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Ariani A, Sverzellati N, Becciolni A, Milanese G, Silva M. Using quantitative computed tomography to predict mortality in patients with interstitial lung disease related to systemic sclerosis: implications for personalized medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2021.1858053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Nicola Sverzellati
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Andrea Becciolni
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Gianluca Milanese
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Mario Silva
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
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Williams SG, Mollaeian A, Katz JD, Gupta S. Immune checkpoint inhibitor-induced inflammatory arthritis: identification and management. Expert Rev Clin Immunol 2020; 16:771-785. [PMID: 32772596 DOI: 10.1080/1744666x.2020.1804362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have proved to be groundbreaking in the field of oncology. However, immune system overactivation from ICIs has introduced a novel medical entity known as immune-related adverse events (irAEs), that can affect any organ or tissue. ICI-induced inflammatory arthritis (ICI-IIA) is the most common musculoskeletal irAE and can lead to significant morbidity and limitation in anti-cancer therapy. AREAS COVERED In this review, the authors focus on ICI-IIA. Relevant articles were identified through PubMed searches, spanning 2010 to the present. The authors detail the current understanding of its pathogenesis, diagnostic evaluation, and management strategies. EXPERT OPINION ICI-IIA is a complex irAE that we are just beginning to understand mechanistically and pathologically. It often presents later in the disease course than other irAEs and, due to various reasons, is under-recognized. In some patients, ICI-IIA may become a chronic disease, which distinguishes it from most irAEs that resolve after ICI discontinuation. Multiple important questions still demand further research including which patients may develop ICI-IIA? What are possible diagnostic and prognostic markers? Do anti-arthritis therapies interfere with the anti-tumor response? and when should steroid-sparing agents be initiated? Close collaboration and shared decision-making between oncologists, rheumatologists, and the patient are essential when managing this particular irAE.
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Affiliation(s)
- Sandra G Williams
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH) , Bethesda, MD, USA
| | - Arash Mollaeian
- Department of Medicine, MedStar Health Internal Medicine Residency Program , Baltimore, MD, USA
| | - James D Katz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH) , Bethesda, MD, USA
| | - Sarthak Gupta
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH) , Bethesda, MD, USA
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Ben Achour W, Bouaziz M, Mechri M, Zouari B, Bahlous A, Abdelmoula L, Laadhar L, Sellami M, Sahli H, Cheour E. A cross sectional study of bone and cartilage biomarkers: correlation with structural damage in rheumatoid arthritis. Libyan J Med 2018; 13:1512330. [PMID: 30160204 PMCID: PMC6127838 DOI: 10.1080/19932820.2018.1512330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of our study was to assess the relationship between bone and cartilage remodeling biomarkers and joint damage in Rheumatoid Arthritis (RA), and to detect whether they have the capacity to predict the progression of joint disease assessment by computed tomography (CT) erosion score. We analyzed 65 female patients with established RA in our Rheumatology Department. Serum levels of bone and cartilage markers were measured: osteocalcin (OC), N-propeptide of type I collagen (PINP), collagen type I and II, C-telopeptide (CTX I, CTX-II) and cartilage oligomeric matrix protein (COMP). Radiography of both wrist and MCP joints were available. Two expert-readers independently scored articular damage and progression using the High-resolution low dose CT scan in a blinded fashion. 65 female patients with established RA with a median age of 44 years were included. The median disease-duration was two years and the median (Disease activity score) DAS 28 score at 4.46 [2.65-7.36]. The percentage of patient with low disease activity was 13.8%, while 55.4 and 30.8% for those with moderate and high disease activity respectively. The resorption bone markers were high in active versus non-active RA. Wrist and MCP erosion scores were also associated with RA activity. Our study shows that biomarkers of bone and cartilage collagen breakdown were related to specific joint erosion in RA and could predict subsequent radiographic damage in RA. Further larger scale longitudinal studies maybe needed to confirm our data.
