1
|
Abstract
Turf toe is a term used to describe myriad injuries to the metatarsophalangeal complex of the great toe, which have been associated with the introduction of artificial turf surfaces in sport. If not diagnosed early and treated properly, these injuries can result in chronic pain and loss of mobility. Accurate injury grading through physical exam and advanced imaging is essential to guide treatment, thereby minimizing long-term complications and maximizing an athlete's recovery and return to play. Levels of Evidence: Level V.
Collapse
Affiliation(s)
- Daniel Chiou
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (DC).,Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts (KLS, GW)
| | - Kristen L Stupay
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (DC).,Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts (KLS, GW)
| | - Gregory Waryasz
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (DC).,Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts (KLS, GW)
| |
Collapse
|
2
|
Nakano N, Gohal C, Duong A, Ayeni OR, Khanduja V. Outcomes of cartilage repair techniques for chondral injury in the hip-a systematic review. INTERNATIONAL ORTHOPAEDICS 2018. [PMID: 29536127 DOI: 10.1007/s00264-018-3862-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE/PURPOSE The aim of the study was to assess the options of treatment and their related outcomes for chondral injuries in the hip based on the available evidence whilst highlighting new and innovative techniques. METHODS A systematic review of the literature from PubMed (Medline), EMBASE, Google Scholar, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED) was undertaken from their inception to March 2017 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series and case reports that described the outcome of cartilage repair technique for the chondral injury in the hip were included. Studies on total hip replacement, animal studies, basic studies, trial protocols and review articles were excluded. RESULTS The systematic review found 21 relevant papers with 596 hips. Over 80% of the included studies were published in or after 2010. Most studies were case series or case reports (18 studies, 85.7%). Arthroscopy was used in 11 studies (52.4%). The minimum follow-up period was six months. Mean age of the participants was 37.2 years; 93.5% of patients had cartilage injuries of the acetabulum and 6.5% of them had injuries of the femoral head. Amongst the 11 techniques described in the systematic review, autologous matrix-induced chondrogenesis, osteochondral autograft transplantation and microfracture were the three frequently reported techniques. CONCLUSION Over ten different techniques are available for cartilage repair in the hip, and most of them have good short- to medium-term outcomes. However, there are no robust comparative studies to assess superiority of one technique over another, and further research is required in this arena.
Collapse
Affiliation(s)
- Naoki Nakano
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK
| | - Chetan Gohal
- Department of Orthopaedics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Andrew Duong
- Department of Orthopaedics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Olufemi R Ayeni
- Department of Orthopaedics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
| |
Collapse
|
3
|
Xu R, Wei B, Li J, Huang C, Lin R, Tang C, Xu Y, Yao Q, Wang L. Investigations of Cartilage Matrix Degeneration in Patients with Early-Stage Femoral Head Necrosis. Med Sci Monit 2017; 23:5783-5792. [PMID: 29208853 PMCID: PMC5727749 DOI: 10.12659/msm.907522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The purpose of this study was to explore changes in cartilage matrix in early-stage femoral head necrosis (FHN). Material/Methods Femoral head samples of patients with early FHN were collected during total hip arthroplasty (THA), high-field 7.0T MRI scans were performed in vitro, and the average T2 values were calculated. Cartilage samples were obtained from the weight-bearing area (FHN group) and non-weight-bearing area (Control group), divided into 3 equal parts and used for biochemical analysis, histopathological staining, and gene expression analysis. Results T2 mapping of the femoral head specimens showed that the density distribution of cartilage surface was not uniform, and the average T2 value increased unevenly. Histological staining demonstrated that the number of chondrocytes was significantly decreased and they were irregularly arranged, SO staining was lost, and collagen fiber arrangement was slightly more irregular on the cartilage surface in the FHN group. The biochemical results in the FHN group showed that the water content increased significantly and the DNA content decreased significantly, while no significant changes in GAG and total collagen contents were detected. Gene expression analysis in the FHN group showed that SOX9 expression was significantly down-regulated, while COL10A1 and RUNX2 expressions were significantly up-regulated. The expression of ACAN and COL2A1 were decreased and COL1A1 was increased, but there was no significant difference compared with the Control group. Conclusions Taken together, the results of this study suggest that patients with early-stage FHN tend to have cartilage matrix degeneration, which provides new ideas for studying the pathogenesis of FHN and selecting treatment strategies.
