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Khan I, Ranjit S, Welck M, Saifuddin A. The role of imaging in the diagnosis, staging, and management of the osteochondral lesions of the talus. Br J Radiol 2024; 97:716-725. [PMID: 38321227 PMCID: PMC11027257 DOI: 10.1093/bjr/tqae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 07/12/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
Osteochondral lesions of the talus (OLT) represent an abnormality of the articular cartilage and sub-chondral bone. The abnormality is typically associated with trauma though the exact aetiology remains unknown. Multiple staging systems have been developed to classify the abnormality and management can vary from conservative treatment to different surgical options. Early diagnosis is essential for optimal outcome and all imaging modalities have a role to play in patient management. The aim of this article is to review the pathology, classification, multimodality imaging appearances of OLT, and how the imaging affects patient management.
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Affiliation(s)
- Imran Khan
- Department of Radiology, University Hospitals of Leicester NHS Trust, LE5 4PW, Leicester, United Kingdom
| | - Srinath Ranjit
- Foot and Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Matt Welck
- Foot and Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Aparisi Gómez MP, Marcheggiani Muccioli GM, Guglielmi G, Zaffagnini S, Bazzocchi A. Particularities on Anatomy and Normal Postsurgical Appearances of the Knee. Radiol Clin North Am 2023; 61:219-247. [PMID: 36739143 DOI: 10.1016/j.rcl.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Detailed knowledge of anatomy helps to understand pathologic processes. This article focuses on the anatomy and functionality of the knee, with emphasis on recently studied concepts and anatomic features that have an association with the development of pathology. The most common anatomic variants posing a challenge for diagnosis and other common findings in asymptomatic patients are reviewed. Good understanding of the different surgical procedures helps in providing as much information as possible to guarantee a positive outcome, improving prognosis. We review what are the commonly expected postsurgical appearances and the most common postsurgical complications.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Radiology, IMSKE, Calle Suiza, 11, Valencia 46024, Spain
| | - Giulio Maria Marcheggiani Muccioli
- 2nd Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, Bologna 40125, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, Hospital San Giovanni Rotondo, Italy; Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, Bologna 40125, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy.
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Heinz T, Meller F, Luetkens KS, Anderson PM, Stratos I, Horas K, Rudert M, Reppenhagen S, Weißenberger M. The AMADEUS score is not a sufficient predictor for functional outcome after high tibial osteotomy. J Exp Orthop 2023; 10:9. [PMID: 36705820 PMCID: PMC9883369 DOI: 10.1186/s40634-023-00575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The Area Measurement And Depth Underlying Structures (AMADEUS) classification system has been proposed as a valuable tool for magnetic resonance (MR)-based grading of preoperatively encountered chondral defects of the knee joint. However, the potential relationship of this novel score with clinical data was yet to determine. It was the primary intention of this study to assess the correlative relationship of the AMADEUS with patient reported outcome scores in patients undergoing medial open-wedge high tibial valgus osteotomy (HTO). Furthermore, the arthroscopic ICRS (International Cartilage Repair Society) grade evaluation was tested for correlation with the AMADEUS classification system. METHODS This retrospective, monocentric study found a total of 70 individuals that were indicated for HTO due to degenerative chondral defects of the medial compartment between 2008 and 2019. A preoperative MR image as well as a pre-osteotomy diagnostic arthroscopy for ICRS grade evaluation was mandatory for all patients. The Knee Osteoarthritis Outcome Score (KOOS) including its five subscale scores (KOOS-ADL, KOOS-QOL, KOOS-Sports, KOOS-Pain, KOOS-Symptoms) was obtained preoperatively and at a mean follow-up of 41.2 ± 26.3 months. Preoperative chondral defects were evaluated using the AMADEUS classification system and the final AMADEUS scores were correlated with the pre- and postoperative KOOS subscale sores. Furthermore, arthroscopic ICRS defect severity was correlated with the AMADEUS classification system. RESULTS There was a statistically significant correlation between the AMADEUS BME (bone marrow edema) subscore and the KOOS Symptoms subscore at the preoperative visit (r = 0.25, p = 0.04). No statistically significant monotonic association between the AMADEUS total score and the AMADEUS grade with pre- and postoperative KOOS subscale scores were found. Intraoperatively obtained ICRS grade did reveal a moderate correlative relation with the AMADEUS total score and the AMADEUS grade (r = 0.28, p = 0.02). CONCLUSIONS The novel AMADEUS classification system largely lacks correlative capacity with patient reported outcome measures in patients undergoing HTO. The MR tomographic appearance of bone marrow edema is the only parameter predictive of the clinical outcome at the preoperative visit.
