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Cipolletta E, Francioso F, Smerilli G, Di Battista J, Filippucci E. Ultrasound reveals a high prevalence of CPPD in consecutive patients with knee pain. Clin Rheumatol 2024; 43:435-441. [PMID: 37975949 DOI: 10.1007/s10067-023-06805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
The objective of this study is to estimate the prevalence of US findings indicative of calcium pyrophosphate deposition (CPPD) in patients with knee pain. Consecutive patients with knee pain, equally distributed among males and females in seven different age-decades (21-90 years), were enrolled in a cross-sectional study. The presence of US OMERACT-defined CPPD (medial and lateral menisci and femoral hyaline cartilage) and osteophytes (medial and lateral compartments of the tibiofemoral joint) was scored as presence/absence in both knees. Four hundred twenty participants were enrolled (210 men/210 women). Fibrocartilage and hyaline cartilage CPPDs were detected by US in 94/420 (22.4%) and 41/420 (9.8%) participants, respectively. No significant sex differences were noted. The prevalence and the extent of CPPD increased with age. Fibrocartilage and hyaline cartilage CPPDs were identified in 0/60 participants in the third decade, and in 28/60 (46.7%) and 14/60 (23.3%) participants in the ninth decade, respectively (p for trend < 0.01). While fibrocartilage and hyaline cartilage CPPD is virtually absent in subjects younger than 40 and 50 years old, their prevalence steeply increases above from these age groups. Age (aIRR, 1.03; 95% CI, 1.02-1.05), osteophyte score (aIRR, 1.40; 95% CI, 1.22-1.60), and hyaline cartilage CPPD score (aIRR, 2.68; 95% CI, 2.06-3.49) were associated with fibrocartilage CPPD score, whereas age (aIRR, 1.02; 95% CI, 1.01-1.05) and fibrocartilage CPPD score (aIRR, 2.92; 95% CI, 2.29-3.72) were associated with hyaline cartilage CPPD score in multivariable negative binomial regression analyses. In conclusion, we report the US prevalence of CPPD in patients with knee pain. Fibrocartilage CPPD occurs at a younger age and is more prevalent than hyaline cartilage CPPD. Key points • Fibrocartilage CPPD occurs at a younger age and is more prevalent than hyaline cartilage CPPD. • Fibrocartilage and hyaline cartilage CPPDs are virtually absent in subjects younger than 40 and 50 years old. • In subjects older than 80 years, fibrocartilage and hyaline cartilage CPPD prevalence rises up to 46.7% and 23.3%, respectively.
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Affiliation(s)
- Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
- Academic Rheumatology, University of Nottingham, Nottingham, UK.
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Di Battista
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Ivanov I, Ranchev S, Stoychev S. Experimental Ultrasound Approach for Studying Knee Intra-Articular Femur-Tibia Movements under Different Loads. J Funct Morphol Kinesiol 2023; 9:8. [PMID: 38249085 PMCID: PMC10801608 DOI: 10.3390/jfmk9010008] [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: 11/04/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
The purpose of the present study was to develop an experimental model for the study of intra-articular knee movements depending on the function of the knee joint and involved muscle groups under isometric stretching conditions with different loads. The experimental procedure included an ultrasound examination of a knee joint after isometric stretching in healthy men (n = 32). The changes (in millimeters) in the distances between the femur and tibia were measured using an ultrasound sonographer at three stages. The first stage was performed on ten (n = 10) healthy men in five different sitting and upright positions. In the second and third experimental model stages, lower limbs loading was applied to 22 participants. Our hypothesis, which was confirmed, was that as a result of increased loads on the participant's back, an intra-articular decrease in the femur-tibia cartilage surface distance would be observed. The accuracy of the created experimental model was improved over its three stages from 30% to 9%. Quantitative model data can help to create a mathematical model of the mechanical effects during the deformation of knee joint bone cartilage and it can also help outline some future tasks: increasing loading weights, enlarging participant groups, performing comparisons of men and women, and performing comparisons of healthy and pathological individuals.
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Affiliation(s)
- Ivan Ivanov
- National Sports Academy “Vassil Levski”, 1700 Sofia, Bulgaria
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
| | - Sergey Ranchev
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
| | - Stoyan Stoychev
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
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Nevalainen MT, Uusimaa AP, Saarakkala S. The ultrasound assessment of osteoarthritis: the current status. Skeletal Radiol 2023; 52:2271-2282. [PMID: 37060461 PMCID: PMC10509065 DOI: 10.1007/s00256-023-04342-3] [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: 10/11/2022] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Traditionally, osteoarthritis (OA) is diagnosed with the clinical examination supplemented by the conventional radiography (CR). In the research literature, the role of ultrasound (US) imaging in the diagnostics of OA has risen steadily during the last two decades. US imaging is cheap and globally widely available often already in primary healthcare. Here, we reviewed the most essential US literature focusing on OA diagnostics and progression prediction using the various search engines. Starting from the year 2000, our search provided 1 445 journal articles. After reviewing the abstracts, 89 articles were finally included. Most of the reviewed articles focused on the imaging of knee and hand OA, whereas only a minority dealt with the imaging of hip, ankle, midfoot, acromioclavicular, and temporomandibular joints. Overall, during the last 20 years, the use of US imaging for OA assessment has increased in the scientific literature. In knee and hand joints, US imaging has been reported to be a promising tool to evaluate OA changes. Furthermore, the reproducibility of US as well as its association to MRI findings are excellent. Importantly, US seems to even outperform CR in certain aspects, such as detection of osteophytes, joint inflammation, meniscus protrusion, and localized cartilage damage (especially at the medial femoral condyle and sulcus area). Based on the reviewed literature, US can be truly considered as a complementary tool to CR in the clinical setup for OA diagnostics. New technical developments may even enhance the diagnostic value of the US in the future.
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Affiliation(s)
- Mika T Nevalainen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland.
