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Guo J, Yan P, Qin Y, Liu M, Ma Y, Li J, Wang R, Luo H, Lv S. Automated measurement and grading of knee cartilage thickness: a deep learning-based approach. Front Med (Lausanne) 2024; 11:1337993. [PMID: 38487024 PMCID: PMC10939064 DOI: 10.3389/fmed.2024.1337993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Background Knee cartilage is the most crucial structure in the knee, and the reduction of cartilage thickness is a significant factor in the occurrence and development of osteoarthritis. Measuring cartilage thickness allows for a more accurate assessment of cartilage wear, but this process is relatively time-consuming. Our objectives encompass using various DL methods to segment knee cartilage from MRIs taken with different equipment and parameters, building a DL-based model for measuring and grading knee cartilage, and establishing a standardized database of knee cartilage thickness. Methods In this retrospective study, we selected a mixed knee MRI dataset consisting of 700 cases from four datasets with varying cartilage thickness. We employed four convolutional neural networks-UNet, UNet++, ResUNet, and TransUNet-to train and segment the mixed dataset, leveraging an extensive array of labeled data for effective supervised learning. Subsequently, we measured and graded the thickness of knee cartilage in 12 regions. Finally, a standard knee cartilage thickness dataset was established using 291 cases with ages ranging from 20 to 45 years and a Kellgren-Lawrence grading of 0. Results The validation results of network segmentation showed that TransUNet performed the best in the mixed dataset, with an overall dice similarity coefficient of 0.813 and an Intersection over Union of 0.692. The model's mean absolute percentage error for automatic measurement and grading after segmentation was 0.831. The experiment also yielded standard knee cartilage thickness, with an average thickness of 1.98 mm for the femoral cartilage and 2.14 mm for the tibial cartilage. Conclusion By selecting the best knee cartilage segmentation network, we built a model with a stronger generalization ability to automatically segment, measure, and grade cartilage thickness. This model can assist surgeons in more accurately and efficiently diagnosing changes in patients' cartilage thickness.
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Affiliation(s)
- JaingRaong Guo
- Department of Orthopedics and Sports Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Pengfei Yan
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Yong Qin
- Department of Orthopedics and Sports Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - MeiNa Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yingkai Ma
- Department of Orthopedics and Sports Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - JaingQi Li
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Ren Wang
- Department of Orthopedics and Sports Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hao Luo
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Songcen Lv
- Department of Orthopedics and Sports Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Cummings J, Gao K, Chen V, Martinez AM, Iriondo C, Caliva F, Majumdar S, Pedoia V. The knee connectome: A novel tool for studying spatiotemporal change in cartilage thickness. J Orthop Res 2024; 42:43-53. [PMID: 37254620 PMCID: PMC10687317 DOI: 10.1002/jor.25637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/01/2023]
Abstract
Cartilage thickness change is a well-documented biomarker of osteoarthritis pathogenesis. However, there is still much to learn about the spatial and temporal patterns of cartilage thickness change in health and disease. In this study, we develop a novel analysis method for elucidating such patterns using a functional connectivity approach. Descriptive statistics are reported for 1186 knees that did not develop osteoarthritis during the 8 years of observation, which we present as a model of cartilage thickness change related to healthy aging. Within the control population, patterns vary greatly between male and female subjects, while body mass index (BMI) has a more moderate impact. Finally, several differences are shown between knees that did and did not develop osteoarthritis. Some but not all significance appears to be accounted for by differences in sex, BMI, and knee alignment. With this work, we present the connectome as a novel tool for studying spatiotemporal dynamics of tissue change.
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Affiliation(s)
- Jennifer Cummings
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Kenneth Gao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Vincent Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Alejandro Morales Martinez
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Claudia Iriondo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Francesco Caliva
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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Maeda T, Kuriyama S, Yoshida S, Nishitani K, Nakamura S, Matsuda S. Decreased Elastic Modulus of Knee Articular Cartilage Based on New Macroscopic Methods Accurately Represents Early Histological Findings of Degeneration. Cartilage 2023:19476035231194770. [PMID: 37655826 DOI: 10.1177/19476035231194770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE Ex vivo nanoindentation measurement has reported that elastic modulus decreases as cartilage degenerates, but no method has been established to macroscopically evaluate mechanical properties in vivo. The objective of this study was to evaluate the elastic modulus of knee joint cartilage based on macroscopic methods and to compare it with gross and histological findings of degeneration. DESIGN Osteochondral sections were taken from 50 knees with osteoarthritis (average age, 75 years) undergoing total knee arthroplasty. The elastic modulus of the cartilage was measured with a specialized elasticity tester. Gross findings were recorded as International Cartilage Repair Society (ICRS) grade. Histological findings were graded as Mankin score and microscopic cartilage thickness measurement. RESULTS In ICRS grades 0 to 2 knees with normal to moderate cartilage abnormalities, the elastic modulus of cartilage decreased significantly as cartilage degeneration progressed. The elastic modulus of cartilage was 12.2 ± 3.8 N/mm for ICRS grade 0, 6.3 ± 2.6 N/mm for ICRS grade 1, and 3.8 ± 2.4 N/mm for ICRS grade 2. Similarly, elastic modulus was correlated with Mankin score (r = -0.51, P < 0.001). Multiple regression analyses showed that increased Mankin score is the most relevant factor associated with decreased elastic modulus of the cartilage (t-value, -4.53; P < 0.001), followed by increased histological thickness of the cartilage (t-value, -3.15; P = 0.002). CONCLUSIONS Mechanical properties of damaged knee cartilage assessed with new macroscopic methods are strongly correlated with histological findings. The method has potential to become a nondestructive diagnostic modality for early cartilage damage in the clinical setting.
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Affiliation(s)
- Takahiro Maeda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeo Yoshida
- Department of Orthopaedic Surgery, Hayashi Hospital, Fukui, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Carlson CG, Chen A, Patterson K, Ablove RH. Glenohumeral Cartilage Thickness: Implications in Prosthetic Design and Osteochondral Allograft Transplantation. Cartilage 2023; 14:278-284. [PMID: 36794814 PMCID: PMC10601562 DOI: 10.1177/19476035231154504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE A complete understanding of the glenohumeral joint anatomy is crucial for osteochondral allograft (OCA) transplantation and prosthetic design. However, existing data on the cartilage thickness distribution are not consistent. This study aims to describe the cartilage thickness distribution at both the glenoid cavity and humeral head in males and females. DESIGN Sixteen fresh cadaveric shoulder specimens were dissected and separated to expose the glenoid and humeral head articular surfaces. The glenoid and humeral head were cut into 5-mm coronal sections. Sections were imaged and cartilage thickness was measured at 5 standardized points on each section. Measurements were analyzed based on age, sex, and regional location. RESULTS For the humeral head, cartilage was thickest centrally (M = 1.77 ± 0.35 mm) and thinnest superiorly and inferiorly (M = 1.42 ± 0.37 mm, 1.42 ± 0.29 mm). At the glenoid cavity, cartilage was thickest in the superior and inferior areas (M = 2.61 ± 0.47 mm, 2.53 ± 0.58 mm) and thinnest centrally (M = 1.69 ± 0.22 mm). Males were found to have thicker cartilage at both the humeral head and glenoid (P = 0.0014, P = 0.0133). CONCLUSIONS Articular cartilage thickness distribution of the glenoid and humeral head is nonuniform and reciprocal in nature. These results can be used to further inform prosthetic design and OCA transplantation. We noted a significant difference in cartilage thickness between males and females. This suggests that the sex of the patient should be taken into consideration when matching donors for OCA transplantation.
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Affiliation(s)
| | - Andreas Chen
- Mercy Hospital Northwest Arkansas, Rogers, AR, USA
| | - Kyle Patterson
- General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Robert H. Ablove
- Department of Orthopaedics, Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA
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Keefe TH, Minnig MC, Arbeeva L, Niethammer M, Xu Z, Shen Z, Chen B, Nissman DB, Golightly YM, Marron J, Nelson AE. Patterns of variation among baseline femoral and tibial cartilage thickness and clinical features: Data from the osteoarthritis initiative. Osteoarthr Cartil Open 2023; 5:100334. [PMID: 36817090 PMCID: PMC9932103 DOI: 10.1016/j.ocarto.2023.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Objective To employ novel methodologies to identify phenotypes in knee OA based on variation among three baseline data blocks: 1) femoral cartilage thickness, 2) tibial cartilage thickness, and 3) participant characteristics and clinical features. Methods Baseline data were from 3321 Osteoarthritis Initiative (OAI) participants with available cartilage thickness maps (6265 knees) and 77 clinical features. Cartilage maps were obtained from 3D DESS MR images using a deep-learning based segmentation approach and an atlas-based analysis developed by our group. Angle-based Joint and Individual Variation Explained (AJIVE) was used to capture and quantify variation, both shared among multiple data blocks and individual to each block, and to determine statistical significance. Results Three major modes of variation were shared across the three data blocks. Mode 1 reflected overall thicker cartilage among men, those with higher education, and greater knee forces; Mode 2 showed associations between worsening Kellgren-Lawrence Grade, medial cartilage thinning, and worsening symptoms; and Mode 3 contrasted lateral and medial-predominant cartilage loss associated with BMI and malalignment. Each data block also demonstrated individual, independent modes of variation consistent with the known discordance between symptoms and structure in knee OA and reflecting the importance of features such as physical function, symptoms, and comorbid conditions independent of structural damage. Conclusions This exploratory analysis, combining the rich OAI dataset with novel methods for determining and visualizing cartilage thickness, reinforces known associations in knee OA while providing insights into the potential for data integration in knee OA phenotyping.
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Affiliation(s)
- Thomas H. Keefe
- Statistics and Operations Research, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Mary Catherine Minnig
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Liubov Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marc Niethammer
- Department of Computer Science, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Zhenlin Xu
- Department of Computer Science, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Zhengyang Shen
- Department of Computer Science, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Boqi Chen
- Department of Computer Science, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Daniel B. Nissman
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - J.S. Marron
- Statistics and Operations Research, University of North Carolina at Chapel Hill College of Arts and Sciences, Chapel Hill, North Carolina, USA
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Nolte T, Westfechtel S, Schock J, Knobe M, Pastor T, Pfaehler E, Kuhl C, Truhn D, Nebelung S. Getting Cartilage Thickness Measurements Right: A Systematic Inter-Method Comparison Using MRI Data from the Osteoarthritis Initiative. Cartilage 2023; 14:26-38. [PMID: 36659857 PMCID: PMC10076900 DOI: 10.1177/19476035221144744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Magnetic resonance imaging is the standard imaging modality to assess articular cartilage. As the imaging surrogate of degenerative joint disease, cartilage thickness is commonly quantified after tissue segmentation. In lack of a standard method, this study systematically compared five methods for automatic cartilage thickness measurements across the knee joint and as a function of region and sub-region: 3D mesh normals (3D-MN), 3D nearest neighbors (3D-NN), 3D ray tracing (3D-RT), 2D centerline normals (2D-CN), and 2D surface normals (2D-SN). DESIGN Based on the manually segmented femoral and tibial cartilage of 507 human knee joints, mean cartilage thickness was computed for the entire femorotibial joint, 4 joint regions, and 20 subregions using these methods. Inter-method comparisons of mean cartilage thickness and computation times were performed by one-way analysis of variance (ANOVA), Bland-Altman analyses and Lin's concordance correlation coefficient (CCC). RESULTS Mean inter-method differences in cartilage thickness were significant in nearly all subregions (P < 0.001). By trend, mean differences were smallest between 3D-MN and 2D-SN in most (sub)regions, which is also reflected by highest quantitative inter-method agreement and CCCs. 3D-RT was prone to severe overestimation of up to 2.5 mm. 3D-MN, 3D-NN, and 2D-SN required mean processing times of ≤5.3 s per joint and were thus similarly efficient, whereas the time demand of 2D-CN and 3D-RT was much larger at 133 ± 29 and 351 ± 10 s per joint (P < 0.001). CONCLUSIONS In automatic cartilage thickness determination, quantification accuracy and computational burden are largely affected by the underlying method. Mesh and surface normals or nearest neighbor searches should be used because they accurately capture variable geometries while being time-efficient.
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Affiliation(s)
- Teresa Nolte
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Simon Westfechtel
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Justus Schock
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Matthias Knobe
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, University Hospital Aachen, Aachen, Germany
| | - Torsten Pastor
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Elisabeth Pfaehler
- Institute for Advanced Simulation, Forschungszentrum Jülich, Jülich, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
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Muacevic A, Adler JR, Badhal S, Wadhwa R. Effects of Intra-articular Platelet Rich Plasma on Cartilage Thickness, Clinical and Functional Outcomes in Knee Osteoarthritis. Cureus 2022; 14:e32256. [PMID: 36620792 PMCID: PMC9815489 DOI: 10.7759/cureus.32256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Osteoarthritis of the knee is one of the most common degenerative diseases and the fourth leading cause of years lived with disability at the global level. This study assessed the efficacy of platelet-rich plasma (PRP) in osteoarthritis of knees as to changes in cartilage thickness and clinical and functional outcomes. METHODS Thirty participants with Kellgren-Lawrence grade two and grade three osteoarthritis knee who satisfied the inclusion and exclusion criteria were enrolled in this prospective interventional study after taking written informed consent. Each participant received three doses of two ml intraarticular platelet-rich plasma at an interval of seven days. Clinical assessment was determined using the Visual Analogue Scale (VAS) and Knee Osteoarthritis Outcome Score (KOOS) on Day 0, Day 90, and Day 180. Cartilage thickness (femoral and trochlear cartilage) was measured pre (Day 0) and post-PRP (Day 180) under ultrasound guidance. RESULTS The mean VAS score for pain was 7.4 before treatment which changed to 5.3 (p= <0.0001) on Day 90 and 3.37 (p= <0.0001) on Day 180 post-PRP. The mean total KOOS was 19.16 ± 10.73 before treatment which improved to 37.42 ± 9.88 (p= <0.0001) and 49.98 ± 8.82 (p= <0.0001) at 90 days, and 180 days post-injection, respectively. The mean cartilage thickness (femoral and trochlear cartilage) improved from baseline (day 0) to final follow-up on day 180, which was statistically significant and implied cartilage repair following PRP administration. CONCLUSION This study supports the efficacy of PRP in the management of osteoarthritis knee by improvement in pain, joint stiffness, and activities of daily living, as well as aids in the repair and regeneration of articular cartilage.