Collapse
Affiliation(s)
- Ronghua Xu
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Department of Orthopedics, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu, China (mainland)
| | - Bo Wei
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jiayi Li
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Chenyu Huang
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Rongcai Lin
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Cheng Tang
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yan Xu
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Qingqiang Yao
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Liming Wang
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Digital Medicine Institute, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| |
Collapse
|
4
|
Abstract
Groin pain in a performing athlete can be very challenging to diagnose and treat. The differential diagnosis includes intra-articular causes, extra-articular causes and non-musculoskeletal causes. A detailed clinical and radiological assessment of groin pain in this group is critical and can identify the underlying pathology. Diagnostic hip block is a valuable tool to differentiate intra-articular causes from extra-articular causes. Hip arthroscopy can help in identifying some of the elusive intra-articular conditions, which were once undiagnosed and therefore, left untreated, resulting in premature ending of competitive careers. This article attempts to explore current thinking on evaluation of groin pain, particularly in young individuals, and to establish a simple protocol for a clinical and diagnostic approach to this difficult problem.
Collapse
Affiliation(s)
- Vijay D Shetty
- Hiranandani Orthopaedic Medical Education (HOME), Dr. L. H. Hiranandani Hospital Hillside Avenue, Hiranandani Gardens Powai, Mumbai 400076 India
| | - Nikhil S Shetty
- Hiranandani Orthopaedic Medical Education (HOME), Dr. L. H. Hiranandani Hospital Hillside Avenue, Hiranandani Gardens Powai, Mumbai 400076 India
| | - Amith P Shetty
- Hiranandani Orthopaedic Medical Education (HOME), Dr. L. H. Hiranandani Hospital Hillside Avenue, Hiranandani Gardens Powai, Mumbai 400076 India
| |
Collapse
|
5
|
Wei B, Mao F, Guo Y, Yao Q, Tang C, Xu Y, Jin C, Zang F, Zhang S, Wang L. Using 7.0T MRI T2 mapping to detect early changes of the cartilage matrix caused by immobilization in a rabbit model of immobilization-induced osteoarthritis. Magn Reson Imaging 2015; 33:1000-6. [PMID: 26117694 DOI: 10.1016/j.mri.2015.06.007] [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: 01/11/2015] [Revised: 05/15/2015] [Accepted: 06/20/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of this study was to detect early changes in the cartilage matrix caused by immobilization in a rabbit model of immobilization-induced osteoarthritis (OA) by T2 mapping with 7.0T MRI. MATERIALS AND METHODS Left knee joints of 28 mature rabbits were immobilized at 180° of extension with orthopedic casting tape for 1, 2, or 3weeks (n=7 rabbits each). No immobilization was performed in the control group (n=7 rabbits). T2 mapping was performed after 1, 2, and 3weeks. Osteochondral specimens harvested from the trochlea groove (TG) and medial femoral condyle (MFC) were subjected to histologic, immunohistochemical, and microscopic evaluation, followed by biochemical assays for water, glycosaminoglycan (GAG), and collagen. The ability of T2 mapping to reveal changes in the cartilage matrix was further assessed. RESULTS Rabbits demonstrated elevated T2 values (9.9% in TG, 10.6% in MFC), a dulled cartilage surface, reduced Safranin-O staining, and decreased GAG content (14.2% in TG and MFC) after 2weeks, with cartilage surface softening, irregularity, and markedly reduced GAG content by 3weeks. T2 values were correlated positively with water (r=0.836 in TG, r=0.821 in MFC) and negatively with GAG content (r=-0.945 in TG, r=-0.957 in MFC), but had no discernible relationship with collagen content (r=-0.196 in TG, r=-0.213 in MFC). CONCLUSIONS 7.0T MRI T2 mapping can be used to detect early changes of the cartilage matrix caused by immobilization in an immobilization-induced OA model.
