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Clark SC, Pareek A, Hevesi M, Okoroha KR, Saris DBF, Camp CL, Krych AJ. High incidence of medial meniscus root/radial tears and extrusion in 253 patients with subchondral insufficiency fractures of the knee. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38769782 DOI: 10.1002/ksa.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE The demographic and radiological risk factors of subchondral insufficiency fractures of the knee (SIFK) continue to be a subject of debate. The purpose of this study was to associate patient-specific factors with SIFK in a large cohort of patients. METHODS Inclusion criteria consisted of patients with SIFK as verified on magnetic resonance imaging (MRI). All radiographs and MRIs were reviewed to assess characteristics such as meniscus tear presence and type, subchondral oedema presence and location, location of SIFK, mechanical limb alignment, osteoarthritis as assessed by Kellgren-Lawrence grade and ligamentous injury. A total of 253 patients (253 knees) were included, with 171 being female. The average body mass index (BMI) was 32.1 ± 7.0 kg/m2. RESULTS SIFK was more common in patients with medial meniscus tears (77.1%, 195/253) rather than tears of the lateral meniscus (14.6%, 37/253) (p < 0.001). Medial meniscus root and radial tears of the posterior horn were present in 71.1% (180/253) of patients. Ninety-one percent (164/180) of medial meniscus posterior root and radial tears had an extrusion ≥3.0 mm. Eighty-one percent (119/147) of patients with SIFK on the medial femoral condyle and 86.8% (105/121) of patients with SIFK on the medial tibial plateau had a medial meniscus tear. Varus knees had a significantly increased rate of SIFK on the medial femoral condyle in comparison to valgus knees (p = 0.016). CONCLUSION In this large cohort of patients with SIFK, there was a high association with medial meniscus root and radial tears of the posterior horn, meniscus extrusion ≥3.0 mm as well as higher age, female gender and higher BMI. Additionally, there was a particularly strong association of medial compartment SIFK with medial meniscus tears. As SIFK is frequently undiagnosed, identifying patient-specific demographic and radiological risk factors will help achieve a prompt diagnosis. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sean C Clark
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayoosh Pareek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Huppertz MS, Lemainque T, Yüksel C, Siepmann R, Kuhl C, Roemer F, Truhn D, Nebelung S. [Current MR imaging of cartilage in the context of knee osteoarthritis (part 2) : Cartilage pathologies and their assessment]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:304-311. [PMID: 38170243 DOI: 10.1007/s00117-023-01253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
High-quality magnetic resonance (MR) imaging is essential for the precise assessment of the knee joint and plays a key role in the diagnostics, treatment and prognosis. Intact cartilage tissue is characterized by a smooth surface, uniform tissue thickness and an organized zonal structure, which are manifested as depth-dependent signal intensity variations. Cartilage pathologies are identifiable through alterations in signal intensity and morphology and should be communicated based on a precise terminology. Cartilage pathologies can show hyperintense and hypointense signal alterations. Cartilage defects are assessed based on their depth and should be described in terms of their location and extent. The following symptom constellations are of overarching clinical relevance in image reading and interpretation: symptom constellations associated with rapidly progressive forms of joint degeneration and unfavorable prognosis, accompanying symptom constellations mostly in connection with destabilizing meniscal lesions and subchondral insufficiency fractures (accelerated osteoarthritis) as well as symptoms beyond the "typical" degeneration, especially when a discrepancy is observed between (minor) structural changes and (major) synovitis and effusion (inflammatory arthropathy).