- Department of Diagnostic Radiology, Oulu University Hospital, P.O. Box 50, 90029, Oulu, Finland.
| | - Antti-Pekka Uusimaa
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland
| | - Simo Saarakkala
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland
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Sugimura N, Aso K, Wada H, Izumi M, Ikeuchi M. Association Between Power Doppler Ultrasound Signals and Chronic Pain After Total Knee Arthroplasty: A Cross-Sectional Explorative Study. J Pain Res 2023; 16:2981-2992. [PMID: 37664487 PMCID: PMC10474857 DOI: 10.2147/jpr.s403641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose Some patients experience chronic postsurgical pain (CPSP) after total knee arthroplasty (TKA) despite the absence of clinical or radiographic abnormalities. Postoperative synovitis as a cause of CPSP after TKA has received limited research attention. This study aimed to investigate the relationship between synovitis after TKA and CPSP. Patients and Methods A total of 111 knees of 85 patients, with at least 1-year post-TKA follow-up, were assessed retrospectively and cross-sectionally. Power Doppler (PD) ultrasonography was used to detect the synovial hypervascularity associated with synovitis. The knee joint was divided into 15 areas, and PD signals were graded semi-quantitatively (0-3) in each area, the sum of which was defined as the total PD score. Clinical information regarding CPSP, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscales, was recorded. The relationship between pain and PD ultrasonography findings was accessed. Patients were divided into two groups (CPSP+ and CPSP- groups) based on pain severity. Clinical information, including PD ultrasonography findings and other possible causes, was compared between the groups. Results The WOMAC pain subscale was significantly correlated with the total PD score and maximum PD grade (r=0.3977, p<0.0001; r=0.2797, p=0.0029; respectively). The CPSP+ group had a significantly higher maximum PD grade and total PD score than the CPSP- group (median [interquartile range]: 2 [1, 2] vs 1 [1, 2], p=0.0001; 6 [2, 11] vs 2 [1, 4], p=0.0002; respectively). Multiple and logistic regression analyses showed that the total PD score was an independent factor for the WOMAC pain subscale (β=0.3822, 95% confidence interval [CI]=0.1460, 0.6184, p=0.00176) and CPSP (odds ratio=1.19, 95% CI=1.01, 1.41, p=0.0424). Conclusion This study indicated a possible association between the total PD score and chronic pain after TKA; however, further studies are needed to corroborate these findings.
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Affiliation(s)
- Natsuki Sugimura
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
- Department of Orthopedic Surgery, Hata Prefectural Hospital, Sukumo, Kochi, 788-0785, Japan
| | - Koji Aso
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Wada
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Masashi Izumi
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Masahiko Ikeuchi
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
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Diagnostics of Articular Cartilage Damage Based on Generated Acoustic Signals Using ANN—Part II: Patellofemoral Joint. SENSORS 2022; 22:s22103765. [PMID: 35632174 PMCID: PMC9146478 DOI: 10.3390/s22103765] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 12/04/2022]
Abstract
Cartilage loss due to osteoarthritis (OA) in the patellofemoral joint provokes pain, stiffness, and restriction of joint motion, which strongly reduces quality of life. Early diagnosis is essential for prolonging painless joint function. Vibroarthrography (VAG) has been proposed in the literature as a safe, noninvasive, and reproducible tool for cartilage evaluation. Until now, however, there have been no strict protocols for VAG acquisition especially in regard to differences between the patellofemoral and tibiofemoral joints. The purpose of this study was to evaluate the proposed examination and acquisition protocol for the patellofemoral joint, as well as to determine the optimal examination protocol to obtain the best diagnostic results. Thirty-four patients scheduled for knee surgery due to cartilage lesions were enrolled in the study and compared with 33 healthy individuals in the control group. VAG acquisition was performed prior to surgery, and cartilage status was evaluated during the surgery as a reference point. Both closed (CKC) and open (OKC) kinetic chains were assessed during VAG. The selection of the optimal signal measures was performed using a neighborhood component analysis (NCA) algorithm. The classification was performed using multilayer perceptron (MLP) and radial basis function (RBF) neural networks. The classification using artificial neural networks was performed for three variants: I. open kinetic chain, II. closed kinetic chain, and III. open and closed kinetic chain. The highest diagnostic accuracy was obtained for variants I and II for the RBF 9-35-2 and MLP 10-16-2 networks, respectively, achieving a classification accuracy of 98.53, a sensitivity of 0.958, and a specificity of 1. For variant III, a diagnostic accuracy of 97.79 was obtained with a sensitivity and specificity of 0.978 for MLP 8-3-2. This indicates a possible simplification of the examination protocol to single kinetic chain analyses.
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Karpiński R, Krakowski P, Jonak J, Machrowska A, Maciejewski M, Nogalski A. Diagnostics of Articular Cartilage Damage Based on Generated Acoustic Signals Using ANN-Part I: Femoral-Tibial Joint. SENSORS 2022; 22:s22062176. [PMID: 35336346 PMCID: PMC8950358 DOI: 10.3390/s22062176] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023]
Abstract
Osteoarthritis (OA) is a chronic, progressive disease which has over 300 million cases each year. Some of the main symptoms of OA are pain, restriction of joint motion and stiffness of the joint. Early diagnosis and treatment can prolong painless joint function. Vibroarthrography (VAG) is a cheap, reproducible, non-invasive and easy-to-use tool which can be implemented in the diagnostic route. The aim of this study was to establish diagnostic accuracy and to identify the most accurate signal processing method for the detection of OA in knee joints. In this study, we have enrolled a total of 67 patients, 34 in a study group and 33 in a control group. All patients in the study group were referred for surgical treatment due to intraarticular lesions, and the control group consisted of healthy individuals without knee symptoms. Cartilage status was assessed during surgery according to the International Cartilage Repair Society (ICRS) and vibroarthrography was performed one day prior to surgery in the study group. Vibroarthrography was performed in an open and closed kinematic chain for the involved knees in the study and control group. Signals were acquired by two sensors placed on the medial and lateral joint line. Using the neighbourhood component analysis (NCA) algorithm, the selection of optimal signal measures was performed. Classification using artificial neural networks was performed for three variants: I—open kinetic chain, II—closed kinetic chain, and III—open and closed kinetic chain. Vibroarthrography showed high diagnostic accuracy in determining healthy cartilage from cartilage lesions, and the number of repetitions during examination can be reduced only to closed kinematic chain.
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Affiliation(s)
- Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (J.J.); (A.M.)
- Correspondence: (R.K.); (P.K.)
| | - Przemysław Krakowski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland;
- Orthopaedic Department, Łęczna Hospital, Krasnystawska 52 str, 21-010 Łęczna, Poland
- Correspondence: (R.K.); (P.K.)
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (J.J.); (A.M.)
| | - Anna Machrowska
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland; (J.J.); (A.M.)
| | - Marcin Maciejewski
- Department of Electronics and Information Technology, Faculty of Electrical Engineering and Computer Science, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
| | - Adam Nogalski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland;
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Mortada M, Dawa GA, Amer YA. Construct validity of a clinically correlated knee osteoarthritis ultrasonographic scale: a cross-sectional observational study. BMJ Open 2021; 11:e048444. [PMID: 34907044 PMCID: PMC8671929 DOI: 10.1136/bmjopen-2020-048444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To assess the validity of a novel ultrasonographic scale for knee osteoarthritis (KOA) and its relation with the degree of pain and clinical features. DESIGN A cross-sectional observational study including 245 patients with knee pain who fulfilled the American College of Rheumatology criteria for KOA. All patients were subjected to clinical assessment Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) scale, global visual analogue scale (VAS) and functional assessment through the use of Health Assessment Questionnaire-II (HAQ-II). Ultrasonographic assessment was conducted following ZAGAZIG scale comprising five domains: one for degenerative features (one-third of total score) and the other four for inflammatory features (two-thirds of score). RESULTS There were positive correlations between ZAGAZIG score and all WOMAC subscales (pain, stiffness and function) (r=0.71, p=0.00; r=0.62, p=0.00; r=0.70, p=0.00, respectively).Moreover, there was a strong positive correlation between ZAGAZIG scale and both VAS and HAQ-II (r=0.82, p=0.00 and r=0.67, p=0.00). At cut-off point of >5, total US score distinguishes between patients with KOA with no or mild pain and those with moderate pain (87.2 sensitivity and 87.2 specificity). At cut-off point of 7, total score of ZAGAZIG scale distinguishes between patients with KOA with moderate pain and those with severe pain (94.5 sensitivity and 42.5 specificity). CONCLUSION ZAGAZIG scale constitutes a validated tool for KOA assessment. ZAGAZIG scale correlated with WOMAC subscales (pain, stiffness and function), VAS and HAQ.
