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van der Weegen W, Warren T, Das D, Agricola R, Timmers T, Siebelt M. Operative or Nonoperative Treatment is Predicted Accurately for Patients Who Have Hip Complaints Consulting an Orthopedic Surgeon Using Machine Learning Algorithms Trained With Prehospital Acquired History-Taking Data. J Arthroplasty 2024; 39:1173-1177.e6. [PMID: 38007205 DOI: 10.1016/j.arth.2023.11.022] [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: 07/26/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Increasing numbers of patients suffering from hip osteoartritis will lead to increased orthopaedic health care consumption. Artificial intelligence might alleviate this problem, using Machine learning (ML) to optimize orthopaedic consultation workflow by predicting treatment strategy (non-operative or operative) prior to consultation. The purpose of this study was to assess ML accuracy in clinical practice, by comparing ML predictions to the outcome of clinical consultations. METHODS In this prospective clinical cohort study, adult patients referred for hip complaints between January 20th to February 20th 2023 were included. Patients completed a computer-assisted history taking (CAHT) form and using these CAHT answers, a ML-algorithm predicted non-operative or operative treatment outcome prior to in-hospital consultation. During consultation, orthopaedic surgeons and physician assistants were blinded to the prediction in 90 and unblinded in 29 cases. Consultation outcome (non-operative or operative) was compared to ML treatment prediction for all cases, and for blinded and unblinded conditions separately. Analysis was done on 119 consultations. RESULTS Overall treatment strategy prediction was correct in 101 cases (accuracy 85%, P < .0001). Non-operative treatment prediction (n = 71) was 97% correct versus 67% for operative treatment prediction (n = 48). Results from unblinded consultations (86.2% correct predictions,) were not statistically different from blinded consultations (84.4% correct, P > .05). CONCLUSIONS Machine Learning algorithms can predict non-operative or operative treatment for patients with hip complaints with high accuracy. This could facilitate scheduling of non-operative patients with physician assistants, and operative patients with orthopaedic surgeons including direct access to pre-operative screening, thereby optimizing usage of health care resources.
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Affiliation(s)
- Walter van der Weegen
- Department of Orthopedic Surgery, Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
| | | | - Dirk Das
- Department of Orthopedic Surgery, Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
| | - Rintje Agricola
- Department of Orthopedic Surgery, Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
| | - Thomas Timmers
- InteractiveStudios, Den Bosch, The Netherlands; IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel Siebelt
- Department of Orthopedic Surgery, Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
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van der Weegen W, Das D, Vrints K, Agricola R, Siebelt M. A 20 mg dose of dexamethasone does not reduce the proportion of joint replacement patients needing rescue analgesia: a matched cohort study. Ann Jt 2023; 8:4. [PMID: 38529231 PMCID: PMC10929338 DOI: 10.21037/aoj-22-34] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/23/2022] [Indexed: 03/27/2024]
Abstract
Background Consistent pain control after total joint replacement (TJR) has not yet been reached in all patients managed with a multimodal analgesia regime. Questions remain on dosage and timing of analgesics. Glucocorticoids such as dexamethasone are considered most powerful in reducing the surgery-induced inflammatory response with most pain studies using a 6-12 mg dose. Reviews agree that additional glucocorticoids may provide more analgesia, but a dose-finding analysis is limited. The primary aim of this study was to determine if a high, single preoperative dose of dexamethasone resulted in a reduced need for rescue analgesics during the first 24 hours after TJR when compared to a standard 8 mg dose of dexamethasone. Methods A cohort study in which 59 patients who received 20 mg dexamethasone intravenously just prior to incision were matched 1:1 to patients who received a standard 8 mg dose. Consecutive elective hip and knee replacement patients managed by one anaesthesiologist were included in the high dose group between June 2019 and March 2020. Patients were matched for arthroplasty type, gender, age, anaesthesia type and pre-operative pain. Patients with opioid use before surgery or with diabetes mellitus were excluded. Oxynorm rescues analgesics (number of times given and dosage) usage during hospitalization was retrieved from the electronic nursing files. Results There were no significant differences between groups in gender distribution, mean age and body mass index (BMI), in American Society of Anesthesiologists (ASA), type of arthroplasty, anaesthesia type and pre-operative pain score. In the 20 mg group 54 patients (91.5%) needed oxynorm during hospitalization versus 58 (98.3%) in the 8 mg group (P=0.09). High dose group patients received a median of 5 mg [interquartile range (IQR): 0] oxynorm versus 5 mg (IQR: 0) in the standard dose group (P=0.70). Conclusions In this matched cohort study there was no difference in the proportion of patients needing rescue analgesics during hospitalization between the group of patients who preoperatively received 20 mg dexamethasone and the group of patients who received 8 mg. Future blinded randomized controlled trials are needed to further investigate the effect of different glucocorticoids dosages on pain after joint replacement surgery.
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Affiliation(s)
| | - Dirk Das
- Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
| | - Katleen Vrints
- Department of Anesthesiology, Geldrop, St. Anna Hospital, Geldrop, The Netherlands
| | - Rintje Agricola
- Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michiel Siebelt
- Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
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Cohen A, Claessen T, van den Berg C, Siebelt M, Hagenaars T, Kraan GA, Waarsing JH, Reijman M, Colaris JW. Morphological risk factors for scaphoid fracture: a case-control study. Eur J Trauma Emerg Surg 2023; 49:133-141. [PMID: 36166077 PMCID: PMC9925522 DOI: 10.1007/s00068-022-02101-y] [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: 03/14/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Most patients with a clinically suspected scaphoid fracture and normal initial radiograph are unnecessarily treated. Previously developed prediction rules using demographic and clinical risk are unable to accurately predict occult fractures. Adding other risk factors could enhance this. Therefore, we aim to explore if there are morphological risk factors of the wrist for sustaining a scaphoid fracture. METHODS We retrospectively included adult patients with a clinically suspected scaphoid fracture between 2013 and 2019 in our case-control study. There were 82 patients with a scaphoid fracture and 158 patients with a wrist contusion. Morphological risk factors were identified using statistical shape modelling (SSM) and linear measurements. Independent wrist shape variations on posteroanterior and lateral radiographs were captured in modes using SSM. Associations between outcomes and a scaphoid fracture were explored using logistic regression and the reliability was assessed. RESULTS Of the 15 posteroanterior modes and 8 lateral modes identified and linear measurements performed, 1 PA mode was associated with a scaphoid fracture (PA mode 4; OR 1.40, CI 1.04-1.93, p = 0.031). We described this mode as an ulna plus and narrower distal radius with more volar tilt and radial inclination. The reliability of the posteroanterior modes and linear measurements was mostly good/excellent and moderate/poor for the lateral modes. CONCLUSION There was one complex wrist shape significantly associated with a scaphoid fracture. Since the association was weak and the shape is difficult to identify radiographs, we believe this morphological risk factor would not enhance identifying occult scaphoid fractures in the future.