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Affiliation(s)
- Tizian Heinz
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Felix Meller
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Karsten Sebastian Luetkens
- grid.411760.50000 0001 1378 7891Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080 Wuerzburg, Germany
| | - Philip Mark Anderson
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Ioannis Stratos
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Konstantin Horas
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Maximilian Rudert
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Stephan Reppenhagen
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
| | - Manuel Weißenberger
- grid.8379.50000 0001 1958 8658Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany
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Waltenspül M, Zindel C, Altorfer FCS, Wirth S, Ackermann J. Correlation of Postoperative Imaging With MRI and Clinical Outcome After Cartilage Repair of the Ankle: A Systematic Review and Meta-analysis. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221092021. [PMID: 35520475 PMCID: PMC9067057 DOI: 10.1177/24730114221092021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is commonly used for evaluation of ankle cartilage repair, yet its association with clinical outcome is controversial. This study analyzes the correlation between MRI and clinical outcome after cartilage repair of the talus including bone marrow stimulation, cell-based techniques, as well as restoration with allo- or autografting. Methods A systematic search was performed in MEDLINE, Embase, and Cochrane Collaboration. Articles were screened for correlation of MRI and clinical outcome. Guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were used. Chi-square test and regression analysis were performed to identify variables that determine correlation between clinical and radiologic outcome. Results Of 2687 articles, a total of 43 studies (total 1212 cases) were included with a mean Coleman score of 57 (range, 33-70). Overall, 93% were case series, and 5% were retrospective and 2% prospective cohort studies. Associations between clinical outcome and ≥1 imaging variable were found in 21 studies (49%). Of 24 studies (56%) using the composite magnetic resonance observation of cartilage repair tissue (MOCART) score, 7 (29%) reported a correlation of the composite score with clinical outcome. Defect fill was associated with clinical outcome in 5 studies (12%), and 5 studies (50%) reported a correlation of T2 mapping and clinical outcome. Advanced age, shorter follow-up, and larger study size were associated with established correlation between clinical and radiographic outcome (P = .021, P = .028, and P = .033). Conclusion Interpreting MRI in prediction of clinical outcome in ankle cartilage repair remains challenging; however, it seems to hold some value in reflecting clinical outcome in patients with advanced age and/or at a shorter follow-up. Yet, further research is warranted to optimize postoperative MRI protocols and assessments allowing for a more comprehensive repair tissue evaluation, which eventually reflect clinical outcome in patients after cartilage repair of the ankle.Level of Evidence: Level III, systematic review and meta-analysis.