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Affiliation(s)
- Wael Ben Achour
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Mouna Bouaziz
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia.,b Radiology Department , Orthopedics kassab institute , Tunis , Tunisia
| | - Meriem Mechri
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia.,b Radiology Department , Orthopedics kassab institute , Tunis , Tunisia
| | - Béchir Zouari
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Afef Bahlous
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia.,c Biochemistry Department , Pasteur Institute , Tunis , Tunisia
| | - Leila Abdelmoula
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Lilia Laadhar
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Maryam Sellami
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Hela Sahli
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Elhem Cheour
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
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Ferretti R, Dellepiane SG. Multitemporal Volume Registration for the Analysis of Rheumatoid Arthritis Evolution in the Wrist. Int J Biomed Imaging 2017; 2017:7232751. [PMID: 29201039 PMCID: PMC5672126 DOI: 10.1155/2017/7232751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/09/2017] [Accepted: 06/12/2017] [Indexed: 11/23/2022] Open
Abstract
This paper describes a method based on an automatic segmentation process to coregister carpal bones of the same patient imaged at different time points. A rigid registration was chosen to avoid artificial bone deformations and to allow finding eventual differences in the bone shape due to erosion, disease regression, or other eventual pathological signs. The actual registration step is performed on the basis of principal inertial axes of each carpal bone volume, as estimated from the inertia matrix. In contrast to already published approaches, the proposed method suggests splitting the 3D rotation into successive rotations about one axis at a time (the so-called basic or elemental rotations). In such a way, singularity and ambiguity drawbacks affecting other classical methods, for instance, the Euler angles method, are addressed. The proposed method was quantitatively evaluated using a set of real magnetic resonance imaging (MRI) sequences acquired at two different times from healthy wrists and by choosing a direct volumetric comparison as a cost function. Both the segmentation and registration steps are not based on a priori models, and they are therefore able to obtain good results even in pathological cases, as proven by the visual evaluation of actual pathological cases.
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Affiliation(s)
- Roberta Ferretti
- DITEN, Università degli Studi di Genova, Via Opera Pia 11a, 16145 Genova, Italy
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Hoffmann B, Svensson CM, Straßburger M, Gebser B, Irmler IM, Kamradt T, Peter Saluz H, Thilo Figge M. Automated Quantification of Early Bone Alterations and Pathological Bone Turnover in Experimental Arthritis by in vivo PET/CT Imaging. Sci Rep 2017; 7:2217. [PMID: 28533505 PMCID: PMC5440413 DOI: 10.1038/s41598-017-02389-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/11/2017] [Indexed: 12/29/2022] Open
Abstract
The assessment of bone damage is required to evaluate disease severity and treatment efficacy both in arthritis patients and in experimental arthritis models. Today there is still a lack of in vivo methods that enable the quantification of arthritic processes at an early stage of the disease. We performed longitudinal in vivo imaging with [18F]-fluoride PET/CT before and after experimental arthritis onset for diseased and control DBA/1 mice and assessed arthritis progression by clinical scoring, tracer uptake studies and bone volume as well as surface roughness measurements. Arthritic animals showed significantly increased tracer uptake in the paws compared to non-diseased controls. Automated CT image analysis revealed increased bone surface roughness already in the earliest stage of the disease. Moreover, we observed clear differences between endosteal and periosteal sites of cortical bone regarding surface roughness. This study shows that in vivo PET/CT imaging is a favorable method to study arthritic processes, enabling the quantification of different aspects of the disease like pathological bone turnover and bone alteration. Especially the evaluation of bone surface roughness is sensitive to early pathological changes and can be applied to study the dynamics of bone erosion at different sites of the bones in an automated fashion.
