture versus mosaicplasty have been published, and only 2 studies reported a follow-up of 10 years. Hypothesis/Purpose: The purpose was to compare the clinical outcome of microfracture versus mosaicplasty/osteochondral autograft transfer in symptomatic cartilage lesions. The null hypothesis was that the outcome was not statistically different at any point of time. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Forty patients with articular cartilage defects were randomized to undergo cartilage repair by either microfracture (n = 20) or mosaicplasty (n = 20). Inclusion criteria were as follows: age 18 to 50 years at the time of surgery, 1 or 2 symptomatic focal full-thickness articular chondral defects on the femoral condyles or trochlea, and size 2 to 6 cm2. The main outcome variable was the Lysholm knee score recorded before the surgery and at 12 months, median 5 years, median 10 years, and minimum 15 years after the surgery. RESULTS Forty patients were included in the study (28 men, 12 women; median age, 32 years; range, 18-48 years). Defects with a median size of 3.5 cm2 (range, 2-5 cm2) were treated. A significant increase in the Lysholm score was seen for all subjects- from a mean 53 (SD, 16) at baseline to 69 (SD, 21) at the minimum 15-year follow-up ( P = .001). The mean Lysholm score was significantly higher in the mosaicplasty group than the microfracture group at 12 months, median 5 years, median 10 years, and minimum 15 years: 77 (SD, 17) versus 61 (SD, 22), respectively ( P = .01), at the last follow-up. At all follow-up time points, the difference in mean Lysholm score was clinically significant (>10 points). CONCLUSION At short, medium, and long term (minimum 15 years), mosaicplasty results in a better, clinically relevant outcome than microfracture in articular cartilage defects (2-5 cm2) of the distal femur of the knee in patients aged 18 to 50 years.
Collapse
Affiliation(s)
- Eirik Solheim
- Department of Orthopedics, Deaconess University Hospital, Haraldsplass, Bergen, Norway.,Department of Orthopedics, Aleris Nesttun Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Janne Hegna
- Department of Orthopedics, Aleris Nesttun Hospital, Bergen, Norway
| | - Torbjørn Strand
- Department of Orthopedics, Deaconess University Hospital, Haraldsplass, Bergen, Norway
| | - Thomas Harlem
- Department of Orthopedics, Deaconess University Hospital, Haraldsplass, Bergen, Norway
| | - Eivind Inderhaug
- Department of Orthopedics, Deaconess University Hospital, Haraldsplass, Bergen, Norway
| |
Collapse
|
25
|
Nelson BB, Kawcak CE, Barrett MF, McIlwraith CW, Grinstaff MW, Goodrich LR. Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging. Equine Vet J 2018; 50:564-579. [DOI: 10.1111/evj.12808] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences Colorado State University Fort Collins Colorado USA
| | - C. W. McIlwraith
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry and Medicine Boston University Boston Massachusetts USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| |
Collapse
|
26
|
Mars M, Chelli M, Tbini Z, Ladeb F, Gharbi S. MRI T2 Mapping of Knee Articular Cartilage Using Different Acquisition Sequences and Calculation Methods at 1.5 Tesla. Med Princ Pract 2018; 27:443-450. [PMID: 29895028 PMCID: PMC6243913 DOI: 10.1159/000490796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/12/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study aims to determine how magnetic resonance imaging (MRI) acquisition techniques and calculation methods affect T2 values of knee cartilage at 1.5 tesla and to identify sequences that can be used for high-resolution T2 mapping in short scanning times. MATERIALS AND METHODS This study was performed on phantom and 29 patients who underwent MRI of the knee joint at 1.5 tesla. The protocol includes T2 mapping sequences based on Single-Echo Spin Echo (SESE), Multi-Echo Spin Echo (MESE), Fast Spin Echo (FSE) and Turbo Gradient Spin Echo (TGSE). The T2 relaxation times were quantified and evaluated using three calculation methods (MapIt, Syngo Offline and mono-exponential fit). signal-to-noise ratios (SNR) were measured in all sequences. All statistical analyses were performed using the t-test. RESULTS The average T2 values in phantom were 41.7 ± 13.8 ms for SESE, 43.2 ± 14.4 ms for MESE, 42.4 ± 14.1 ms for FSE and 44 ± 14.5 ms for TGSE. In the patient study, the mean differences were 6.5 ± 8.2 ms, 7.8 ± 7.6 ms and 8.4 ± 14.2 ms for MESE, FSE and TGSE compared to SESE, respectively; these statistical results were not significantly different (p > 0.05). The comparison between the three calculation methods showed no significant difference (p > 0.05). The t-test showed no significant difference between SNR values for all sequences. CONCLUSION T2 values depend not only on the sequence type but also on the calculation method. None of the sequences revealed significant differences compared to the SESE reference sequence. TGSE with its short scanning time can be used for high-resolution T2 mapping.