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Affiliation(s)
| | - Ghada A Dawa
- Rheumatology, Zagazig University, Zagazig, Egypt
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Ultrasonographic Assessment of the Normal Femoral Articular Cartilage of the Knee Joint: Comparison with 3D MRI. ScientificWorldJournal 2021; 2021:9978819. [PMID: 34456636 PMCID: PMC8387170 DOI: 10.1155/2021/9978819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Ultrasonography (US) has a promising role in evaluating the knee joint, but capability to visualize the femoral articular cartilage needs systematic evaluation. We measured the extent of this acoustic window by comparing standardized US images with the corresponding MRI views of the femoral cartilage. Design Ten healthy volunteers without knee pathology underwent systematic US and MRI evaluation of both knees. The femoral cartilage was assessed on the oblique transverse axial plane with US and with 3D MRI. The acoustic window on US was compared to the corresponding views of the femoral sulcus and both condyles on MRI. The mean imaging coverage of the femoral cartilage and the cartilage thickness measurements on US and MRI were compared. Results Mean imaging coverage of the cartilage of the medial femoral condyle was 66% (range 54%-80%) and on the lateral femoral condyle 37% (range 25%-51%) compared with MRI. Mean cartilage thickness measurement in the femoral sulcus was 3.17 mm with US and 3.61 mm with MRI (14.0% difference). The corresponding measurements in the medial femoral condyle were 1.95 mm with US and 2.35 mm with MRI (21.0% difference), and in the lateral femoral condyle, they were 2.17 mm and 2.73 mm (25.6% difference), respectively. Conclusion Two-thirds of the articular cartilage of the medial femoral condyle, and one-third in the lateral femoral condyle, can be assessed with US. The cartilage thickness measurements seem to be underestimated by US. These results show promise for the evaluation of the weight-bearing cartilage of the medial femoral condyle with US.
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El-Tamboly S, Medhat M, Khattab R, Darwish H, deghady A. Pulsed radiofrequency ablation of genicular nerve versus intra-articular radiofrequency ablation combined with platelets rich plasma for chronic kneeosteoarthritis. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1949679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Sameh El-Tamboly
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohammed Medhat
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ragab Khattab
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hamed Darwish
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Akram deghady
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Lee LS, Chan PK, Fung WC, Chan VWK, Yan CH, Chiu KY. Imaging of knee osteoarthritis: A review of current evidence and clinical guidelines. Musculoskeletal Care 2021; 19:363-374. [PMID: 33387447 DOI: 10.1002/msc.1536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is one of the most common and debilitating degenerative joint diseases worldwide. While radiography is the most commonly used imaging modality, it is associated with drawbacks which newer modalities such as magnetic resonance imaging (MRI) and ultrasound could overcome. Nevertheless, the role of imaging in clinical practice and research in knee OA has not been clearly defined. Furthermore, guidelines on imaging in knee OA from different authoritative bodies have not been compared in previous studies. Therefore, the present review aims to summarise existing evidence and compare guidelines on the use of different imaging modalities in evaluating knee OA. METHODS This is a narrative review based on a search of published clinical guidelines and the PubMed database for articles published between 1 January 1990 and 31 May 2020. RESULTS There is no broad consensus on the value of imaging in patients with typical OA presentation. If imaging is required, current evidence and clinical guidelines support the use of radiography and MRI as first- and second-line diagnostic modalities respectively. Since radiographic OA features have limited sensitivity and do not manifest in early stages, MRI is the preferred option for whole-joint evaluation in OA research. Discrepancies exist regarding the use of alternative imaging modalities including ultrasound, computed tomography and nuclear medicine. CONCLUSION Radiography and MRI are the imaging modalities of choice. Other modalities have their respective advantages, and more research is warranted for the standardisation of image acquisition and interpretation methodology, in order to evaluate their validity, reliability and responsiveness in OA research.
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Affiliation(s)
- Lok Sze Lee
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Wing Chiu Fung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent Wai Kwan Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Chun Hoi Yan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Sonographic evaluation of lateral meniscal extrusion: implementation and validation. Arch Orthop Trauma Surg 2021; 141:271-281. [PMID: 33215303 PMCID: PMC7886729 DOI: 10.1007/s00402-020-03683-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 11/04/2020] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Meniscal extrusion (ME) is an important indicator of and prognostic factor for various knee pathologies. To date, no standardized protocol for the ultrasound-based examination of lateral ME exists. The purpose of the present study was to test the reliability and validity of lateral ME measurements using a standardized ultrasound-based examination protocol. MATERIALS AND METHODS A group consisting of 11 healthy volunteers (Group I, male and female, 18-45 years) as well as a group of 10 consecutive patients who had undergone all-inside lateral meniscal radial tear repair were included (Group II, male and female, 23-43 years). Lateral ME, the main outcome parameter, was measured by ultrasound (US; both groups) and magnetic resonance imaging (MRI; Group II only). Both knees of all subjects were examined in an unloaded state and under axial compression of the knee (50% of body weight). Repeated measurements obtained in Group I by 2 observers were used for reliability testing, and the validity of US was assessed through comparison with MRI data (Group II). RESULTS A total of 66 US images of Group I, obtained by each observer, were analyzed for reliability testing. Forty US and MR images of Group II were assessed for validation. Results showed good interrater (ICC = 0.904) and excellent intrarater (ICC = 0.942) reliability of US-based measurements of lateral ME. Agreement with MRI results was poor (ICC = 0.439), with US systematically overestimating results by 1.1 mm on average. CONCLUSIONS Ultrasound is a reliable, quick and cost-effective technique for lateral ME measurement, but results are not readily comparable with MRI. TRIAL REGISTRATION The study was registered in the European Union Clinical Trials Register (EudraCT-Number: 2017-005037-24).