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Affiliation(s)
- Bianca Hoffmann
- Departemet Cell and Molecular Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany.,Friedrich Schiller University, Fürstengraben 1, 07743, Jena, Germany
| | - Carl-Magnus Svensson
- Applied Systems Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany
| | - Maria Straßburger
- Transfer Group Anti-infectives, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany
| | - Björn Gebser
- Departemet Cell and Molecular Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany
| | - Ingo M Irmler
- Institute of Immunology, Jena University Hospital, Leutragraben 3, 07743, Jena, Germany
| | - Thomas Kamradt
- Institute of Immunology, Jena University Hospital, Leutragraben 3, 07743, Jena, Germany
| | - Hans Peter Saluz
- Departemet Cell and Molecular Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany. .,Friedrich Schiller University, Fürstengraben 1, 07743, Jena, Germany.
| | - Marc Thilo Figge
- Friedrich Schiller University, Fürstengraben 1, 07743, Jena, Germany. .,Applied Systems Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany.
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Duryea J, Russell R, Gravallese EM, Kay J, Han R, Lu B, Solomon DH. Brief Report: Development and Validation of a Semiautomated Method to Measure Erosion Volume in Inflammatory Arthritis by Computed Tomography Scanning. Arthritis Rheumatol 2016; 68:332-6. [DOI: 10.1002/art.39459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/29/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Jeffrey Duryea
- Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Ruby Russell
- Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | | | - Jonathan Kay
- University of Massachusetts Medical School; Worcester
| | - Roger Han
- Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Bing Lu
- Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Daniel H. Solomon
- Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
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Preston T, Glyde M, Hosgood G, Snow L. Morphometric description of the feline radius and ulna generated from computed tomography. J Feline Med Surg 2015; 17:991-9. [PMID: 25537946 PMCID: PMC10816352 DOI: 10.1177/1098612x14564000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OBJECTIVES This study aimed to describe the length, internal and external diameters, cancellous bone volume and extent, and cortical thickness at predetermined locations in the radius and ulna of a cohort of skeletally mature, disease-free feline cadavers using radiography and computed tomography (CT). METHODS Five feline cadavers were used (mean weight 3.31 kg, range 2.55-4.24 kg). Antebrachii (n = 10) were radiographed to confirm skeletal maturity and normal radiographic appearance prior to CT. Reconstructed CT images were used to measure bone length, cortical thickness, internal and external diameters, and cancellous extent. Cancellous bone volume was calculated automatically using OsiriX after manual segmentation (350-850 Hounsfield units window) from axial CT slices. RESULTS CT images were used to measure bone length, cortical thickness, internal and external diameters, and cancellous extent and volume. Mean radial length was 95.89 mm (95% confidence interval [CI] 88.52-103.26 mm) and mean ulna length was 114.67 mm (95% CI 105.53-123.81 mm). The olecranon had the largest mean cancellous bone volume (94.16 mm(3); 95% CI 72.09-116.23 mm(3)) and it extended a mean of 13.12 mm (95% CI 11.73-14.51 mm) distally. The radius at the level of the trochlea and the ulna at the level of the coronoid processes had the largest external diameters, respectively. The medullary canal narrowed at the level of the coronoid processes and became cranially eccentric at the proximal third of the diaphysis. The cranial cortex at the level of the coronoid processes and the caudal cortex of the olecranon were markedly thicker than other cortices at those levels. CONCLUSIONS AND RELEVANCE Morphometry of the feline antebrachium was described using CT, and should be a useful reference for future research investigations and clinical applications.
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Affiliation(s)
- Timothy Preston
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Mark Glyde
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Giselle Hosgood
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Lynne Snow
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
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Aoki EM, Abdala-Júnior R, de Oliveira JX, Arita ES, Cortes ARG. Reliability and Reproducibility of Manual and Automated Volumetric Measurements of Periapical Lesions. J Endod 2015; 41:1555-9. [PMID: 26234544 DOI: 10.1016/j.joen.2015.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/17/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The present study aimed to test the reliability and reproducibility of 2 methods: manual and automated segmentation (using a threshold-based region growing algorithm) for measuring the volume of periapical lesions. METHODS A total of 43 cone-beam computed tomographic scans (14 men and 29 women, mean age of 54.6 ± 8.5 years) were analyzed by 3 observers. Intraobserver reproducibility and interobserver reliability were assessed using the intraclass correlation coefficient. Parametric correlation between manual and automated volumetric measurements was performed. In addition, the Student t test was also used to compare the mean time required for manual and automated volumetric measurements. RESULTS Automated segmentation showed slightly higher intraclass correlation coefficient values for all observers. A strong significant correlation was found between manual and automated volumetric measurements performed by the 3 observers. A significant difference in the mean procedure time was also found between both methods (P = .001). CONCLUSIONS Within the limitations of this study, the present results suggest that automated segmentation with a region growing algorithm is faster and slightly more reliable to calculate the volume of periapical lesions.