Collapse
Affiliation(s)
- Mokhtar Mars
- Tunis University EL Manar, Higher Institute of Medical Technologies of Tunis, Research Laboratory of Biophysics and Medical Technologies, Tunis, Tunisia
- *Mokhtar Mars, 29 Rue Imam Chafai La Petite Ariana, Jaafar, 2083 Tunis (Tunisia), E-Mail
| | - Mouna Chelli
- Tunis University EL Manar, Faculty of Medicine of Tunis, Department of Radiology, Kassab Institute of Orthopedics, Ksar Saïd, Tunis, Tunisia
| | - Zeineb Tbini
- Tunis University EL Manar, Higher Institute of Medical Technologies of Tunis, Research Laboratory of Biophysics and Medical Technologies, Tunis, Tunisia
| | - Fethi Ladeb
- Tunis University EL Manar, Faculty of Medicine of Tunis, Department of Radiology, Kassab Institute of Orthopedics, Ksar Saïd, Tunis, Tunisia
| | - Souha Gharbi
- Tunis University EL Manar, Higher Institute of Medical Technologies of Tunis, Research Laboratory of Biophysics and Medical Technologies, Tunis, Tunisia
| |
Collapse
|
27
|
Solheim E, Hegna J, Inderhaug E. Long-term clinical follow-up of microfracture versus mosaicplasty in articular cartilage defects of medial femoral condyle. Knee 2017; 24:1402-1407. [PMID: 28958686 DOI: 10.1016/j.knee.2017.08.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/03/2017] [Accepted: 08/31/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the outcome after cartilage repair surgery in focal defects of the knee by microfracture versus mosaicplasty. METHODS A cohort of 102 patients undergoing microfracture (n=52) or mosaicplasty (n=50) of a single articular cartilage defect in the medial femoral condyle of ≤50mm2 was evaluated by Lysholm score before surgery, at six months, 12months, five years, 10years, and 15-18years after surgery. RESULTS Median age of patients at the time of surgery was 36years (range 16-58) and median follow-up time was 16years (range 14-18). Defects were treated with a median size of three square centimetres (range one to five). A significant increase was seen in the Lysholm score from mean 48 (SD 16) at baseline to 66 (SD 23; P<0.001) at the 15-18year follow-up. The Lysholm score was higher in the mosaicplasty group at six months, 12months, five years and 10years (P<0.05 for all comparisons). These differences were clinically significant at all points (>10 points). However, at the final follow-up, the difference (eight points) did not reach statistical significance. CONCLUSIONS In the short-term, medium-term and long-term (10years), mosaicplasty in a single cartilage defect size one to five square centimetres of the femoral condyle resulted in clinically relevant better outcome than microfracture. However, at 15-18years after the surgery such a difference could not be found. In the six month to 10-15year (after surgery) perspective, the mosaicplasty procedure offered a better outcome in this type of lesion. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Eirik Solheim
- Department of Orthopedics, Deaconess University Hospital, Haraldsplass, Bergen, Norway; Department of Orthopedics, Aleris Nesttun Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
| | - Janne Hegna
- Department of Orthopedics, Aleris Nesttun Hospital, Bergen, Norway
| | - Eivind Inderhaug
- Department of Orthopedics, Deaconess University Hospital, Haraldsplass, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| |
Collapse
|
28
|
Albrecht C, Reuter CA, Stelzeneder D, Zak L, Tichy B, Nürnberger S, Boesmueller S, Marlovits S, Trattnig S, Hajdu S, Aldrian S. Matrix Production Affects MRI Outcomes After Matrix-Associated Autologous Chondrocyte Transplantation in the Knee. Am J Sports Med 2017; 45:2238-2246. [PMID: 28575639 DOI: 10.1177/0363546517707499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Matrix-associated autologous chondrocyte transplantation (MACT) has been an effective therapy for large, full-thickness cartilage lesions for years. However, little is known about how graft maturation is affected by characteristics of transplanted chondrocytes. PURPOSE To investigate the influence of gene expression of chondrocytes at the time of transplantation on MRI outcomes up to 2 years after MACT. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study included 25 patients with 27 symptomatic traumatic defects of articular cartilage, who had undergone MACT in the knee. Postoperative MRI examinations were conducted at 3, 6, 12, and 24 months after surgery. Biochemical graft maturation was assessed by measuring T2 relaxation time values of the transplant and healthy native cartilage areas. The MOCART (magnetic resonance observation of cartilage repair tissue) score was used to evaluate the morphological quality of regeneration tissue. Gene expression (collagen type I, collagen type II, aggrecan, versican, and interleukin-1β) was determined by real-time polymerase chain reaction (PCR) in transplant residuals at the time point of transplantation and was correlated with MRI outcomes using Spearman's rank correlation coefficient. A Friedman test with post hoc analysis (Wilcoxon signed rank test) conducted with a Bonferroni correction was applied to compare scores at different time points. RESULTS T2 relaxation time of regeneration tissue improved from a mean ± SD of 74.6 ± 20.1 milliseconds at 3 months to 47.9 ±13.3 milliseconds at 24 months ( P < .003). These values were similar to the T2 relaxation times of the native surrounding cartilage (50.9 ± 15 ms). The calculated T2 index (ratio of regeneration tissue to native cartilage) improved from 1.63 ± 0.76 at 3 months to 1.0 ± 0.4 at 24 months ( P < .011). The MOCART score increased from 51.6 ± 15 points to 72.4 ± 12.2 points ( P < .001). Improvement of the T2 index over time significantly correlated with aggrecan, COL1A1, COL2A1, and versican expression ( rs = 0.9, P < .001; rs = 0.674, P < .012; rs = 0.553, P < .05; and rs = 0.575, P < .04, respectively). No correlation was found for IL-1β. CONCLUSION These data demonstrate that matrix production in transplanted chondrocytes affects maturation of MACT grafts in MRI 2 years after surgery.
Collapse
Affiliation(s)
- Christian Albrecht
- Department of Trauma-Surgery, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Carla-Antonia Reuter
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - David Stelzeneder
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | - Lukas Zak
- Department of Trauma-Surgery, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Brigitte Tichy
- Department of Trauma-Surgery, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Sylvia Nürnberger
- Department of Trauma-Surgery, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Sandra Boesmueller
- Department of Trauma-Surgery, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Stefan Marlovits
- Department of Trauma-Surgery, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Hajdu
- Department of Trauma-Surgery, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Silke Aldrian
- Department of Trauma-Surgery, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| |
Collapse
|
29
|
Schreiner MM, Mlynarik V, Zbýň Š, Szomolanyi P, Apprich S, Windhager R, Trattnig S. New Technology in Imaging Cartilage of the Ankle. Cartilage 2017; 8:31-41. [PMID: 27994718 PMCID: PMC5154418 DOI: 10.1177/1947603516632848] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The incidence of osteochondral lesions, as well as osteoarthritis of the ankle joint following osteochondritis dissecans and trauma, has been reappraised in recent years. Consequently, an increasing number of surgical interventions using different cartilage repair techniques is performed in the ankle joint, which has resulted in a growing demand for repetitive and objective assessment of cartilage tissue and its repair. While morphological imaging does enable monitoring of macroscopic changes with increasing precision, it fails to provide information about the ultrastructural composition of cartilage. The significance of molecular changes in cartilage matrix composition, however, is increasingly recognized, as it is assumed that macroscopic cartilage degeneration is preceded by a loss in glycosaminoglycans and a disorganization of the collagen network. Recent advances in biochemical magnetic resonance imaging (MRI) have yielded sequences sensitive to these changes, thus providing invaluable insight into both early cartilage degeneration and maturation of repair tissue, on a molecular level. The aim of this review was to provide a comprehensive overview of these techniques, including water and collagen-sensitive T2/T2* mapping, as well as glycosaminoglycan-sensitive sequences such as delayed gadolinium-enhanced MRI of cartilage dGEMRIC, and sodium imaging, and describe their applications for the ankle joint.