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Affiliation(s)
- Marc Sebastian Huppertz
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Teresa Lemainque
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Can Yüksel
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Robert Siepmann
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Christiane Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Frank Roemer
- Radiologisches Institut, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Deutschland
- Department of Radiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Daniel Truhn
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Sven Nebelung
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Habaxi K, Wang W, Taximaimaiti M, Wang L. Methylation Regulation of LPCAT3 Improves Osteoarthritis by Regulating ACSL4 to Inhibit Chondrocyte Ferroptosis. Crit Rev Eukaryot Gene Expr 2024; 34:77-86. [PMID: 38073444 DOI: 10.1615/critreveukaryotgeneexpr.2023049244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
With the increasing aging population in China, the incidence rate of knee osteoarthritis is expected to rise annually. Therefore, we conducted a study to investigate the crucial role of LPCAT3 in osteoarthritis and its underlying mechanisms. We collected samples from normal volunteers (n = 12) and patients with osteoarthritis (n = 12) at our hospital. It was observed that LPCAT3 mRNA expression was reduced and positively correlated with IL-1β mRNA expression in patients with osteoarthritis. In a mouse model, LPCAT3 mRNA and protein expression were found to be suppressed. Furthermore, in an in vitro model, the enrichment level of LPCAT3 mRNA was inhibited by a specific m6A antibody through si-METTL3. Si-METTL3 also reduced the stability of LPCAT3 mRNA in the in vitro model. The inhibition of LPCAT3 was found to exacerbate osteoarthritis in the mouse model. Additionally, LPCAT3 was shown to reduce inflammation in the in vitro model. It was also observed that LPCAT3 reduced chondrocyte ferroptosis by inhibiting mitochondrial damage. LPCAT3 protein was found to interact with ACSL4 protein, and its up-regulation suppressed ACSL4 expression in the in vitro model. ACSL4 was identified as a target of LPCAT3 for suppressing mitochondrial damage in the in vitro model. In conclusion, this study demonstrates that LPCAT3 improves osteoarthritis by regulating ACSL4 to inhibit chondrocyte ferroptosis, thus providing a novel target for the treatment of osteoarthritis.
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Affiliation(s)
- Kaken Habaxi
- Department of Joint Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
| | - Wei Wang
- Department of Joint Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
| | - Maimaitiaili Taximaimaiti
- Department of Joint Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
| | - Li Wang
- Department of Joint Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
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Jarraya M, Guermazi A, Roemer FW. Osteoarthritis year in review 2023: Imaging. Osteoarthritis Cartilage 2024; 32:18-27. [PMID: 37879600 DOI: 10.1016/j.joca.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/24/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE This narrative review summarizes the original research in the field of in vivo osteoarthritis (OA) imaging between 1 January 2022 and 1 April 2023. METHODS A PubMed search was conducted using the following several terms pertaining to OA imaging, including but not limited to "Osteoarthritis / OA", "Magnetic resonance imaging / MRI", "X-ray" "Computed tomography / CT", "artificial intelligence /AI", "deep learning", "machine learning". This review is organized by topics including the anatomical structure of interest and modality, AI, challenges of OA imaging in the context of clinical trials, and imaging biomarkers in clinical trials and interventional studies. Ex vivo and animal studies were excluded from this review. RESULTS Two hundred and forty-nine publications were relevant to in vivo human OA imaging. Among the articles included, the knee joint (61%) and MRI (42%) were the predominant anatomical area and imaging modalities studied. Marked heterogeneity of structural tissue damage in OA knees was reported, a finding of potential relevance to clinical trial inclusion. The use of AI continues to rise rapidly to be applied in various aspect of OA imaging research but a lack of generalizability beyond highly standardized datasets limit interpretation and wide-spread application. No pharmacologic clinical trials using imaging data as outcome measures have been published in the period of interest. CONCLUSIONS Recent advances in OA imaging continue to heavily weigh on the use of AI. MRI remains the most important modality with a growing role in outcome prediction and classification.