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Thomeer LT, Guan S, Gray HA, Pandy MG. Articular contact motion at the knee during daily activities. J Orthop Res 2022; 40:1756-1769. [PMID: 34878691 DOI: 10.1002/jor.25222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/31/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
We combined mobile biplane X-ray imaging and magnetic resonance imaging to measure the regions of articular cartilage contact and cartilage thickness at the tibiofemoral and patellofemoral joints during six functional activities: standing, level walking, downhill walking, stair ascent, stair descent, and open-chain (non-weight-bearing) knee flexion. The contact centers traced similar paths on the medial and lateral femoral condyles, femoral trochlea, and patellar facet in all activities while their locations on the tibial plateau were more varied. The translations of the contact centers on the femur and patella were tightly coupled to the tibiofemoral flexion angle in all activities (r2 > 0.95) whereas those on the tibia were only moderately related to the flexion angle (r2 > 0.62). The regions of contacting cartilage were significantly thicker than the regions of non-contacting cartilage on the patella, femoral trochlea, and the medial and lateral tibial plateaus in all activities (p < 0.001). There were no significant differences in thickness between contacting and non-contacting cartilage on the medial and lateral femoral condyles in all activities, except open-chain knee flexion. Our results provide partial support for the proposition that cartilage thickness is adapted to joint load and do not exclude the possibility that other factors, such as joint congruence, also play a role in regulating the structure and organization of healthy cartilage. The data obtained in this study may serve as a guide when evaluating articular contact motion in osteoarthritic and reconstructed knees.
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Affiliation(s)
- Lucas T Thomeer
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Shanyuanye Guan
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Hans A Gray
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
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Teoli A, Cloutier-Gendron M, Ho SYK, Gu S, Pelletier JP, Martel-Pelletier J, Robbins SM. The relationship between knee loading during gait and cartilage thickness in nontraumatic and posttraumatic knee osteoarthritis. J Orthop Res 2022; 40:1778-1786. [PMID: 34796548 DOI: 10.1002/jor.25219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 02/04/2023]
Abstract
The relationship between knee moments and markers of knee osteoarthritis progression has not been examined in different knee osteoarthritis subtypes. The objective was to examine relationships between external knee moments during gait and tibiofemoral cartilage thickness in patients with nontraumatic and posttraumatic knee osteoarthritis. For this cross-sectional study, participants with knee osteoarthritis were classified into two groups: nontraumatic (n = 22; mean age 60 years) and posttraumatic (n = 19; mean age 56 years, history of anterior cruciate ligament rupture). Gait data were collected with a three-dimensional motion capture system sampled at 100 Hz and force plates sampled at 2000 Hz. External knee moments were calculated using inverse dynamics. Cartilage thickness was determined with magnetic resonance imaging (T1-weighted, 3D sagittal gradient-echo sequence). Linear regression analyses examined relationships between cartilage thickness with knee moments, group, and their interaction. A higher knee adduction moment impulse was negatively associated with medial to lateral cartilage thickness ratio (B = -1.97). This relationship differed between participants in the nontraumatic osteoarthritis group (r = -0.56) and posttraumatic osteoarthritis group (r = -0.30). A higher late stance knee extension moment was associated with greater medial femoral condyle cartilage thickness (B = -0.86) and medial to lateral cartilage thickness (B = -0.73). These relationships also differed between participants in the nontraumatic osteoarthritis group (r = -0.61 and r = -0.51, respectively) and posttraumatic osteoarthritis group (r = 0.10 and r = 0.25, respectively). Clinical Significance: The relationship between knee moments with tibiofemoral cartilage thickness differs between patients with nontraumatic and posttraumatic knee osteoarthritis. The potential influence of mechanical knee loading on articular cartilage may also differ between these subtypes.
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Affiliation(s)
- Anthony Teoli
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Melissa Cloutier-Gendron
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Shirley Y K Ho
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Susan Gu
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Rapagna S, Roberts BC, Solomon LB, Reynolds KJ, Thewlis D, Perilli E. Relationships between tibial articular cartilage, in vivo external joint moments and static alignment in end-stage knee osteoarthritis: A micro-CT study. J Orthop Res 2022; 40:1125-1134. [PMID: 34191337 DOI: 10.1002/jor.25140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/16/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
Biomechanical factors (e.g., joint loading) have a significant role in the progression of osteoarthritis (OA). However, some relationships between in vivo joint loading indices and tibial cartilage thickness are conflicting. This study investigated relationships between pre-operative in vivo external knee joint moments, joint alignment and regional tibial cartilage thickness using micro-CT in subjects with end-stage knee OA. Tibial plateaus from 25 patients that underwent knee replacement for OA were micro-CT scanned (17 µm/voxel). Prior to surgery, subjects underwent gait analysis to calculate external knee moments. The mechanical axis deviation (MAD) was obtained from pre-operative radiographs. Cartilage thickness (Cart.Th) was analyzed from micro-CT images, in anteromedial, anterolateral, posteromedial and posterolateral subregions of interest. Medial-to-lateral Cart.Th ratios were also explored. Relationships between Cart.Th and joint loading indices were examined using Pearson's correlations. Significant correlations were found between Cart.Th and joint loading indices, positive anteromedially with the first peak knee adduction moment (r = 0.55, p < 0.01) and external rotation moment (ERM; r = 0.52, p < 0.01), and negative with MAD (r = -0.76, p < 0.001). In the lateral regions, these correlations had opposite signs. The medial-to-lateral Cart.Th ratio correlated strongly with ERM (r = 0.63, p = 0.001) and MAD (r = -0.75, p < 0.001). Joint loading indices correlated with regional cartilage thickness values and their medial-to-lateral ratios in end-stage knee OA subjects, with higher regional loads corresponding to thinner cartilage. These relationships have the opposite sign compared to the subchondral bone microarchitecture found in our previous study on the same specimens, which may suggest a complementary bone-cartilage interplay in response to loading.
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Affiliation(s)
- Sophie Rapagna
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Bryant C Roberts
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.,Department of Oncology & Metabolism and Insigneo Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen J Reynolds
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
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11
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Harkey MS, Michel N, Kuenze C, Fajardo R, Salzler M, Driban JB, Hacihaliloglu I. Validating a Semi-Automated Technique for Segmenting Femoral Articular Cartilage on Ultrasound Images. Cartilage 2022; 13:19476035221093069. [PMID: 35438030 PMCID: PMC9251823 DOI: 10.1177/19476035221093069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To validate a semi-automated technique to segment ultrasound-assessed femoral cartilage without compromising segmentation accuracy to a traditional manual segmentation technique in participants with an anterior cruciate ligament injury (ACL). DESIGN We recruited 27 participants with a primary unilateral ACL injury at a pre-operative clinic visit. One investigator performed a transverse suprapatellar ultrasound scan with the participant's ACL injured knee in maximum flexion. Three femoral cartilage ultrasound images were recorded. A single expert reader manually segmented the femoral cartilage cross-sectional area in each image. In addition, we created a semi-automatic program to segment the cartilage using a random walker-based method. We quantified the average cartilage thickness and echo-intensity for the manual and semi-automated segmentations. Intraclass correlation coefficients (ICC2,k) and Bland-Altman plots were used to validate the semi-automated technique to the manual segmentation for assessing average cartilage thickness and echo-intensity. A dice correlation coefficient was used to quantify the overlap between the segmentations created with the semi-automated and manual techniques. RESULTS For average cartilage thickness, there was excellent reliability (ICC2,k = 0.99) and a small mean difference (+0.8%) between the manual and semi-automated segmentations. For average echo-intensity, there was excellent reliability (ICC2,k = 0.97) and a small mean difference (-2.5%) between the manual and semi-automated segmentations. The average dice correlation coefficient between the manual segmentation and semi-automated segmentation was 0.90, indicating high overlap between techniques. CONCLUSIONS Our novel semi-automated segmentation technique is a valid method that requires less technical expertise and time than manual segmentation in patients after ACL injury.
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Affiliation(s)
- Matthew S. Harkey
- Department of Kinesiology, Michigan
State University, East Lansing, MI, USA,Matthew S. Harkey, Department of
Kinesiology, Michigan State University, 308 W. Circle Drive #112, East Lansing,
MI 48824, USA.
| | - Nicholas Michel
- College of Osteopathic Medicine,
Michigan State University, East Lansing, MI, USA
| | - Christopher Kuenze
- Department of Kinesiology, Michigan
State University, East Lansing, MI, USA
| | - Ryan Fajardo
- Department of Radiology, Michigan State
University, East Lansing, MI, USA
| | - Matt Salzler
- Department of Orthopaedics, Tufts
Medical Center, Boston, MA, USA
| | - Jeffrey B. Driban
- Division of Rheumatology, Allergy, and
Immunology, Tufts Medical Center, Boston, MA, USA
| | - Ilker Hacihaliloglu
- Department of Radiology, Department of
Medicine, The University of British Columbia, Vancouver, BC, Canada
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12
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Thaha R, Jogi SP, Rajan S, Mahajan V, Mehndiratta A, Singh A. A semi-automatic framework based upon quantitative analysis of MR-images for classification of femur cartilage into asymptomatic, early OA, and advanced-OA groups. J Orthop Res 2022; 40:779-790. [PMID: 34057761 DOI: 10.1002/jor.25109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 02/04/2023]
Abstract
To develop a semi-automatic framework for quantitative analysis of biochemical properties and thickness of femur cartilage using magnetic resonance (MR) images and evaluate its potential for femur cartilage classification into asymptomatic (AS), early osteoarthritis (OA), and advanced OA groups. In this study, knee joint MRI data (fat suppressed-proton density-weighted and multi-echo T2-weighted images) of eight AS-volunteers (data acquired twice) and 34 OA patients including 20 early OA (16 Grade-I and 4 Grade-II), 14 advanced-OA (Grade-III) were acquired at 3.0T MR scanner. Modified Outerbridge classification criteria was performed for the clinical evaluation of data by an experienced radiologist. Cartilage segmentation, T2-mapping, 2D-WearMap generation, and subregion analysis were performed semi-automatically using in-house developed algorithms. The intraclass correlation coefficient (ICC) and coefficient of variation (CV) were computed for testing the reproducibility of T2 values. One-way analysis of variance with Tukey-Kramer post hoc test was performed for evaluating the differences among the groups. The performance of individual T2 and thickness, as well as their combination using logistic regression, were evaluated with receiver operating characteristics (ROC) curve analysis. The interscan agreement based on the ICC index was 0.95 and the CV was 2.45 ± 1.33%. T2 mean of values greater than 75th percentile showed sensitivity and specificity of 94.1% and 81.3% (AUC = 0.93, cut-off value = 47.9 ms) in differentiating AS volunteers versus OA group, while sensitivity and specificity of 90.0% and 81.3% (AUC = 0.90, cut-off value = 47.9 ms) in differentiating AS volunteers versus early OA groups, respectively. In the differentiation of early OA versus advanced-OA group, ROC results of combination (T2 and thickness) showed the highest sensitivity and specificity of 85.7%, and 70.0% (AUC = 0.79, cut-off value = 0.39) compared with individual T2 and thickness features, respectively. A computer-aided quantitative evaluation of femur cartilage degeneration showed promising results and can be used to assist clinicians in diagnosing OA.
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Affiliation(s)
- Rafeek Thaha
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Sandeep P Jogi
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, ASET, Amity University, Gurgaon, Haryana, India
| | | | | | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
| | - Anup Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
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13
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Chen E, Hou W, Wang H, Li J, Lin Y, Liu H, Du M, Li L, Wang X, Yang J, Yang R, Zhou C, Chen P, Zeng M, Yao Q, Chen W. Quantitative MRI evaluation of articular cartilage in patients with meniscus tear. Front Endocrinol (Lausanne) 2022; 13:911893. [PMID: 35966082 PMCID: PMC9372396 DOI: 10.3389/fendo.2022.911893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to assess quantitatively articular cartilage volume, thickness, and T2 value alterations in meniscus tear patients. MATERIALS AND METHODS The study included 32 patients with meniscus tears (17 females, 15 males; mean age: 40.16 ± 11.85 years) and 24 healthy controls (12 females; 12 males; mean age: 36 ± 9.14 years). All subjects were examined by 3 T magnetic resonance imaging (MRI) with 3D dual-echo steady-state (DESS) and T2 mapping images. All patients underwent diagnostic arthroscopy and treatment. Cartilage thickness, cartilage volume and T2 values of 21 subregions of knee cartilage were measured using the prototype KneeCaP software (version 2.1; Siemens Healthcare, Erlangen, Germany). Mann-Whitney-U tests were utilized to determine if there were any significant differences among subregional articular cartilage volume, thickness and T2 value between patients with meniscus tear and the control group. RESULTS The articular cartilage T2 values in all subregions of the femur and tibia in the meniscus tear group were significantly higher (p< 0.05) than in the healthy control group. The cartilage thickness of the femoral condyle medial, femur trochlea, femur condyle lateral central, tibia plateau medial anterior and patella facet medial inferior in the meniscus tear group were slightly higher than in the control group (p< 0.05). In the femur trochlea medial, patella facet medial inferior, tibia plateau lateral posterior and tibia plateau lateral central, there were significant differences in relative cartilage volume percentage between the meniscus tear group and the healthy control group (p< 0.05). Nineteen patients had no cartilage abnormalities (Grade 0) in the meniscus tear group, as confirmed by arthroscopic surgery, and their T2 values in most subregions were significantly higher (p< 0.05) than those of the healthy control group. CONCLUSION The difference in articular cartilage indexes between patients with meniscus tears and healthy people without such tears can be detected by using quantitative MRI. Quantitative T2 values enable early and sensitive detection of early cartilage lesions.