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Affiliation(s)
- Abigael Cohen
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Room Nc-424, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Thomas Claessen
- Department of Neurology, Dijklander Hospital, Maelsonstraat 3, 1624 NP Hoorn, The Netherlands
| | - Corne van den Berg
- Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Toneellaan 2, 2725 NA Zoetermeer, The Netherlands
| | - Michiel Siebelt
- Department of Orthopaedic Surgery, St. Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The Netherlands
| | - Tjebbe Hagenaars
- Trauma Research Unit, Department of Surgery, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands ,Department of Emergency Medicine, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Gerald A. Kraan
- Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Toneellaan 2, 2725 NA Zoetermeer, The Netherlands
| | - Johannes H. Waarsing
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Room Nc-424, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Room Nc-424, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Joost W. Colaris
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Room Nc-424, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Kornuijt A, Kuijer PPFM, van Drumpt RA, Siebelt M, Lenssen AF, van der Weegen W. A high physical activity level after total knee arthroplasty does not increase the risk of revision surgery during the first twelve years: A systematic review with meta-analysis and GRADE. Knee 2022; 39:168-184. [PMID: 36208528 DOI: 10.1016/j.knee.2022.08.004] [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: 02/08/2022] [Accepted: 08/12/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND High physical activity (HPA) levels after total knee arthroplasty (TKA) might be related to increased wear and subsequent aseptic loosening, negatively affecting TKA survival. This systematic review studied the association between activity levels and risk of revision surgery at medium (3-10 years) and long term (>10 years) follow up in patients with TKA. METHODS Databases (PubMed, Embase) were searched up to 12 October 2021. Studies comparing low physical activity (LPA) and HPA levels in TKA patients and related risk of revision surgery were eligible for inclusion. After data extraction and evaluation of methodological quality, a meta-analysis was performed. Quality of evidence was assessed using the GRADE framework. PROSPERO registration: CRD42020194284. RESULTS Five cohort studies and one case-control study met the inclusion criteria, involving 4811 TKA procedures in 4263 patients (mean follow up 4-12 years). Five studies were of moderate methodological quality and one of low quality. Meta-analysis demonstrated no association between HPA level and an increased risk of all-cause revision surgery (risk ratio (RR) 0.62, 95 % confidence interval (CI) 0.24-1.63, level of certainty: very low) or revision surgery due to aseptic loosening (RR 1.33, 95 % CI 0.34-5.24, level of certainty: moderate). Only one study reported on survivorship, with an improved survivorship for the HPA group (odds ratio of 2.4, 95 % CI 1.2-4.7, level of certainty: low). CONCLUSION During the first 12 postoperative years after TKA, there seems to be no increased risk for revision surgery for patients with a HPA level compared with patients with an LPA level.
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Affiliation(s)
- A Kornuijt
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands; Department of Physical Therapy, Anna Hospital, Geldrop, the Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - P P F M Kuijer
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - R A van Drumpt
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
| | - M Siebelt
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
| | - A F Lenssen
- Department of Physical Therapy, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - W van der Weegen
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
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Warmink K, Siebelt M, Low PS, Riemers FM, Wang B, Plomp SGM, Tryfonidou MA, van Weeren PR, Weinans H, Korthagen NM. Folate Receptor Expression by Human Monocyte-Derived Macrophage Subtypes and Effects of Corticosteroids. Cartilage 2022; 13:19476035221081469. [PMID: 35255727 PMCID: PMC9137314 DOI: 10.1177/19476035221081469] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Folate receptor beta (FR-β) has been used as a clinical marker and target in multiple inflammatory diseases, including osteoarthritis (OA) and rheumatoid arthritis (RA). However, the conditions under which FR-β+ macrophages arise remain unclear and could be affected by corticosteroids. Therefore, we studied FR-β expression in vitro in macrophage subtypes and determined their response to triamcinolone acetonide (TA), a clinically often-used corticosteroid. DESIGN Human monocyte-derived macrophages were differentiated to the known M0, M1, or M2 macrophage phenotypes. The phenotype and FR-β expression and plasticity of the macrophage subtypes were determined using flow cytometry, reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA). RESULTS FR-β expression was low in granulocyte-macrophage colony-stimulating factor (GM-CSF)-generated (M1-like) macrophages and high in macrophage colony-stimulating factor (M-CSF)-generated (M0 and M2-like) macrophages. FR-β expression remained high once the M0 or M2 macrophages were stimulated with pro-inflammatory stimuli (interferon-γ plus lipopolysaccharide) to induce M1-like macrophages. On the contrary, anti-inflammatory TA treatment skewed GM-CSF macrophage differentiation toward an M2 and FR-β+ phenotype. CONCLUSIONS As corticosteroids skewed monocytes toward an FR-β-expressing, anti-inflammatory phenotype, even in an M1 priming GM-CSF environment, FR-β has potential as a biomarker to monitor success of treatment with corticosteroids. Without corticosteroid treatment, M-CSF alone induces high FR-β expression which remains high under pro-inflammatory conditions. This explains why pro-inflammatory FR-β+ macrophages (exposed to M-CSF) are observed in arthritis patients and correlate with disease severity.
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Affiliation(s)
- Kelly Warmink
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands,Kelly Warmink, Department of Orthopedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Michiel Siebelt
- Department of Orthopedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Philip S. Low
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
| | - Frank M. Riemers
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Bingbing Wang
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
| | - Saskia G. M. Plomp
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Marianna A. Tryfonidou
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P. René van Weeren
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Biomechanical Engineering, TU Delft, Delft, The Netherlands
| | - Nicoline M. Korthagen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Tan A, Tan Z, Li T, Harris I, Naylor J, Siebelt M, Tiel JV, Pinheiro M, Harris L, Chamberlain K, Adie S. 1379Has the reporting quality of published randomised controlled trial protocols improved since the SPIRIT statement? Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The impact of the SPIRIT statement on the reporting quality of RCT protocols in health research is unknown. This methodological study aimed to determine the reporting quality of published randomised controlled trial (RCT) protocols before and after the SPIRIT statement, and any association with author, trial or journal factors.
Methods
RCT protocols were identified by searching MEDLINE, Embase and CENTRAL, included if published in full-text, English language and a peer-reviewed journal, and assessed with the SPIRIT statement checklist items.
Results
300 RCT protocols were retrieved; 150 from the period immediately before the SPIRIT statement and 150 from a recent period after the SPIRIT statement. 47.9% (95% CI, 46.5% to 49.3%) of checklist items were adequately reported in RCT protocols before the SPIRIT statement and 56.7% (95% CI, 54.9% to 58.5%) after the SPIRIT statement. This represents an 8.8% (95% CI, 6.6% to 11.1%; p < 0.0001) mean improvement in the overall proportion of checklist items adequately reported since the SPIRIT statement. The factors associated with higher reporting quality of RCT protocols in multiple regression analysis were author expertise or experience in epidemiology or statistics, multicentre trials, longer protocol word length and publicly reported journal policy of compliance with the SPIRIT statement.