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Oo WM, Linklater JM, Bennell KL, Pryke D, Yu S, Fu K, Wang X, Duong V, Hunter DJ. Are OMERACT Knee Osteoarthritis Ultrasound Scores Associated With Pain Severity, Other Symptoms, and Radiographic and Magnetic Resonance Imaging Findings? J Rheumatol 2020; 48:270-278. [PMID: 32414954 DOI: 10.3899/jrheum.191291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the associations of Outcome Measures in Rheumatology (OMERACT) ultrasound scores for knee osteoarthritis (OA) with pain severity, other symptoms, and OA severity on radiographs and magnetic resonance imaging (MRI). METHODS Participants with symptomatic and mild to moderate radiographic knee OA underwent baseline dynamic ultrasound (US) assessment according to standardized OMERACT scanning protocol. Using the published US image atlas, a physician operator obtained semiquantitative or binary scores for US pathologies. Clinical severity was measured on numerical rating scale (NRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscores. OA severity was assessed using the Kellgren-Lawrence (KL) grade on radiographs and MRI Osteoarthritis Knee Score (MOAKS) on noncontrast-enhanced MRI. Separate linear regression models were used to determine associations of US OA pathologies with pain and KOOS subscores, and Spearman correlations were used for US scores with KL grade and MOAKS. RESULTS Eighty-nine participants were included. Greater synovial hypertrophy, power Doppler (PD), and meniscal extrusion scores were associated with worse NRS pain [β 0.92 (95% CI 0.25-1.58), β 0.73 (95% CI 0.11-1.35), and β 1.01 (95% CI 0.22-1.80), respectively]. All greater US scores, except for cartilage grade, demonstrated significant associations with worse KOOS symptoms, whereas only PD and meniscal extrusion were associated with worse KOOS pain. All US scores, except for PD, were significantly correlated with KL grade. US pathologies, except for cartilage, revealed moderate to good correlation with their MOAKS counterparts, with US synovitis having the greatest correlation (0.69, 95% CI 0.60-0.78). CONCLUSION OMERACT US scores revealed significant associations with pain severity, KL grade, and MOAKS.
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Affiliation(s)
- Win Min Oo
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney;
| | - James M Linklater
- J.M. Linklater, FRANZCR, D. Pryke, Grad Dip Medical Sonography, Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney
| | - Kim L Bennell
- K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Danielle Pryke
- J.M. Linklater, FRANZCR, D. Pryke, Grad Dip Medical Sonography, Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney
| | - Shirley Yu
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Kai Fu
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Xia Wang
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Vicky Duong
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - David J Hunter
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
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Kauppinen K, Pylväläinen J, Pamilo K, Helminen O, Haapea M, Saarakkala SS, Nevalainen MT. Association between grayscale sonographic and clinical findings in severe knee osteoarthritis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:75-81. [PMID: 31580500 DOI: 10.1002/jcu.22779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To assess whether ultrasonographic (US) findings associate with clinical findings in severe knee osteoarthritis (OA). Association of US findings with side-of-knee pain and inter-reader agreement of knee US were also evaluated. METHODS One-hundred-two patients (in total 123 knees) with severe knee OA were recruited for this cross-sectional study. US was performed by a single observer, and on 53 knees by two independent observers to assess inter-reader reliability. Preoperative clinical data was available for 69 knees. Cutoff values were applied to dichotomize US and clinical findings. The Chi-square test, Mann-Whitney test, and prevalence- and bias-adjusted kappa (PABAK) were applied for statistical analyses. RESULTS Seven of 99 associations tested were statistically significant. Associations were observed between range of flexion and lateral femoral (P = .009) and tibial (P = .001) osteophytes, mediolateral instability and damage to the lateral femoral cartilage (P = .014) and damage to the lateral meniscus (P = .031), and alignment and damage to the lateral femoral cartilage (P < .001), lateral tibial osteophytes (P = .037), and damage to the lateral meniscus (P < .001). A strong association was observed between medial-sided pain and same-sided cartilage damage and osteophytes (P < .001). That inter-reader agreement was excellent on the medial side of the knee joint (PABAK = 0.811-0.887). CONCLUSIONS US findings show a rather poor association with clinical OA findings. Inter-reader agreement of knee US is excellent on the medial side.
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Affiliation(s)
- Kyösti Kauppinen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juho Pylväläinen
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
- Department of Radiology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Olli Helminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Simo S Saarakkala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mika T Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Radiology, Central Finland Central Hospital, Jyväskylä, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
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Özdemir M, Turan A. Correlation Between Medial Meniscal Extrusion Determined by Dynamic Ultrasound and Magnetic Resonance Imaging Findings of Medial-Type Knee Osteoarthritis in Patients With Knee Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2709-2719. [PMID: 30828848 DOI: 10.1002/jum.14976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/16/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of our study was to investigate the relationship between medial meniscal extrusion (MME) determined by dynamic ultrasound (US) and magnetic resonance imaging findings of medial-type knee osteoarthritis (OA). METHODS Single knees of 102 patients with knee pain were assessed by radiography, dynamic US, and magnetic resonance imaging. All knee radiographs were interpreted and grouped according to the Kellgren-Lawrence (KL) scale. Medial meniscal extrusion in non-weight-bearing and weight-bearing positions and the difference of these values (ΔMME) were measured by dynamic US. The medial tibiofemoral compartments of all knees were evaluated and grouped according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Mean values of non-weight-bearing MME, weight-bearing MME, and ΔMME ± standard deviations for groups formed according to the KL scale and WORMS system were compared. RESULTS We demonstrated that different from non-weight-bearing MME, weight-bearing MME was significantly correlated with not only high grades but also lower grades of cartilage damage and subchondral bone marrow lesions in medial-type knee OA. Although the difference in non-weight-bearing MME between cartilage status groups 1 and 2 was not significant (P = .071), there were significant differences in of weight-bearing MME between groups 1 and 2, between groups 2 and 3, and between groups 3 and group 4 (P = .003, .002, and .032, respectively). CONCLUSIONS We found statistically significant associations between MME values and the severity of the OA findings according to both the KL scale and WORMS system. We offer dynamic US as an initial tool for the diagnosis and a screening method to estimate the severity of knee OA.