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Affiliation(s)
- Enqi Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjing Hou
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hu Wang
- Department of Radiology, Sichuan Science City Hospital, Mianyang, China
| | - Jing Li
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yangjing Lin
- Centre of Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - He Liu
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Mingshan Du
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lian Li
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xianqi Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jing Yang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Rui Yang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Changru Zhou
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Pinzhen Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Meng Zeng
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qiandong Yao
- Department of Radiology, Sichuan Science City Hospital, Mianyang, China
- *Correspondence: Wei Chen, ; Qiandong Yao,
| | - Wei Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- *Correspondence: Wei Chen, ; Qiandong Yao,
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14
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Wisser A, Lapper A, Roemer F, Fuerst D, Maschek S, Wirth W, Duda GN, Eckstein F. Longitudinal Change in Knee Cartilage Thickness and Function in Subjects with and without MRI-Diagnosed Cartilage Damage. Cartilage 2021; 13:685S-693S. [PMID: 33356475 PMCID: PMC8808787 DOI: 10.1177/1947603520980157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Cartilage damage diagnosed by magnetic resonance imaging (MRI) is highly prevalent in the population. In this article, we explore whether such cartilage damage is associated with greater longitudinal change in 3D cartilage thickness and knee function in subjects without (risk factors of) knee osteoarthritis. DESIGN Eighty-two knees of Osteoarthritis Initiative healthy reference cohort participants had baseline and 4-year follow-up MRI and knee function data. Baseline presence of semiquantitatively assessed MRI-based cartilage damage (MOAKS [MRI Osteoarthritis Knee Score] ≥ grade 1.0) was recorded by an experienced radiologist. Longitudinal femorotibial cartilage thickness change was determined after segmentation, using location-independent methodology. Knee function was evaluated by patient-reported outcomes and functional performance measures. Statistical comparisons included analysis of covariance adjusting for age, sex, and body mass index. RESULTS Forty-five percent of the participants had cartilage damage in at least one femorotibial subregion; the cartilage thickness change score was 15% greater in participants with than in those without damage (1216 ± 434 vs. 1058 ± 277 µm). This difference reached borderline statistical significance with and without adjustment for age, sex, and body mass index (P = 0.05). No significant differences in the change of patient-reported outcomes of knee function (PASE [physical activity score of the elderly] and WOMAC [Western Ontario McMaster Osteoarthritis Index]) or chair stand test results were detected. Of those without femorotibial damage, 58% had cartilage damage in at least one femoropatellar subregion; these had a 9% greater femorotibial cartilage change score than those without femoropatellar or femorotibial damage (difference not statistically significant). CONCLUSIONS In the absence of osteoarthritis risk factors, semiquantitatively assessed MRI-based cartilage damage appears to be associated with greater longitudinal location-independent femorotibial cartilage thickness changes, but not with greater functional deteriorations.
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Affiliation(s)
- Anna Wisser
- Department of Imaging & Functional
Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus
Medical University, Salzburg, Austria,Chondrometrics GmbH, Ainring,
Germany
| | - Andreas Lapper
- Department of Imaging & Functional
Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus
Medical University, Salzburg, Austria
| | - Frank Roemer
- Department of Radiology,
Friedrich-Alexander University Erlangen-Nürnberg & Universitätsklinikum
Erlangen, Erlangen, Germany,Quantitative Imaging Center, Department
of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - David Fuerst
- Department of Imaging & Functional
Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus
Medical University, Salzburg, Austria,Chondrometrics GmbH, Ainring,
Germany,Ludwig Boltzmann Institute for Arthritis
and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Susanne Maschek
- Department of Imaging & Functional
Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus
Medical University, Salzburg, Austria,Chondrometrics GmbH, Ainring,
Germany
| | - Wolfgang Wirth
- Department of Imaging & Functional
Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus
Medical University, Salzburg, Austria,Chondrometrics GmbH, Ainring,
Germany,Ludwig Boltzmann Institute for Arthritis
and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Georg N. Duda
- Julius Wolff Institute and Berlin
Institute of Health Center for Regenerative Therapies, Charite—Universitätsmedizin
Berlin, Berlin, Germany
| | - Felix Eckstein
- Department of Imaging & Functional
Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus
Medical University, Salzburg, Austria,Chondrometrics GmbH, Ainring,
Germany,Ludwig Boltzmann Institute for Arthritis
and Rehabilitation, Paracelsus Medical University, Salzburg, Austria,Felix Eckstein, MD, Institute of Anatomy
& Cell Biology, Paracelsus Medical University, Strubergasse 21, Salzburg,
5020, Austria.
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15
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Misir A, Gunay AE, Oguzkaya S, Uzun E, Kizkapan TB, Yildiz KI, Ozcamdalli M. A Comprehensive Coronal and Axial Bone Dimension and Cartilage Thickness Evaluation of the Distal Humerus: Age and Sex Differences. Cartilage 2021; 13:464S-472S. [PMID: 32037860 PMCID: PMC8808949 DOI: 10.1177/1947603520903780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE There are limited data on bone dimension and cartilage thickness of the distal humeral articular surface. This study aimed to evaluate sex- and age-related bone dimension and cartilage thickness differences and assess the effect of cartilage thickness on distal humeral shape. DESIGN Elbow magnetic resonance images of 180 healthy participants were evaluated. Cartilage thicknesses of the trochlea and capitellum were measured at 19 points using coronal and axial images. In addition, bone diameters were measured from the flexion-extension axis to the 19 points on the coronal and axial magnetic resonance images. Sex differences were evaluated, and the correlation between age and measurement parameters was assessed. RESULTS Significant sex differences regarding the diameters of the axial trochlear bone, coronal lateral trochlear bone, and medial capitellar bone, cartilage thickness at the apex of the lateral trochlear ridge in the axial and coronal plane and at the most lateral point of the capitellar articular surface in the axial plane were observed. A negative correlation was observed between age and axial plane trochlear bone dimensions and between age and coronal plane lateral trochlear and medial capitellar bone dimensions. No significant correlation was found between cartilage thickness and bone dimensions. CONCLUSIONS Bone dimension and cartilage thickness at the distal humerus vary according to sex and age. The data could be used in the donor site selection and graft preparation while osteochondral autograft transfer and allograft transplantation, and in the development of gender-compatible hemiarthroplasty implants.
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Affiliation(s)
- Abdulhamit Misir
- Department of Orthopedics and
Traumatology, Health Sciences University Gaziosmanpasa Taksim Training and Research
Hospital, Istanbul, Turkey,Abdulhamit Misir, Health Sciences
University, Gaziosmanpasa Taksim Training and Research Hospital, Karayollari
Mah. Osmanbey Cad. 621. Sk. 34255 Gaziosmanpasa, Istanbul, Turkey.
| | - Ali Eray Gunay
- Department of Orthopedics and
Traumatology, Kayseri City Hospital, Kayseri, Talas, Turkey
| | - Sinan Oguzkaya
- Department of Orthopedics and
Traumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Erdal Uzun
- Department of Orthopedics and
Traumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopedics and
Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey
| | - Kadir Ilker Yildiz
- Department of Orthopedics and
Traumatology, Health Sciences University Baltalimani Bone and Joint Diseases
Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopedics and
Traumatology, Ahi Evran University Training and Research Hospital, Kirsehir,
Turkey
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16
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Steppacher SD, Meier MK, Albers CE, Tannast M, Siebenrock KA. Acetabular Cartilage Thickness Differs Among Cam, Pincer, or Mixed-Type Femoroacetabular Impingement: A Descriptive Study Using In Vivo Ultrasonic Measurements During Surgical Hip Dislocation. Cartilage 2021; 13:465S-475S. [PMID: 33550853 PMCID: PMC8804723 DOI: 10.1177/1947603521990879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate acetabular cartilage thickness among (1) 8 measurement locations on the lunate surface and (2) different types of femoroacetabular impingement (FAI). DESIGN Prospective descriptive study comparing in vivo measured acetabular cartilage thickness using a validated ultrasonic device during surgical hip dislocation in 50 hips. Measurement locations included the anterior/posterior horn and 3 locations on each peripheral and central aspect of the acetabulum. The clock system was used for orientation. Thickness was compared among cam (11 hips), pincer (8 hips), and mixed-type (31 hips) of FAI. Mean age was 31 ± 8 (range, 18-49) years. Hips with no degenerative changes were included (Tönnis stage = 0). RESULTS Acetabular cartilage thickness ranged from 1.7 mm to 2.7 mm and differed among the 8 locations (P < 0.001). Thicker cartilage was found on the peripheral aspect at 11 and 1 o'clock positions (mean of 2.4 mm and 2.7 mm, respectively). At 5 out of 8 locations of measurement (anterior and posterior horn, 1 o'clock peripheral, 12 and 2 o'clock central), cartilage thickness was thinner in hips with pincer impingement compared to cam and/or mixed-type of FAI (P ranging from <0.001 to 0.031). No difference in thickness existed between cam and mixed-type of impingement (P = 0.751). CONCLUSION Acetabular cartilage thickness varied topographically and among FAI types. This study provides first baseline information about topographical cartilage thickness in FAI measured in vivo. Thinner cartilage thickness in pincer deformities could be misinterpreted as joint degeneration and could therefore have an impact on indication for hip preserving surgery.
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Affiliation(s)
- Simon Damian Steppacher
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
| | - Malin Kristin Meier
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland,Malin Kristin Meier, Department of
Orthoapedic Surgery and Traumatology, Inselspital, Bern University Hospital,
University of Bern, Freiburgstrasse, Bern 3010, Switzerland.
| | - Christoph Emanuel Albers
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and
Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg,
Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopaedic Surgery and
Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern,
Switzerland
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17
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Duzenli T, Ata E, Kosem M. Ultrasonographic Assessment of Knee Cartilage Thickness in Patients with Ulcerative Colitis: Decreased Femoral Cartilage Thickness May Be an Indicator of Extraintestinal Manifestation in Patients with Mild Activity Ulcerative Colitis. Cartilage 2021; 13:658S-664S. [PMID: 33095026 PMCID: PMC8808833 DOI: 10.1177/1947603520968204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Ulcerative colitis is a systemic inflammatory disease which primarily involves the gut but presented by numerous extraintestinal manifestations. The effect of ulcerative colitis on knee cartilage has not been evaluated up to the present. In the current study, we aimed to investigate the possible relationship between the presence of ulcerative colitis and femoral cartilage thickness. DESIGN Sixty-two patients with confirmed diagnosis of ulcerative colitis and 70 healthy controls aged 18 to 50 years referred to the gastroenterology outpatient department between January 2018 and January 2019 participated in this cross-sectional study. The measurements were made by ultrasonography with the patient in a supine position and the knees in complete flexion. Demographic, clinical, endoscopic and laboratory data were collected for all the subjects. RESULTS The groups of ulcerative colitis and control group were similar with regard to sex, mean age, weight, height, body mass index, extremity dominancy, and existence of knee pain (P > 0.05). Medial femoral condyles, intercondylar areas, and lateral femoral condyles of both right and left knees had thinner cartilage thickness in ulcerative colitis group than control group (P < 0.001). CONCLUSION Knee cartilage was thinner in subjects with mild activity ulcerative colitis than in healthy controls. Decreased knee cartilage thickness may be an indicator of extraintestinal manifestation in patients with mild activity ulcerative colitis. This association between ulcerative colitis and knee cartilage degeneration may be effective in early detection of possible risk factors and potential treatment strategies for both ulcerative colitis and specific subtypes of knee osteoarthritis.
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Affiliation(s)
- Tolga Duzenli
- Department of Gastroenterology, Hitit
University Erol Olcok Training and Research Hospital, Corum, Turkey,Tolga Düzenli, Department of
Gastroenterology, Hitit University Erol Olcok Training and Research Hospital,
Çepni Mah. İnönü Cad., Corum, 19030, Turkey.
| | - Emre Ata
- Department of Physical Medicine and
Rehabilitation, Sultan Abdulhamid Han Training and Research Hospital, Istanbul,
Turkey
| | - Murat Kosem
- Department of Physical Medicine and
Rehabilitation, Afyon Emirdağ State Hospital, Afyon, Turkey
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18
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Ruediger T, Horbert V, Reuther A, Kumar Kalla P, Burgkart RH, Walther M, Kinne RW, Mika J. Thickness of the Stifle Joint Articular Cartilage in Different Large Animal Models of Cartilage Repair and Regeneration. Cartilage 2021; 13:438S-452S. [PMID: 33269611 PMCID: PMC8721693 DOI: 10.1177/1947603520976763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Regulatory guidelines for preclinical cartilage repair studies suggest large animal models (e.g., sheep, goat, [mini]-pig, or horse) to obtain results representative for humans. However, information about the 3-dimensional thickness of articular cartilage at different implantation sites in these models is limited. DESIGN To identify the most suitable site for experimental surgery, cartilage thickness at the medial femoral condyle (MFC), lateral femoral condyle (LFC), and trochlea in ovine, caprine, and porcine cadaver stifle joints was systematically measured using hematoxylin-eosin staining of 6 µm paraffin sections and software-based image analysis. RESULTS Regarding all ventral-dorsal regions of the MFC, goat showed the thickest articular cartilage (maximal mean thickness: 1299 µm), followed by sheep (1096 µm) and mini-pig (604 µm), with the highest values in the most ventral and dorsal regions. Also for the LFC, the most ventral regions showed the thickest cartilage in goat (maximal mean thickness: 1118 µm), followed by sheep (678 µm) and mini-pig (607 µm). Except for the mini-pig, however, the cartilage thickness on the LFC was consistently lower than that on the MFC. The 3 species also differed along the transversal measuring points on the MFC and LFC. In contrast, there were no consistent differences for the regional cartilage thickness of the trochlea among goat and sheep (≥780 µm) and mini-pig (≤500 µm). CONCLUSIONS Based on their cartilage thickness, experimental defects on goat and sheep MFC may be viable options for preclinical cartilage repair studies, in addition to well-established horse models.