Conclusions
The overall reporting quality of RCT protocols has significantly improved since the SPIRIT statement, although a substantial proportion of individual checklist items remain poorly reported.
Key messages
Continued, concerted and coordinated efforts are required by journals, editors, reviewers and investigators to improve the completeness and transparency of RCT protocols.
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Affiliation(s)
- Aidan Tan
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Zet Tan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Tom Li
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian Harris
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Justine Naylor
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Michiel Siebelt
- Orthopaedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jasper van Tiel
- Orthopaedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, University of Sydney, Sydney, Australia
| | - Laura Harris
- Sydney Orthopaedic Trauma and Reconstructive Surgery, Sydney, Australia
| | - Kira Chamberlain
- Sydney Orthopaedic Trauma and Reconstructive Surgery, Sydney, Australia
| | - Sam Adie
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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Siebelt M, Das D, Van Den Moosdijk A, Warren T, Van Der Putten P, Van Der Weegen W. Machine learning algorithms trained with pre-hospital acquired history-taking data can accurately differentiate diagnoses in patients with hip complaints. Acta Orthop 2021; 92:254-257. [PMID: 33573429 PMCID: PMC8231380 DOI: 10.1080/17453674.2021.1884408] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Machine learning (ML) techniques are a form of artificial intelligence able to analyze big data. Analyzing the outcome of (digital) questionnaires, ML might recognize different patterns in answers that might relate to different types of pathology. With this study, we investigated the proof-of-principle of ML-based diagnosis in patients with hip complaints using a digital questionnaire and the Kellgren and Lawrence (KL) osteoarthritis score.Patients and methods - 548 patients (> 55 years old) scheduled for consultation of hip complaints were asked to participate in this study and fill in an online questionnaire. Our questionnaire consists of 27 questions related to general history-taking and validated patient-related outcome measures (Oxford Hip Score and a Numeric Rating Scale for pain). 336 fully completed questionnaires were related to their classified diagnosis (either hip osteoarthritis, bursitis or tendinitis, or other pathology). Different AI techniques were used to relate questionnaire outcome and hip diagnoses. Resulting area under the curve (AUC) and classification accuracy (CA) are reported to identify the best scoring AI model. The accuracy of different ML models was compared using questionnaire outcome with and without radiologic KL scores for degree of osteoarthritis.Results - The most accurate ML model for diagnosis of patients with hip complaints was the Random Forest model (AUC 82%, 95% CI 0.78-0.86; CA 69%, CI 0.64-0.74) and most accurate analysis with addition of KL scores was with a Support Vector Machine model (AUC 89%, CI 0.86-0.92; CA 83%, CI 0.79-0.87).Interpretation - Analysis of self-reported online questionnaires related to hip complaints can differentiate between basic hip pathologies. The addition of radiological scores for osteoarthritis further improves these outcomes.
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Affiliation(s)
- Michiel Siebelt
- Department of Orthopedic Surgery, St Anna Hospital, Geldrop;
| | - Dirk Das
- Department of Orthopedic Surgery, St Anna Hospital, Geldrop;
| | | | - Tristan Warren
- Department of Orthopedic Surgery, St Anna Hospital, Geldrop;
| | - Peter Van Der Putten
- Leiden Institute of Advanced Computer Science, Leiden University Leiden, The Netherlands
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Tan ZW, Tan AC, Li T, Harris I, Naylor JM, Siebelt M, van Tiel J, Pinheiro M, Harris L, Chamberlain K, Adie S. Has the reporting quality of published randomised controlled trial protocols improved since the SPIRIT statement? A methodological study. BMJ Open 2020; 10:e038283. [PMID: 32847919 PMCID: PMC7451949 DOI: 10.1136/bmjopen-2020-038283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To determine the reporting quality of published randomised controlled trial (RCT) protocols before and after the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement (2013), and any association with author, trial or journal factors. DESIGN Methodological study. DATA SOURCES MEDLINE, Embase and CENTRAL were electronically searched using optimised search strategies. ELIGIBILITY CRITERIA Protocols written for an RCT of living humans, published in full text in a peer-reviewed journal and published in the English language. MAIN OUTCOME Primary outcome was the overall proportion of checklist items which were adequately reported in RCT protocols published before and after the SPIRIT statement. RESULTS 300 RCT protocols were retrieved; 150 from the period immediately before the SPIRIT statement (9 July 2012 to 28 December 2012) and 150 from a recent period after the SPIRIT statement (25 January 2019 to 20 March 2019). 47.9% (95% CI, 46.5% to 49.3%) of checklist items were adequately reported in RCT protocols before the SPIRIT statement and 56.7% (95% CI, 54.9% to 58.5%) after the SPIRIT statement. This represents an 8.8% (95% CI, 6.6% to 11.1%; p<0.0001) mean improvement in the overall proportion of checklist items adequately reported since the SPIRIT statement. While 40% of individual checklist items had a significant improvement in adequate reporting after the SPIRIT statement, 11.3% had a significant deterioration and there were no RCT protocols in which all individual checklist items were complete. The factors associated with higher reporting quality of RCT protocols in multiple regression analysis were author expertise or experience in epidemiology or statistics, multicentre trials, longer protocol word length and publicly reported journal policy of compliance with the SPIRIT statement. CONCLUSION The overall reporting quality of RCT protocols has significantly improved since the SPIRIT statement, although a substantial proportion of individual checklist items remain poorly reported. Continued and concerted efforts are required by journals, editors, reviewers and investigators to improve the completeness and transparency of RCT protocols.