Collapse
Affiliation(s)
- Markus M. Schreiner
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Vladimir Mlynarik
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Štefan Zbýň
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
30
|
Trattnig S, Bogner W, Gruber S, Szomolanyi P, Juras V, Robinson S, Zbýň Š, Haneder S. Clinical applications at ultrahigh field (7 T). Where does it make the difference? NMR IN BIOMEDICINE 2016; 29:1316-34. [PMID: 25762432 DOI: 10.1002/nbm.3272] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 05/11/2023]
Abstract
Presently, three major MR vendors provide commercial 7-T units for clinical research under ethical permission, with the number of operating 7-T systems having increased to over 50. This rapid increase indicates the growing interest in ultrahigh-field MRI because of improved clinical results with regard to morphological as well as functional and metabolic capabilities. As the signal-to-noise ratio scales linearly with the field strength (B0 ) of the scanner, the most obvious application at 7 T is to obtain higher spatial resolution in the brain, musculoskeletal system and breast. Of specific clinical interest for neuro-applications is the cerebral cortex at 7 T, for the detection of changes in cortical structure as a sign of early dementia, as well as for the visualization of cortical microinfarcts and cortical plaques in multiple sclerosis. In the imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology can be visualized with excellent resolution. The dynamic and static blood oxygenation level-dependent contrast increases linearly with the field strength, which significantly improves the pre-surgical evaluation of eloquent areas before tumor removal. Using susceptibility-weighted imaging, the plaque-vessel relationship and iron accumulation in multiple sclerosis can be visualized for the first time. Multi-nuclear clinical applications, such as sodium imaging for the evaluation of repair tissue quality after cartilage transplantation and (31) P spectroscopy for the differentiation between non-alcoholic benign liver disease and potentially progressive steatohepatitis, are only possible at ultrahigh fields. Although neuro- and musculoskeletal imaging have already demonstrated the clinical superiority of ultrahigh fields, whole-body clinical applications at 7 T are still limited, mainly because of the lack of suitable coils. The purpose of this article was therefore to review the clinical studies that have been performed thus far at 7 T, compared with 3 T, as well as those studies performed at 7 T that cannot be routinely performed at 3 T. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- CD Laboratory for Clinical Molecular MR Imaging
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Gruber
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Vladimir Juras
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Simon Robinson
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Štefan Zbýň
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Haneder
- Vascular and Abdominal Imaging, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| |
Collapse
|
31
|
Ryu YJ, Hong SH, Kim H, Choi JY, Yoo HJ, Kang Y, Park SJ, Kang HS. Fat-suppressed T 2 mapping of femoral cartilage in the porcine knee joint: A comparison with conventional T 2 mapping. J Magn Reson Imaging 2016; 45:1076-1081. [PMID: 27527688 DOI: 10.1002/jmri.25430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/01/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To investigate the effect of fat suppression on T2 mapping of the articular cartilage in the porcine knee joint using magnetic resonance imaging (MRI). MATERIALS AND METHODS Eleven porcine knee joints were harvested en bloc with intact capsules. We performed T2 mapping of the articular cartilage in the medial femoral condyle at 3T either with (fat-suppressed T2 mapping) or without (conventional T2 mapping) fat suppression in the sagittal plane under two frequency-encoding directions: from superior to inferior (SI) and inferior to superior (IS). Two observers measured the T2 values of the medial femoral condyle cartilage in four regions: in the anterior oblique, central horizontal, posterior oblique, and posterior vertical portions. We evaluated reproducibility of the fat-suppressed and conventional T2 mapping by changing the frequency-encoding direction. RESULTS The mean T2 values of fat-suppressed T2 mapping were significantly lower than those of conventional T2 mapping for five of eight comparisons (P < 0.017). The mean T2 values between fat-suppressed T2 -SI and fat-suppressed T2 -IS did not differ significantly in any region (P = 0.077-0.873). However, the mean T2 values of conventional T2 -SI were significantly lower compared with conventional T2 -IS in three of the regions (P < 0.05). The intraclass correlation coefficient (ICC) between the two fat-suppressed T2 maps was higher than the ICC between the two conventional T2 maps (0.276-0.800 vs. -0.032-0.455) for three regions. CONCLUSION Compared with conventional T2 mapping, fat-suppressed T2 mapping provides lower T2 values of the articular cartilage and more reproducible results for the porcine knee joint. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:1076-1081.