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Affiliation(s)
- Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Clinic for Orthopaedics and Traumatology, Department of Surgery, Triemli Hospital, Zürich, Switzerland
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Franziska C. S. Altorfer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan Wirth
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Clinic for Orthopaedics and Traumatology, Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
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Osteoarthritis Progression after ACL Reconstruction Was Significantly Higher Than That of the Healthy Contralateral Knees: Long-Term Follow Up Study of Mean 16.4 Years. J Clin Med 2022; 11:jcm11030775. [PMID: 35160227 PMCID: PMC8836687 DOI: 10.3390/jcm11030775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background: This study aimed to assess long-term progression of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction in athletes compared to the healthy contralateral side. Methods: The study included 15 patients and 30 knees with a mean age of 40 years (range, 35–46) years, none of whom had had revision surgery or an injury to the contralateral side. The mean follow-up period was 16.4 years (range, 13–22). Clinical and radiographic assessment included the Tegner activity scale (TAS), International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Kellgren and Lawrence (KL) grade. The long-term results of the injured knees were compared with the status of the healthy contralateral side and compared with previously published mid-term results of the same cohort of patients. Results: Patients generally remained clinically asymptomatic or mildly symptomatic at final follow-up, which is reflected by a KOOS pain score of 33 points (maximum 36 points) and an IKDC total subjective score of 87% (maximum 100%). There was a significant difference between mid-term and final follow-up in terms of the function score of the IKDC subjective questionnaire (p = 0.031), compartment findings and donor site morbidity of the IKDC functional examination (both p = 0.034), and the total KOOS score (p = 0.047). The KL score indicated significant progression of OA from mid-term to final follow-up in the injured knees (p = 0.004) and healthy contralateral knees (p = 0.014). Mean OA grades of the injured knees were significantly higher compared with the healthy contralateral side (p = 0.006) at final follow-up, and two patients showed moderate to severe signs of OA in the injured knee. Conclusions: Although most patients remained clinically asymptomatic or mildly symptomatic, long-term progression of OA after isolated ACL reconstruction in athletes was significantly higher compared with the healthy contralateral knee.
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Xu X, Gao J, Liu S, Chen L, Chen M, Yu X, Ma N, Zhang J, Chen X, Zhong L, Yu L, Xu L, Guo Q, Ding J. Magnetic resonance imaging for non-invasive clinical evaluation of normal and regenerated cartilage. Regen Biomater 2021; 8:rbab038. [PMID: 34408910 PMCID: PMC8369076 DOI: 10.1093/rb/rbab038] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/06/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
With the development of tissue engineering and regenerative medicine, it is much desired to establish bioimaging techniques to monitor the real-time regeneration efficacy in vivo in a non-invasive way. Herein, we tried magnetic resonance imaging (MRI) to evaluate knee cartilage regeneration after implanting a biomaterial scaffold seeded with chondrocytes, namely, matrix-induced autologous chondrocyte implantation (MACI). After summary of the T2 mapping and the T1-related delayed gadolinium-enhanced MRI imaging of cartilage (dGEMRIC) in vitro and in vivo in the literature, these two MRI techniques were tried clinically. In this study, 18 patients were followed up for 1 year. It was found that there was a significant difference between the regeneration site and the neighboring normal site (control), and the difference gradually diminished with regeneration time up to 1 year according to both the quantitative T1 and T2 MRI methods. We further established the correlation between the quantitative evaluation of MRI and the clinical Lysholm scores for the first time. Hence, the MRI technique was confirmed to be a feasible semi-quantitative yet non-invasive way to evaluate the in vivo regeneration of knee articular cartilage.
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Affiliation(s)
- Xian Xu
- Department of Radiology, The Second Medical Center & National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Jingming Gao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, No. 2005 Songhu Road, Yangpu District, Shanghai 200438, China
| | - Shuyun Liu
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Liang Chen
- Institute for Medical Device Control, National Institutes for Food and Drug Control, No. 31 Huatuo Road, Daxing District, Beijing 102629, China
| | - Min Chen
- Department of Radiology, The Second Medical Center & National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Xiaoye Yu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, No. 2005 Songhu Road, Yangpu District, Shanghai 200438, China
| | - Ning Ma
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Jun Zhang
- Department of Radiology, The Second Medical Center & National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Xiaobin Chen
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, No. 2005 Songhu Road, Yangpu District, Shanghai 200438, China