Collapse
Affiliation(s)
- Bo Wei
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fengyong Mao
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yang Guo
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qingqiang Yao
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Cheng Tang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Xu
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chengzhe Jin
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fengchao Zang
- Department of Radiology, Jiangsu Key Laboratory of Molecule Imaging and Functional Imaging, Zhong Da Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Shaoxiang Zhang
- Institute of Computing Medicine, Third Military Medical University, Chongqing, China.
| | - Liming Wang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; Cartilage Regeneration Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
| |
Collapse
|
6
|
Abstract
The patellofemoral (PF) joint is a complex articulation, with interplay between the osseous and soft tissue structures to maintain the balance between knee mobility and stability. Disorders of the PF joint can be a source of anterior knee pain (AKP). In this article, radiographic and magnetic resonance imaging of the PF joint are reviewed, including normal anatomy, imaging techniques, and imaging-based measurements. Common imaging findings associated with AKP are reviewed, including symptomatic normal variants, tendinopathy, apophysitis, osteoarthritis, chondromalacia patella, trochlear dysplasia, excessive lateralization of tibial tuberosity, patellar maltracking, patellar dislocation and fractures, anterior bursitis, Morel-Lavallée effusions, and fat pad edema.
Collapse
Affiliation(s)
- Stephen Thomas
- Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60637, USA
| | - David Rupiper
- Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60637, USA
| | - G Scott Stacy
- Department of Radiology, University of Chicago, 5841 South Maryland Avenue, MC 2026, Chicago, IL 60637, USA.
| |
Collapse
|
7
|
Wall CR, Cook CR, Cook JL. DIAGNOSTIC SENSITIVITY OF RADIOGRAPHY, ULTRASONOGRAPHY, AND MAGNETIC RESONANCE IMAGING FOR DETECTING SHOULDER OSTEOCHONDROSIS/OSTEOCHONDRITIS DISSECANS IN DOGS. Vet Radiol Ultrasound 2014; 56:3-11. [DOI: 10.1111/vru.12179] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/23/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Corey R. Wall
- Comparative Orthopaedic Laboratory and Department of Veterinary Medicine and Surgery; College of Veterinary Medicine; University of Missouri; Columbia
| | - Cristi R. Cook
- Comparative Orthopaedic Laboratory and Department of Veterinary Medicine and Surgery; College of Veterinary Medicine; University of Missouri; Columbia
| | - James L. Cook
- Comparative Orthopaedic Laboratory and Department of Veterinary Medicine and Surgery; College of Veterinary Medicine; University of Missouri; Columbia
| |
Collapse
|
8
|
T1ρ magnetic resonance imaging for detection of early cartilage changes in knees of asymptomatic collegiate female impact and nonimpact athletes. Clin J Sport Med 2014; 24:218-25. [PMID: 24172654 PMCID: PMC6425943 DOI: 10.1097/jsm.0000000000000013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if T1ρ magnetic resonance imaging (T1ρ MRI) could assess early articular cartilage changes in knees of asymptomatic female collegiate athletes. It was hypothesized that impact cohort would demonstrate greater changes than nonimpact cohort. DESIGN An institutional review board-approved prospective cohort study. Blinded MRI analyses. SETTING Participants from collegiate athletic program. Imaging at university hospital, February 2008 to July 2009. PARTICIPANTS Inclusion criteria were female collegiate athletes in athletic season and asymptomatic. Exclusion criteria were previous/current knee injuries/surgeries. Twenty-one female NCAA Division I athletes, 11 impact (basketball players) and 10 nonimpact (swimmers) participants were consented and imaged with 3.0-T MRI (Siemens) and T1ρ sequence (University of Pennsylvania). One patient was removed (injury diagnosis). Final roster was 10 impact and 10 nonimpact participants. No difference in cohort body mass index, height, or weight. MAIN OUTCOME MEASURES Average T1ρ relaxation times (ART) for patellar and femoral cartilage to analyze defined regions and depth and modified International Cartilage Repair Society classification. RESULTS Statistical analyses showed that ART of radial zone of central third weight-bearing region of cartilage in basketball players was significantly greater (P = 0.041) than swimmers and ART of the superficial zone in basketball players was significantly less (P = 0.003) than that of swimmers. For both groups, the ART of superficial zones were significantly greater than that of radial zones (P < 0.001). Four impact athletes showed macroscopic changes (none in nonimpact cohort). CONCLUSIONS T1ρ MRI detected early changes in articular cartilage of asymptomatic collegiate female impact athletes, with significant differences between cohorts in radial zone of central third weight-bearing region and superficial zones ART. Both cohorts showed increased ART in superficial zone. Four impact athletes showed macroscopic changes. CLINICAL RELEVANCE This study demonstrates a quantitative MRI sequence able to detect signal differences in articular cartilage in asymptomatic athletes.