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Affiliation(s)
- Zet Wei Tan
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Aidan Christopher Tan
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Tom Li
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ian Harris
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Justine M Naylor
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Michiel Siebelt
- Orthopaedics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Jasper van Tiel
- Orthopaedics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Laura Harris
- Sydney Orthopaedic Trauma and Reconstructive Surgery, Sydney, New South Wales, Australia
| | - Kira Chamberlain
- Sydney Orthopaedic Trauma and Reconstructive Surgery, Sydney, New South Wales, Australia
| | - Sam Adie
- South Western Sydney Clinical School, University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
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van Tiel J, Siebelt M, Reijman M, Bos PK, Waarsing JH, Zuurmond AM, Nasserinejad K, van Osch GJVM, Verhaar JAN, Krestin GP, Weinans H, Oei EHG. Quantitative in vivo CT arthrography of the human osteoarthritic knee to estimate cartilage sulphated glycosaminoglycan content: correlation with ex-vivo reference standards. Osteoarthritis Cartilage 2016; 24:1012-20. [PMID: 26851449 DOI: 10.1016/j.joca.2016.01.137] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/07/2015] [Revised: 12/24/2015] [Accepted: 01/19/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Recently, computed tomography arthrography (CTa) was introduced as quantitative imaging biomarker to estimate cartilage sulphated glycosaminoglycan (sGAG) content in human cadaveric knees. Our aim was to assess the correlation between in vivo CTa in human osteoarthritis (OA) knees and ex vivo reference standards for sGAG and collagen content. DESIGN In this prospective observational study 11 knee OA patients underwent CTa before total knee replacement (TKR). Cartilage X-ray attenuation was determined in six cartilage regions. Femoral and tibial cartilage specimens harvested during TKR were re-scanned using equilibrium partitioning of an ionic contrast agent with micro-CT (EPIC-μCT), which served as reference standard for sGAG. Next, cartilage sGAG and collagen content were determined using dimethylmethylene blue (DMMB) and hydroxyproline assays. The correlation between CTa X-ray attenuation, EPIC-μCT X-ray attenuation, sGAG content and collagen content was assessed. RESULTS CTa X-ray attenuation correlated well with EPIC-μCT (r = 0.76, 95% credibility interval (95%CI) 0.64 to 0.85). CTa correlated moderately with the DMMB assay (sGAG content) (r = -0.66, 95%CI -0.87 to -0.49) and to lesser extent with the hydroxyproline assay (collagen content) (r = -0.56, 95%CI -0.70 to -0.36). CONCLUSIONS Outcomes of in vivo CTa in human OA knees correlate well with sGAG content. Outcomes of CTa also slightly correlate with cartilage collagen content. Since outcomes of CTa are mainly sGAG dependent and despite the fact that further validation using hyaline cartilage of other joints with different biochemical composition should be conducted, CTa may be suitable as quantitative imaging biomarker to estimate cartilage sGAG content in future clinical OA research.
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Affiliation(s)
- J van Tiel
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - M Siebelt
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - M Reijman
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - P K Bos
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - J H Waarsing
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | | | - K Nasserinejad
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - G J V M van Osch
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Otorhinolaryngology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - G P Krestin
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - H Weinans
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands; Department of Orthopedics and Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - E H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Siebelt M, Korthagen N, Wei W, Groen H, Bastiaansen-Jenniskens Y, Müller C, Waarsing JH, de Jong M, Weinans H. Triamcinolone acetonide activates an anti-inflammatory and folate receptor-positive macrophage that prevents osteophytosis in vivo. Arthritis Res Ther 2015; 17:352. [PMID: 26637220 PMCID: PMC4670534 DOI: 10.1186/s13075-015-0865-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/18/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Triamcinolone acetonide (TA) is used for osteoarthritis management to reduce pain, and pre-clinical studies have shown that TA limits osteophyte formation. Osteophyte formation is known to be facilitated by synovial macrophage activation. TA injections might influence macrophage activation and subsequently reduce osteophytosis. Although widely applied in clinical care, the mechanism through which TA exerts this effect remains unknown. In this animal study, we investigated the in vivo effects of TA injections on macrophage activation, osteophyte development and joint degeneration. Furthermore, in vitro macrophage differentiation experiments were conducted to further explain working mechanisms of TA effects found in vivo. Methods Osteoarthritis was induced in rat knees using papain injections and a running protocol. Untreated and TA-treated animals were longitudinally monitored for 12 weeks with in vivo micro–computed tomography (μCT) to measure subchondral bone changes. Synovial macrophage activation was measured in vivo using folate receptor β (FRβ)-targeted single-photon emission computed tomography/computed tomography. Articular cartilage was analyzed at 6 and 12 weeks with ex vivo contrast-enhanced μCT and histology. To further explain the outcomes of our in vivo study, TA on macrophages was also studied in vitro. These cultured macrophages were either M1- or M2-activated, and they were analyzed using fluorescence-activated cell sorting for CD163 and FRβ expression as well as for messenger RNA (mRNA) expression of interleukin (IL)-10. Results Our in vivo study showed that intra-articular injections with TA strongly enhanced FRβ+ macrophage activation. Despite stimulated macrophage activation, osteophyte formation was fully prevented. There was no beneficial effect of TA against cartilage degradation or subchondral bone sclerosis. In vitro macrophage cultures showed that TA strongly induced monocyte differentiation towards CD163+ and FRβ+ macrophages. Furthermore, TA-stimulated M2 macrophages showed enhanced IL-10 expression at the mRNA level. Conclusions TA injections potently induce a CD163+- and FRβ+-activated macrophage with anti-inflammatory characteristics such as reduced IL-10 production in vitro and lack of osteophytosis in vivo.
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Affiliation(s)
- Michiel Siebelt
- Department of Orthopaedics, Erasmus Medical Centre, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands. .,Department of Otorhinolaryngology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Nicoline Korthagen
- Department Orthopaedics, UMC Utrecht, Utrecht, The Netherlands. .,Department Rheumatology, UMC Utrecht, Utrecht, The Netherlands.
| | - Wu Wei
- Department of Orthopaedics, Erasmus Medical Centre, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Harald Groen
- Department of Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | | | - Christina Müller
- Centre for Radiopharmaceutical Sciences, Swiss Federal Institute of Technology (ETH) Zurich, Paul Scherrer Institute, University Hospital Zurich, Villigen, Switzerland.
| | - Jan Hendrik Waarsing
- Department of Orthopaedics, Erasmus Medical Centre, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Marion de Jong
- Department Rheumatology, UMC Utrecht, Utrecht, The Netherlands. .,Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Harrie Weinans
- Department Orthopaedics, UMC Utrecht, Utrecht, The Netherlands. .,Department Rheumatology, UMC Utrecht, Utrecht, The Netherlands. .,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
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Abstract
Hip osteoarthritis (OA) is characterized by cartilage degradation, subchondral bone sclerosis and osteophyte formation. Nowadays, OA is thought to develop via different etiologies that all lead to a similar form of end stage joint degradation. One of these subtypes is related to an abnormal shaped hip joint, like acetabular dysplasia and a cam deformity. These bony abnormalities are highly predictive for development of hip OA, but they are likely to already be present from childhood. This suggests that these deformations induce OA changes in the hip, well before extensive hip degradation becomes present three to four decades later. Accurate detection and successful characterization of these early OA events might lead to better treatment options for hip OA besides nowadays available invasive joint replacement surgery. However, current diagnostic imaging techniques like radiographs or plain magnetic resonance imaging (MRI), are not sensitive enough to detect these subtle early OA changes. Nor are they able to disentangle intertwined and overlapping cascades from different OA subtypes, and neither can they predict OA progression. New and more sensitive imaging techniques might enable us to detect first OA changes on a cellular level, providing us with new opportunities for early intervention. In this respect, shape analysis using radiography, MRI, computed tomography (CT), single photon emission computed tomography (SPECT)/CT, and positron emission tomography (PET) might prove promising techniques and be more suited to detect early pathological changes in the hip joint. A broad application of these techniques might give us more understanding what can be considered physiological adaptation of the hip, or when early OA really starts. With a more clear definition of early OA, more homogenous patient populations can be selected and help with the development of new disease modifying OA interventions.