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Affiliation(s)
- Meltem Özdemir
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Health Application and Research Center, Ankara, Turkey
| | - Aynur Turan
- Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Health Application and Research Center, Ankara, Turkey
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15
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Bernardo-Bueno MM, Gonzalez-Suarez CB, Malvar AK, Cua R, Feliciano D, Tan-Sales BG, Aycardo SMO, Tan-Ong M, Chan R, De Los Reyes F. Stratifying Minimal Versus Severe Pain in Knee Osteoarthritis Using a Musculoskeletal Ultrasound Protocol. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1411-1423. [PMID: 30239017 DOI: 10.1002/jum.14819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim of this cross-sectional correlational study was to determine the association of pain with morphologic and inflammatory sonographic findings in patients with knee osteoarthritis. METHODS A total of 113 participants with knee osteoarthritis were assessed using visual analog scale pain score and sonography. Ultrasound evaluation included morphologic changes (ie, articular cartilage degeneration, medial and lateral meniscal protrusion, and presence of osteophytes on the joint margins) and inflammatory changes (ie suprapatellar effusion and/or synovitis, Baker cyst, superficial and deep infrapatellar effusion, pes anserine tendinopathy, and Hoffa panniculitis). RESULTS Cluster analysis via Ward's method grouped patients with minimal pain (visual analog scale score, 0-4) and with substantial pain (visual analog scale score, 5-10). Stepwise logistic regression yielded 5 variables that significantly explained the variation in the probability of perceived substantial pain at 10% level of significance: lateral cartilage clarity (LCC; P = .025), medial cartilage clarity (MCC; P = .20), medial cartilage thickness (MCT; P = .041), medial meniscus protrusion (MMP) (P = .029), and osteophytes at medial femoral margin (P = .082), with 63% overall prediction accuracy. When age and sex were added, 4 variables remained significant at a 10% level of significance: LCC, MCC, MCT, and MMP, with 65% overall prediction accuracy. The receiver operating characteristic curve of this model was 0.667. CONCLUSION The study was able to demonstrate that morphologic abnormalities in the ultrasound parameters for LCC, MCC, MCT, and MMP were able to predict significant joint pain in knee osteoarthritis. There were no inflammatory changes that contributed to significant joint pain in this study.
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Affiliation(s)
- Mary Monica Bernardo-Bueno
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital
- Department of Physical Medicine and Rehabilitation, Our Lady of Lourdes Hospital, Manila, Philippines
- East Avenue Medical Center Quezon City, Philippines College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
| | - Consuelo B Gonzalez-Suarez
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital
- Department of Physical Medicine and Rehabilitation, Our Lady of Lourdes Hospital, Manila, Philippines
| | | | - Ronald Cua
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital
| | - Daniel Feliciano
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital
| | - Bee Giok Tan-Sales
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital
| | | | - Millicent Tan-Ong
- Faculty of Medicine and Surgery, Department of Medicine, Section of Rheumatology, Clinical Immunology and Osteoporosis, University of Santo Tomas, Manila Philippines
| | - Robert Chan
- Department of Orthopedic Surgery, University of Santo Tomas Hospital
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16
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Okano T, Mamoto K, Di Carlo M, Salaffi F. Clinical utility and potential of ultrasound in osteoarthritis. Radiol Med 2019; 124:1101-1111. [DOI: 10.1007/s11547-019-01013-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/21/2019] [Indexed: 02/06/2023]
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17
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Ulasli AM, Ozcakar L, Murrel WD. Ultrasound imaging and guidance in the management of knee osteoarthritis in regenerative medicine field. J Clin Orthop Trauma 2019; 10:24-31. [PMID: 30705527 PMCID: PMC6349666 DOI: 10.1016/j.jcot.2018.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022] Open
Abstract
Ultrasound (US) is an excellent imaging tool to evaluate most of the structures in the knee joint. US is useful in various applications of regenerative medicine, starting from the biomaterial harvesting stage of the procedures, it can thus/conveniently be used for the diagnosis and treatment of various forms of knee osteoarthritis (OA) where the interventions need to be carried out under US guidance. In this paper, we have reviewed US guided bioharvesting of venous blood, bone marrow and adipose tissue, the US evaluation of the knee joint and the relevant findings in knee OA along with US guided regenerative interventions for the knee joint.
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Affiliation(s)
- Alper Murat Ulasli
- Lokman Hekim University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey,Corresponding author. Lokman Hekim Akay Hastanesi, Büklüm Sokak No: 3 Kavaklıdere, Çankaya, Ankara, Turkey.
| | - Levent Ozcakar
- Hacettepe University, School of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkey
| | - William D. Murrel
- Emirates Integra Medical & Surgery Centre, Department Orthopaedic Sports Medicine, Dubai Healthcare City, Dubai, United Arab Emirates,Emirates Healthcare, Dubai, United Arab Emirates,Landsthul Regional Medical Center, Division of Surgery, Department of Orthopedic Surgery, Landsthul, Germany,7th Medical Support Unit-Europe, Kaiserslautern, Germany
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18
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Ultrasonography of the late-stage knee osteoarthritis prior to total knee arthroplasty: comparison of the ultrasonographic, radiographic and intra-operative findings. Sci Rep 2018; 8:17742. [PMID: 30531827 PMCID: PMC6288097 DOI: 10.1038/s41598-018-35824-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to assess the effectiveness of the ultrasonography (US) on detecting osteoarthritis of the knee, and compare US and radiographic findings to intraoperative total knee arthroplasty (TKA) findings. Fifty-seven late-stage osteoarthritic knees undergoing TKA were evaluated with US and radiography. Standard knee US assessing femoral cartilage damage, osteophytes, effusion, synovitis, and meniscal extrusion was performed. On radiographs, osteophytes, joint space narrowing, and Kellgren-Lawrence grade were evaluated. Corresponding intra-operative findings were assessed during TKA as the gold standard. On the damage of the medial femoral condyle cartilage, the sensitivity of US was high (92%), whereas on the lateral condyle and sulcus area, sensitivities were 58% and 46%, respectively. On osteophytes, the detection rate of the US was remarkable especially on the medial side yielding sensitivities of 90–95%. The sensitivities for detecting effusion and synovitis were also excellent (97%). US detection rate of femoral cartilage damage was in concordance with the radiographic joint space narrowing. For the detection of osteophytes, US provided superior results to radiography particularly on the medial side. In conclusion, US can reliably assess the late-stage OA changes of the knee especially on the medial side of the knee joint.
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19
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Mosalem DM, Alghunaim SM, Shehab DK, Baqer AB, Alfeeli AK, Ahmed MM. Soft Tissue Pathology Detected By Ultrasound Seem To Be Risk Factors for Painful Flare in Osteoarthritic Knee. Open Access Maced J Med Sci 2018; 6:1599-1605. [PMID: 30337972 PMCID: PMC6182512 DOI: 10.3889/oamjms.2018.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND: To our knowledge, the importance of US findings, pain (brief pain inventory (BPI)) and disability in osteoarthritic knee (OA) pain patients remain uncertain. AIM: The objectives are to evaluate the correlation of US findings, pain (brief pain inventory (BPI)) and disability in OA pain patients. MATERIALS AND METHODS: Eighty - three patients with OA knee were divided into two groups. The first group was OA as symptomatic knee group and the second group was an asymptomatic control group. The maximum sagittal height of synovial fluid in 12 scans at 0, 30, 60 and 90 degrees flexion knee in 3 major recesses were measured. RESULTS: There were a significant positive correlation between BPI Pain severity index, or BPI function interference index and a maximum height of effusion at 30-degree flexion angle in a supra-patellar recess in painful symptomatic knees. But, there was a significant negative correlation between BPI Pain severity index, and BPI function interference index and cartilage thickness in painful symptomatic knees. CONCLUSION: The increase of maximum height of synovial effusion at different angles of knee and decrease of cartilage thickness associated with pain and disability in OA pain patients and are being predictors for pain severity and disability in OA pain patients.