Collapse
Affiliation(s)
- Young Jin Ryu
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hwan Hong
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeonjin Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ja-Young Choi
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yusuhn Kang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Joon Park
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Heung Sik Kang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
32
|
Ho CP, Surowiec RK, Frisbie DD, Ferro FP, Wilson KJ, Saroki AJ, Fitzcharles EK, Dornan GJ, Philippon MJ. Prospective In Vivo Comparison of Damaged and Healthy-Appearing Articular Cartilage Specimens in Patients With Femoroacetabular Impingement: Comparison of T2 Mapping, Histologic Endpoints, and Arthroscopic Grading. Arthroscopy 2016; 32:1601-11. [PMID: 27132779 DOI: 10.1016/j.arthro.2016.01.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe T2 mapping values in arthroscopically determined International Cartilage Repair Society (ICRS) grades in damaged and healthy-appearing articular cartilage waste specimens from arthroscopic femoroacetabular impingement (FAI) treatment. Furthermore, we sought to compare ICRS grades of the specimens with biochemical, immunohistochemistry and histologic endpoints and assess correlations with T2 mapping. METHODS Twenty-four patients were prospectively enrolled, consecutively, between December 2011 and August 2012. Patients were included if they were aged 18 years or older and met criteria that followed the clinical indications for arthroscopy to treat FAI. Patients with prior hip trauma including fracture or dislocation or who have undergone prior hip surgery were excluded. All patients received a preoperative sagittal T2 mapping scan of the hip joint. Cartilage was graded intraoperatively using the ICRS grading system, and graded specimens were collected as cartilage waste for histologic, biochemical, and immunohistochemistry analysis. RESULTS Forty-four cartilage specimens (22 healthy-appearing, 22 damaged) were analyzed. Median T2 values were significantly higher among damaged specimens (55.7 ± 14.9 ms) than healthy-appearing specimens (49.3 ± 12.3 ms; P = .043), which was most exaggerated among mild (grade 1 or 2) defects where the damaged specimens (58.1 ± 16.4 ms) were significantly higher than their paired healthy-appearing specimens (48.7 ± 15.4 ms; P = .026). Severely damaged specimens (grade 3 or 4) had significantly lower cumulative H&E than their paired healthy-appearing counterparts (P = .02) but was not statistically significant among damaged specimens with mild (grade 1 or 2) defects (P = .198). Among healthy-appearing specimens, median T2 and the percentage of collagen fibers oriented parallel were significantly correlated (rho = 0.425, P = .048). CONCLUSIONS This study outlines the potential for T2 mapping to identify early cartilage degeneration in patients undergoing arthroscopy to treat FAI. Findings in ICRS grade 1 and 2 degeneration corresponded to an increase in T2 values. Further biochemical evaluation revealed a significant difference between healthy-appearing cartilage and late degeneration in cumulative H&E as well as significantly lower percentage of collagen fibers oriented parallel and a higher percentage of collagen fibers oriented randomly when considering all grades of cartilage damage. LEVEL OF EVIDENCE Level II, prospective comparative study.
Collapse
Affiliation(s)
- Charles P Ho
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - David D Frisbie
- Orthopaedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Studies, Colorado State University, Fort Collins, Colorado, U.S.A
| | | | | | | | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
| |
Collapse
|
33
|
Juras V, Bohndorf K, Heule R, Kronnerwetter C, Szomolanyi P, Hager B, Bieri O, Zbyn S, Trattnig S. A comparison of multi-echo spin-echo and triple-echo steady-state T2 mapping for in vivo evaluation of articular cartilage. Eur Radiol 2016; 26:1905-12. [PMID: 26334512 PMCID: PMC4863907 DOI: 10.1007/s00330-015-3979-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/06/2015] [Accepted: 08/10/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To assess the clinical relevance of T2 relaxation times, measured by 3D triple-echo steady-state (3D-TESS), in knee articular cartilage compared to conventional multi-echo spin-echo T2-mapping. METHODS Thirteen volunteers and ten patients with focal cartilage lesions were included in this prospective study. All subjects underwent 3-Tesla MRI consisting of a multi-echo multi-slice spin-echo sequence (CPMG) as a reference method for T2 mapping, and 3D TESS with the same geometry settings, but variable acquisition times: standard (TESSs 4:35min) and quick (TESSq 2:05min). T2 values were compared in six different regions in the femoral and tibial cartilage using a Wilcoxon signed ranks test and the Pearson correlation coefficient (r). The local ethics committee approved this study, and all participants gave written informed consent. RESULTS The mean quantitative T2 values measured by CPMG (mean: 46±9ms) in volunteers were significantly higher compared to those measured with TESS (mean: 31±5ms) in all regions. Both methods performed similarly in patients, but CPMG provided a slightly higher difference between lesions and native cartilage (CPMG: 90ms→61ms [31%],p=0.0125;TESS 32ms→24ms [24%],p=0.0839). CONCLUSIONS 3D-TESS provides results similar to those of a conventional multi-echo spin-echo sequence with many benefits, such as shortening of total acquisition time and insensitivity to B1 and B0 changes. KEY POINTS • 3D-TESS T 2 mapping provides clinically comparable results to CPMG in shorter scan-time. • Clinical and investigational studies may benefit from high temporal resolution of 3D-TESS. • 3D-TESS T 2 values are able to differentiate between healthy and damaged cartilage.
Collapse
Affiliation(s)
- Vladimir Juras
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
- Department of Imaging Methods, Institute of Measurement Science, Bratislava, Slovakia.
| | - Klaus Bohndorf
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rahel Heule
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland
| | - Claudia Kronnerwetter
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Science, Bratislava, Slovakia
| | - Benedikt Hager
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland
| | - Stefan Zbyn
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| |
Collapse
|
34
|
Load distribution in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1815-25. [PMID: 27085358 DOI: 10.1007/s00167-016-4123-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/29/2016] [Indexed: 01/30/2023]
Abstract
Total knee replacement is an accepted standard of care for the treatment of advanced knee osteoarthritis with good results in the vast majority of older patients. The use in younger and more active populations, however, remains controversial due to concerns over activity restrictions, implant survival, and patient satisfaction with the procedure. It is in these younger patient populations that alternatives to arthroplasty are increasingly being explored. Historically, osteotomy was utilized to address unicompartmental pain from degeneration and overload, for example, after meniscectomy. Utilization rates of osteotomy have fallen in recent years due to the increasing popularity of partial and total knee arthroplasty. This article explores the indications and outcomes of traditional unloading osteotomy, as well as newer options that are less invasive and offer faster return to function.