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Affiliation(s)
- M Siebelt
- Department of Orthopaedics, Orthopaedic Research Laboratory, Erasmus MC, The Netherlands
| | - R Agricola
- Department of Orthopaedics, Orthopaedic Research Laboratory, Erasmus MC, The Netherlands
| | - H Weinans
- Department of Orthopaedics & Dept. Rheumatology, UMC Utrecht, The Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Y J Kim
- Department of Orthopaedic Surgery, Boston Children's Hospital, USA
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Siebelt M, Waarsing JH, Groen HC, Müller C, Koelewijn SJ, de Blois E, Verhaar JAN, de Jong M, Weinans H. Inhibited osteoclastic bone resorption through alendronate treatment in rats reduces severe osteoarthritis progression. Bone 2014; 66:163-70. [PMID: 24933343 DOI: 10.1016/j.bone.2014.06.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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: 02/15/2014] [Revised: 06/05/2014] [Accepted: 06/06/2014] [Indexed: 11/30/2022]
Abstract
Osteoarthritis (OA) is a non-rheumatoid joint disease characterized by progressive degeneration of extra-cellular cartilage matrix (ECM), enhanced subchondral bone remodeling, osteophyte formation and synovial thickening. Alendronate (ALN) is a potent inhibitor of osteoclastic bone resorption and results in reduced bone remodeling. This study investigated the effects of pre-emptive use of ALN on OA related osteoclastic subchondral bone resorption in an in vivo rat model for severe OA. Using multi-modality imaging we measured effects of ALN treatment within cartilage and synovium. Severe osteoarthritis was induced in left rat knees using papain injections in combination with a moderate running protocol. Twenty rats were treated with subcutaneous ALN injections and compared to twenty untreated controls. Animals were longitudinally monitored for 12weeks with in vivo μCT to measure subchondral bone changes and SPECT/CT to determine synovial macrophage activation using a folate-based radiotracer. Articular cartilage was analyzed at 6 and 12weeks with ex vivo contrast enhanced μCT and histology to measure sulfated-glycosaminoglycan (sGAG) content and cartilage thickness. ALN treatment successfully inhibited subchondral bone remodeling. As a result we found less subchondral plate porosity and reduced osteophytosis. ALN treatment did not reduce subchondral sclerosis. However, after the OA induction phase, ALN treatment protected cartilage ECM from degradation and reduced synovial macrophage activation. Surprisingly, ALN treatment also improved sGAG content of tibia cartilage in healthy joints. Our data was consistent with the hypothesis that osteoclastic bone resorption might play an important role in OA and may be a driving force for progression of the disease. However, our study suggest that this effect might not solely be effects on osteoclastic activity, since ALN treatment also influenced macrophage functioning. Additionally, ALN treatment and physical activity exercised a positive effect in healthy control joints, which increased cartilage sGAG content. More research on this topic might lead to novel insights as to improve cartilage quality.
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Affiliation(s)
- M Siebelt
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - J H Waarsing
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H C Groen
- Department of Nuclear Medicine, Erasmus University Medical Center, The Netherlands
| | - C Müller
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - S J Koelewijn
- Department of Nuclear Medicine, Erasmus University Medical Center, The Netherlands
| | - E de Blois
- Department of Nuclear Medicine, Erasmus University Medical Center, The Netherlands
| | - J A N Verhaar
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M de Jong
- Department of Nuclear Medicine, Erasmus University Medical Center, The Netherlands; Department of Radiology, Erasmus University Medical Center, The Netherlands
| | - H Weinans
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands; Dept. Orthopaedics & Dept. Rheumatology, UMC Utrecht, The Netherlands
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van Buul GM, Siebelt M, Leijs MJC, Bos PK, Waarsing JH, Kops N, Weinans H, Verhaar JAN, Bernsen MR, van Osch GJVM. Mesenchymal stem cells reduce pain but not degenerative changes in a mono-iodoacetate rat model of osteoarthritis. J Orthop Res 2014; 32:1167-74. [PMID: 24839120 DOI: 10.1002/jor.22650] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [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] [Received: 02/23/2014] [Accepted: 04/24/2014] [Indexed: 02/04/2023]
Abstract
We studied the effects of intra-articularly injected bone marrow derived mesenchymal stem cells (MSCs), as well as freshly isolated bone marrow mononuclear cells (BMMNCs), on pain, cartilage damage, bone changes and inflammation in an in-vivo rat osteoarthritis (OA) model. OA was induced unilaterally by injection of mono-iodoacetate (MIA) and allowed to develop for 3 weeks. Then, animals were treated by intra-articular injection with MSCs, BMMNCs, or saline as a control. Four weeks later, pain was assessed with an incapitance tester, subchondral bone alterations were measured with µCT and cartilage quality and joint inflammation were assessed by histological analysis. Animals treated with MSCs distributed significantly more weight to the affected limb after treatment, which was not observed in the other groups. No statistically significant differences between treatment groups regarding cartilage damage, subchondral bone alterations and synovial inflammation were observed. Additional cell tracking experiments indicated adequate intra-articular cell injection and cell survival up to 2 weeks. In our OA model, injected MSCs were able to reduce MIA induced pain, as measured by an increased weight distribution to the affected limb. No statistically significant effects of the cellular therapies on structural damage and synovial inflammation were found.
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Affiliation(s)
- Gerben M van Buul
- Department of Orthopaedics, Erasmus MC, Wytemaweg 80, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
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Siebelt M, van der Windt AE, Groen HC, Sandker M, Waarsing JH, Müller C, de Jong M, Jahr H, Weinans H. FK506 protects against articular cartilage collagenous extra-cellular matrix degradation. Osteoarthritis Cartilage 2014; 22:591-600. [PMID: 24561282 DOI: 10.1016/j.joca.2014.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 10/30/2013] [Revised: 01/22/2014] [Accepted: 02/06/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a non-rheumatologic joint disease characterized by progressive degeneration of the cartilage extra-cellular matrix (ECM), enhanced subchondral bone remodeling, activation of synovial macrophages and osteophyte growth. Inhibition of calcineurin (Cn) activity through tacrolimus (FK506) in in vitro monolayer chondrocytes exerts positive effects on ECM marker expression. This study therefore investigated the effects of FK506 on anabolic and catabolic markers of osteoarthritic chondrocytes in 2D and 3D in vitro cultures, and its therapeutic effects in an in vivo rat model of OA. METHODS Effects of high and low doses of FK506 on anabolic (QPCR/histochemistry) and catabolic (QPCR) markers were evaluated in vitro on isolated (2D) and ECM-embedded chondrocytes (explants, 3D pellets). Severe cartilage damage was induced unilaterally in rat knees using papain injections in combination with a moderate running protocol. Twenty rats were treated with FK506 orally and compared to twenty untreated controls. Subchondral cortical and trabecular bone changes (longitudinal microCT) and macrophage activation (SPECT/CT) were measured. Articular cartilage was analyzed ex vivo using contrast enhanced microCT and histology. RESULTS FK506 treatment of osteoarthritic chondrocytes in vitro induced anabolic (mainly collagens) and reduced catabolic ECM marker expression. In line with this, FK506 treatment clearly protected ECM integrity in vivo by markedly decreasing subchondral sclerosis, less development of subchondral pores, depletion of synovial macrophage activation and lower osteophyte growth. CONCLUSION FK506 protected cartilage matrix integrity in vitro and in vivo. Additionally, FK506 treatment in vivo reduced OA-like responses in different articular joint tissues and thereby makes Cn an interesting target for therapeutic intervention of OA.
