Proteoglycan epitope in synovial fluid in gonarthrosis. 28 cases of tibial osteotomy studied prospectively for 2 years

dGEMRIC as a tool for measuring changes in cartilage quality following high tibial osteotomy: a feasibility study

OBJECTIVE

The high tibial osteotomy (HTO) is an effective strategy for treatment of painful medial compartment knee osteoarthritis. Effects on cartilage quality are largely unknown. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) enables non-invasive assessment of cartilage glycosaminoglycan content. This study aimed to evaluate if dGEMRIC could detect relevant changes in cartilage glycosaminoglycan content following HTO.

DESIGN

Ten patients with medial compartment osteoarthritis underwent a dGEMRIC scan prior to HTO, and after bone healing and subsequent hardware removal. A dGEMRIC index (T1Gd) was used for changes in cartilage glycosaminoglycan content, a high T1Gd indicating a high glycosaminoglycan content and vice versa. Radiographic analysis included mechanical axis and tibial slope measurement. clinical scores [knee osteoarthritis outcome scale (KOOS), visual analogue score (VAS) for pain, Knee Society clinical rating system (KSCRS)] before, 3 and 6 months after HTO and after hardware removal were correlated to T1Gd changes.

RESULTS

Overall a trend towards a decreased T1Gd, despite HTO, was observed. Before and after HTO, lateral femoral condyle T1Gd was higher than medial femoral condyle (MFC) T1Gd and tibial cartilage T1Gd was higher than that of femoral cartilage (P < 0.001). The MFC had the lowest T1Gd before and after HTO. Clinical scores all improved significantly (P < 0.01), KOOS Symptoms and QOL were moderately related to changes in MFC T1Gd.

CONCLUSIONS

dGEMRIC effectively detected differences in cartilage quality within knee compartments before and after HTO, but no changes due to HTO were detected. Hardware removal post-HTO seems essential for adequate T(1)Gd interpretation. T(1)Gd was correlated to improved clinical scores on a subscore level only. Longer follow-up after HTO may reveal lasting changes. ClinicalTrials.gov registration ID: NCT01269944.

Cartilage repair in the rabbit knee: mosaic plasty resulted in higher degree of tissue filling but affected subchondral bone more than microfracture technique: a blinded, randomized, controlled, long-term follow-up trial in 88 knees

PURPOSE

Discrepancies and variances in outcome following different surgical techniques for cartilage repair are poorly understood. Successful repair relies on proper tissue filling without initiating degenerative processes in the cartilage-bone unit. Consequently, the objective of the current study was to compare two available techniques for cartilage repair, i.e., microfracture technique and mosaic plasty, regarding tissue filling and subchondral bone changes in an experimental model.

METHODS

A 4-mm pure chondral defect was created in the medial femoral condyle of both knees in New Zealand rabbits, aged 22 weeks. A stereomicroscope was used to optimize the preparation of the defects. In one knee (randomized), the defect was treated with microfracture technique whereas in the other with mosaic plasty. The animals were killed at 12, 24 and 36 weeks after surgery. Defect filling, new bone formation above the level of the tidemark and the density of subchondral mineralized tissue were estimated by histomorphometry.

RESULTS

Mosaic plasty resulted in a significantly 34% higher degree of tissue filling than microfracture technique at 36 weeks, SD of mean difference being 34%. Mosaic plasty resulted in significantly more new bone formation and reduced subchondral mineralized tissue density compared to microfracture technique. The differences between the two techniques were apparent mainly at the long-term follow-up.

CONCLUSION

Tissue filling is a limiting factor regarding microfracture technique when compared to mosaic plasty, whereas mosaic plasty resulted in more bone changes than microfracture technique-the implications of the latter remain to be settled. This study underlines the difficulty in predicting outcome in the single case with any of these two techniques, particularly in a long-term perspective.

Intraarticular location predicts cartilage filling and subchondral bone changes in a chondral defect

BACKGROUND AND PURPOSE

The natural history of, and predictive factors for outcome of cartilage restoration in chondral defects are poorly understood. We investigated the natural history of cartilage filling subchondral bone changes, comparing defects at two locations in the rabbit knee.

ANIMALS AND METHODS

In New Zealand rabbits aged 22 weeks, a 4-mm pure chondral defect (ICRS grade 3b) was created in the patella of one knee and in the medial femoral condyle of the other. A stereo microscope was used to optimize the preparation of the defects. The animals were killed 12, 24, and 36 weeks after surgery. Defect filling and the density of subchondral mineralized tissue was estimated using Analysis Pro software on micrographed histological sections.