| | - Lisen Zhong
- Department of Radiology, The Second Medical Center & National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Lin Yu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, No. 2005 Songhu Road, Yangpu District, Shanghai 200438, China
| | - Liming Xu
- Institute for Medical Device Control, National Institutes for Food and Drug Control, No. 31 Huatuo Road, Daxing District, Beijing 102629, China
| | - Quanyi Guo
- Institute of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, No. 2005 Songhu Road, Yangpu District, Shanghai 200438, China
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Knee articular cartilage injury treatment with matrix-induced autologous chondrocyte implantation (MACI): correlation at 24 and 120 months between clinical and radiological findings using MR arthrography. Skeletal Radiol 2021; 50:2079-2090. [PMID: 33855594 PMCID: PMC8364544 DOI: 10.1007/s00256-021-03775-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the long-term evolution of matrix-induced autologous chondrocyte implantation (MACI) with magnetic resonance (MR) arthrography and verify the correlation between radiological and clinical findings. MATERIALS AND METHODS Twenty-six patients (20 m/6f) were diagnosed with knee chondral injuries and treated with MACI implantation. Each patient received MR arthrography and clinical examination at mid-term (range 22-36 months) and long term (range 96-194 months) after surgery. MR arthrography was performed with dedicated coil and a 1.5-Tesla MR unit. The modified MOCART scale was used to evaluate the status of chondral implants. Implant coating, integration to the border zone, and the surface and structure of the repaired tissue were evaluated. Presence of bone marrow oedema was evaluated. The Cincinnati Knee Rating System (CKRS) was used for clinical assessment. RESULTS At long term, 4/26 patients had complete alignment; 5/26 had a complete integration of the margins; in 4/26 cases, the implant surface was undamaged; in 14/26 cases, the reparative tissue was homogeneous. In 9/26 cases, the implant showed isointense signal compared to articular cartilage, while the presence of subchondral bone oedema was documented in 19/26 cases. The average radiological score decreased from 59.2 (mid-term) to 38.6 (long term). The average clinical score decreased from 8.9 to 8.3. CONCLUSIONS Decrease in clinical results was not significant (0.6 points p = .06), but mMOCART scores decreased significantly (p = .00003). Although imaging studies showed deterioration of the grafts, the patients did not have significant clinical deterioration (231/250).
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Lee HS, Lee YH, Jung I, Song OK, Kim S, Song HT, Suh JS. Optimization of MRI Protocol for the Musculoskeletal System. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:21-40. [PMID: 36238123 PMCID: PMC9432082 DOI: 10.3348/jksr.2020.81.1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/08/2020] [Accepted: 01/21/2020] [Indexed: 12/05/2022]
Abstract
자기공명영상(magnetic resonance imaging; 이하 MRI)은 다른 영상 기법에 비해 연부 조직 대조도와 해상력이 높아 근골격계 영역에서 중요한 진단 기기로 이용되고 있다. 최근 MRI 관련 기술이 발달함에 따라 빠른 영상 촬영 및 다양한 영상면 재구성이 가능해짐으로써 입체적인 근골격계 해부학적 구조와 병변을 더욱 잘 평가할 수 있게 되었다. 또한, MRI는 최적화 정도에 따라 영상의 질, 진단 정확도 및 촬영 시간 등이 달라지며, MRI 장치의 효율적 인 운용과도 관련이 있어, 이를 관리하는 것은 영상의학과 의사의 중요한 역할이다. 본 종설에서는 6개 주요 관절에 따른 환자 자세, radiofrequency 코일 선택, 권장 펄스열, 영상면 구성 및 스캔 파라미터에 대한 지침을 제시함으로써 근골격계 MRI의 최적화에 도움이 되고자 한다.
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Affiliation(s)
- Hong Seon Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Inha Jung
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Ok Kyu Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Sungjun Kim
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Taek Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Suck Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, Seoul, Korea
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Preclinical safety study of a combined therapeutic bone wound dressing for osteoarticular regeneration. Nat Commun 2019; 10:2156. [PMID: 31089136 PMCID: PMC6517440 DOI: 10.1038/s41467-019-10165-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/16/2019] [Indexed: 01/01/2023] Open
Abstract
The extended life expectancy and the raise of accidental trauma call for an increase of osteoarticular surgical procedures. Arthroplasty, the main clinical option to treat osteoarticular lesions, has limitations and drawbacks. In this manuscript, we test the preclinical safety of the innovative implant ARTiCAR for the treatment of osteoarticular lesions. Thanks to the combination of two advanced therapy medicinal products, a polymeric nanofibrous bone wound dressing and bone marrow-derived mesenchymal stem cells, the ARTiCAR promotes both subchondral bone and cartilage regeneration. In this work, the ARTiCAR shows 1) the feasibility in treating osteochondral defects in a large animal model, 2) the possibility to monitor non-invasively the healing process and 3) the overall safety in two animal models under GLP preclinical standards. Our data indicate the preclinical safety of ARTiCAR according to the international regulatory guidelines; the ARTiCAR could therefore undergo phase I clinical trial. Arthroplasty is the main clinical option for the treatment of osteoarticular lesions, but has limited efficacy. Here, the authors use a wound dressing with autologous mesenchymal stromal cells, functionalised for local BMP2 delivery, and show feasibility and safety in standardised preclinical tests in animal models, suggesting suitability for use in clinical trials.