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Affiliation(s)
- Tina Ruediger
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
| | - Anne Reuther
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
| | - Pavan Kumar Kalla
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
| | - Rainer H. Burgkart
- Biomechanics Laboratory, Chair of
Orthopedics and Sport Orthopedics, Technische Universität München, Munich,
Germany
| | - Mario Walther
- Department of Medical Statistics,
Computer Sciences and Documentation, Jena University Hospital, Jena, Germany,Ernst-Abbe-Hochschule Jena, University
of Applied Sciences, Jena, Germany
| | - Raimund W. Kinne
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany,Raimund W. Kinne, Experimental Rheumatology
Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken
Eisenberg GmbH, Klosterlausnitzer Straße 81, Eisenberg, 07607, Germany.
| | - Joerg Mika
- Experimental Rheumatology Unit,
Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH,
Eisenberg, Germany
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Nott E, Matheny LM, Clanton TO, Lockard C, Douglass BW, Tanghe KK, Matta N, Brady AW. Accessibility and Thickness of Medial and Lateral Talar Body Cartilage for Treatment of Ankle and Foot Osteochondral Lesions. Foot Ankle Int 2021; 42:1330-1339. [PMID: 34049457 DOI: 10.1177/10711007211015189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purposes of this study were to determine (1) if cartilage thicknesses on the talar dome and medial/lateral surfaces of the talus were similar, (2) whether there was sufficient donor cartilage surface area on the medial and lateral talar surfaces to repair talar dome cartilage injuries of the talus, and (3) whether the cartilage surface could be increased following anterior talofibular ligament (ATFL) and sectioning of the tibionavicular and tibiospring portion of the anterior deltoid. METHODS Medial and lateral approaches were utilized in 8 cadaveric ankles to identify the accessible medial, lateral, and talar dome cartilage surfaces in 3 conditions: (1) intact, (2) ATFL release, and (3) superficial anterior deltoid ligament release. The talus was explanted, and the cartilage areas were digitized with a coordinate measuring machine. Cartilage thickness was quantified using a laser scanner. RESULTS The mean cartilage thickness was 1.0 ± 0.1 mm in all areas tested. In intact ankles, the medial side of the talus showed a larger total area of available cartilage than the lateral side (152 mm2 vs 133 mm2). ATFL release increased the available cartilage area on the medial and lateral sides to 167 mm2 and 194 mm2, respectively. However, only the lateral talar surface had sufficient circular graft donor cartilage available for autologous osteochondral transplantation (AOT) procedures of the talus. After ATFL and deltoid sectioning, there was an increase in available graft donor cartilage available for AOT procedures. CONCLUSION The thickness of the medial and lateral talar cartilage surfaces is very similar to that of the talar dome cartilage surface, which provides evidence that the medial and lateral surfaces may serve as acceptable AOT donor cartilage. The surface area available for AOT donor site grafting was sufficient in the intact state; however, sectioning the ATFL and superficial anterior deltoid ligament increased the overall lateral talar surface area available for circular grafting for an AOT procedure that requires a larger graft. These results support the idea that lateral surfaces of the talus may be used as donor cartilage for an AOT procedure since donor and recipient sites are similar in cartilage thickness, and there is sufficient cartilage surface area available for common lesion sizes in the foot and ankle. CLINICAL RELEVANCE This anatomical study investigates the feasibility of talar osteochondral autografts from the medial or lateral talar surfaces exposed with standard approaches. It confirms the similar cartilage thickness of the talar dome and the ability to access up to an 8- to 10-mm donor graft from the lateral side of the talus after ligament release. This knowledge may allow better operative planning for use of these surfaces for osteochondral lesions within the foot and ankle, particularly in certain circumstances of a revision microfracture.
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Affiliation(s)
- Erik Nott
- The Steadman Clinic, Vail, CO, USA.,The Steadman Philippon Research Institute, Vail, CO, USA
| | | | | | - Carly Lockard
- The Steadman Philippon Research Institute, Vail, CO, USA
| | | | - Kira K Tanghe
- The Steadman Philippon Research Institute, Vail, CO, USA
| | - Nicholas Matta
- The Steadman Philippon Research Institute, Vail, CO, USA
| | - Alex W Brady
- The Steadman Philippon Research Institute, Vail, CO, USA
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20
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Jansen MP, Mastbergen SC, Eckstein F, van Heerwaarden RJ, Spruijt S, Lafeber FPJG. Comparison between 2D radiographic weight-bearing joint space width and 3D MRI non-weight-bearing cartilage thickness measures in the knee using non-weight-bearing 2D and 3D CT as an intermediary. Ther Adv Chronic Dis 2021; 12:20406223211037868. [PMID: 34434539 PMCID: PMC8381425 DOI: 10.1177/20406223211037868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: In knee osteoarthritis, radiographic joint space width (JSW) is frequently
used as a surrogate marker for cartilage thickness; however, longitudinal
changes in radiographic JSW have shown poor correlations with those of
magnetic resonance imaging (MRI) cartilage thickness. There are fundamental
differences between the techniques: radiographic JSW represents
two-dimensional (2D), weight-bearing, bone-to-bone distance, while on MRI
three-dimensional (3D) non-weight-bearing cartilage thickness is measured.
In this exploratory study, computed tomography (CT) was included as a third
technique, as it can measure bone-to-bone under non-weight-bearing
conditions. The objective was to use CT to compare the impact of
weight-bearing versus non-weight-bearing, as well as
bone-to-bone JSW versus actual cartilage thickness, in the
knee. Methods: Osteoarthritis patients (n = 20) who were treated with knee
joint distraction were included. Weight-bearing radiographs,
non-weight-bearing MRIs and CTs were acquired before and 2 years after
treatment. The mean radiographic JSW and cartilage thickness of the most
affected compartment were measured. From CT, the 3D median JSW was
calculated and a 2D projectional image was rendered, positioned similarly
and measured identically to the radiograph. Pearson correlations between the
techniques were derived, both cross-sectionally and longitudinally. Results: Fourteen patients could be analyzed. Cross-sectionally, all comparisons
showed moderate to strong significant correlations (R = 0.43–0.81; all
p < 0.05). Longitudinal changes over time were
small; only the correlations between 2D CT and 3D CT (R = 0.65;
p = 0.01) and 3D CT and MRI (R = 0.62;
p = 0.02) were statistically significant. Conclusion: The poor correlation between changes in radiographic JSW and MRI cartilage
thickness appears primarily to result from the difference in weight-bearing,
and less so from measuring bone-to-bone distance versus
cartilage thickness.
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Affiliation(s)
- Mylène P Jansen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100 (G02.228), Utrecht 3584CX, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Felix Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
| | - Ronald J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Sander Spruijt
- Reinier Haga Orthopaedic Centre, Zoetermeer, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Jogi SP, Thaha R, Rajan S, Mahajan V, Venugopal VK, Mehndiratta A, Singh A. Device for Assessing Knee Joint Dynamics During Magnetic Resonance Imaging. J Magn Reson Imaging 2021; 55:895-907. [PMID: 34369633 DOI: 10.1002/jmri.27877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Knee assessment with and without load using magnetic resonance imaging (MRI) can provide information on knee joint dynamics and improve the diagnosis of knee joint diseases. Performing such studies on a routine MRI-scanner require a load-exerting device during scanning. There is a need for more studies on developing loading devices and evaluating their clinical potential. PURPOSE Design and develop a portable and easy-to-use axial loading device to evaluate the knee joint dynamics during the MRI study. STUDY TYPE Prospective study. SUBJECTS Nine healthy subjects. FIELD STRENGTH/SEQUENCE A 0.25 T standing-open MRI and 3.0 T MRI. PD-T2 -weighted FSE, 3D-fast-spoiled-gradient-echo, FS-PD, and CartiGram sequences. ASSESSMENT Design and development of loading device, calibration of loads, MR safety assessment (using projectile angular displacement, torque, and temperature tests). Scoring system for ease of doing. Qualitative (by radiologist) and quantitative (using structural similarity index measure [SSIM]) image-artifact assessment. Evaluation of repeatability, comparison with various standing stances load, and loading effect on knee MR parameters (tibiofemoral bone gap [TFBG], femoral cartilage thickness [FCT], tibial cartilage thickness [TCT], femoral cartilage T2 -value [FCT2], and tibia cartilage T2 -value [TCT2]). The relative percentage change (RPC) in parameters due to the device load was computed. STATISTICAL TEST Pearson's correlation coefficient (r). RESULTS The developed device is conditional-MR safe (details in the manuscript and supplementary materials), 15 × 15 × 45 cm3 dimension, and <3 kg. The ease of using the device was 4.9/5. The device introduced no visible image artifacts, and SSIM of 0.9889 ± 0.0153 was observed. The TFBG intraobserver variability (absolute difference) was <0.1 mm. Interobserver variability of all regions of interest was <0.1 mm. The load exerted by the device was close to the load during standing on both legs in 0.25 T scanner with r > 0.9. Loading resulted in RPC of 1.5%-11.0%, 7.9%-8.5%, and -1.5% to 13.0% in the TFBG, FCT, and TCT, respectively. FCT2 and TCT2 were reduced in range of 1.5-2.7 msec and 0.5-2.3 msec due to load. DATA CONCLUSION The proposed device is conditionally MR safe, low cost (material cost < INR 6000), portable, and effective in loading the knee joint with up to 50% of body weight. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Sandeep P Jogi
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, ASET, Amity University Haryana, Gurgaon, Haryana, India
| | - Rafeek Thaha
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | | | | | | | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
| | - Anup Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
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22
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Iriondo C, Liu F, Calivà F, Kamat S, Majumdar S, Pedoia V. Towards understanding mechanistic subgroups of osteoarthritis: 8-year cartilage thickness trajectory analysis. J Orthop Res 2021; 39:1305-1317. [PMID: 32897602 DOI: 10.1002/jor.24849] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/23/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Many studies have validated cartilage thickness as a biomarker for knee osteoarthritis (OA); however, few studies investigate beyond cross-sectional observations or comparisons across two timepoints. By characterizing the trajectory of cartilage thickness changes over 8 years in healthy individuals from the OA initiative data set, this study discovers associations between the dynamics of cartilage changes and OA incidence. A fully automated cartilage segmentation and thickness measurement method were developed and validated against manual measurements: mean absolute error = 0.11-0.14 mm (n = 4129 knees) and automatic reproducibility = 0.04-0.07 mm (n = 316 knees). The mean thickness for the medial and lateral tibia (MT, LT), central weight-bearing medial and lateral femur (cMF, cLF), and patella (P) cartilage compartments were quantified for 1453 knees at seven timepoints. Trajectory subgroups were defined per cartilage compartment such as stable, thinning to thickening, accelerated thickening, plateaued thickening, thickening to thinning, accelerated thinning, or plateaued thinning. For tibiofemoral compartments, the stable (22%-36%) and plateaued thinning (22%-37%) trajectories were the most common, with an average initial velocity (μm/month), acceleration (μm/month2 ) for the plateaued thinning trajectories LT: -2.66, 0.0326; MT: -2.49, 0.0365; cMF: -3.51, 0.0509; and cLF: -2.68, 0.041. In the patella compartment, the plateaued thinning (35%) and thickening to thinning (24%) trajectories were the most common, with an average initial velocity, acceleration for each -4.17, 0.0424; 1.95, -0.0835. Knees with nonstable trajectories had higher adjusted odds of OA incidence than stable trajectories: accelerated thickening, accelerated thinning, and plateaued thinning trajectories of the MT had adjusted odds ratio (OR) of 18.9, 5.48, and 1.47, respectively; in the cMF, adjusted OR of 8.55, 10.1, and 2.61, respectively.
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Affiliation(s)
- Claudia Iriondo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Bioengineering, University of California, San Francisco and University of California, Berkeley Joint Graduate Group in Bioengineering, San Francisco, California, USA
| | - Felix Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Francesco Calivà
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Sarthak Kamat
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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23
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Jansen MP, Mastbergen SC, MacKay JW, Turmezei TD, Lafeber F. Knee joint distraction results in MRI cartilage thickness increase up to ten years after treatment. Rheumatology (Oxford) 2021; 61:974-982. [PMID: 34022055 PMCID: PMC8889280 DOI: 10.1093/rheumatology/keab456] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/12/2021] [Indexed: 01/21/2023] Open
Abstract
Objectives Knee joint distraction (KJD) has been shown to result in long-term clinical improvement and short-term cartilage restoration in young OA patients. The objective of the current study was to evaluate MRI cartilage thickness up to 10 years after KJD treatment, using a 3D surface-based approach. Methods Twenty end-stage knee OA patients were treated with KJD. MRI scans (1.5 T) were performed before and at 1, 2, 5, 7, and 10 years after treatment. Tibia and femur cartilage segmentation and registration to a canonical surface were performed semi-automatically. Statistical parametric mapping with linear mixed models was used to analyse whole-joint changes. The influence of baseline patient characteristics was analysed with statistical parametric mapping using linear regression. Relevant weight-bearing parts of the femur were selected to obtain the average cartilage thickness in the femur and tibia of the most- (MAC) and least-affected compartment. These compartmental changes over time were analysed using repeated measures ANOVA; missing data was imputed. In all cases, P <0.05 was considered statistically significant. Results One and 2 years post-treatment, cartilage in the MAC weight-bearing region was significantly thicker than pre-treatment, gradually thinning after 5 years, but still increased at 10 years post-treatment. Long-term results showed that areas in the least-affected compartment were significantly thicker than pre-treatment. Male sex and more severe OA at baseline somewhat predicted shorter-term benefit (P >0.05). Compartmental analyses showed significant short- and long-term thickness increase in the tibia and femur MAC (all P <0.05). Conclusion KJD results in significant short- and long-term cartilage regeneration, up to 10 years post-treatment. Trial registration Netherlands Trial Register, https://www.trialregister.nl, NL419.