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Affiliation(s)
- Eduardo Massaharu Aoki
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Reinaldo Abdala-Júnior
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Emiko Saito Arita
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Arthur Rodriguez Gonzalez Cortes
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Ono Y, Kamishima T, Yasojima N, Tamura K, Tsutsumi K. Detection and measurement of rheumatoid bone and joint lesions of fingers by tomosynthesis: a phantom study for reconstruction filter setting optimization. Radiol Phys Technol 2015; 9:6-14. [PMID: 26092218 DOI: 10.1007/s12194-015-0327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic disease that is caused by autoimmunity. RA causes synovial proliferation, which may result in bone erosion and joint space narrowing in the affected joint. Tomosynthesis is a promising modality which may detect early bone lesions such as small bone erosion and slight joint space narrowing. Nevertheless, so far, the optimal reconstruction filter for detection of early bone lesions of fingers on tomosynthesis has not yet been known. Our purpose in this study was to determine an optimal reconstruction filter setting by using a bone phantom. We obtained images of a cylindrical phantom with holes simulating bone erosions (diameters of 0.6, 0.8, 1.0, 1.2, and 1.4 mm) and joint spaces by aligning two phantoms (space widths from 0.5 to 5.0 mm with 0.5 mm intervals), examining six reconstruction filters by using tomosynthesis. We carried out an accuracy test of the bone erosion size and joint space width, done by one radiological technologist, and a test to assess the visibility of bone erosion, done by five radiological technologists. No statistically significant difference was observed in the measured bone erosion size and joint space width among all of the reconstruction filters. In the visibility assessment test, reconstruction filters of Thickness+- and Thickness-- were among the best statistically in all characteristics except the signal-to-noise ratio. The Thickness+- and Thickness-- reconstruction filter may be optimal for evaluation of RA bone lesions of small joints in tomosynthesis.
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Affiliation(s)
- Yohei Ono
- Graduate School of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060 0812, Japan
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060 0812, Japan.
| | - Nobutoshi Yasojima
- Department of Radiology, NTT East Japan Sapporo Hospital, South-1, West-15, Cyuo-ku, Sapporo, 060 0061, Japan
| | - Kenichi Tamura
- Department of Mechanical Engineering, College of Engineering, Nihon University, Nakagawara, Tokusada, Tamuramachi, Koriyama, Fukushima Prefecture, 963 8642, Japan
| | - Kaori Tsutsumi
- Faculty of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060 0812, Japan
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Snekhalatha U, Anburajan M. Computer-based measurements of joint space analysis using metacarpal morphometry in hand radiograph for evaluation of rheumatoid arthritis. Int J Rheum Dis 2015; 20:1120-1131. [PMID: 25865479 DOI: 10.1111/1756-185x.12559] [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] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES The aim and objectives are as follows: (i) to perform an automated segmentation of the hand from radiographs using a dual tree complex wavelet-based watershed algorithm; ii) to compare the measured statistical features of the joint space of the hand using gray level co-occurrence matrix (GLCM) method with standard diagnostic parameters of rheumatoid arthritis (RA). METHODS Fifty-three patients with RA and 17 age- and sex-matched healthy controls were included in the study. The erythrocyte sedimentation rate (ESR), C-reactive protein, rheumatoid factor, health assessment questionnaire score (HAQ), disease activity score (DAS) and hand radiographs of all the subjects were obtained. Joint space width and cortical thickness were measured in metacarpophalangeal joints (MCP) and metacarpal bone semi-automatically using MIMICS software. Dual tree complex wavelet transform-based watershed algorithm was applied for automated segmentation, and feature extraction was performed using the GLCM method in hand radiographs of the total population. RESULTS In the RA group (n = 53), the joint space width measured in the MCP1, MCP3, MCP5 of the hand were reduced significantly (P < 0.01) by 16.4%, 15.6%, and 17.5%, respectively compared to the normal group (n = 17). The measured combined cortical thickness at the second, third and fourth metacarpal bones of the hand were reduced significantly (P < 0.01) by 9.5%, 12% and 8%, respectively in the RA group compared to the normal group. CONCLUSION The dual tree complex wavelet transform-based watershed algorithm provided effective segmentation in the digitized hand radiographs. The standard diagnostic parameters for RA were highly correlated with measured statistical features at MCP3 hand joint in the total population studied.