Collapse
|
35
|
Li H, Qian J, Chen J, Zhong K, Chen S. Osteochondral repair with synovial membrane‑derived mesenchymal stem cells. Mol Med Rep 2016; 13:2071-7. [PMID: 26781689 PMCID: PMC4768977 DOI: 10.3892/mmr.2016.4795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 11/10/2015] [Indexed: 12/25/2022] Open
Abstract
The aim of the present study was to analyze cartilage repair tissue quality following synovial membrane-derived mesenchymal stem cell (SMSC) transplantation in a rabbit osteochondral defect. A total of 15 New Zealand white rabbits were randomly distributed into three groups (n=5 in each group). In group 1, an osteochondral defect model was established in the right knee trochlea, prior to transplantation with SMSCs (SMSC group). In group 2, an osteochondral defect model was established without further treatment (control group). Group 3 did not undergo osteochondral defect model establishment and served as the sham control (normal group). All animals were sacrificed 12 weeks following the surgical procedures for magnetic resonance imaging and histological examination. No significant differences were observed between the control and SMSC group in the macroscopic score (P>0.05), the 2D magnetic resonance observation of cartilage repair tissue score (P>0.05) or the modified O'Driscoll scale (P>0.05). Compared with the control group, a significant improvement in tissue quality was observed in the SMSCs group postoperatively. The repair tissue of the SMSCs group had a shorter T2, compared with that of the control group, although no significant difference was detected (P>0.05). Furthermore, the apparent diffusion coefficient in the repair tissue of the SMSC group had a significantly lower value, compared with that of the control group (P=0.016). The results of the present study demonstrated that osteochondral repair using SMSCs facilitated the repair of appropriate tissue texture.
Collapse
Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai 200040, P.R. China
| | - Junchao Qian
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P.R. China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai 200040, P.R. China
| | - Kai Zhong
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P.R. China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai 200040, P.R. China
| |
Collapse
|
36
|
T2 Relaxation Values of the Talar Trochlear Articular Cartilage: Comparison Between Patients With Lateral Instability of the Ankle Joint and Healthy Volunteers. AJR Am J Roentgenol 2016; 206:136-43. [DOI: 10.2214/ajr.15.14364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
37
|
Méthot S, Changoor A, Tran-Khanh N, Hoemann CD, Stanish WD, Restrepo A, Shive MS, Buschmann MD. Osteochondral Biopsy Analysis Demonstrates That BST-CarGel Treatment Improves Structural and Cellular Characteristics of Cartilage Repair Tissue Compared With Microfracture. Cartilage 2016; 7:16-28. [PMID: 26958314 PMCID: PMC4749746 DOI: 10.1177/1947603515595837] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The efficacy and safety of BST-CarGel, a chitosan-based medical device for cartilage repair, was compared with microfracture alone at 1 year during a multicenter randomized controlled trial (RCT) in the knee. The quality of repair tissue of osteochondral biopsies collected from a subset of patients was compared using blinded histological assessments. METHODS The international RCT evaluated repair tissue quantity and quality by 3-dimensional quantitative magnetic resonance imaging as co-primary endpoints at 12 months. At an average of 13 months posttreatment, 21/41 BST-CarGel and 17/39 microfracture patients underwent elective second look arthroscopies as a tertiary endpoint, during which ICRS (International Cartilage Repair Society) macroscopic scoring was carried out, and osteochondral biopsies were collected. Stained histological sections were evaluated by blinded readers using ICRS I and II histological scoring systems. Collagen organization was evaluated using a polarized light microscopy score. RESULTS BST-CarGel treatment resulted in significantly better ICRS macroscopic scores (P = 0.0002) compared with microfracture alone, indicating better filling, integration, and tissue appearance. Histologically, BST-CarGel resulted in a significant improvement of structural parameters-Surface Architecture (P = 0.007) and Surface/Superficial Assessment (P = 0.042)-as well as cellular parameters-Cell Viability (P = 0.006) and Cell Distribution (P = 0.032). No histological parameters were significantly better for the microfracture group. BST-CarGel treatment also resulted in a more organized repair tissue with collagen stratification more similar to native hyaline cartilage, as measured by polarized light microscopy scoring (P = 0.0003). CONCLUSION Multiple and independent analyses in this biopsy substudy demonstrated that BST-CarGel treatment results in improved structural and cellular characteristics of repair tissue at 1 year posttreatment compared with microfracture alone, supporting previously reported results by quantitative magnetic resonance imaging.
Collapse
Affiliation(s)
- Stéphane Méthot
- Bio-Orthopaedics Division, Piramal Life Sciences, Laval, Quebec, Canada,Stéphane Méthot, Bio-Orthopaedics Division, Piramal Life Sciences, 475 Armand-Frappier, Laval, Quebec, H7V 4B3, Canada.
| | - Adele Changoor
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montreal, Quebec, Canada
| | - Nicolas Tran-Khanh
- Department of Chemical Engineering, École Polytechnique de Montréal, Montreal, Quebec, Canada
| | - Caroline D. Hoemann
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montreal, Quebec, Canada,Department of Chemical Engineering, École Polytechnique de Montréal, Montreal, Quebec, Canada
| | - William D. Stanish
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alberto Restrepo
- Bio-Orthopaedics Division, Piramal Life Sciences, Laval, Quebec, Canada
| | - Matthew S. Shive
- Bio-Orthopaedics Division, Piramal Life Sciences, Laval, Quebec, Canada
| | - Michael D. Buschmann
- Institute of Biomedical Engineering, École Polytechnique de Montréal, Montreal, Quebec, Canada,Department of Chemical Engineering, École Polytechnique de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
38
|
Bergen CJAV, Gerards RM, Opdam KTM, Terra MP, Kerkhoffs GMMJ. Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities. World J Orthop 2015; 6:944-953. [PMID: 26716090 PMCID: PMC4686441 DOI: 10.5312/wjo.v6.i11.944] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/02/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
This current concepts review outlines the role of different imaging modalities in the diagnosis, preoperative planning, and follow-up of osteochondral ankle defects. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an ankle supination trauma. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate imaging modalities. Recently, ultrasonography and single photon emission CT have been described for the evaluation of osteochondral talar defects. CT is the most valuable modality for assessing the exact location and size of bony lesions. Cartilage and subchondral bone damage can be visualized using MRI, but the defect size tends to be overestimated due to bone edema. CT with the ankle in full plantar flexion has been shown a reliable tool for preoperative planning of the surgical approach. Postoperative imaging is useful for objective assessment of repair tissue or degenerative changes of the ankle joint. Plain radiography, CT and MRI have been used in outcome studies, and different scoring systems are available.