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Affiliation(s)
- M Siebelt
- Department of Orthopedics, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - A E van der Windt
- Department of Orthopedics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H C Groen
- Department of Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Sandker
- Department of Orthopedics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopedics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Müller
- Center for Radiopharmaceutical Sciences PSI-ETH-USZ, Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - M de Jong
- Department of Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Jahr
- Department of Orthopedics, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Orthopedic Surgery, University Hospital RWTH, Aachen, Germany
| | - H Weinans
- Department of Biomechanical Engineering, TU Delft, The Netherlands; Department of Orthopaedics, UMC Utrecht, The Netherlands; Department of Rheumatology, UMC Utrecht, The Netherlands
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Siebelt M, Groen HC, Koelewijn SJ, de Blois E, Sandker M, Waarsing JH, Müller C, van Osch GJVM, de Jong M, Weinans H. Increased physical activity severely induces osteoarthritic changes in knee joints with papain induced sulfate-glycosaminoglycan depleted cartilage. Arthritis Res Ther 2014; 16:R32. [PMID: 24472689 PMCID: PMC3978821 DOI: 10.1186/ar4461] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/22/2014] [Indexed: 12/16/2022] Open
Abstract
Introduction Articular cartilage needs sulfated-glycosaminoglycans (sGAGs) to withstand high pressures while mechanically loaded. Chondrocyte sGAG synthesis is regulated by exposure to compressive forces. Moderate physical exercise is known to improve cartilage sGAG content and might protect against osteoarthritis (OA). This study investigated whether rat knee joints with sGAG depleted articular cartilage through papain injections might benefit from moderate exercise, or whether this increases the susceptibility for cartilage degeneration. Methods sGAGs were depleted from cartilage through intraarticular papain injections in the left knee joints of 40 Wistar rats; their contralateral joints served as healthy controls. Of the 40 rats included in the study, 20 rats remained sedentary, and the other 20 were subjected to a moderately intense running protocol. Animals were longitudinally monitored for 12 weeks with in vivo micro-computed tomography (μCT) to measure subchondral bone changes and single-photon emission computed tomography (SPECT)/CT to determine synovial macrophage activation. Articular cartilage was analyzed at 6 and 12 weeks with ex vivo contrast-enhanced μCT and histology to measure sGAG content and cartilage thickness. Results All outcome measures were unaffected by moderate exercise in healthy control joints of running animals compared with healthy control joints of sedentary animals. Papain injections in sedentary animals resulted in severe sGAG-depleted cartilage, slight loss of subchondral cortical bone, increased macrophage activation, and osteophyte formation. In running animals, papain-induced sGAG-depleted cartilage showed increased cartilage matrix degradation, sclerotic bone formation, increased macrophage activation, and more osteophyte formation. Conclusions Moderate exercise enhanced OA progression in papain-injected joints and did not protect against development of the disease. This was not restricted to more-extensive cartilage damage, but also resulted in pronounced subchondral sclerosis, synovial macrophage activation, and osteophyte formation.
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Kok AC, Tuijthof GJM, den Dunnen S, van Tiel J, Siebelt M, Everts V, van Dijk CN, Kerkhoffs GMMJ. No effect of hole geometry in microfracture for talar osteochondral defects. Clin Orthop Relat Res 2013; 471:3653-62. [PMID: 23893362 PMCID: PMC3792274 DOI: 10.1007/s11999-013-3189-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 07/15/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Débridement and bone marrow stimulation is an effective treatment option for patients with talar osteochondral defects. However, whether surgical factors affect the success of microfracture treatment of talar osteochondral defects is not well characterized. QUESTIONS/PURPOSES We hypothesized (1) holes that reach deeper into the bone marrow-filled trabecular bone allow for more hyaline-like repair; and (2) a larger number of holes with a smaller diameter result in more solid integration of the repair tissue, less need for new bone formation, and higher fill of the defect. METHODS Talar osteochondral defects that were 6 mm in diameter were drilled bilaterally in 16 goats (32 samples). In eight goats, one defect was treated by drilling six 0.45-mm diameter holes in the defect 2 mm deep; in the remaining eight goats, six 0.45-mm diameter holes were punctured to a depth of 4 mm. All contralateral defects were treated with three 1.1-mm diameter holes 3 mm deep, mimicking the clinical situation, as internal controls. After 24 weeks, histologic analyses were performed using Masson-Goldner/Safranin-O sections scored using a modified O'Driscoll histologic score (scale, 0-22) and analyzed for osteoid deposition. Before histology, repair tissue quality and defect fill were assessed by calculating the mean attenuation repair/healthy cartilage ratio on Equilibrium Partitioning of an Ionic Contrast agent (EPIC) micro-CT (μCT) scans. Differences were analyzed by paired comparison and Mann-Whitney U tests. RESULTS Significant differences were not present between the 2-mm and 4-mm deep hole groups for the median O'Driscoll score (p = 0.31) and the median of the μCT attenuation repair/healthy cartilage ratios (p = 0.61), nor between the 0.45-mm diameter and the 1.1-mm diameter holes in defect fill (p = 0.33), osteoid (p = 0.89), or structural integrity (p = 0.80). CONCLUSIONS The results indicate that the geometry of microfracture holes does not influence cartilage healing in the caprine talus. CLINICAL RELEVANCE Bone marrow stimulation technique does not appear to be improved by changing the depth or diameter of the holes.