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Affiliation(s)
- Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - James W MacKay
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Tom D Turmezei
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Radiology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
| | - Floris Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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24
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MacKay JW, Kaggie JD, Treece GM, McDonnell SM, Khan W, Roberts AR, Janiczek RL, Graves MJ, Turmezei TD, McCaskie AW, Gilbert FJ. Three-Dimensional Surface-Based Analysis of Cartilage MRI Data in Knee Osteoarthritis: Validation and Initial Clinical Application. J Magn Reson Imaging 2020; 52:1139-1151. [PMID: 32447815 DOI: 10.1002/jmri.27193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Traditional quantitative analysis of cartilage with MRI averages measurements (eg, thickness) across regions-of-interest (ROIs) which may reduce responsiveness. PURPOSE To validate and describe clinical application of a semiautomated surface-based method for analyzing cartilage relaxation times ("composition") and morphology on MRI, 3D cartilage surface mapping (3D-CaSM). STUDY TYPE Validation study in cadaveric knees and prospective observational (cohort) study in human participants. POPULATION Four cadaveric knees and 14 participants aged 40-60 with mild-moderate knee osteoarthritis (OA) and 6 age-matched healthy volunteers, imaged at baseline, 1, and 6 months. FIELD STRENGTH/SEQUENCE 3D spoiled gradient echo, T1 rho/T2 magnetization-prepared 3D fast spin echo for mapping of T1 rho/T2 relaxation times and delayed gadolinium enhanced MRI of cartilage (dGEMRIC) using variable flip angle T1 relaxation time mapping at 3T. ASSESSMENT 3D-CaSM was validated against high-resolution peripheral quantitative computed tomography (HRpQCT) in cadaveric knees, with comparison to expert manual segmentation. The clinical study assessed test-retest repeatability and sensitivity to change over 6 months for cartilage thickness and relaxation times. STATISTICAL TESTS Bland-Altman analysis was performed for the validation study and evaluation of test-retest repeatability. Six-month changes were assessed via calculation of the percentage of each cartilage surface affected by areas of significant change (%SC), defined using thresholds based on area and smallest detectable difference (SDD). RESULTS Bias and precision (0.06 ± 0.25 mm) of 3D-CaSM against reference HRpQCT data were comparable to expert manual segmentation (-0.13 ± 0.26 mm). 3D-CaSM demonstrated significant (>SDD) 6-month changes in cartilage thickness and relaxation times in both OA participants and healthy controls. The parameter demonstrating the greatest 6-month change was T2 relaxation time (OA median %SC [IQR] = 8.8% [5.5 to 12.6]). DATA CONCLUSION This study demonstrates the construct validity and potential clinical utility of 3D-CaSM, which may offer advantages to conventional ROI-based methods. LEVEL OF EVIDENCE 2. TECHNICAL EFFICACY STAGE 2. J. Magn. Reson. Imaging 2020;52:1139-1151.
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Affiliation(s)
- James W MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Graham M Treece
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Stephen M McDonnell
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Alexandra R Roberts
- Clinical Imaging, GlaxoSmithKline, London, UK
- Antaros Medical, Uppsala, Sweden
| | | | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tom D Turmezei
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Andrew W McCaskie
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
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Abstract
OBJECTIVE The aim of this study was to determine the effects of platelet-rich plasma (PRP) treatment on pain, functionality, quality of life, and cartilage thickness in patients with knee osteoarthritis (OA). METHODS Sixty patients with chronic knee pain were randomly separated into two groups. The first group was administered 4-ml PRP intra-articularly (IA) in three doses at one-week intervals, and the second group had only one dose of a 4-ml saline solution IA. The patients' pain was measured using the Visual Analogue Scale (VAS); functionality was measured using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). The distal femur cartilage thickness was assessed using ultrasonography (USG). RESULTS All baseline parameters were similar (p> 0.05). In the first and sixth months after the treatment, the VAS scores of the PRP group were significantly low (p< 0.001). In the same group, only the pain sub-score was low in the WOMAC assessment in the first month after treatment. However, in the sixth month, all parameters of the WOMAC score were lower than those of the placebo group (p< 0.05). Cartilage thickness measurements were similar in the two groups (p< 0.05). CONCLUSION PRP treatment had positive effects on the pain, physical function, and quality of life of patients with knee OA, but it did not increase cartilage thickness.
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Affiliation(s)
- Hüseyin Elik
- Department of Physical and Rehabilitation Medicine, Hamidiye Şişli Etfal Training and Research Hospital, Istanbul, Turkey.,Department of Physical Medicine and Rehabilitation, Siverek State Hospital, Şanlıurfa, Turkey
| | - Beril Doğu
- Department of Physical and Rehabilitation Medicine, Hamidiye Şişli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Figen Yılmaz
- Department of Physical and Rehabilitation Medicine, Hamidiye Şişli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Feyza Akan Begoğlu
- Department of Physical and Rehabilitation Medicine, Hamidiye Şişli Etfal Training and Research Hospital, Istanbul, Turkey.,Department of Physical and Rehabilitation Medicine, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Banu Kuran
- Department of Physical and Rehabilitation Medicine, Hamidiye Şişli Etfal Training and Research Hospital, Istanbul, Turkey
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26
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Shah RF, Martinez AM, Pedoia V, Majumdar S, Vail TP, Bini SA. Variation in the Thickness of Knee Cartilage. The Use of a Novel Machine Learning Algorithm for Cartilage Segmentation of Magnetic Resonance Images. J Arthroplasty 2019; 34:2210-5. [PMID: 31445869 DOI: 10.1016/j.arth.2019.07.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The variation in articular cartilage thickness (ACT) in healthy knees is difficult to quantify and therefore poorly documented. Our aims are to (1) define how machine learning (ML) algorithms can automate the segmentation and measurement of ACT on magnetic resonance imaging (MRI) (2) use ML to provide reference data on ACT in healthy knees, and (3) identify whether demographic variables impact these results. METHODS Patients recruited into the Osteoarthritis Initiative with a radiographic Kellgren-Lawrence grade of 0 or 1 with 3D double-echo steady-state MRIs were included and their gender, age, and body mass index were collected. Using a validated ML algorithm, 2 orthogonal points on each femoral condyle were identified (distal and posterior) and ACT was measured on each MRI. Site-specific ACT was compared using paired t-tests, and multivariate regression was used to investigate the risk-adjusted effect of each demographic variable on ACT. RESULTS A total of 3910 MRI were included. The average femoral ACT was 2.34 mm (standard deviation, 0.71; 95% confidence interval, 0.95-3.73). In multivariate analysis, distal-medial (-0.17 mm) and distal-lateral cartilage (-0.32 mm) were found to be thinner than posterior-lateral cartilage, while posterior-medial cartilage was found to be thicker (0.21 mm). In addition, female sex was found to negatively impact cartilage thickness (OR, -0.36; all values: P < .001). CONCLUSION ML was effectively used to automate the segmentation and measurement of cartilage thickness on a large number of MRIs of healthy knees to provide normative data on the variation in ACT in this population. We further report patient variables that can influence ACT. Further validation will determine whether this technique represents a powerful new tool for tracking the impact of medical intervention on the progression of articular cartilage degeneration.
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27
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Podolsky DJ, Mainprize J, McMillan C, Binhammer P. Suitability of Using the Hamate for Reconstruction of the Finger Middle Phalanx Base: An Assessment of Cartilage Thickness. Plast Surg (Oakv) 2019; 27:211-216. [PMID: 31453140 DOI: 10.1177/2292550319826084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Osteochondral grafts are indicated for reconstructing the finger middle phalanx base when there is greater than 50% involvement of the articular surface and significant comminution. This study aims to compare the cartilage thickness of the distal surface of the hamate to the finger middle phalanx base to assess its suitability as an osteochondral graft. Methods A 3-dimensional laser scanner and computer modelling techniques were utilized to determine the cartilage thickness of the distal surface of the hamate, and finger middle phalanx base using cadaver specimens. The mean, maximum, and coefficient of variation (CV%; a measure of uniformity of cartilage distribution), as well as cartilage distribution maps were determined. Results The mean cartilage thickness of the hamate was 0.73 ± 0.08 mm compared to the average mean thickness of the finger middle phalanx base of 0.40 ± 0.12 mm. The maximum cartilage thickness of the hamate was 1.27 ± 0.14 mm compared to the average maximum of the finger middle phalanx base of 0.67 ± 0.14 mm. The CV% of the hamate was 27.8 ± 4.2 compared to the average CV% for the finger middle phalanx base of 26.6 ± 8.1. The hamate and finger middle phalanx base have maximum areas that were most frequently at or spanning the median ridge; however, this was more consistently observed with the hamate. Conclusion The distal surface of the hamate is a suitable osteochondral graft with respect to cartilage thickness and distribution providing sufficient cartilage for reconstruction of the finger middle phalanx base.
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Affiliation(s)
- Dale J Podolsky
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James Mainprize
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Catherine McMillan
- Department of Plastic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul Binhammer
- Department of Plastic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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28
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Erhart-Hledik JC, Chu CR, Asay JL, Favre J, Andriacchi TP. Longitudinal Changes in the Total Knee Joint Moment After Anterior Cruciate Ligament Reconstruction Correlate With Cartilage Thickness Changes. J Orthop Res 2019; 37:1546-1554. [PMID: 30977551 PMCID: PMC6588477 DOI: 10.1002/jor.24295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/19/2019] [Accepted: 03/15/2019] [Indexed: 02/04/2023]
Abstract
This study investigated associations between changes in the total joint moment (TJM) at the knee and changes in cartilage thickness after anterior cruciate ligament reconstruction (ACLR). Seventeen subjects (five males; age: 29.6 ± 7.3 years) with unilateral ACLR underwent gait analysis and magnetic resonance imaging at baseline (2.2 ± 0.3 years post-ACLR) and at long-term follow-up (7.7 ± 0.7 years post-ACLR). Knee loading was assessed using the TJM, and differences in loading were analyzed using repeated measures analysis of variance. Pearson correlation coefficients assessed associations between changes in TJM and changes in (medial-to-lateral) M/L femoral cartilage thickness ratios in the ACLR limb. Bilaterally, there was no significant change in the magnitude of the TJM first peak (TJM1), however, there was a significant increase in the percent contribution of the knee flexion moment (KFM) (p < 0.001) and decrease in the percent contribution of the knee adduction moment (KAM) to TJM1 (p < 0.001). The change in the percent contributions of KFM and KAM to TJM1 were associated with changes in M/L femoral cartilage thickness in the ACLR limb. Specifically, subjects with smaller increases in KFM contribution (R = 0.521, p = 0.032) and smaller decreases in KAM contribution (R = -0.521, p = 0.032) had a reduction in the M/L ratio in the central femoral subregion over the follow-up period, with similar trends in the external femoral subregion. The study results provide new insight into changes in the loading environment at the knee joint prospectively following ACL reconstruction and give evidence that there are modifiable gait metrics that are associated with cartilage changes after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1546-1554, 2019.
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Affiliation(s)
- Jennifer C. Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Constance R. Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jessica L. Asay
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA,Department of Mechanical Engineering, Stanford University, Stanford, CA
| | - Julien Favre
- Department of Musculoskeletal Medicine, Centre Hospitalier Universiatire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Thomas P. Andriacchi
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA,Department of Mechanical Engineering, Stanford University, Stanford, CA
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Ohtaka M, Hiramoto I, Minagawa H, Matsuzaki M, Kodama H. Screening of the Maturity Status of the Tibial Tuberosity by Ultrasonography in Higher Elementary School Grade Schoolchildren. Int J Environ Res Public Health 2019; 16:ijerph16122138. [PMID: 31212938 PMCID: PMC6616442 DOI: 10.3390/ijerph16122138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 11/16/2022]
Abstract
This study aimed to obtain screening data on the maturity status of the tibial tuberosity in schoolchildren of higher elementary school grades for risk management of Osgood-Schlatter disease (OSD). The maturity stages and cartilage thicknesses at the tibial tuberosity were determined by ultrasonography on the occasion of a school-based musculoskeletal examination for 124 grade 5-6 elementary schoolchildren, and their associations with the students' demographic characteristics and OSD were examined. The time-dependent changes of the maturity status of the tibial tuberosity were also examined in grade 5 students (n = 26) by a longitudinal survey. The cross-sectional survey showed that the epiphyseal stage was reached in 89% of girls and 35% of boys. The girls who had experienced menarche (n = 28) were all in the epiphyseal stage and had a decreased cartilage thickness (p = 0.004, after adjusting maturity stages). Students with OSD (n = 5) were all girls in the epiphyseal stage, and only two of them had an increased cartilage thickness. During the longitudinal survey, a marked increase in cartilage thickness from the previous measurement was observed in three boys (without clinical symptoms) and a girl who newly developed OSD. Two students with OSD without chronic pain had thin cartilage. In conclusion, for schoolchildren of higher elementary school grades, the risk of OSD is higher among girls with the epiphyseal stage. Cartilage thickness may not contribute to the diagnosis of OSD, since thick cartilage is not very common in OSD. However, cartilage thickness may reflect the status of OSD.
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Affiliation(s)
- Maiko Ohtaka
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan.
| | - Izumi Hiramoto
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan.
| | | | - Masashi Matsuzaki
- Akita University Graduate School of Medicine, Akita 010-8543, Japan.
| | - Hideya Kodama
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan.
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Desai P, Hacihaliloglu I. Knee-Cartilage Segmentation and Thickness Measurement from 2D Ultrasound. J Imaging 2019; 5:jimaging5040043. [PMID: 34460481 PMCID: PMC8320944 DOI: 10.3390/jimaging5040043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 11/20/2022] Open
Abstract
Ultrasound (US) could become a standard of care imaging modality for the quantitative assessment of femoral cartilage thickness for the early diagnosis of knee osteoarthritis. However, low contrast, high levels of speckle noise, and various imaging artefacts hinder the analysis of collected data. Accurate, robust, and fully automatic US image-enhancement and cartilage-segmentation methods are needed in order to improve the widespread deployment of this imaging modality for knee-osteoarthritis diagnosis and monitoring. In this work, we propose a method based on local-phase-based image processing for automatic knee-cartilage image enhancement, segmentation, and thickness measurement. A local-phase feature-guided dynamic-programming approach is used for the fully automatic localization of knee-bone surfaces. The localized bone surfaces are used as seed points for automating the seed-guided segmentation of the cartilage. We evaluated the Random Walker (RW), watershed, and graph-cut-based segmentation methods from 200 scans obtained from ten healthy volunteers. Validation against manual expert segmentation achieved a mean dice similarity coefficient of 0.90, 0.86, and 0.84 for the RW, watershed, and graph-cut segmentation methods, respectively. Automatically segmented cartilage regions achieved 0.18 mm localization accuracy compared to manual expert thickness measurement.