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Affiliation(s)
- U Snekhalatha
- Department of Biomedical Engineering, SRM University, Kattankulathur, Chennai, Tamilnadu, India
| | - M Anburajan
- Department of Biomedical Engineering, SRM University, Kattankulathur, Chennai, Tamilnadu, India
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Femoral marrow cavity bone harvesting used for arthroscopic refilling of misplaced or enlarged bone tunnels in revision ACL surgery: an arthroscopically supported technique with antegrade intramedullary bone harvesting by a reamer-irrigator-aspirator (RIA) system. Knee Surg Sports Traumatol Arthrosc 2015; 23:808-15. [PMID: 24682491 DOI: 10.1007/s00167-013-2736-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 10/14/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE In anterior cruciate ligament (ACL) revision surgery, refilling of misplaced or enlarged tunnels frequently requires bone harvesting from the iliac crest. Unfortunately, donor-site pain displays a relevant complication. In order to optimize patients' comfort, we developed a procedure combining minimally invasive intramedullary bone harvesting from the femur with arthroscopic tunnel refilling. METHODS Patients with ACL reconstruction failure that were not eligible for one-step revision surgery but required tunnel refilling prior to the next ACL reconstruction were enrolled prospectively. Cancellous bone was harvested intramedullarily from the ipsilateral femur using the reamer-irrigator-aspirator system in a minimally invasive manner. Afterwards, the femoral and tibial tunnels were arthroscopically refilled using cones and push rods. Computer tomography (CT) analyses were carried out before and after the filling procedure. Pain levels were assessed during the entire follow-up. Patients undergoing iliac crest bone harvesting for other reasons served as a control group. Finally, the quality of the newly formed bone stock was evaluated in the subsequent ACL reconstruction procedure. RESULTS Five patients were included during a 6-month period. Prior to refilling, tunnel analysis revealed a mean tunnel volume of 7.9 cm(3) at the femur [SD ± 5.3 cm(3)] and of 6.7 cm(3) [SD ± 5.1 cm(3)] at the tibia. The CT analyses further revealed that graft failure was predominantly caused by tunnel misplacement. Post-operatively, pain levels due to intramedullary bone harvesting were significantly lower compared to iliac crest bone harvesting at every analysed time point. Three to five months after tunnel filling, CT analyses showed sufficiently incorporated bone stocks with filling rates of 75 % femoral and 94 % tibial. ACL revision surgery was performed 4-5 months after tunnel filling without any complication. CONCLUSION Intramedullary bone harvesting from the ipsilateral femur combined with arthroscopic refilling of the bone tunnels ensures a high-quality bone stock for further ACL reconstruction. The clinical relevance is shown by the feasibility of this technique and the significantly reduced pain levels during post-operative recovery.
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Nishimoto N. [Comparing multiple groups with continuous data -one-way analysis of variance]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2013; 69:1320-30. [PMID: 24256658 DOI: 10.6009/jjrt.2013_jsrt_69.11.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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