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Affiliation(s)
- Douaa M Mosalem
- Physical Medicine and Rehabilitation Departments, Al-Razi Hospital, Kuwait
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20
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Sconfienza LM, Albano D, Allen G, Bazzocchi A, Bignotti B, Chianca V, Facal de Castro F, Drakonaki EE, Gallardo E, Gielen J, Klauser AS, Martinoli C, Mauri G, McNally E, Messina C, Mirón Mombiela R, Orlandi D, Plagou A, Posadzy M, de la Puente R, Reijnierse M, Rossi F, Rutkauskas S, Snoj Z, Vucetic J, Wilson D, Tagliafico AS. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol 2018; 28:5338-5351. [DOI: 10.1007/s00330-018-5474-3] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/02/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
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21
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Oo WM, Linklater JM, Daniel M, Saarakkala S, Samuels J, Conaghan PG, Keen HI, Deveza LA, Hunter DJ. Clinimetrics of ultrasound pathologies in osteoarthritis: systematic literature review and meta-analysis. Osteoarthritis Cartilage 2018; 26:601-611. [PMID: 29426009 DOI: 10.1016/j.joca.2018.01.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aims of this study were to systematically review clinimetrics of commonly assessed ultrasound pathologies in knee, hip and hand osteoarthritis (OA), and to conduct a meta-analysis for each clinimetric. METHODS Medline, Embase, and Cochrane Library databases were searched from their inceptions to September 2016. According to the Outcome Measures in Rheumatology (OMERACT) Instrument Selection Algorithm, data extraction focused on ultrasound technical features and performance metrics. Methodological quality was assessed with modified 19-item Downs and Black score and 11-item Quality Appraisal of Diagnostic Reliability (QAREL) score. Separate meta-analyses were performed for clinimetrics: (1) inter-rater/intra-rater reliability; (2) construct validity; (3) criteria validity; and (4) internal/external responsiveness. Statistical Package for the Social Sciences (SPSS), Excel and Comprehensive Meta-analysis were used. RESULT Our search identified 1126 records; of these, 100 were eligible, including a total of 8542 patients and 32,373 joints. The average Downs and Black score was 13.01, and average QAREL was 5.93. The stratified meta-analysis was performed only for knee OA, which demonstrated moderate to substantial reliability [minimum kappa > 0.44(0.15,0.74), minimum intraclass correlation coefficient (ICC) > 0.82(0.73-0.89)], weak construct validity against pain (r = 0.12 to 0.27), function (r = 0.15 to 0.23), and blood biomarkers (r = 0.01 to 0.21), but weak to strong correlation with plain radiography (r = 0.13 to 0.60), strong association with Magnetic Resonance Imaging (MRI) [minimum r = 0.60(0.52,0.67)] and strong discrimination against symptomatic patients (OR = 3.08 to 7.46). There was strong criterion validity against cartilage histology [r = 0.66(-0.05,0.93)], and small to moderate internal [standardized mean difference(SMD) = 0.20 to 0.58] and external (r = 0.35 to 0.43) responsiveness to interventions. CONCLUSION Ultrasound demonstrated strong criterion validity with cartilage histology, poor to strong correlation with patient findings and MRI, moderate reliability, and low responsiveness to interventions. PROSPERO REGISTRATION NO CRD42016039954.
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Affiliation(s)
- W M Oo
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia.
| | - J M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging, St. Leonards, Sydney, Australia
| | - M Daniel
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - J Samuels
- Division of Rheumatology, Centre for Musculoskeletal Care, NYU Langone Medical Centre, New York, USA
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - H I Keen
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - L A Deveza
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
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23
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Abstract
Ultrasound has become popular among rheumatologists as the first-choice imaging investigation for the evaluation and monitoring of osteoarthritis (OA). Because of recent improvement in technology, ultrasound has the ability to demonstrate and assess the minimal structural abnormalities, which involve the pathophysiology and progression of OA, such as articular cartilage, synovial tissue, bony cortex, and other soft tissue. Nowadays, ultrasonography is a promising technique for assessing soft tissue abnormalities such as joint effusion, synovial hypertrophy, Baker cyst, and other structural changes including the decrease in cartilage thickness, meniscus bulging, and formation of osteophyte. Ultrasonography not only possesses diagnostic potential in knee OA but also reveals long-term predictability for disease progress as imaging biomarker. Ultrasonography has also been proven as a useful tool in guiding therapeutic interventions and monitoring treatment effectiveness. This review addresses the utility, reliability, and potential utilization of ultrasonography as an imaging technique in knee OA.
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24
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He L, Qi Y, Wang Q, Tian X, Zhang D, Yang L, Wang W, Ding H, Chang Q, Ma Y. The correlation between ultrasonographic findings and the Lysholm scores in knee osteoarthritis. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2017. [DOI: 10.1016/j.jtcms.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Podlipská J, Koski JM, Kaukinen P, Haapea M, Tervonen O, Arokoski JP, Saarakkala S. Structure-symptom relationship with wide-area ultrasound scanning of knee osteoarthritis. Sci Rep 2017; 7:44470. [PMID: 28295049 PMCID: PMC5353612 DOI: 10.1038/srep44470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 02/09/2017] [Indexed: 12/13/2022] Open
Abstract
The aetiology of knee pain in osteoarthritis (OA) is heterogeneous and its relationship with structural changes and function is unclear. Our goal was to determine the prevalence of wide-area scanned ultrasound-defined knee OA structural features and their association with pain and functional impairment in 79 symptomatic and 63 asymptomatic subjects. All subjects underwent ultrasound knee wide-area scanning and the severity of articular cartilage degeneration, the presence and size of osteophytes, and meniscal extrusion were evaluated. Subjects filled in a self-administrated questionnaire on present knee pain, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) on clinical symptoms and function over the past week. Cartilage changes were the most prevalent followed by lateral meniscal extrusion, osteophytes and medial meniscal extrusion. The global femoral cartilage grade associated strongly with pain and the WOMAC index. Site-specifically, early medial cartilage changes and thinning in sulcus and lateral site were associated with symptoms. The presence of femoral lateral osteophytes was also associated with both outcomes. Using the novel wide-area ultrasound scanning technique, we were able to confirm the negative impact of femoral cartilage OA changes on clinical symptoms. Presence, not necessarily size, of lateral femoral osteophytes was also associated with increased pain and disability.