Collapse
|
9
|
Ross KA, Williams RM, Schnabel LV, Mohammed HO, Potter HG, Bradica G, Castiglione E, Pownder SL, Satchell PW, Saska RA, Fortier LA. Comparison of Three Methods to Quantify Repair Cartilage Collagen Orientation. Cartilage 2013; 4:111-20. [PMID: 26069654 PMCID: PMC4297104 DOI: 10.1177/1947603512461440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine if the noninvasive or minimally invasive and nondestructive imaging techniques of quantitative T2-mapping or multiphoton microscopy (MPM) respectively, could detect differences in cartilage collagen orientation similar to polarized light microscopy (PLM). It was hypothesized that MRI, MPM, and PLM would all detect quantitative differences between repair and normal cartilage tissue. METHODS Osteochondral defects in the medial femoral condyle were created and repaired in 5 mature goats. Postmortem, MRI with T2-mapping and histology were performed. T2 maps were generated and a mean T2 value was calculated for each region of interest. Histologic slides were assessed using MPM with measurements of autocorrelation ellipticity, and by PLM with application of a validated scoring method. Collagen orientation using each of the 3 modalities (T2-mapping, MPM, and PLM) was measured in the center of the repair tissue and compared to remote, normal cartilage. RESULTS MRI, MPM, and PLM were able to detect a significant difference between repair and normal cartilage (n = 5). The average T2 value was longer for repair tissue (41.43 ± 9.81 ms) compared with normal cartilage (27.12 ± 14.22 ms; P = 0.04); MPM autocorrelation ellipticity was higher in fibrous tissue (3.75 ± 1.17) compared with normal cartilage (2.24 ± 0.51; P = 0.01); the average PLM score for repair tissue was lower (1.6 ± 1.02) than the score for remote normal cartilage (4.4 ± 0.42; P = 0.002). The strongest correlation among the methods was between MRI and PLM (r = -0.76; P = 0.01), followed by MPM and PLM (r = -0.58; P = 0.08), with the weakest correlation shown between MRI and MPM (r = 0.35; P = 0.31). CONCLUSION All 3 imaging methods quantitatively measured differences in collagen orientation between repair and normal cartilage, but at very different levels of resolution. PLM is destructive to tissue and requires euthanasia, but because MPM can be used arthroscopically, both T2-mapping and MPM can be performed in vivo, offering nondestructive means to assess collagen orientation that could be used to obtain longitudinal data in cartilage repair studies.
Collapse
Affiliation(s)
- Keir A. Ross
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Rebecca M. Williams
- Department of Biomedical Engineering, College of Engineering, Cornell University, Ithaca, NY, USA
| | - Lauren V. Schnabel
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Hussni O. Mohammed
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Hollis G. Potter
- Hospital for Special Surgery, Weill Cornell Medical College, New York, USA
| | | | | | - Sarah L. Pownder
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Patrick W. Satchell
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | | | - Lisa A. Fortier
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| |
Collapse
|
10
|
Walker EA, Davis D, Mosher TJ. Rapidly progressive osteoarthritis: biomechanical considerations. Magn Reson Imaging Clin N Am 2011; 19:283-94. [PMID: 21665091 DOI: 10.1016/j.mric.2011.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
An underlying hypothesis for rapid cartilage loss in patients with osteoarthritis (OA) is that perturbation from normal joint mechanics produces locally high biomechanical strains that exceed the material properties of the tissue, leading to rapid destruction. Several imaging findings are associated with focally high biomechanical forces and thus are potential candidates for predictive biomarkers of rapid OA progression. This article focuses on 3 aspects of knee biomechanics that have potential magnetic resonance imaging correlates, and which may serve as prognostic biomarkers: knee malalignment, meniscal dysfunction, and injury of the osteochondral unit.