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Chan KW, Ferkel RD, Kern B, Chan SS, Applegate GR. Correlation of MRI Appearance of Autologous Chondrocyte Implantation in the Ankle with Clinical Outcome. Cartilage 2018; 9:21-29. [PMID: 29219020 PMCID: PMC5724669 DOI: 10.1177/1947603516681131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED The objective of this study was to characterize magnetic resonance imaging (MRI) findings and correlate with clinical results in patients who underwent autologous chondrocyte implantation (ACI) of osteochondral lesions of the talus (OLT). METHODS Twenty-four grafts were evaluated at a mean 65.8 months after ACI for OLT. MRI was performed on a 1.5-T GE scanner using multiple sequences. Graft appearance was compared with preoperative MRI and evaluated for 6 criteria: defect fill, surface regularity, signal pattern, bone marrow edema, subchondral plate irregularity, and presence of cystic lesions. Clinical outcome was measured with the American Orthopaedic Foot and Ankle Society (AOFAS) clinical outcome score. RESULTS Of 24 grafts, 22 (92%) demonstrated >75% defect fill. Eighteen (75%) had a mildly irregular and 6 (25%) had a moderately irregular articular surface. The signal pattern of the repair tissue was heterogenous in 23 (96%); 14 (58%) layered and 9 (38%) mottled. Fourteen grafts (58%) showed decreased amount of bone marrow edema while 4 (17%) had no change and 5 (21%) had an increase in the amount of bone marrow edema. The subchondral bone plate was abnormal in most grafts, with focal defects seen in 10, slight depression in 7, and both in 5. Seven had an increase in cystic lesions while the others had no change, decrease or no cysts seen. Mean postoperative AOFAS score was 87.5 with mean improvement of 39.4. CONCLUSIONS At 66-month mean follow-up, MRI appearance of the ACI grafts show imaging abnormalities but demonstrate good clinical results. While MRI is an important tool in the postoperative assessment of ACI grafts, the various variations from a normal/nonoperative ankle must be interpreted with caution.
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Affiliation(s)
- Keith W. Chan
- California Orthopedic & Sports Medicine, San Francisco, CA, USA
| | - Richard D. Ferkel
- Southern California Orthopedic Institute, Van Nuys, CA, USA,Richard D. Ferkel, Southern California Orthopedic Institute, 6815 Noble Avenue, Van Nuys, CA 91405, USA.