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Affiliation(s)
- Prajna Desai
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA
| | - Ilker Hacihaliloglu
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08873, USA
- Correspondence: ; Tel.: +1-848-445-6564
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Harkey MS, Blackburn JT, Nissman D, Davis H, Durrington I, Rizk C, Kuismanen A, Pietrosimone B. Ultrasonographic Assessment of Femoral Cartilage in Individuals With Anterior Cruciate Ligament Reconstruction: A Case-Control Study. J Athl Train 2019; 53:1082-1088. [PMID: 30615493 DOI: 10.4085/1062-6050-376-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Developing osteoarthritis is common after anterior cruciate ligament reconstruction (ACLR). Monitoring changes in femoral cartilage size after ACLR may be a way to detect the earliest structural alterations before the radiographic onset of osteoarthritis. Diagnostic ultrasonography (US) offers a clinically accessible and valid method for evaluating anterior femoral cartilage size. OBJECTIVE To compare the US measurements of anterior femoral cross-sectional area and cartilage thickness between limbs in individuals with a unilateral ACLR and between the ACLR limbs of these individuals and the limbs of uninjured control participants. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 20 volunteers with an ACLR (37.0 ± 26.6 months after surgery) and 28 uninjured volunteers. MAIN OUTCOME MEASURE(S) We used US to assess anterior femoral cartilage cross-sectional area and thickness (ie, medial, lateral, and intercondylar) in the ACLR and contralateral limbs of participants with ACLR and unilaterally in the reference limbs of uninjured participants. RESULTS The ACLR limb presented with greater anterior femoral cartilage cross-sectional area (96.68 ± 22.68 mm2) than both the contralateral (85.69 ± 17.57 mm2, t19 = 4.47; P < .001) and uninjured (84.62 ± 15.89 mm2, t46 = 2.17; P = .04) limbs. The ACLR limb presented with greater medial condyle thickness (2.61 ± 0.61 mm) than both the contralateral (2.36 ± 0.47 mm, t19 = 2.78; P = .01) and uninjured limbs (2.22 ± 0.40 mm, t46 = 2.69; P = .01) and greater lateral condyle thickness (2.46 ± 0.65 mm) than the uninjured limb (2.12 ± 0.41 mm, t46 = 2.20; P = .03). CONCLUSIONS Anterior femoral cartilage cross-sectional area and thickness assessed via US were greater in the ACLR limb than in the contralateral and uninjured limbs. Greater thickness and cross-sectional area may have been due to cartilage swelling or hypertrophy after ACLR, which may affect the long-term health of the joint.
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Affiliation(s)
- Matthew S Harkey
- Division of Rheumatology, Tufts Medical Center, Boston, MA, and Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester
| | - J Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | - Daniel Nissman
- Department of Radiology, University of North Carolina at Chapel Hill
| | - Hope Davis
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | | | - Christina Rizk
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | | | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
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Ünal HU, Tok F, Adıgüzel E, Gezer M, Aydın İ, Yılmaz B, Oğuz Y. Ultrasonographic evaluation of the femoral cartilage thickness in patients with chronic renal failure. Ren Fail 2016; 38:600-4. [PMID: 26905953 DOI: 10.3109/0886022x.2016.1149685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the effects of chronic renal failure (CRF) on the distal femoral cartilage thickness by using ultrasonography and to determine the relationship between cartilage thickness and certain disease-related parameters. DESIGN Fifty-seven CRF patients (41 male and 16 female) (mean [SD] age, 44.7 [12.1] years) and 60 healthy controls (41 male and 19 female) (mean [SD] age, 43.5 [13.3] years) were enrolled in this study. Demographic and clinical characteristics were recorded. Cartilage thickness measurements were taken from the medial and lateral condyles, and intercondylar areas of both knees. RESULTS Groups were similar in terms of age, weight, height, body mass index and gender (all p>0.05). The mean cartilage thickness was found to be less in CRF patients than in controls (statistically significant for medial condyles and intercondylar areas both in right and the left knees [all p<0.05]). Cartilage thickness showed no correlation with eGFR, and with the levels of serum urea, creatinine, calcium, magnesium, phosphor, hemoglobin, uric acid and as well as steroid use (all p>0.05) in CRF patients. CONCLUSION In the light of our findings, we imply that patients with CRF have thinner femoral cartilage than healthy controls. This result may support the view that patients with CRF are at increased risk for developing early knee osteoarthritis. Last but not least, clinicians should be aware of the importance of rehabilitation strategies aimed at decreasing onset and progression of knee osteoarthritis in patients with CRF.
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Affiliation(s)
- Hilmi Umut Ünal
- a Department of Nephrology , Gulhane Military Medical Academy , Ankara , Turkey
| | - Fatih Tok
- b Department of Physical Medicine and Rehabilitation , Gulhane Military Medical Academy , Ankara , Turkey
| | - Emre Adıgüzel
- b Department of Physical Medicine and Rehabilitation , Gulhane Military Medical Academy , Ankara , Turkey
| | - Mustafa Gezer
- a Department of Nephrology , Gulhane Military Medical Academy , Ankara , Turkey
| | - İbrahim Aydın
- c Department of Biochemistry , Gulhane Military Medical Academy , Ankara , Turkey
| | - Bilge Yılmaz
- b Department of Physical Medicine and Rehabilitation , Gulhane Military Medical Academy , Ankara , Turkey
| | - Yusuf Oğuz
- a Department of Nephrology , Gulhane Military Medical Academy , Ankara , Turkey
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Giannicola G, Sedati P, Polimanti D, Cinotti G, Bullitta G. Contribution of cartilage to size and shape of radial head circumference: magnetic resonance imaging analysis of 78 elbows. J Shoulder Elbow Surg 2016; 25:120-6. [PMID: 26410345 DOI: 10.1016/j.jse.2015.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/30/2015] [Accepted: 07/08/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aims of our study were to quantify cartilage thickness at the minimum and maximum diameters of the radial head circumference and to investigate its influence on the size and shape of the proximal radius. METHODS We analyzed high-definition magnetic resonance imaging scans of 78 healthy elbows in 19 men and 20 women, with a mean age of 28 (21-32) years. All measurements were estimated in the axial plane just distal to the fovea radialis. Maximum and minimum bone diameters, maximum and minimum total diameters (including cartilage thickness), and cartilage thickness were calculated. Cartilage thickness was measured at 4 different points: (1) at the articular side of the maximum diameter (point A), (2) at the nonarticular side of the maximum diameter (point B), (3) at the medial side of the minimum diameter (point C), and (4) at the lateral side of the minimum diameter (point D). Pearson correlation and t test were used for the statistical analysis. RESULTS Mean maximum and minimum bone diameters and maximum and minimum total diameters were 22.2, 21.5, 24.0, and 23.2 mm, respectively. All differences between diameters were statistically significant. Mean cartilage thickness at points A, C, and D was 1.7, 0.8, and 0.8 mm, respectively. No measurable cartilage thickness was found at point B. No significant correlation was found between bone diameters and cartilage thickness. CONCLUSIONS Cartilage surface significantly increases and modifies the size and shape of the radial head. The observation that cartilage thickness varies between subjects and does not correlate with bone parameters suggests that the diameters of the radial head cannot be inferred from indirect measurements of dry bones or radiographs.
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Affiliation(s)
- Giuseppe Giannicola
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - Pietro Sedati
- Department of Radiology, Campus Bio-medico University of Rome, Rome, Italy
| | - David Polimanti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Gianluca Cinotti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Gianluca Bullitta
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, "Sapienza" University of Rome, Rome, Italy
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Abraham CL, Bangerter NK, McGavin LS, Peters CL, Drew AJ, Hanrahan CJ, Anderson AE. Accuracy of 3D dual echo steady state (DESS) MR arthrography to quantify acetabular cartilage thickness. J Magn Reson Imaging 2015; 42:1329-38. [PMID: 25851109 DOI: 10.1002/jmri.24902] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/18/2015] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To deploy and quantify the accuracy of 3D dual echo steady state (DESS) MR arthrography with hip traction to image acetabular cartilage. Clinical magnetic resonance imaging (MRI) sequences used to image hip cartilage often have reduced out-of-plane resolution and may lack adequate signal-to-noise to image cartilage. MATERIALS AND METHODS Saline was injected into four cadaver hips placed under traction. 3D DESS MRI scans were obtained before and after cores of cartilage were harvested from the acetabulum; the two MRIs were spatially aligned to reference core positions. The thickness of cartilage cores was measured under microscopy to serve as the reference standard. 3D reconstructions of cartilage and subchondral bone were generated using automatic and semiautomatic image segmentation. Cartilage thickness estimated from the 3D reconstructions was compared to physical measurements using Bland-Altman plots. RESULTS As revealed by the automatic segmentation mask, saline imbibed the joint space throughout the articulating surface, with the exception of the posteroinferior region in two hips. Locations where air bubbles were introduced and regions of suspected low density bone disrupted an otherwise smooth automatic segmentation mask. Automatic and semiautomatic segmentation yielded a bias ± repeatability coefficient (95% limits of agreement) of 0.10 ± 0.51 mm (-0.41 to 0.61 mm) and 0.06 ± 0.43 mm (-0.37 to 0.49 mm), respectively. CONCLUSION Cartilage thickness can be estimated to within ∼0.5 mm of the physical value with 95% confidence using 3D reconstructions of 3D DESS MR arthrography images. Manual correction of the automatic segmentation mask may improve reconstruction accuracy.
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Affiliation(s)
- Christine L Abraham
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA.,Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Neal K Bangerter
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA.,Department of Electrical and Computer Engineering, Brigham Young University, Provo, Utah, USA
| | - Lance S McGavin
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | | | - Alex J Drew
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA.,Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | | | - Andrew E Anderson
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA.,Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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Lee H, Kirkland WG, Whitmore RN, Theis KM, Young HE, Richardson AJ, Jackson RL, Hanson RR. Comparison of equine articular cartilage thickness in various joints. Connect Tissue Res 2014; 55:339-47. [PMID: 25111191 DOI: 10.3109/03008207.2014.949698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Thicknesses of fresh equine articular cartilage surfaces from the fetlock, carpal and stifle joints were measured employing a needle probe test. MATERIALS AND METHODS Eighty-seven samples used in measurement were cultivated from fetlock, carpal and stifle joints of 12 deceased within 4 h of death. After approximately three minutes of exposure to air during dissection, all cartilage samples were preserved in a saline solution to keep the articular cartilage hydrated for testing. The thickness was measured on five different spots on the same sample. The thicknesses of the fetlock, carpus and stifle were compared. RESULTS The articular cartilage of the stifle was thicker than the fetlock and carpus, while the fetlock and the carpus had similar thickness values. The average thickness of the fetlock, carpal and stifle joint are 0.86, 0.87 and 2.1 mm, respectively. They were statistically compared using the Student t-test. The differences on the articular cartilage thicknesses between the fetlock and stifle, and carpus and stifle were "very highly significant" (p < 0.001). This indicates that the articular cartilage thickness of the stifle is significantly different from that of the fetlock and carpus. Four different surfaces in the fetlock and four in the carpal joint were also compared. Significant differences between each set of the four surfaces were not observed. In the carpus, the difference in thickness between the distal radius and proximal third carpal bone articular cartilage surfaces as well as the proximal radial carpal bone and distal radial carpal bone articular cartilage surfaces were statistically significant.
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Affiliation(s)
- Hyeon Lee
- Department of Mechanical Engineering, Auburn University , Auburn, AL , USA and
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Grzelak P, Domzalski M, Majos A, Podgórski M, Stefanczyk L, Krochmalski M, Polguj M. Thickening of the knee joint cartilage in elite weightlifters as a potential adaptation mechanism. Clin Anat 2014; 27:920-8. [PMID: 24648385 DOI: 10.1002/ca.22393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 02/03/2014] [Accepted: 02/20/2014] [Indexed: 01/17/2023]
Abstract
Thickening and increase of area of cartilage have been proposed as two alternative mechanisms of cartilage functional adaptation. The latter has been reported in endurance sportsmen. In weightlifters, extreme strain applied to the articular surfaces can result in other forms of adaptation. The aim of this research is to determine whether cartilage thickness is greater in elite weightlifters than in physically inactive men. Weightlifters (13) and 20 controls [age and body mass index (BMI) matched] underwent knee Magnetic Resonance Imaging (MRI). A single sagittal slice of the knee was taken and cartilage thickness was measured in five and six regions of the medial and lateral femoral condyles, respectively. The analyzed segments represented weight-bearing and nonweight-bearing regions. The tibia cartilage in the weight-bearing area was also measured. The time of training onset and its duration in the weightlifter group were recorded. The cartilage was found to be significantly thicker in weightlifters in most of the analyzed regions. The distribution of cartilage thickness on the medial and lateral femoral condyles was similar in both groups. The duration of training was not associated with cartilage thickness, but the time of training onset correlated inversely with cartilage thickness. It is possible that in high-strain sports, joint cartilage can undergo functional adaptation by thickening. Thus, mechanical loading history could exert a postnatal influence on cartilage morphology.