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Affiliation(s)
- Jana Podlipská
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Juhani M Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Päivi Kaukinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Kuopio, Finland.,Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Osmo Tervonen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jari P Arokoski
- Department of Physical and Rehabilitation Medicine, University of Helsinki, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
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26
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Murakami T, Enokida M, Kawaguchi K, Otsuki R, Nagashima H. Useful ultrasonographic evaluation of the medial meniscus as a feature predicting the onset of radiographic knee osteoarthritis. J Orthop Sci 2017; 22:318-324. [PMID: 28034603 DOI: 10.1016/j.jos.2016.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/14/2016] [Accepted: 12/02/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Medial radial displacement (MRD) of the medial meniscus is a feature proving a dysfunction in the medial meniscus in osteoarthritis (OA) of the knee. MRD was measured in radiographic pre-OA knee and early osteoarthritis of the knee (early-OA) longitudinally using ultrasound (US) to investigate the characteristics involved in the onset and progression of OA. METHODS Fifty-five patients with pain on the medial side of the knee participated in the present study. It was possible to follow-up 46 patients for 5 years, and, thus, they were divided into 32 pre-OA patients (female: 59%, mean age: 69.0 years) and 14 early-OA patients (female: 78%, mean age: 74.4 years) based on radiography at the baseline time-point. MRD was measured in standing and supine positions at baseline and after 1 and 5 years using US. MRD corrected with the skeletal size, i.e., the medial displacement index (MDI), was analyzed. The pre- and early-OA groups were divided into subgroups at 5 years: stable and OA progression groups, following the Kellgren/Lawrence classification, and ⊿MDI (gap of the MDI between the standing and supine positions) were retrospectively compared between the subgroups at baseline, 1 and 5 years. RESULTS In the overall pre-OA group, MDI increased by 7% and 10% at 5 years in the supine and standing position, showing a significant increase (P = 0.044, 0.0147). ⊿MDI was significantly greater in the subgroup with OA progression in the pre- and early-OA groups (P = 0.02 and 0.03, respectively), and was continuously 6-7% in the pre-OA progression group, showing that the displacement rate was 2-fold or higher than in the stable group. CONCLUSION An increase in ⊿MDI on US may be an important risk factor for the disease stage progression of OA and useful as a feature predicting the onset of radiographic knee OA.
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Affiliation(s)
- Taiki Murakami
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, 36-1 Nishimachi, Yonago, Tottori, 683-8504 Japan.
| | - Makoto Enokida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, 36-1 Nishimachi, Yonago, Tottori, 683-8504 Japan
| | - Kei Kawaguchi
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, 36-1 Nishimachi, Yonago, Tottori, 683-8504 Japan
| | - Ryoji Otsuki
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, 36-1 Nishimachi, Yonago, Tottori, 683-8504 Japan
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, 36-1 Nishimachi, Yonago, Tottori, 683-8504 Japan
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Barré FPY, Flinders B, Garcia JP, Jansen I, Huizing LRS, Porta T, Creemers LB, Heeren RMA, Cillero-Pastor B. Derivatization Strategies for the Detection of Triamcinolone Acetonide in Cartilage by Using Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry Imaging. Anal Chem 2016; 88:12051-12059. [PMID: 28193015 DOI: 10.1021/acs.analchem.6b02491] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA), characterized by degeneration of the cartilaginous tissue in articular joints, severely impairs mobility in many people worldwide. The degeneration is thought to be mediated by inflammatory processes occurring in the tissue of the joint, including the cartilage. Intra-articular administered triamcinolone acetonide (TAA) is one of the drug treatments employed to ameliorate the inflammation and pain that characterizes OA. However, the penetration and distribution of TAA into the avascular cartilage is not well understood. We employed matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI), which has been previously used to directly monitor the distribution of drugs in biological tissues, to evaluate the distribution of TAA in human cartilage after in vitro incubation. Unfortunately, TAA is not easily ionized by regular electrospray ionization (ESI) or MALDI. To overcome this problem, we developed an on-tissue derivatization method with Girard's reagent T (GirT) in human incubated cartilage being able to study its distribution and quantify the drug abundance (up to 3.3 ng/μL). Our results demonstrate the depth of penetration of a corticosteroid drug in human OA cartilage using MALDI-MSI.
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Affiliation(s)
- Florian P Y Barré
- The Maastricht Multimodal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University , Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Bryn Flinders
- The Maastricht Multimodal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University , Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - João P Garcia
- University Medical Centre (UMC) Utrecht , Orthopedics Department, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Imke Jansen
- University Medical Centre (UMC) Utrecht , Orthopedics Department, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Lennart R S Huizing
- The Maastricht Multimodal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University , Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Tiffany Porta
- The Maastricht Multimodal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University , Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Laura B Creemers
- University Medical Centre (UMC) Utrecht , Orthopedics Department, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ron M A Heeren
- The Maastricht Multimodal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University , Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Berta Cillero-Pastor
- The Maastricht Multimodal Molecular Imaging Institute (M4I), Division of Imaging Mass Spectrometry, Maastricht University , Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
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Crane DM, Oliver KS, Bayes MC. Orthobiologics and Knee Osteoarthritis. Phys Med Rehabil Clin N Am 2016; 27:985-1002. [DOI: 10.1016/j.pmr.2016.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Cho SJ, Yang JR, Yang HS, Yang HE. Effects of Extracorporeal Shockwave Therapy in Chronic Stroke Patients With Knee Osteoarthritis: A Pilot Study. Ann Rehabil Med 2016; 40:862-870. [PMID: 27847716 PMCID: PMC5108713 DOI: 10.5535/arm.2016.40.5.862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/02/2016] [Indexed: 11/11/2022] Open
Abstract
Objective To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA). Methods A total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm2 on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height). Results The experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT. Conclusion It is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site.
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Affiliation(s)
- Sung Jun Cho
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Ja Ryung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Hea-Eun Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
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30
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Okano T, Filippucci E, Di Carlo M, Draghessi A, Carotti M, Salaffi F, Wright G, Grassi W. Ultrasonographic evaluation of joint damage in knee osteoarthritis: feature-specific comparisons with conventional radiography. Rheumatology (Oxford) 2016; 55:2040-2049. [DOI: 10.1093/rheumatology/kew304] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/13/2016] [Indexed: 01/07/2023] Open
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Abstract
Context: Radiography is widely accepted as the gold standard for diagnosing osteoarthritis (OA), but it has limitations when assessing early stage OA and monitoring progression. While there are improvements in the treatment of OA, the challenge is early recognition. Evidence Acquisition: MEDLINE and PubMed as well as professional orthopaedic and imaging websites were reviewed from 2006 to 2016. Study Design: Clinical review. Level of Evidence: Level 4. Results: Magnetic resonance imaging (MRI) can provide the most comprehensive assessment of joint injury and OA with the advantages of being noninvasive and multiplanar with excellent soft tissue contrast. However, MRI is expensive, time consuming, and not widely used for monitoring OA clinically. Computed tomography (CT) and CT arthrography (CTA) can also be used to evaluate OA, but these are also invasive and require radiation exposure. Ultrasound is particularly useful for evaluation of synovitis but not for progression of OA. Conclusion: MRI, CT, and CTA are available for the diagnosis and monitoring of OA. Improvement in techniques and decrease in cost can allow some of these modalities to be effective methods of detecting early OA.