| | - Brian Kern
- The Orthopaedic Institute, Paducah, KY, USA
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Danieli MV, Guerreiro JPF, Queiroz AD, Pereira HD, Tagima S, Marini MG, Cataneo DC. Diagnosis and classification of chondral knee injuries: comparison between magnetic resonance imaging and arthroscopy. Knee Surg Sports Traumatol Arthrosc 2016; 24:1627-33. [PMID: 25957606 DOI: 10.1007/s00167-015-3622-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 04/27/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the magnetic resonance imaging (MRI) findings of patients undergoing knee arthroscopy for chondral lesions. The hypothesis was that MRI displays low sensitivity in the diagnosis and classification of chondral injuries. METHODS A total of 83 knees were evaluated. The MRIs were performed using the same machine (GE SIGNA HDX 1.45 T). The MRI results were compared with the arthroscopy findings, and an agreement analysis was performed. Thirty-eight of the 83 MRI exams were evaluated by another radiologist for inter-observer agreement analysis. These analyses were performed using the kappa (κ) coefficient. RESULTS The highest incidence of chondral injury was in the patella (14.4 %). The κ coefficient was 0.31 for the patellar surface; 0.38 for the trochlea; 0.46 for the medial femoral condyle; 0.51 for the lateral femoral condyle; and 0.19 for the lateral plateau. After dividing the injuries into two groups (ICRS Grades 0-II and Grades III and IV), the following κ coefficients were obtained as follows: 0.49 (patella); 0.53 (trochlea); 0.46 (medial femoral condyle); 0.43 (medial plateau); 0.67 (lateral femoral condyle); and 0.51 (lateral plateau). The MRI sensitivity was 76.4 % (patella), 88.2 % (trochlea), 69.7 % (medial femoral condyle), 85.7 % (medial plateau), 81.8 % (lateral femoral condyle) and 75 % (lateral plateau). Comparing the radiologists' evaluations, the following κ coefficients were obtained as follows: 0.73 (patella); 0.63 (trochlea); 0.84 (medial femoral condyle); 0.72 (medial plateau); 0.77 (lateral femoral condyle); and 0.91 (lateral plateau). CONCLUSION Compared with arthroscopy, MRI displays moderate sensitivity for detecting and classifying chondral knee injuries. It is an important image method, but we must be careful in the assessment of patients with suspected chondral lesions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marcus Vinicius Danieli
- Uniorte - Hospital de Ortopedia, Antonio Pisicchio, 155, apto 1402, Londrina, PR, CEP 86040-482, Brazil.
- Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP, Brazil.
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Hani AFM, Kumar D, Malik AS, Razak R, Kiflie A. Fusion of multinuclear magnetic resonance images of knee for the assessment of articular cartilage. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:6466-9. [PMID: 24111222 DOI: 10.1109/embc.2013.6611035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The onset of osteoarthritis (OA), a most common knee joint disease, can be characterized by the degeneration of articular cartilage (AC). Degenerative changes in AC have been assessed by the morphological and physiological measurements using non-invasive modality such as Magnetic Resonance Imaging (MRI) to obtain MRI images of the knee. However, visualization and quantification of AC from MR images is difficult due to the low visibility contrast of AC compared to surrounding tissues, low and varying signal intensities in cartilage region and variable intensities in different slices of single dataset. In this work, we present a method to fuse multinuclear ((23)Na and (1)H) MR images acquired in the same plane without changing the position of the human knee as well as the Radio Frequency (RF) coil. This work is performed towards our hypothesis that fusion of sodium and proton images will provide an enhanced image that can be used for an accurate assessment of cartilage morphology. Our result shows that merging of sodium knee MR image with proton knee MR image resulting in enhanced contrast information in the cartilage region and resolves low visibility and varying intensities issue with 2D/3D proton MR. We conclude that the proposed method can further be utilized for the accurate assessment of cartilage morphology.
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de Windt TS, Welsch GH, Brittberg M, Vonk LA, Marlovits S, Trattnig S, Saris DBF. Is magnetic resonance imaging reliable in predicting clinical outcome after articular cartilage repair of the knee? A systematic review and meta-analysis. Am J Sports Med 2013; 41:1695-702. [PMID: 23364897 DOI: 10.1177/0363546512473258] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While MRI can provide a detailed morphological evaluation after articular cartilage repair, its additional value in determining clinical outcome has yet to be determined. PURPOSE To evaluate the correlation between MRI and clinical outcome after cartilage repair and to identify parameters that are most important in determining clinical outcome. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic search was performed in Embase, MEDLINE, and the Cochrane Collaboration. Articles were screened for relevance and appraised for quality. Guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement were used. Chi-square tests were performed to find variables that could determine correlation between clinical and radiological parameters. RESULTS A total of 32 articles (total number of patients, 1019) were included. A majority (81%) were case series or cohort studies that used similar standardized MRI techniques. The mean Coleman score was 63 (range, 42-96). For the majority of MRI parameters, limited or no correlation was found. Nine studies (28%) found a correlation between clinical outcome and the composite magnetic resonance observation of cartilage repair tissue (MOCART) or Henderson score and 7 (22%) with defect fill. In 5 studies, a weak to moderate correlation was found between clinical outcome and the T2 index (mean Pearson coefficient r = .53). CONCLUSION Strong evidence to determine whether morphological MRI is reliable in predicting clinical outcome after cartilage repair is lacking. Future research aiming specifically at clinical sensitivity of advanced morphological and biochemical MRI techniques after articular cartilage repair could be of great importance to the field.