RESULTS

The mean filling of the patellar defects was more than twice that of the medial femoral condylar defects at 24 and 36 weeks of follow-up. There was a statistically significant increase in filling from 24 to 36 weeks after surgery at both locations. The density of subchondral mineralized tissue beneath the defects subsided with time in the patellas, in contrast to the density in the medial femoral condyles, which remained unchanged.

INTERPRETATION

The intraarticular location is a predictive factor for spontaneous filling and subchondral bone changes of chondral defects corresponding to ICRS grade 3b. Disregarding location, the spontaneous filling increased with long-term follow-up. This should be considered when evaluating aspects of cartilage restoration.

Concentrations of proteoglycan fragments in relation to maturation, sex and time of day: physiologic variations in knee joint fluid of rabbits

We analyzed the concentrations of proteoglycan fragments in knee joint fluid in 142 rabbits to investigate the effect of physiologic variations--i.e., maturation, sex and time of day. The concentrations of proteoglycan fragments differed significantly between young, adolescent and adult animals and showed an inverse correlation to the stage of maturation of the rabbit. Adolescent male rabbits had higher concentrations than age-matched females. Morning and evening samples had similar concentrations. No relation was found between the proteoglycan fragment concentrations in joint fluid and the cartilage mass. The proteoglycan fragment concentrations in knee joint fluid apparently reflect the metabolic status of growing articular cartilage. There are considerable physiologic variations associated with maturation and sex, and these need to be taken into account when using the proteoglycan fragment concentration as a marker for joint diseases.

Neocartilage after artificial cartilage repair in the rabbit: histology and proteoglycan fragments in joint fluid

Repair of full-thickness cartilage defects of the rabbit medial femoral condyle with artificial plugs and periosteal grafts was followed for 1 year. The morphological characteristics of the neocartilage after repair and the concentration of proteoglycan fragments in the joint fluid (CPFF) were evaluated. The CPFF showed only a weak correlation to the histological score of the neocartilage. Normal cartilage and subchondral bone did not develop with any of the repair alternatives. With a Dacron plug, neocartilage formation appeared earlier than with natural repair and was better than with periosteal grafting. Increased CPFFs were found in all specimens with repair at 3 months, probably reflecting the remaining effect of surgery. At 6 months, the CPFFs had normalized to control values. At 1 year, the CPFFs were again similar to those at the 3-month evaluation. This was paralleled by a degeneration of the neocartilage. We conclude that Dacron plugs could serve as a scaffold for neocartilage formation. The CPFF reflected surgical trauma and late degeneration of neocartilage but did not indicate minor differences in quality between cartilage repair techniques, probably because of the limited size of the grafted defect.

Cartilage mechanics and morphology, synovitis and proteoglycan fragments in rabbit joint fluid after prosthetic meniscal substitution

The effects of meniscal substitution with a Dacron or Teflon prosthesis on rabbit knee-joint cartilage were studied by indentation tests, gross and histological inspection, analysis of proteoglycan fragments in joint fluid and an evaluation of synovial changes. Cartilage mechanics and cartilage morphology were similarly abnormal after meniscectomy and meniscal substitution. The elevated concentrations of proteoglycan fragments in joint fluid and the more severe synovial changes in joints with a meniscal substitute, as compared to meniscectomy, probably resulted from irritation of the artificial implant, but also reflected the remaining effects from the necessary bone drilling. In this short-term experiment, the use of an artificial meniscal substitute could not prevent cartilage degeneration after meniscectomy.

Markers of cartilage metabolism in arthrosis. A review

The mechanisms involved in the disease process in arthrosis are largely unknown, with genetics, joint malalignment, overload or trauma, obesity, and aging as some of the known or suspected contributing factors. Even less well known is how these general factors are translated into disease mechanisms at the cell and tissue levels. However, it may be argued that degradation of cartilage matrix is a key event at some time in the development of arthrosis. During this process, fragments of matrix molecules and other chondrocyte products are released into the joint fluid and eventually into other body fluids. These molecules can be used as markers of cartilage metabolism to monitor joint disease. In addition, by identifying the proteases and the structure of the released matrix fragments, we may improve our understanding of the cellular mechanisms active in cartilage degradation. Such information offers improved diagnostic and prognostic tools for rational treatment aimed at retarding cartilage destruction in arthrosis.