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Affiliation(s)
- Piotr Grzelak
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Poland
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Blazek K, Favre J, Asay J, Erhart-Hledik J, Andriacchi T. Age and obesity alter the relationship between femoral articular cartilage thickness and ambulatory loads in individuals without osteoarthritis. J Orthop Res 2014; 32:394-402. [PMID: 24281940 DOI: 10.1002/jor.22530] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 11/12/2013] [Indexed: 02/04/2023]
Abstract
Articular cartilage is sensitive to mechanical loading, so increased risk of osteoarthritis in older or obese individuals may be linked to changes in the relationship between cartilage properties and extrinsic joint loads. A positive relationship has been reported between ambulatory loads and cartilage thickness in young individuals, but whether this relationship exists in individuals who are older or obese is unknown. This study examined the relationship between femoral cartilage thickness and load, measured by weight × height and the peak adduction moment, in young normal-weight (28 subjects, age: 28.0 ± 3.8 years, BMI: 21.9 ± 1.9 kg/m(2)), middle-aged normal-weight (27 subjects, 47.0 ± 6.5 years, 22.7 ± 1.7 kg/m(2)), young overweight/obese (27 subjects, 28.4 ± 3.6 years, 33.3 ± 4.6 kg/m(2)), and middle-aged overweight/obese (27 subjects, 45.8 ± 7.2 years, 31.9 ± 4.4 kg/m(2)) individuals. On the lateral condyle, cartilage thickness was positively correlated with weight × height for all groups (R(2) = 0.26-0.20) except the middle-aged overweight/obese. On the medial condyle, weight × height was significantly correlated only in young normal-weight subjects (R(2) = 0.19), as was the case for the correlation between adduction moment and medial-lateral thickness ratio (R(2) = 0.20). These results suggest that aging and obesity are both associated with a loss of the positive relationship between cartilage thickness and ambulatory loads, and that the relationship is dependent on the compartment and whether the load is generated by body size or subject-specific gait mechanics.
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Affiliation(s)
- Katerina Blazek
- Mechanical Engineering Department, BioMotion Laboratory, Stanford University, 496 Lomita Mall, Durand 061, Stanford, California, 94306; Center for Tissue Regeneration, Repair, and Restoration, Veterans Administration Hospital, Palo Alto, California
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Wirth W, Nevitt M, Hellio Le Graverand MP, Lynch J, Maschek S, Hudelmaier M, Eckstein F; OA Initiative Investigators Group. Lateral and medial joint space narrowing predict subsequent cartilage loss in the narrowed, but not in the non-narrowed femorotibial compartment--data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2014; 22:63-70. [PMID: 24185111 DOI: 10.1016/j.joca.2013.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/01/2013] [Accepted: 10/22/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the predictive value of unicompartimental joint space narrowing (JSN) for MRI-based cartilage thickness loss in the narrowed and the non-narrowed femorotibial compartment. METHODS 922 knees from 922 Osteoarthritis Initiative (OAI) participants (62.2 ± 9.0 years, 61% females) with radiographic OA (158 without JSN [noJSN], 175 with lateral JSN [latJSN], 589 with medial JSN [medJSN]) were analyzed using 3 T MRI. One-year cartilage thickness change was determined in the lateral (LFTC) and medial femorotibial compartment (MFTC), and in femorotibial subregions. The probability of subsequent cartilage loss was calculated using predefined thresholds. The predictive value of JSN for the probability and magnitude of cartilage loss was compared between latJSN, medJSN and noJSN knees using Fisher's exact and Mann-Whitney-U tests. RESULTS The probability of cartilage loss was greater in the narrowed compartment of latJSN/medJSN knees (34.9%/32.4%) than in noJSN knees (13.3%/12.7%, P ≤ 6.4 × 10(-6)) and so was the magnitude of cartilage thickness change (P ≤ 8.2 × 10(-6)). No significant differences were observed between the narrowed compartments of latJSN vs. medJSN knees (probability: P = 0.58, magnitude: P = 0.19) or between the non-narrowed compartment of latJSN/medJSN vs. noJSN knees (probability: P ≥ 0.35, magnitude: P = ≥0.23). These results were confirmed by the location-independent ordered value (OV) analyses of femorotibial subregions. CONCLUSION The predictive value of latJSN for lateral compartment cartilage loss was comparable to that of medJSN for medial compartment cartilage loss, whereas cartilage loss in the non-narrowed compartment was similar to that in noJSN knees. These findings provide important clues to predicting progression of knee OA, and in tailoring inclusion criteria for clinical trials.
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Akkaya N, Akkaya S, Özçakar L, Demirkan F, Kiter E, Konukcu S, Ardic F. Ultrasonographic measurement of the distal femoral cartilage thickness in patients with unilateral transtibial amputation. Prosthet Orthot Int 2013; 37:268-74. [PMID: 23144161 DOI: 10.1177/0309364612464233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lower limb amputation sometimes predisposes to degenerative secondary disorders. OBJECTIVES To evaluate the distal femoral cartilage thicknesses of patients with unilateral transtibial amputations using ultrasound and to investigate the relationship between cartilage thickness and disease-related parameters. STUDY DESIGN Cross-sectional study. METHODS Twenty-four unilateral transtibial amputees (mean age: 46.4 ± 8.5 years, range: 28-60 years) were evaluated. Duration of prosthesis use (years) and daily walking time with prosthesis (hours) were recorded. Functional status was assessed by gate velocity (m/s), and 6-min walking distance (m) with prosthesis. Ultrasound was used to measure distal femoral cartilage thicknesses bilaterally at medial/lateral condyles and the intercondylar areas. The percentages of cartilage loss (of the amputee-side in comparison with the nonamputee-side) were calculated. RESULTS Compared to the nonamputee-sides, distal femoral cartilage was significantly thinner at lateral condyles and the intercondylar areas on the amputee-sides (p < 0.05). Significant positive correlations were detected between the percentage of cartilage loss (at all three sites of measurement) and gate velocity, 6-min walking distance, and daily walking time with prosthesis (all p < 0.05). CONCLUSIONS Future prospective controlled studies are warranted to determine the principles of optimum prosthetic use regarding its possible effects on the femoral cartilage of amputee patients. CLINICAL RELEVANCE The correlations between the cartilage loss in the amputee extremity with faster gait and longer daily prosthetic use suggest that abnormal gait patterns might increase the loading on the amputated extremity.
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Affiliation(s)
- Nuray Akkaya
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Pamukkale University, Denizli, Turkey.
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Cromer MS, Bourne RM, Fransen M, Fulton R, Wang SC. Responsiveness of quantitative cartilage measures over one year in knee osteoarthritis: comparison of radiography and MRI assessments. J Magn Reson Imaging 2013; 39:103-9. [PMID: 23580461 DOI: 10.1002/jmri.24141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/27/2013] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To directly compare the responsiveness of quantitative imaging measures of disease progression in knee osteoarthritis (OA). In the medial compartment of the knee comparison was made between: 1) radiographic joint space narrowing (JSN); 2) global quantitative magnetic resonance imaging (qMRI) of cartilage volume; 3) regional qMRI of cartilage thickness; and 4) regional analysis using an ordered value (OV) methodology. MATERIALS AND METHODS 3T MRI and weight-bearing radiography of the knees were performed at baseline and 1-year timepoints in 23 subjects (mean age 63 years) with symptomatic knee OA. Standardized response means (SRM) were calculated for each measure. Statistical analysis to determine significance of change between timepoints was performed with a two-tailed Student's t-test (JSN, global, regional analysis) and nonparametric Mann-Whitney test (ordered values). RESULTS At 1 year, global cartilage volume losses of 2.3% (SRM -0.44) in the medial tibia and 6.9% in the medial femur (SRM -0.74) were recorded. SRM for JSN was -0.46. Regional analysis revealed largest reductions in cartilage thickness in the external (SRM -0.84) weight-bearing subregion of the medial femur and in the posterior subregion of the medial tibia (SRM -0.79). OV analysis in the medial compartment revealed areas of cartilage thinning (four ranked OV) and cartilage thickening (two ranked OV). CONCLUSION The MRI OV approach proved to be a superior analysis tool for detecting changes in cartilage morphology over a 1-year period. Radiographically defined JSN was found to be the least responsive measurement method of knee OA disease progression.
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Affiliation(s)
- Megan S Cromer
- Department of Radiology, Westmead Hospital, Westmead, Australia; Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Abstract
OBJECTIVE Understanding how knee cartilage is affected by osteoarthritis (OA) is critical in the development of sensitive biomarkers that may be used as surrogate endpoints in clinical trials. The objective of this study was to analyze longitudinal changes in cartilage thickness using detailed change maps and to examine if current methods for subregional analysis are able to capture the underlying cartilage changes. MATERIALS AND METHODS MRI images of 267 knees from 135 participants were acquired at baseline and 21-month follow-up and processed using a fully automatic framework for cartilage segmentation and quantification. The framework provides an anatomical coordinate system that allows for direct comparison across cartilage thickness maps. The reproducibility of this method was evaluated on 37 scan-rescan image pairs. RESULTS In OA knees, an annualized thickness loss of 3.7% was observed in the medial femoral cartilage plate (MF) whereas subregional measurements varied between -9.0% (loss) and 1.6%. The largest changes were observed in the posterior part of the MF. In the medial tibial cartilage plate (MT), a thickness increase of 0.4% was observed whereas subregional measurements varied between -0.8% (loss) and 1.6%. In addition, notable differences in the patterns of cartilage change were observed between genders. CONCLUSIONS This study indicated that the spatial changes, although highly heterogeneous, showed distinct patterns of cartilage thinning and cartilage thickening in both the MF and the MT. These patterns were not accurately reflected when thickness changes were averaged over large, predefined subregions as defined in current methods for subregional analysis.
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Affiliation(s)
- Dan R. Jørgensen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark,Biomediq A/S, Copenhagen, Denmark
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Eckstein F, Mc Culloch CE, Lynch JA, Nevitt M, Kwoh CK, Maschek S, Hudelmaier M, Sharma L, Wirth W. How do short-term rates of femorotibial cartilage change compare to long-term changes? Four year follow-up data from the osteoarthritis initiative. Osteoarthritis Cartilage 2012; 20:1250-7. [PMID: 22800771 PMCID: PMC3471368 DOI: 10.1016/j.joca.2012.06.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 05/15/2012] [Accepted: 06/25/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare unbiased estimates of short- vs long-term cartilage loss in osteoarthritic knees. METHOD 441 knees [216 Kellgren Lawrence (KL) grade 2, 225 KL grade 3] from participants of the Osteoarthritis Initiative were studied over a 4-year period. Femorotibial cartilage thickness was determined using 3 T double echo steady state magnetic resonance imaging, the readers being blinded to time points. Because common measurement time points bias correlations, short-term change (year-1 to year-2: Y1 → Y2) was compared with long-term change (baseline to year-4: BL → Y4), and initial (BL → Y1) with subsequent (Y2 → Y4) observation periods. RESULTS The mean femorotibial cartilage thickness change (standardized response mean) was -1.2%/-0.8% (-0.42/-0.28) over 1 (BL → Y1/Y1 → Y2), -2.1%/-2.5% (-0.56/-0.55) over 2 (BL → Y2/Y2 → Y4), -3.3% (-0.63) over 3 (Y1 → Y4), and -4.5% (-0.78) over 4 years. Spearman correlations were 0.33 for Y1 → Y2 vs BL → Y4, and 0.17 for BL → Y1 vs Y2 → Y4 change. Percent agreement between knees showing progression during Y1 → Y2 vs BL → Y4 was 59%, and 64% for BL → Y1 vs Y2 → Y4. The area under the receiver operating characteristic curve was 0.66 for using Y1 → Y2 to predict BL → Y4, and 0.59 for using BL → Y1 to predict Y2 → Y4 change. CONCLUSION Weak to moderate correlations and agreement were observed between individual short- vs long-term cartilage loss, and between initial and subsequent observation periods. Hence, longer observation periods are recommended to achieve robust results on cartilage loss in individual knees. At cohort and subcohort level (e.g., KLG3 vs KLG2 knees), the mean cartilage loss increased almost linearly with the length of the observation period and was constant throughout the study.
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Affiliation(s)
- Felix Eckstein
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria,Chondrometrics GmbH, Ainring, Germany
| | | | - John A. Lynch
- University of California San Francisco, San Francisco, CA
| | - Michael Nevitt
- University of California San Francisco, San Francisco, CA
| | - C. Kent Kwoh
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Susanne Maschek
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria,Chondrometrics GmbH, Ainring, Germany
| | - Martin Hudelmaier
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria,Chondrometrics GmbH, Ainring, Germany
| | - Leena Sharma
- Division of Rheumatology, Feinberg School of Medicine at Northwestern University
| | - Wolfgang Wirth
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria,Chondrometrics GmbH, Ainring, Germany
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Eckstein F, Nevitt M, Gimona A, Picha K, Lee JH, Davies RY, Dreher D, Benichou O, Le Graverand MPH, Hudelmaier M, Maschek S, Wirth W. Rates of change and sensitivity to change in cartilage morphology in healthy knees and in knees with mild, moderate, and end-stage radiographic osteoarthritis: results from 831 participants from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2011; 63:311-9. [PMID: 20957657 PMCID: PMC3106126 DOI: 10.1002/acr.20370] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To study the longitudinal rate of (and sensitivity to) change of knee cartilage thickness across defined stages of radiographic osteoarthritis (OA), specifically healthy knees and knees with end-stage radiographic OA. METHODS One knee of 831 Osteoarthritis Initiative participants was examined: 112 healthy knees, without radiographic OA or risk factors for knee OA, and 719 radiographic OA knees (310 calculated Kellgren/Lawrence [K/L] grade 2, 300 calculated K/L grade 3, and 109 calculated K/L grade 4). Subregional change in thickness was assessed after segmentation of weight-bearing femorotibial cartilage at baseline and 1 year from coronal magnetic resonance imaging (MRI). Regional and ordered values (OVs) of change were compared by baseline radiographic OA status. RESULTS Healthy knees displayed small changes in plates and subregions (±0.7%; standardized response mean [SRM] ±0.15), with OVs being symmetrically distributed close to zero. In calculated K/L grade 2 knees, changes in cartilage thickness were small (<1%; minimal SRM -0.22) and not significantly different from healthy knees. Knees with calculated K/L grade 3 showed substantial loss of cartilage thickness (up to -2.5%; minimal SRM -0.35), with OV1 changes being significantly (P < 0.05) greater than those in healthy knees. Calculated K/L grade 4 knees displayed the largest rate of loss across radiographic OA grades (up to -3.9%; minimal SRM -0.51), with OV1 changes also significantly (P < 0.05) greater than in healthy knees. CONCLUSION MRI-based cartilage thickness showed high rates of loss in knees with moderate and end-stage radiographic OA, and small rates (indistinguishable from healthy knees) in mild radiographic OA. From the perspective of sensitivity to change, end-stage radiographic OA knees need not be excluded from longitudinal studies using MRI cartilage morphology as an end point.