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Affiliation(s)
- Qi Li
- West China Hospital, Orthopaedic Department, Sichuan University, Sichuan Province, China
| | - Keiko Amano
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
| | - Thomas M Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
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32
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Henricsdotter C, Ellegaard K, Klokker L, Bartholdy C, Bandak E, Bartels EM, Bliddal H, Henriksen M. Changes in ultrasound assessed markers of inflammation following intra-articular steroid injection combined with exercise in knee osteoarthritis: exploratory outcome from a randomized trial. Osteoarthritis Cartilage 2016; 24:814-21. [PMID: 26746147 DOI: 10.1016/j.joca.2015.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/02/2015] [Accepted: 12/16/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee osteoarthritis (KOA) is a multifactorial joint disease affecting many people worldwide. Recommended treatments for KOA include exercise and steroid injections, or a combination of these. The objective of this exploratory outcome analysis of a randomized trial was to assess changes in inflammation markers assessed by ultrasound imaging (US) in KOA secondary to intra-articular corticosteroid injection given prior to exercise therapy. DESIGN This study is a sub-study to a larger clinical trial which compared the clinical effects of steroid injection in KOA to placebo injection, both given prior to exercise therapy. The US outcomes were changes from baseline in US-assessed synovial size, Doppler activity presence in the synovial membrane, and numbers of US-detected Baker's cysts. US was performed at baseline, week 14 (exercise stop), and week 26 (follow-up). RESULTS Fifty participants received steroid injection, and 50 received placebo injection. All participants received 12 weeks of exercise. Forty-five and 44, respectively, completed the study. At week 14, the group difference in the change in synovium thickness was 2.2 mm (95%, confidence interval (CI) -0.5 to 4.8), P = 0.11. There were no group differences in the changes in distribution of patients with presence of synovial Doppler activity (P = 0.98) or Baker's cysts (P = 0.35). There were no statistically significant differences between groups at week 26 in any outcome. CONCLUSION Intra-articular steroid injection of KOA-patients prior to a 3 months exercise programme did not reduce synovial hypertrophy, synovial Doppler activity, or Baker's cyst presence more than a placebo saline injection according to US-assessments. TRIAL REGISTRATION EudraCT: 2012-002607-18.
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Affiliation(s)
- C Henricsdotter
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - K Ellegaard
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - L Klokker
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - C Bartholdy
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - E Bandak
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - E M Bartels
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - M Henriksen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark.
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Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study. Sci Rep 2016; 6:22365. [PMID: 26926836 PMCID: PMC4772126 DOI: 10.1038/srep22365] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/12/2016] [Indexed: 12/24/2022] Open
Abstract
Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level.
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Wang Y, Teichtahl AJ, Cicuttini FM. Osteoarthritis year in review 2015: imaging. Osteoarthritis Cartilage 2016; 24:49-57. [PMID: 26707992 DOI: 10.1016/j.joca.2015.07.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This narrative review covers original publications related to imaging in osteoarthritis (OA) published in English between 1 April 2014 and 30 April 2015. Novel lessons relating to imaging are described. METHODS An extensive PubMed database search was performed based on, but not limited to the terms "OA" in combination with "Magnetic resonance imaging (MRI)", "Imaging", "Radiography", "Ultrasound", "Computed tomography (CT)" and "Nuclear medicine" to extract relevant studies. In vitro data and animal studies were excluded. This review focuses on the new developments and observations based on the aforementioned imaging modalities, as well as a 'whole-organ' approach by presenting findings from different tissues (bone, meniscus, synovium, muscle and fat) and joints (hip, lumbar spine and hand). RESULTS AND CONCLUSIONS Over the past year, studies using imagine have made a major contribution to the understanding of the pathogenesis of OA. Significant work has continued at the knee, with MRI now being increasingly used to assess structural endpoints in clinical trials. This offers the exciting opportunity to explore potential disease modifying OA therapies. There has been a clear interest in the role of bone in the pathogenesis of OA. There is now a growing body of literature examining the pathogenesis of OA at the hip, lumbar spine and hand. The future of imaging in OA offers the exciting potential to better understand the disease process across all joints and develop more effective preventive and therapeutic interventions.
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Affiliation(s)
- Y Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - A J Teichtahl
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia; Baker IDI Heart and Diabetes Institute, Commercial Road, Melbourne, VIC 3004, Australia
| | - F M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia.
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Razek AAKA, El-Basyouni SR. Ultrasound of knee osteoarthritis: interobserver agreement and correlation with Western Ontario and McMaster Universities Osteoarthritis. Clin Rheumatol 2015; 35:997-1001. [PMID: 26089198 DOI: 10.1007/s10067-015-2990-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/20/2015] [Accepted: 06/03/2015] [Indexed: 12/19/2022]
Abstract
The aim of this work was to assess the reproducibility of ultrasound findings of knee osteoarthritis and to correlate ultrasound findings with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Prospective study was conducted upon 80 patients (56 F, 24 M; mean age 57 years) with primary osteoarthritis of knee joint. All patients underwent clinical assessment with calculation of WOMAC and high-resolution ultrasound of the knee joint. The ultrasound images were analyzed for cartilage thinning, osteophytes, synovial effusion, synovial proliferation, popliteal cyst, and meniscal protrusion. Image analysis was performed by two readers and linear regression analysis was used to determine association of ultrasound findings with WOMAC. There was excellent inter-observer agreement of both readers for cartilage thinning (k = 0.99, P = 0.001), osteophytes (k = 0.94, P = 0.001), synovial effusion (k = 0.98, P = 0.001), synovial thickening (k = 0.96, P = 0.001), popliteal cyst (k = 1.00, P = 0.001), and meniscal protrusion (k = 0.86, P = 0.001). There was significant association of WOMAC with cartilage changes (t = 3.406, 3.302, P = 0.001), osteophytes (t = 3.841, 3.006, P = 0.001), and synovial effusion (t = 4.140 and 2.787, P = 0.05) of both readers. We concluded that ultrasound is a reproducible method for assessment of knee osteoarthritis and well correlated with WOMAC.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura University, Elgomheryia Street, Mansoura, 35512, Egypt.
| | - Sherif Refaat El-Basyouni
- Department of Rheumatology and Rehabilitation, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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