Collapse
|
39
|
Morphological and compositional monitoring of a new cell-free cartilage repair hydrogel technology - GelrinC by MR using semi-quantitative MOCART scoring and quantitative T2 index and new zonal T2 index calculation. Osteoarthritis Cartilage 2015; 23:2224-2232. [PMID: 26187572 DOI: 10.1016/j.joca.2015.07.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/24/2015] [Accepted: 07/07/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate cartilage repair tissue (RT) using MOCART scoring for morphological and T2 mapping for biochemical assessment following implantation of GelrinC, a biosynthetic, biodegradable hydrogel implant. DESIGN MR imaging (1.5/3T) was performed on 21 patients at six sites. Standard protocols were used for MOCART evaluation at 1 week (baseline) 1, 3, 6, 12, 18 and 24 months. Multi-echo SE was used for T2 mapping. Global (T2 in RT divided by T2 in normal cartilage) and zonal T2 index (deep T2 divided by superficial T2) of RT were calculated. RESULTS Average MOCART score was 71.8 (95% CI 62.2 to 81.3) at six, 75.2 (95% CI 62.8 to 87.5) at twelve, 71.8 (95% CI 55.4 to 88.2) at eighteen and 84.4 (95% CI 77.7 to 91.0) at twenty-four months. The global T2 index ranged between 0.8 and 1.2 (normal healthy cartilage) in 1/11 (9%) patients at baseline, 8/12 (67%) at 12 months, 11/13 (85%) at 18 months and 13/16 (81%) at 24 months. The zonal T2 index for RT was <20% difference to the zonal T2 index for normal cartilage in: 6/12 patients (50%) at 12 months, 7/13 (53.8%) at 18 months and 10/16 (63.5%) at 24 months. The standard deviation for T2 showed a significant decrease over the study. CONCLUSIONS The increase of MOCART scores over follow-up indicates improving cartilage repair tissue. Global and zonal T2 repair values at 24 months reached normal cartilage in 81% and 63.5% of the patients respectively, reflecting collagen organization similar to hyaline cartilage.
Collapse
|
40
|
Guermazi A, Roemer FW, Alizai H, Winalski CS, Welsch G, Brittberg M, Trattnig S. State of the Art: MR Imaging after Knee Cartilage Repair Surgery. Radiology 2015; 277:23-43. [DOI: 10.1148/radiol.2015141146] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
41
|
Schoenbauer E, Szomolanyi P, Shiomi T, Juras V, Zbýň Š, Zak L, Weber M, Trattnig S. Cartilage evaluation with biochemical MR imaging using in vivo Knee compression at 3 T - comparison of patients after cartilage repair with healthy volunteers. J Biomech 2015; 48:3349-55. [DOI: 10.1016/j.jbiomech.2015.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 05/05/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
|
42
|
Cha JG, Yi JS, Han JK, Lee YK. Comparison of Quantitative Cartilage T2 Measurements and Qualitative MR Imaging between Professional Ballet Dancers and Healthy Volunteers. Radiology 2015; 276:199-206. [PMID: 25759971 DOI: 10.1148/radiol.15142021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jang Gyu Cha
- From the Departments of Radiology (J.G.C., J.S.Y.) and Orthopedics (Y.K.L.), Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, South Korea, 420-767; and Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea (J.K.H.)
| | - Ji Sook Yi
- From the Departments of Radiology (J.G.C., J.S.Y.) and Orthopedics (Y.K.L.), Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, South Korea, 420-767; and Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea (J.K.H.)
| | - Jong Kyu Han
- From the Departments of Radiology (J.G.C., J.S.Y.) and Orthopedics (Y.K.L.), Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, South Korea, 420-767; and Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea (J.K.H.)
| | - Young Koo Lee
- From the Departments of Radiology (J.G.C., J.S.Y.) and Orthopedics (Y.K.L.), Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, South Korea, 420-767; and Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea (J.K.H.)
| |
Collapse
|
43
|
Hontoir F, Clegg P, Nisolle JF, Tew S, Vandeweerd JM. Magnetic resonance compositional imaging of articular cartilage: What can we expect in veterinary medicine? Vet J 2015; 205:11-20. [PMID: 26021889 DOI: 10.1016/j.tvjl.2015.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 02/25/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
Since cartilage has limited ability to repair itself, it is useful to determine its biochemical composition early in clinical cases. It is also important to assess cartilage content in research animals in longitudinal studies in vivo. In recent years, compositional imaging techniques using magnetic resonance imaging (MRI) have been developed to assess the biochemical composition of cartilage. This article describes MR compositional imaging techniques, and discusses their use and interpretation. Technical concerns still limit the use of some techniques for research and clinical use, especially in veterinary medicine. Glycosaminoglycan chemical-exchange saturation transfer and sodium imaging are better used with high field magnets, which have limited availability. Long acquisition times are sometimes required, for instance in T1rho (ρ) and diffusion-weighted imaging, and necessitate general anaesthesia. Even in human medicine, some techniques such as ultra-short echo T2 are not fully validated, and nearly all techniques require validation for veterinary research and clinical practice. Delayed gadolinium-enhanced MRI of cartilage and T2 mapping appear to be the most applicable methods for compositional imaging of animal cartilage. Combining T2 mapping and T1ρ allows for the assessment of proteoglycans and the collagen network, respectively.