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Affiliation(s)
- Aimee Claire Kok
- Department of Orthopedic Surgery, Orthopedic Research Center Amsterdam, Academic Medical Center, G4-262 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands,
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Van der Stok J, Weinans H, Kops N, Siebelt M, Patka P, Van Lieshout EMM. Properties of commonly used calcium phosphate cements in trauma and orthopaedic surgery. Injury 2013; 44:1368-74. [PMID: 23876622 DOI: 10.1016/j.injury.2013.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/07/2013] [Accepted: 06/02/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Johan Van der Stok
- Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Sandker MJ, Petit A, Redout EM, Siebelt M, Müller B, Bruin P, Meyboom R, Vermonden T, Hennink WE, Weinans H. In situ forming acyl-capped PCLA–PEG–PCLA triblock copolymer based hydrogels. Biomaterials 2013; 34:8002-11. [DOI: 10.1016/j.biomaterials.2013.07.046] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/12/2013] [Indexed: 11/25/2022]
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Lau S, Hazewinkel H, Grinwis G, Wolschrijn C, Siebelt M, Vernooij J, Voorhout G, Tryfonidou M. Delayed endochondral ossification in early medial coronoid disease (MCD): A morphological and immunohistochemical evaluation in growing Labrador retrievers. Vet J 2013; 197:731-8. [DOI: 10.1016/j.tvjl.2013.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 04/26/2013] [Accepted: 04/27/2013] [Indexed: 11/29/2022]
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van der Stok J, Wang H, Amin Yavari S, Siebelt M, Sandker M, Waarsing JH, Verhaar JAN, Jahr H, Zadpoor AA, Leeuwenburgh SCG, Weinans H. Enhanced bone regeneration of cortical segmental bone defects using porous titanium scaffolds incorporated with colloidal gelatin gels for time- and dose-controlled delivery of dual growth factors. Tissue Eng Part A 2013; 19:2605-14. [PMID: 23822814 DOI: 10.1089/ten.tea.2013.0181] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Porous titanium scaffolds are a promising class of biomaterials for grafting large bone defects, because titanium provides sufficient mechanical support, whereas its porous structure allows bone ingrowth resulting in good osseointegration. To reinforce porous titanium scaffolds with biological cues that enhance and continue bone regeneration, scaffolds can be incorporated with bioactive gels for time- and dose-controlled delivery of multiple growth factors (GFs). In this study, critical femoral bone defects in rats were grafted with porous titanium scaffolds incorporated with nanostructured colloidal gelatin gels. Gels were loaded with bone morphogenetic protein-2 (BMP-2, 3 μg), fibroblast growth factor-2 (FGF-2, 0.6 μg), BMP-2, and FGF-2 (BMP-2/FGF-2, ratio 5:1) or were left unloaded. GF delivery was controlled by fine tuning the crosslinking density of oppositely charged nanospheres. Grafted femurs were evaluated using in vivo and ex vivo micro-CT, histology, and three-point bending tests. All porous titanium scaffolds containing GF-loaded gels accelerated and enhanced bone regeneration: BMP-2 gels gave an early increase (0-4 weeks), and FGF-2 gels gave a late increase (8-12 weeks). Interestingly, stimulatory effects of 0.6 μg FGF-2 were similar to a fivefold higher dose of BMP-2 (3 μg). BMP-2/FGF-2 gels gave more bone outside the porous titanium scaffolds than gels with only BMP-2 or FGF-2, resulted in bridging of most defects and showed superior bone-implant integrity in three-point bending tests. In conclusion, incorporation of nanostructured colloidal gelatin gels capable of time- and dose-controlled delivery of BMP-2 and FGF-2 in porous titanium scaffolds is a promising strategy to enhance and continue bone regeneration of large bone defects.
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Affiliation(s)
- Johan van der Stok
- 1 Orthopaedic Research Laboratory, Department of Orthopaedics, Erasmus University Rotterdam Medical Centre , Rotterdam, The Netherlands
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Lau SF, Wolschrijn CF, Siebelt M, Vernooij JCM, Voorhout G, Hazewinkel HAW. Assessment of articular cartilage and subchondral bone using EPIC-microCT in Labrador retrievers with incipient medial coronoid disease. Vet J 2013; 198:116-21. [PMID: 23846028 DOI: 10.1016/j.tvjl.2013.05.038] [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: 11/01/2012] [Revised: 05/07/2013] [Accepted: 05/27/2013] [Indexed: 01/02/2023]
Abstract
The aetiopathogenesis of medial coronoid disease (MCD) remains obscure, despite its high prevalence. The role of changes to subchondral bone or articular cartilage is much debated. Although there is evidence of micro-damage to subchondral bone, it is not known whether this is a cause or a consequence of MCD, nor is it known whether articular cartilage is modified in the early stages of the disease. The aim of the present study was to use equilibrium partitioning of an ionic contrast agent with micro-computed tomography (microCT) to investigate changes to both the articular cartilage and the subchondral bone of the medial coronoid processes (MCP) of growing Labrador retrievers at an early stage of the disease and at different bodyweights. Of 14 purpose-bred Labrador retrievers (15-27 weeks), six were diagnosed with bilateral MCD and one was diagnosed with unilateral MCD on the basis of microCT studies. The mean X-ray attenuation of articular cartilage was significantly higher in dogs with MCD than in dogs without MCD (P<0.01). In all dogs, the mean X-ray attenuation of articular cartilage was significantly higher at the lateral (P<0.001) than at the proximal aspect of the MCP, indicating decreased glycosaminoglycan content. Changes in parameters of subchondral bone micro-architecture, namely the ratio of bone volume to tissue volume (BV/TV), bone surface density (BS/TV), bone surface to volume ratio (BS/BV), trabecular thickness (Tb.Th; mm), size of marrow cavities described by trabecular spacing (Tb.Sp; mm), and structural model index (SMI), differed significantly by litter (P<0.05) due to the difference in age and weight, but not by the presence/absence of MCD (P>0.05), indicating that subchondral bone density is not affected in early MCD. This study demonstrated that cartilage matrix and not subchondral bone density is affected in the early stages of MCD.
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Affiliation(s)
- S F Lau
- Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584CM Utrecht, The Netherlands; Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, University Putra Malaysia, 43400 Serdang, Malaysia.
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Monge M, Van Pel M, Aleksinskaya M, Siebelt M, Koekkoek K, Slot E, Massy Z, Rabelink T, Van Zonneveld A. L’insuffisance rénale chronique est associée à des anomalies de la niche hématopoïétique chez la souris. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Weinans H, Siebelt M, Agricola R, Botter SM, Piscaer TM, Waarsing JH. Pathophysiology of peri-articular bone changes in osteoarthritis. Bone 2012; 51:190-6. [PMID: 22343134 DOI: 10.1016/j.bone.2012.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/01/2012] [Accepted: 02/02/2012] [Indexed: 12/01/2022]
Abstract
Osteoarthritis (OA) is a disease that involves the entire joint, but its pathophysiology is not well described. Alterations in peri-articular bone are an integral part of the OA disease process and different aspects of bone changes have been described in different patient (sub)groups and animal models. In this review we will discuss the osteoarthritis pathophysiology from the perspective of periarticular bone changes, which can be considered at three hierarchical levels: the bone (or joint) shape, the subchondral bone architecture and its cellular and molecular phenotype. In this review we try to provide an overview of the current knowledge of peri-articular bone changes in OA and what it could possibly imply for the initiation of OA and its progression. This article is part of a Special Issue entitled "Osteoarthritis".