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Affiliation(s)
- Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ali Guermazi
- Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA.
| | - Frank W Roemer
- Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Oláh T, Cucchiarini M, Madry H. Subchondral bone remodeling patterns in larger animal models of meniscal injuries inducing knee osteoarthritis - a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5346-5364. [PMID: 37742232 PMCID: PMC10719152 DOI: 10.1007/s00167-023-07579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Elucidating subchondral bone remodeling in preclinical models of traumatic meniscus injury may address clinically relevant questions about determinants of knee osteoarthritis (OA). METHODS Studies on subchondral bone remodeling in larger animal models applying meniscal injuries as standardizing entity were systematically analyzed. Of the identified 5367 papers reporting total or partial meniscectomy, meniscal transection or destabilization, 0.4% (in guinea pigs, rabbits, dogs, minipigs, sheep) remained eligible. RESULTS Only early or mid-term time points were available. Larger joint sizes allow reporting higher topographical details. The most frequently reported parameters were BV/TV (61%), BMD (41%), osteophytes (41%) and subchondral bone plate thickness (39%). Subchondral bone plate microstructure is not comprehensively, subarticular spongiosa microstructure is well characterized. The subarticular spongiosa is altered shortly before the subchondral bone plate. These early changes involve degradation of subarticular trabecular elements, reduction of their number, loss of bone volume and reduced mineralization. Soon thereafter, the previously normal subchondral bone plate becomes thicker. Its porosity first increases, then decreases. CONCLUSION The specific human topographical pattern of a thinner subchondral bone plate in the region below both menisci is present solely in the larger species (partly in rabbits), but absent in rodents, an important fact to consider when designing animal studies examining subchondral consequences of meniscus damage. Large animal models are capable of providing high topographical detail, suggesting that they may represent suitable study systems reflecting the clinical complexities. For advanced OA, significant gaps of knowledge exist. Future investigations assessing the subchondral bone in a standardized fashion are warranted.
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Affiliation(s)
- Tamás Oláh
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg/Saar, Germany
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg/Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg/Saar, Germany.
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Takase R, Ohsawa T, Hashimoto S, Kurihara S, Yanagisawa S, Hagiwara K, Kimura M, Chikuda H. Insufficient restoration of meniscal extrusion by transtibial pullout repair for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 2023; 31:4895-4902. [PMID: 37573532 DOI: 10.1007/s00167-023-07528-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE The long-term changes in the dynamics of the medial meniscus after transtibial pullout repair for medial meniscus posterior root tears (MMPRTs) are not completely understood. Thus, the aim of this study was to investigate the effects of transtibial pullout repair on MMPRTs and whether the effects would be sustained. METHODS Nineteen knees with MMPRTs that were treated by trans-tibial pullout repair were enrolled in this study. Medial meniscus extrusion (MME) was measured by ultrasonography during knee extension (no weight-bearing with the knee at 0° extension: NW0°) and 90° flexion (no weight-bearing with the knee at 90° flexion: NW90°) with the patient in the supine position and with full weight-bearing (FW0°) preoperatively and at 3 and 12 months postoperatively. The clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score, Lysholm score, and International Knee Documentation Committee score. RESULTS The difference in MME with NW0° was not statistically significant between the preoperative (3.4 ± 1.0 mm) and 12-month postoperative (3.7 ± 0.6 mm) time points. The MME with NW90° at 3 (2.1 ± 0.7 mm) and 12 months (2.9 ± 0.6 mm) postoperatively were significantly lower than the preoperative values (3.4 ± 0.8 mm) (P < 0.05). However, the value significantly increased from 3 to 12 months postoperatively (P < 0.05). The MME with FW0° at 12 months postoperatively (4.3 ± 0.6 mm) was significantly larger than that at pre-operatively (3.6 ± 0.9 mm) (P < 0.05). All the patients' clinical conditions were significantly improved at 12 months postoperatively when compared to their preoperative clinical conditions. CONCLUSION Surgery did not reduce the extrusion in the no weight-bearing and weight-bearing positions at knee extension, and these values increased in the postoperative period. In addition, while the surgery reduced the extrusion in the knee flexion position, the restoration achieved by the surgery was not sustained in the long term. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ryota Takase
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan
| | - Shogo Hashimoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan
| | - Shingo Kurihara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan
| | - Shinya Yanagisawa
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Keiichi Hagiwara
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Masashi Kimura
- Zenshukai Hospital Gunma Sports Medicine Research Center, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan
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