Collapse
Affiliation(s)
- Fanny Hontoir
- Integrated Veterinary Research Unit (IVRU), Department of Veterinary Medicine, Faculty of Sciences, University of Namur, Rue de Bruxelles 61, Namur 5000, Belgium
| | - Peter Clegg
- Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, Leahurst Campus, University of Liverpool, Neston, UK
| | | | - Simon Tew
- Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, Leahurst Campus, University of Liverpool, Neston, UK
| | - Jean-Michel Vandeweerd
- Integrated Veterinary Research Unit (IVRU), Department of Veterinary Medicine, Faculty of Sciences, University of Namur, Rue de Bruxelles 61, Namur 5000, Belgium.
| |
Collapse
|
44
|
Shive MS, Stanish WD, McCormack R, Forriol F, Mohtadi N, Pelet S, Desnoyers J, Méthot S, Vehik K, Restrepo A. BST-CarGel® Treatment Maintains Cartilage Repair Superiority over Microfracture at 5 Years in a Multicenter Randomized Controlled Trial. Cartilage 2015; 6:62-72. [PMID: 26069709 PMCID: PMC4462252 DOI: 10.1177/1947603514562064] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The efficacy and safety of BST-CarGel®, a chitosan scaffold for cartilage repair was compared with microfracture alone at 1 year during a multicenter randomized controlled trial in the knee. This report was undertaken to investigate 5-year structural and clinical outcomes. DESIGN The international randomized controlled trial enrolled 80 patients, aged 18 to 55 years, with grade III or IV focal lesions on the femoral condyles. Patients were randomized to receive BST-CarGel® treatment or microfracture alone, and followed standardized 12-week rehabilitation. Co-primary endpoints of repair tissue quantity and quality were evaluated by 3-dimensional MRI quantification of the degree of lesion filling (%) and T2 relaxation times. Secondary endpoints were clinical benefit measured with WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) questionnaires and safety. General estimating equations were used for longitudinal statistical analysis of repeated measures. RESULTS Blinded MRI analysis demonstrated that BST-CarGel®-treated patients showed a significantly greater treatment effect for lesion filling (P = 0.017) over 5 years compared with microfracture alone. A significantly greater treatment effect for BST-CarGel® was also found for repair tissue T2 relaxation times (P = 0.026), which were closer to native cartilage compared to the microfracture group. BST-CarGel® and microfracture groups showed highly significant improvement at 5 years from pretreatment baseline for each WOMAC subscale (P < 0.0001), and there were no differences between the treatment groups. Safety was comparable for both groups. CONCLUSIONS BST-CarGel® was shown to be an effective mid-term cartilage repair treatment. At 5 years, BST-CarGel® treatment resulted in sustained and significantly superior repair tissue quantity and quality over microfracture alone. Clinical benefit following BST-CarGel® and microfracture treatment were highly significant over baseline levels.
Collapse
Affiliation(s)
| | - William D. Stanish
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert McCormack
- Department of Orthopedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nicholas Mohtadi
- University of Calgary Sports Medicine Centre, Calgary, Alberta, Canada
| | - Stéphane Pelet
- Department of Orthopedics, CHA-Pavillon Enfant-Jésus, Quebec, Quebec, Canada
| | | | | | - Kendra Vehik
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, Florida, USA
| | | |
Collapse
|
45
|
Tao H, Li H, Hua Y, Chen Z, Feng X, Chen S. Quantitative magnetic resonance imaging (MRI) evaluation of cartilage repair after microfracture treatment for full-thickness cartilage defect models in rabbit knee joints: correlations with histological findings. Skeletal Radiol 2015; 44:393-402. [PMID: 25425345 DOI: 10.1007/s00256-014-2062-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 09/04/2014] [Accepted: 11/11/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate repair tissue (RT) after microfracture treatment for full-thickness cartilage defect models using quantitative MRI and investigate the correlations between MRI and histological findings. MATERIALS AND METHODS The animal experiment was approved by the Animal Care and Use Committee of our college. Thirty-six full-thickness cartilage defect models in rabbit knee joints were assigned to the microfracture or joint debridement group (as control). Each group consisted of 3-week, 5-week, and 7-week subgroups. MR imaging, including a three-dimensional double-echo steady-state sequence (3D-DESS), and T2 mapping were performed at 3, 5, and 7 weeks postoperatively. The thickness and T2 indices of RT were calculated. After MRI scans at each time point, operation sites were removed to make hematoxylin-eosin (H&E)-stained sections. Histological results were evaluated using the modified O'Driscoll score system. Comparisons were made between the two groups with respect to the MRI and histological findings, and correlation analysis was performed within each group. RESULTS The thickness index and histological O'Driscoll score of RT in the two groups increased over time, while the T2 index decreased. The thickness index and histological O'Driscoll score of the microfracture group were higher than in the joint debridement group at each time point. The T2 index of the microfracture group was lower than in the joint debridement group at 3 weeks (P = 0.006), while it was higher than in the joint debridement group at 5 and 7 weeks (P = 0.025 and 0.025). The thickness index was positively correlated with the histological O'Driscoll score in both groups (microfracture: r s = 0.745, P < 0.001; joint debridement: r s = 0.680, P = 0.002). The T2 index was negatively correlated with the histological O'Driscoll score in both groups (microfracture: r s = -0.715, P = 0.002; joint debridement: r s = -0.826, P < 0.001). CONCLUSION Significant improvement over time after microfracture can be expected on the basis of the quantitative MRI finding and histological O'Driscoll score. MRI was correlated with the histological O'Driscoll score, which indicated that quantitative MRI 3D-DESS and T2 mapping could evaluate cartilage repair after microfracture as an effective noninvasive tool.