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Affiliation(s)
- Tommy S de Windt
- Department of Orthopaedics, University Medical Center Utrecht, POB 85500, 3508 GA, Utrecht, the Netherlands
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Moktassi A, Popkin CA, White LM, Murnaghan ML. Imaging of osteochondritis dissecans. Orthop Clin North Am 2012; 43:201-11, v-vi. [PMID: 22480469 DOI: 10.1016/j.ocl.2012.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteochondritis dissecans (OCD) is a localized process that affects the subchondral bone and can progress to the overlying articular cartilage. The cause of this lesion remains elusive. With the vague clinical symptoms and signs of OCD, imaging plays a vital role in making the diagnosis and helping with the prognosis of OCD lesions. This article reviews current imaging modalities for the assessment of OCD including conventional radiography, nuclear medicine, computed tomography (CT), CT arthrography, magnetic resonance (MR) and MR arthrography. The role of imaging in evaluating healing of the OCD and articular congruity after surgical and nonsurgical management is discussed.
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Affiliation(s)
- Aiden Moktassi
- Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
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Hoffelner T, Resch H, Moroder P, Atzwanger J, Wiplinger M, Hitzl W, Tauber M. No increased occurrence of osteoarthritis after anterior cruciate ligament reconstruction after isolated anterior cruciate ligament injury in athletes. Arthroscopy 2012; 28:517-25. [PMID: 22265043 DOI: 10.1016/j.arthro.2011.09.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 09/21/2011] [Accepted: 09/24/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the long-term radiographic and clinical results of anterior cruciate ligament (ACL) reconstruction by comparing the injured knee with the contralateral knee in athletes with isolated ACL tear returning to preinjury sports. METHODS Twenty-eight patients with isolated ACL tears without concomitant injuries at baseline returning to previous sports were selected. ACL reconstruction was performed with patella or hamstring tendon graft. Conventional radiographs and a 3-T magnetic resonance imaging study of both knees were obtained at a mean follow-up of 10 years after ACL reconstruction and were compared with each other. The International Knee Documentation Committee score and Tegner activity index were used for clinical evaluation and the Knee Injury and Osteoarthritis Outcome Score for evaluating self-reported knee function. RESULTS The 3-T magnetic resonance imaging study showed positive signs of osteoarthritis in 33% of operated knees and 39% of nonoperated knees (P = .64). Conventional radiographs showed ongoing signs of radiographic osteoarthritis in 14% of uninjured knees according to Kellgren and Lawrence, in comparison with 21% of injured knees (P = .73). The functional outcomes between the injured knee and uninjured knee did not show any statistical differences. The mean postoperative International Knee Documentation Committee score was 89.2 ± 9.3 points, and the total Knee Injury and Osteoarthritis Outcome Score was 92.7 ± 7.8. The median preinjury Tegner score was 8 ± 2, corresponding to 7 ± 2 at follow-up. In 68% of patients, the Tegner score was unchanged from preinjury to follow-up. CONCLUSIONS Athletes with an isolated ACL rupture showed no increased risk of the development of post-traumatic osteoarthritis in the long-term after ACL replacement when compared with the uninjured contralateral knee. Our findings support the evidence to perform ACL replacement in athletes. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Thomas Hoffelner
- Department of Traumatology and Sports Injuries, Paracelsus Medical University Salzburg, Salzburg, Austria.