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Affiliation(s)
- Felix Eckstein
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria.
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Farrokhi S, Colletti PM, Powers CM. Differences in patellar cartilage thickness, transverse relaxation time, and deformational behavior: a comparison of young women with and without patellofemoral pain. Am J Sports Med 2011; 39:384-91. [PMID: 20962335 PMCID: PMC4893957 DOI: 10.1177/0363546510381363] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The origin of patellofemoral pain (PFP) may be associated with the inability of the patellofemoral joint cartilage to absorb and distribute patellofemoral joint forces. HYPOTHESIS When compared with a pain-free control group, young active women with PFP will demonstrate differences in their baseline patellar cartilage thickness and transverse (T2) relaxation time, as well as a less adaptive response to an acute bout of joint loading. STUDY DESIGN Controlled laboratory study; Level of evidence, 3. METHODS Ten women between the ages of 23 to 37 years with PFP and 10 sex-, age-, and activity-matched pain-free controls participated. Quantitative magnetic resonance imaging of the patellofemoral joint was performed at baseline and after participants performed 50 deep knee bends. Differences in baseline cartilage thickness and T2 relaxation time, as well as the postexercise change in patellar cartilage thickness and T2 relaxation time, were compared between groups. RESULTS Individuals with PFP demonstrated reductions in baseline cartilage thickness of 14.0% and 14.1% for the lateral patellar facet and total patellar cartilage, respectively. Similarly, individuals with PFP exhibited significantly lower postexercise cartilage thickness change for the lateral patellar facet (2.1% vs 8.9%) and the total patellar cartilage (4.4% vs 10.0%) when compared with the control group. No group differences in baseline or postexercise change in T2 relaxation time were found. CONCLUSION The findings suggest that a baseline reduction in patellar cartilage thickness and a reduced deformational behavior of patellar cartilage following an acute bout of loading are associated with presence of PFP symptoms.
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Affiliation(s)
- Shawn Farrokhi
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick M. Colletti
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Christopher M. Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
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Hannink G, van Tienen TG, Schouten AJ, Buma P. Changes in articular cartilage after meniscectomy and meniscus replacement using a biodegradable porous polymer implant. Knee Surg Sports Traumatol Arthrosc 2011; 19:441-51. [PMID: 20802995 PMCID: PMC3038217 DOI: 10.1007/s00167-010-1244-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 08/02/2010] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the long-term effects of implantation of a biodegradable polymer meniscus implant on articular cartilage degeneration and compare this to articular cartilage degeneration after meniscectomy. METHODS Porous polymer polycaprolacton-based polyurethane meniscus implants were implanted for 6 or 24 months in the lateral compartment of Beagle dog knees. Contralateral knees were meniscectomized, or left intact and served as controls. Articular cartilage degeneration was evaluated in detail using India ink staining, routine histology, immunochemistry for denatured (Col2-¾M) and cleaved (Col2-¾C(short)) type II collagen, Mankin's grading system, and cartilage thickness measurements. RESULTS Histologically, fibrillation and substantial immunohistochemical staining for both denatured and cleaved type II collagen were found in all three treatment groups. The cartilage of the three groups showed identical degradation patterns. In the 24 months implant group, degradation appeared to be more severe when compared to the 6 months implant group and meniscectomy group. Significantly more cartilage damage (India ink staining, Mankin's grading system, and cartilage thickness measurements) was found in the 24 months implant group compared to the 6 months implant group and meniscectomy group. CONCLUSION Degradation of the cartilage matrix was the result of both mechanical overloading as well as localized cell-mediated degradation. The degeneration patterns were highly variable between animals. Clinical application of a porous polymer implant for total meniscus replacement is not supported by this study.
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Affiliation(s)
- Gerjon Hannink
- Orthopaedic Research Lab, Department of Orthopaedics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | | | - Arend Jan Schouten
- Polymer Chemistry, Faculty of Mathematics and Natural Sciences, University of Groningen, Nijenborgh 4, 9747 AG Groningen, The Netherlands
| | - Pieter Buma
- Orthopaedic Research Lab, Department of Orthopaedics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Wirth W, Larroque S, Davies RY, Nevitt M, Gimona A, Baribaud F, Lee JH, Benichou O, Wyman BT, Hudelmaier M, Maschek S, Eckstein F. Comparison of 1-year vs 2-year change in regional cartilage thickness in osteoarthritis results from 346 participants from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2011; 19:74-83. [PMID: 21044690 PMCID: PMC3046392 DOI: 10.1016/j.joca.2010.10.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 10/13/2010] [Accepted: 10/26/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare femorotibial cartilage thickness changes over a 2- vs a 1-year observation period in knees with radiographic knee osteoarthritis (OA). METHODS One knee of 346 Osteoarthritis Initiative (OAI) participants was studied at three time points [baseline (BL), year-1 (Y1), year-2 (Y2) follow-up]: 239 using coronal fast low angle shot (FLASH) and 107 using sagittal double echo at steady state (DESS) MR imaging. Changes in cartilage thickness were assessed in femorotibial cartilage plates and subregions, after manual segmentation with blinding to time-point. RESULTS The standardized response mean (SRM) of total joint cartilage thickness over 2 years was modestly higher than over 1 year (FLASH: -0.44 vs -0.32/-0.28 [first/second year]; DESS: -0.42 vs -0.39/-0.18). For the subregion showing the largest change per knee (OV1), the 2-year SRM was similar or lower (FLASH: -1.20 vs -1.22/-1.61; DESS: -1.38 vs -1.64/-1.51) than the 1-year SRM. The changes in total joint cartilage thickness were not significantly different in the first and second year (FLASH: -0.8% vs -0.7%; DESS: -1.3% vs -0.8%) and were negatively correlated. Analysis of smallest detectable changes (SDCs) revealed that only few participants displayed significant progression in both consecutive periods. The location of the subregion contributing to OV1 in each knee was highly inconsistent between the first and second year observation period. CONCLUSIONS The SRM of region-based cartilage thickness change in OA is modestly larger following a 2-year vs a 1-year observation period, while it is relatively similar when an OV-approach is chosen. Structural progression displays strong temporal and spatial heterogeneity at an individual knee level that should be considered when planning clinical trials.
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Affiliation(s)
- W Wirth
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria.
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Eckstein F, Yang M, Guermazi A, Roemer FW, Hudelmaier M, Picha K, Baribaud F, Wirth W, Felson DT. Reference values and Z-scores for subregional femorotibial cartilage thickness--results from a large population-based sample (Framingham) and comparison with the non-exposed Osteoarthritis Initiative reference cohort. Osteoarthritis Cartilage 2010; 18:1275-83. [PMID: 20691798 DOI: 10.1016/j.joca.2010.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 07/14/2010] [Accepted: 07/27/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To establish sex-specific (subregional) reference values of cartilage thickness and potential maximal Z-scores in the femorotibial joint. METHODS The mean cartilage thickness (ThCtAB.Me) in femorotibial compartments, plates and subregions was determined on coronal magnetic resonance imaging (MRI) from a population-based sample (Framingham) and from a healthy reference sample of the Osteoarthritis Initiative (OAI). RESULTS 686 Framingham participants (309 men, 377 women, age 62 ± 8 years) had no radiographic femorotibial osteoarthritis (OA) ("normals") and 376 (156 men, 220 women) additionally had no MRI features of cartilage lesions ("supernormals"). The Framingham "normals" had thinner cartilage in the medial (3.59 mm) than in the lateral femorotibial compartment (3.86 mm). Medially, the femur displayed thicker cartilage (1.86 mm) than the tibia (1.73 mm), and laterally the tibia thicker cartilage (2.09 mm) than the femur (1.77 mm). The thickest cartilage was observed in central, and the thinnest in external femorotibial subregions. Potential maximal Z-scores ranged from 5.6 to 9.8 throughout the subregions; men displayed thicker cartilage but similar potential maximal Z-scores as women. Mean values and potential maximal Z-scores in Framingham "supernormals" and non-exposed OAI reference participants (112 participants without symptoms or risk factors of knee OA) were similar to Framingham "normals". CONCLUSIONS We provide reference values and potential maximal Z-scores of cartilage thickness in middle aged to elderly non-diseased populations without radiographic OA. Results were similar for "supernormal" participants without MRI features of cartilage lesions, and in a cohort without OA symptoms or risk factors. A cartilage thickness loss of around 27% is required for attaining a Z-score of -2.
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Hunter D, Bowes M, Eaton C, Holmes A, Mann H, Kwoh C, Maciewicz R, Samuels J, Waterton J. Can cartilage loss be detected in knee osteoarthritis (OA) patients with 3-6 months' observation using advanced image analysis of 3T MRI? Osteoarthritis Cartilage 2010; 18:677-83. [PMID: 20219688 PMCID: PMC4398342 DOI: 10.1016/j.joca.2010.02.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 01/19/2010] [Accepted: 02/01/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Prior investigations of magnetic resonance imaging (MRI) biomarkers of cartilage loss in knee osteoarthritis (OA) suggest that trials of interventions which affect this biomarker with adequate statistical power would require large clinical studies of 1-2 years duration. We hypothesized that smaller, shorter duration, "Proof of Concept" (PoC) studies might be achievable by: (1) selecting a population at high risk of rapid medial tibio-femoral (TF) progression, in conjunction with; (2) high-field MRI (3T), and; (3) using advanced image analysis. The primary outcome was the cartilage thickness in the central medial femur. METHODS Multi-centre, non-randomized, observational cohort study at four sites in the US. Eligible participants were females with knee pain, a body mass index (BMI)> or =25 kg/m(2), symptomatic radiographic evidence of medial TF OA, and varus mal-alignment. The 29 participants had a mean age of 62 years, mean BMI of 36 kg/m(2), with eight index knees graded as Kellgren-Lawrence (K&L)=2 and 21 as K&L=3. Eligible participants had four MRI scans of one knee: two MRIs (1 week apart) were acquired as a baseline with follow-up MRI at 3 and 6 months. A trained operator, blind to time-point but not subject, manually segmented the cartilage from the Dual Echo Steady State water excitation MR images. Anatomically corresponding regions of interest were identified on each image by using a three-dimensional statistical shape model of the endosteal bone surface, and the cartilage thickness (with areas denuded of cartilage included as having zero thickness - ThCtAB) within each region was calculated. The percentage change from baseline at 3 and 6 months was assessed using a log-scale analysis of variance (ANOVA) model including baseline as a covariate. The primary outcome was the change in cartilage thickness within the aspect of central medial femoral condyle exposed within the meniscal window (w) during articulation, neglecting cartilage edges [nuclear (n)] (nwcMF x ThCtAB), with changes in other regions considered as secondary endpoints. RESULTS Anatomical mal-alignment ranged from -1.9 degrees to 6.3 degrees , with mean 0.9 degrees . With one exception, no changes in ThCtAB were detected at the 5% level for any of the regions of interest on the TF joint at 3 or 6 months of follow-up. The change in the primary variable (nwcMF x ThCtAB) from (mean) baseline at 3 months from the log-scale ANOVA model was -2.1% [95% confidence interval (CI) (-4.4%, +0.2%)]. The change over 6 months was 0.0% [95% CI (-2.7%, +2.8%)]. The 95% CI for the change from baseline did not include zero for the cartilage thickness within the meniscal window of the lateral tibia (wLT x ThCtAB) at 6 month follow-up (-1.5%, 95% CI [-2.9, -0.2]), but was not significant at the 5% level after correction for multiple comparisons. CONCLUSIONS The small inconsistent compartment changes, and the relatively high variabilities in cartilage thickness changes seen over time in this study, provide no additional confidence for a 3- or 6-month PoC study using a patient population selected on the basis of risk for rapid progression with the MRI acquisition and analyses employed.
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Affiliation(s)
- D.J. Hunter
- Division of Research, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA,Address correspondence and reprint requests to: David John Hunter, Division of Research, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA. Tel: 1-617-754-6655; Fax: 1-617-754-6888. (D.J. Hunter)
| | - M.A. Bowes
- Imorphics, Kilburn House, Manchester Science Park, Manchester M15 6SE, UK
| | - C.B. Eaton
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02860, USA,Department of Family Medicine and Community Health (Epidemiology), Alpert Medical School of Brown University, Pawtucket, RI 02860, USA
| | - A.P. Holmes
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - H. Mann
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - C.K. Kwoh
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, 3500 Terrace St, Pittsburgh, PA 15261, USA,Pittsburgh VA Healthcare System, Pittsburgh, PA 15206, USA
| | - R.A. Maciewicz
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - J. Samuels
- Seligman Center far Advanced Therapeutics, NYU Hospital for Joint Diseases, 301 East 17th St, New York, NY 10003, USA
| | - J.C. Waterton
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
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Abstract
Articular hyaline cartilage takes on the contours of the subchondral bone on which it lies, but its thickness varies between joints, within a single joint and within a single articular surface. Previous studies have correlated articular cartilage thickness distribution with the degree of stress and weight bearing on joint surfaces, but few studies have considered the thickness of the calcified cartilage in relation to these parameters. Here we report a correlation between the cartilage thickness distribution and weight bearing distribution on the head of the 1st metatarsal bone, a component of one of the major weight bearing joints in the lower extremity during the gait cycle. The greatest total and uncalcified articular cartilage thickness was found on the central and lateral distal aspects of the metatarsal head, a region that receives maximal ground reactive force during the propulsive phase of the normal gait cycle. Although the thickness of the calcified cartilage was correlated with the thickness of the uncalcified cartilage, it varied to a lesser extent across the articular surface than did that of the uncalcified cartilage.
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Affiliation(s)
- C Muehleman
- Department of Anatomy, Rush Medical College, Rush-Presbyterian-St Lukes Medical Center, Chicago, IL 60612, USA
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