Collapse
Affiliation(s)
- Eric A Walker
- Department of Radiology MC H066, Penn State University College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | | | | |
Collapse
|
11
|
Carballido-Gamio J, Link TM, Majumdar S. New techniques for cartilage magnetic resonance imaging relaxation time analysis: texture analysis of flattened cartilage and localized intra- and inter-subject comparisons. Magn Reson Med 2008; 59:1472-7. [PMID: 18506807 DOI: 10.1002/mrm.21553] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
MR relaxation time measurements of knee cartilage have shown potential to characterize knee osteoarthritis (OA). In this work, techniques that allow localized intra- and inter-subject comparisons of cartilage relaxation times, as well as cartilage flattening for texture analysis parallel and perpendicular to the natural cartilage layers, are presented. The localized comparisons are based on the registration of bone structures and the assignment of relaxation time feature vectors to each point in the bone-cartilage interface. Cartilage flattening was accomplished with Bezier splines and warping, and texture analysis was performed with second-order texture measures using gray-level co-occurrence matrices (GLCM). In a cohort of five normal subjects the performance and reproducibility of the techniques were evaluated using T1rho maps of femoral knee cartilage. The feasibility of creating a mean cartilage relaxation time map is also presented. Successful localized intra- and inter-subject T1rho comparisons were obtained with reproducibility similar to that reported in the literature for regional T2. Improvement of the reproducibility of GLCM features was obtained by flattening the T1rho maps. The results indicate that the presented techniques have potential in longitudinal and population studies of knee OA at different stages of the disease.
Collapse
Affiliation(s)
- Julio Carballido-Gamio
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology, University of California, San Francisco, San Francisco, California 94158, USA.
| | | | | |
Collapse
|
12
|
Bowers AL, Huffman GR. Suture bridge fixation of a femoral condyle traumatic osteochondral defect. Clin Orthop Relat Res 2008; 466:2276-81. [PMID: 18584263 PMCID: PMC2493009 DOI: 10.1007/s11999-008-0357-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 06/09/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Internal fixation of a traumatic osteochondral defect presents a challenge in terms of obtaining anatomic reduction, fixation, and adequate compression for healing. Fixation with countersunk intraarticular screws, Herbert screws, bioabsorbable screws and pins, mini-cancellous screws, and glue tissue adhesive have been reported with varying results. We present an alternative fixation method used in two patients for femoral condylar defects that achieved anatomic reduction with compression via a cruciate-shaped suture bridge construct tied down over a bony bridge. This fixation method allowed early passive range of motion and permitted high-quality MRI for followup of fracture healing and articular cartilage integrity. Arthroscopic examination of one of two patients at 6 months followup showed the gross appearance of a healed, anatomically reduced fracture. With 1 year followup for one patient and 2 years for the other, the patients have resumed activity as tolerated with full, painless range of motion at the knee. Longer-term outcomes are unknown. However, the suture bridge is an alternative means of fixation with encouraging early results for treatment of traumatic osteochondral fragments in the knee. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Andrea L. Bowers
- Department of Orthopaedic Surgery, Penn Sports Medicine Center, Hospital of the University of Pennsylvania, Weightman Hall, 235 S. 33rd Street, Philadelphia, PA 19104 USA
| | - G. Russell Huffman
- Department of Orthopaedic Surgery, Penn Sports Medicine Center, Hospital of the University of Pennsylvania, Weightman Hall, 235 S. 33rd Street, Philadelphia, PA 19104 USA
| |
Collapse
|
13
|
Abstract
Treatment strategies for osteoarthritis most commonly involve the removal or replacement of damaged joint tissue. Relatively few treatments attempt to arrest, slow down or reverse the disease process. Such options include peri-articular osteotomy around the hip or knee, and treatment of femoro-acetabular impingement, where early intervention may potentially alter the natural history of the disease. A relatively small proportion of patients with osteoarthritis have a clear predisposing factor that is both suitable for modification and who present early enough for intervention to be deemed worthwhile. This paper reviews recent advances in our understanding of the pathology, imaging and progression of early osteoarthritis.
Collapse
Affiliation(s)
- T. C. B. Pollard
- Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - S. E. Gwilym
- Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - A. J. Carr
- Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
| |
Collapse
|
14
|
|
15
|
|