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Affiliation(s)
- H Weinans
- Department of Orthopedics, Orthopaedic Research Laboratory, Erasmus MC, The Netherlands.
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Miclea RL, Siebelt M, Finos L, Goeman JJ, Löwik CWGM, Oostdijk W, Weinans H, Wit JM, Robanus-Maandag EC, Karperien M. Inhibition of Gsk3β in cartilage induces osteoarthritic features through activation of the canonical Wnt signaling pathway. Osteoarthritis Cartilage 2011; 19:1363-72. [PMID: 21911068 DOI: 10.1016/j.joca.2011.07.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 07/24/2011] [Accepted: 07/29/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In the past years, the canonical Wnt/β-catenin signaling pathway has emerged as a critical regulator of cartilage development and homeostasis. In this pathway, glycogen synthase kinase-3β (GSK3β) down-regulates transduction of the canonical Wnt signal by promoting degradation of β-catenin. In this study we wanted to further investigate the role of Gsk3β in cartilage maintenance. DESIGN Therefore, we have treated chondrocytes ex vivo and in vivo with GIN, a selective GSK3β inhibitor. RESULTS In E17.5 fetal mouse metatarsals, GIN treatment resulted in loss of expression of cartilage markers and decreased chondrocyte proliferation from day 1 onward. Late (3 days) effects of GIN included cartilage matrix degradation and increased apoptosis. Prolonged (7 days) GIN treatment resulted in resorption of the metatarsal. These changes were confirmed by microarray analysis showing a decrease in expression of typical chondrocyte markers and induction of expression of proteinases involved in cartilage matrix degradation. An intra-articular injection of GIN in rat knee joints induced nuclear accumulation of β-catenin in chondrocytes 72 h later. Three intra-articular GIN injections with a 2 days interval were associated with surface fibrillation, a decrease in glycosaminoglycan expression and chondrocyte hypocellularity 6 weeks later. CONCLUSIONS These results suggest that, by down-regulating β-catenin, Gsk3β preserves the chondrocytic phenotype, and is involved in maintenance of the cartilage extracellular matrix. Short term β-catenin up-regulation in cartilage secondary to Gsk3β inhibition may be sufficient to induce osteoarthritis-like features in vivo.
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Affiliation(s)
- R L Miclea
- Department of Pediatrics, Leiden University Medical Centre, Leiden, Netherlands
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Siebelt M, Waarsing JH, Kops N, Piscaer TM, Verhaar JAN, Oei EHG, Weinans H. Quantifying osteoarthritic cartilage changes accurately using in vivo microCT arthrography in three etiologically distinct rat models. J Orthop Res 2011; 29:1788-94. [PMID: 21520262 DOI: 10.1002/jor.21444] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 04/05/2011] [Indexed: 02/04/2023]
Abstract
In vivo microCT arthrography (µCTa) can be used to measure both quantity (volumetric) and quality (glycosaminoglycan content) of cartilage. This study investigated the accuracy of four segmentation techniques to isolate cartilage from µCTa datasets and then used the most accurate one to investigate if the µCTa method could show osteoarthritic changes in rat models during longitudinal follow-up. Volumetric measurements and glycosaminoglycan contents of patellar cartilage from in vivo µCTa-scans were compared with an ex vivo gold standard µCT-scan. Cartilage was segmented with three global thresholds and one local threshold algorithm. Comparisons were made for healthy and osteoarthritic cartilage. Next, three rat models were investigated for 24 weeks using µCTa. Osteoarthritis was induced by injection with a chemical (mono-iodoacetate), a surgical intervention (grooves applied in articular cartilage), and via exercise (strenuous running). After euthanasia, all knee joints were isolated for histology. Local thresholds accurately segmented cartilage from in vivo µCTa scans and best measured cartilage quantity and glycosaminoglycan content. Each of the three osteoarthritic rat models showed a specific pattern of osteoarthritis progression. All µCTa results were comparable to histology. In vivo µCTa is a sensitive technique for imaging cartilage degradation. Local thresholds enhanced the sensitivity of this method and will probably more accurately detect disease-modulating effects from interventional strategies. The data from rat models may serve as a reference for the time sequence of cartilage degeneration during in vivo testing of new strategies in osteoarthritis treatment.
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Affiliation(s)
- Michiel Siebelt
- Department of Orthopedic Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Siebelt M, van Tiel J, Waarsing JH, Piscaer TM, van Straten M, Booij R, Dijkshoorn ML, Kleinrensink GJ, Verhaar JAN, Krestin GP, Weinans H, Oei EHG. Clinically applied CT arthrography to measure the sulphated glycosaminoglycan content of cartilage. Osteoarthritis Cartilage 2011; 19:1183-9. [PMID: 21820067 DOI: 10.1016/j.joca.2011.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 06/14/2011] [Accepted: 07/13/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Similar to delayed gadolinium enhanced MRI of cartilage, it might be possible to image cartilage quality using CT arthrography (CTa). This study assessed the potential of CTa as a clinically applicable tool to evaluate cartilage quality in terms of sulphated glycosaminoglycan content (sGAG) and structural composition of the extra-cellular matrix (ECM). METHODS Eleven human cadaveric knee joints were scanned on a clinical CT scanner. Of each knee joint, a regular non-contrast CT (ncCT) and an ioxaglate injected CTa scan were performed. Mean X-ray attenuation of both scans was compared to identify contrast influx in seven anatomical regions of interest (ROIs). All ROIs were rescanned with contrast-enhanced μCT, which served as the reference standard for sGAG content. Mean X-ray attenuation from both ncCT and CTa were correlated with μCT results and analyzed with linear regression. Additionally, residual values from the linear fit between ncCT and μCT were used as a covariate measure to identify the influence of structural composition of cartilage ECM on contrast diffusion into cartilage in CTa scans. RESULTS CTa resulted in higher X-ray attenuation in cartilage compared to ncCT scans for all anatomical regions. Furthermore, CTa correlated excellent with reference μCT values (sGAG) (R=0.86; R(2)=0.73; P<0.0001). When corrected for structural composition of cartilage ECM, this correlation improved substantially (R=0.95; R(2)=0.90; P<0.0001). CONCLUSIONS Contrast diffusion into articular cartilage detected with CTa correlates with sGAG content and to a lesser extent with structural composition of cartilage ECM. CTa may be clinically applicable to quantitatively measure the quality of articular cartilage.
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Affiliation(s)
- M Siebelt
- Department of Orthopedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
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