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Genovese E, Ronga M, Angeretti MG, Novario R, Leonardi A, Albrizio M, Callegari L, Fugazzola C. Matrix-induced autologous chondrocyte implantation of the knee: mid-term and long-term follow-up by MR arthrography. Skeletal Radiol 2011; 40:47-56. [PMID: 20446086 DOI: 10.1007/s00256-010-0939-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 03/18/2010] [Accepted: 04/12/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To define magnetic resonance (MR) arthrography imaging findings of matrix-induced autologous chondrocyte implantation (MACI) grafts of the knee in order to describe implant behaviour and to compare findings with validated clinical scores 30 and 60 months after MACI implant. MATERIALS AND METHODS Thirteen patients were recruited (10 male, 3 female) with a total number of 15 chondral lesions. Each patient underwent an MACI procedure and MR arthrography 30 and 60 months after surgery. MR arthrography was performed using a dedicated coil with a 1.5-Tesla unit. The status of the chondral implant was evaluated with the modified MOCART scoring scale. The lining of the implant, the integration to the border zone, the surface and structure of the repaired tissue were assessed, and the presence of bone marrow oedema and effusion was evaluated. For clinical assessment, the Cincinnati score was used. RESULTS At 60 months, the abnormality showed worsening in 1 out of 15 cases. Integration showed improvement in 3 out of 15 cases, and worsening in 3 out of 15 cases. Two surfaces of the implant showed further deterioration at 60 months, and 1 afflicted implant fully recovered after the same time interval. Implant contrast enhancement at 30 months was seen in 2 out of 15 cases, 1 of which recovered at 60 months. According to the MOCART score, 4 cases were rated 68.4 out of 75 at 30 months and 65 out of 75 at 60 months. The mean clinical score decreased from 8.6 out of 10 at 30 months to 8.1 out of 10 at 60 months. CONCLUSION Magnetic resonance arthrography improved the evaluation of implants and facilitated the characterisation of MACI integration with contiguous tissues. The follow-up showed significant changes in MACI, even at 60 months, allowing for useful long-term MR evaluations.
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Affiliation(s)
- Eugenio Genovese
- Department of Radiology, Insubria University, Via Guicciardini, 21100, Varese, Italy.
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Trattnig S, Winalski CS, Marlovits S, Jurvelin JS, Welsch GH, Potter HG. Magnetic Resonance Imaging of Cartilage Repair: A Review. Cartilage 2011; 2:5-26. [PMID: 26069565 PMCID: PMC4300792 DOI: 10.1177/1947603509360209] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Articular cartilage lesions are a common pathology of the knee joint, and many patients may benefit from cartilage repair surgeries that offer the chance to avoid the development of osteoarthritis or delay its progression. Cartilage repair surgery, no matter the technique, requires a noninvasive, standardized, and high-quality longitudinal method to assess the structure of the repair tissue. This goal is best fulfilled by magnetic resonance imaging (MRI). The present article provides an overview of the current state of the art of MRI of cartilage repair. In the first 2 sections, preclinical and clinical MRI of cartilage repair tissue are described with a focus on morphological depiction of cartilage and the use of functional (biochemical) MR methodologies for the visualization of the ultrastructure of cartilage repair. In the third section, a short overview is provided on the regulatory issues of the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) regarding MR follow-up studies of patients after cartilage repair surgeries.
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Affiliation(s)
- Siegfried Trattnig
- MR Centre - High Field MR, Department of Radiology, Medical University of Vienna, Vienna, Austria,Siegfried Trattnig, MR Centre - High Field MR, Department of Radiology, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria
| | | | - Stephan Marlovits
- Trauma Surgery Department, Medical University of Vienna, Vienna, Austria
| | - Jukka S. Jurvelin
- Department of Physics and Mathematics, University of Eastern Finland, Kuopio, Finland
| | - Goetz H. Welsch
- MR Centre - High Field MR, Department of Radiology, Medical University of Vienna, Vienna, Austria,Department of Trauma Surgery, University Hospital of Erlangen, Erlangen, Germany
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Choi YS, Potter HG, Chun TJ. MR Imaging of Cartilage Repair in the Knee and Ankle. Radiographics 2008; 28:1043-59. [DOI: 10.1148/rg.284075111] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Disler DG. Invited Commentary. Radiographics 2007. [DOI: 10.1148/radiographics.27.1.0270221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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