Collapse
Affiliation(s)
- Hongyue Tao
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, 200040, Shanghai, China
| | | | | | | | | | | |
Collapse
|
46
|
Amirabadi A, Vidarsson L, Miller E, Sussman MS, Patil K, Gahunia H, Peel SAF, Zhong A, Weiss R, Detzler G, Cheng HLM, Moineddin R, Doria AS. USPIO-related T1 and T2 mapping MRI of cartilage in a rabbit model of blood-induced arthritis: a pilot study. Haemophilia 2014; 21:e59-69. [DOI: 10.1111/hae.12601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/27/2022]
Affiliation(s)
- A. Amirabadi
- Department of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - L. Vidarsson
- Department of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - E. Miller
- Department of Diagnostic Imaging; Children's Hospital for Eastern Ontario; Ottawa ON Canada
| | - M. S. Sussman
- Department of Medical Imaging; Toronto General Hospital; the University Health Network; Toronto ON Canada
| | - K. Patil
- Department of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - H. Gahunia
- Department of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - S. A. F. Peel
- Department of Oral and Maxillofacial Surgery; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - A. Zhong
- Department of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - R. Weiss
- Department of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - G. Detzler
- Department of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - H. L. M. Cheng
- Department of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - R. Moineddin
- Department of Family and Community Medicine; University of Toronto; Toronto ON Canada
| | - A. S. Doria
- Department of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| |
Collapse
|
47
|
Hesper T, Hosalkar HS, Bittersohl D, Welsch GH, Krauspe R, Zilkens C, Bittersohl B. T2* mapping for articular cartilage assessment: principles, current applications, and future prospects. Skeletal Radiol 2014; 43:1429-45. [PMID: 24643762 DOI: 10.1007/s00256-014-1852-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/08/2014] [Accepted: 02/17/2014] [Indexed: 02/02/2023]
Abstract
With advances in joint preservation surgery that are intended to alter the course of osteoarthritis by early intervention, accurate and reliable assessment of the cartilage status is critical. Biochemically sensitive MRI techniques can add robust biomarkers for disease onset and progression, and therefore, could be meaningful assessment tools for the diagnosis and follow-up of cartilage abnormalities. T2* mapping could be a good alternative because it would combine the benefits of biochemical cartilage evaluation with remarkable features including short imaging time and the ability of high-resolution three-dimensional cartilage evaluation-without the need for contrast media administration or special hardware. Several in vitro and in vivo studies, which have elaborated on the potential of cartilage T2* assessment in various cartilage disease patterns and grades of degeneration, have been reported. However, much remains to be understood and certain unresolved questions have become apparent with these studies that are crucial to the further application of this technique. This review summarizes the principles of the technique and current applications of T2* mapping for articular cartilage assessment. Limitations of recent studies are discussed and the potential implications for patient care are presented.
Collapse
Affiliation(s)
- Tobias Hesper
- Department of Orthopaedics Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | | |
Collapse
|
48
|
|
49
|
Pachowsky ML, Trattnig S, Wondrasch B, Apprich S, Marlovits S, Mauerer A, Welsch GH, Blanke M. In vivo evaluation of biomechanical properties in the patellofemoral joint after matrix-associated autologous chondrocyte transplantation by means of quantitative T2 MRI. Knee Surg Sports Traumatol Arthrosc 2014; 22:1360-9. [PMID: 23689961 DOI: 10.1007/s00167-013-2527-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 05/06/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine in vivo biomechanical properties of articular cartilage and cartilage repair tissue of the patella, using biochemical MRI by means of quantitative T2 mapping. METHODS Twenty MR scans were achieved at 3T MRI, using a new 8-channel multi-function coil allowing controlled bending of the knee. Multi-echo spin-echo T2 mapping was prepared in healthy volunteers and in age- and sex-matched patients after matrix-associated autologous chondrocyte transplantation (MACT) of the patella. MRI was performed at 0° and 45° of flexion of the knee after 0 min and after 1 h. A semi-automatic region-of-interest analysis was performed for the whole patella cartilage. To allow stratification with regard to the anatomical (collagen) structure, further subregional analysis was carried out (deep-middle-superficial cartilage layer). Statistical analysis of variance was performed. RESULTS During 0° flexion (decompression), full-thickness T2 values showed no significant difference between volunteers (43 ms) and patients (41 ms). Stratification was more pronounced for healthy cartilage compared to cartilage repair tissue. During 45° flexion (compression), full-thickness T2 values within volunteers were significantly increased (54 ms) compared to patients (44 ms) (p < 0.001). Again, stratification was more pronounced in volunteers compared to patients. The volunteer group showed no significant increase in T2 values measured in straight position and in bended position. There was no significant difference between the 0- and the 60-min MRI examination. T2 values in the patient group increased between the 0- and the 60-min examination. However, the increase was only significant in the superior cartilage layer of the straight position (p = 0.021). CONCLUSION During compression (at 45° flexion), healthy patellar cartilage showed a significant increase in T2-values, indicating adaptations of water content and collagen fibril orientation to mechanical load. This could not be observed within the patella cartilage after cartilage repair (MACT) of the patella, most obvious due to a lack of biomechanical adjustment. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- M L Pachowsky
- Department of Trauma and Orthopaedic Surgery, University of Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Surowiec RK, Lucas EP, Ho CP. Quantitative MRI in the evaluation of articular cartilage health: reproducibility and variability with a focus on T2 mapping. Knee Surg Sports Traumatol Arthrosc 2014; 22:1385-95. [PMID: 24170187 DOI: 10.1007/s00167-013-2714-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 10/08/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE Early diagnosis of cartilage degeneration and longitudinal tracking of cartilage health including repair following surgical intervention would benefit from the ability to detect and monitor changes of the articular cartilage non-invasively and before gross morphological alterations appear. METHODS Quantitative MR imaging has shown promising results with various imaging biomarkers such as T2 mapping, T1 rho and dGEMRIC demonstrating sensitivity in the detection of biochemical alterations within tissues of interest. However, acquiring accurate and clinically valuable quantitative data has proven challenging, and the reproducibility of the quantitative mapping technique and its values are essential. Although T2 mapping has been the focus in this discussion, all quantitative mapping techniques are subject to the same issues including variability in the imaging protocol, unloading and exercise, analysis, scanner and coil, calculation methods, and segmentation and registration concerns. RESULTS The causes for variability between time points longitudinally in a patient, among patients, and among centres need to be understood further and the issues addressed. CONCLUSIONS The potential clinical applications of quantitative mapping are vast, but, before the clinical community can take full advantage of this tool, it must be automated, standardized, validated, and have proven reproducibility prior to its implementation into the standard clinical care routine.
Collapse
Affiliation(s)
- Rachel K Surowiec
- Steadman Philippon Research Institute, 181 W Meadow Dr, Suite 1000, Vail, CO, 81657, USA,
| | | | | |
Collapse
|