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Manatrakul R, Pirmoazen AM, Bharadwaj UU, Akkaya Z, Giesler PJ, Lynch JA, Nevitt MC, McCulloch CE, Joseph GB, Link TM. Thigh muscle and fat volumes are associated with knee cartilage abnormalities and bone marrow edema-like lesions: data from the osteoarthritis initiative. Skeletal Radiol 2024; 53:1279-1286. [PMID: 38206355 PMCID: PMC11096053 DOI: 10.1007/s00256-024-04565-y] [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: 11/11/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To investigate the associations of thigh muscle and fat volumes with structural abnormalities on MRI related to knee osteoarthritis. MATERIALS AND METHODS MRI studies of the thighs and knees from 100 individuals were randomly selected from the Osteoarthritis Initiative Cohort. Whole Organ MR Scoring (WORMS) and effusion-synovitis scoring were performed in all knee MRI. Thigh muscles, intermuscular fat, and subcutaneous fat were manually segmented in 15 consecutive MR thigh images. Radiographic Kellgren-Lawrence grades (KLG) were also obtained in all knee radiographs. Independent t-tests were used to investigate the associations between thigh muscle and fat volumes, and sex. Mixed-effects analyses were obtained to investigate the associations between thigh muscle and fat volumes, KLG, WOMAC pain score, cartilage and bone marrow WORMS, as well as effusion-synovitis scores. RESULTS Women had higher subcutaneous fat volume than men (616.82 vs. 229.13 cm3, p < 0.01) and men had higher muscle volumes than women (p < 0.01). Quadriceps (coef = -2.15, p = 0.01) and vastus medialis (coef = -1.84, p = 0.03) volumes were negatively associated with the WORMS cartilage scores. Intermuscular fat volume (coef = 0.48, p = 0.01) was positively associated with WORMS bone marrow edema-like lesion (BMEL) scores. The quadriceps (coef = -0.99, p < 0.01) and hamstring (coef = -0.59, p = 0.01) volumes were negatively associated with WORMS BMEL scores. No evidence of an association was found between thigh muscle and fat volumes with KLG and effusion-synovitis grading (p > 0.05). CONCLUSION Increased quadriceps and hamstring volumes were negatively associated with cartilage lesion and BMEL scores while no evidence of an association was found between thigh muscle and fat volumes, and radiographic knee osteoarthritis or effusion-synovitis grading.
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Affiliation(s)
- Rawee Manatrakul
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA.
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Amir M Pirmoazen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Radiology, University of Florida, Jacksonville, FL, USA
| | - Upasana U Bharadwaj
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Zehra Akkaya
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Paula J Giesler
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Medical Center, University of Freiburg, Freiburg, Germany
| | - John A Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
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Ferreira AS, Mentiplay BF, Taborda B, Pazzinatto MF, de Azevedo FM, De Oliveira Silva D. Exploring overweight and obesity beyond body mass index: A body composition analysis in people with and without patellofemoral pain. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:630-638. [PMID: 34153479 PMCID: PMC10466189 DOI: 10.1016/j.jshs.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND We compared body mass index (BMI), body fat, and skeletal muscle mass between (1) a mixed-sex nonathletic cohort of people with patellofemoral pain (PFP) and pain-free people, and (2) a nonathletic cohort of people with PFP and pain-free people subgrouped by sex (i.e., men and women with PFP vs. pain-free men and women). METHODS This cross-sectional study included 114 people with PFP (71 women, 43 men) and 54 pain-free controls (32 women, 22 men). All participants attended a single testing session to assess body composition measures, which included BMI, percentage of body fat (%BFBioimpedance), and skeletal muscle mass (both assessed by bioelectrical impedance analysis), and percentage of body fat (%BFSkinfold) (assessed by skinfold caliper analysis). A one-way univariate analysis of covariance (age and physical activity levels as covariates) was used to compare body composition measures between groups (i.e., PFP vs. pain-free group; women with PFP vs. pain-free women; men with PFP vs. pain-free men). RESULTS Women with PFP presented significantly higher BMI, %BFBioimpedance, and %BFSkinfold, and lower skeletal muscle mass compared to pain-free women (p ≤ 0.04; effect size : ‒0.47 to 0.85). Men with PFP and men and women combined had no differences in BMI, %BFBioimpedance, %BFSkinfold, and skeletal muscle mass compared to their respective pain-free groups (p > 0.05). CONCLUSION Our findings indicate that BMI and body composition measures should be considered as part of the evaluation and management of people with PFP, especially in women, who have demonstrated higher BMI and body fat and lower skeletal muscle mass compared to pain-free controls. Future studies should not assess body composition measures in a mixed-sex population without distinguishing men participants from women participants.
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Affiliation(s)
- Amanda Schenatto Ferreira
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil.
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Bianca Taborda
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | - Marcella Ferraz Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Fábio Mícolis de Azevedo
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | - Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
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Yuksel Y, Ergun T, Torun E. Relationship between cervical posterior subcutaneous fat tissue thickness and the presence and degree of cervical intervertebral disc degeneration. Medicine (Baltimore) 2022; 101:e29890. [PMID: 35839037 DOI: 10.1097/md.0000000000029890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between cervical region subcutaneous fat tissue thickness and the presence and level of cervical intervertebral disc degeneration (IVDD). METHODS Magnetic resonance imaging examinations of patients referred to our clinic for the investigation of neck pain were evaluated retrospectively. A total of 300 women aged 30-40 years were included in the study. The presence and level of IVDD were evaluated for each patient. The cervical subcutaneous fat tissue thickness was also measured. RESULTS IVDD was determined as Grade 1 for 88 patients (29.3%), Grade 2 for 56 patients (18.6%), Grade 3 for 82 patients (27.3%), Grade 4 for 60 patients (20%), and Grade 5 for 14 patients (4.6%). Subcutaneous fat tissue thickness was higher in patients with cervical disc degeneration (mean: 6.28 ± 0.19 mm) than in those without cervical disc degeneration (mean: 5.33 ± 0.18 mm) (P = .001). There was a positive correlation between the degree of cervical disc degeneration and subcutaneous fat tissue thickness ( = 0.001, r = 0.245). CONCLUSION An increase in the cervical fat tissue thickness is a predisposing factor for the development of degeneration of the intervertebral disc. There is a close relationship between subcutaneous fat tissue thickness and the degree of degeneration.
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Affiliation(s)
- Yavuz Yuksel
- Department of Radiology, Faculty of Medicine, Alaaddin Keykubat University, Alanya, Turkey
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Abstract
Obesity is an independent risk factor for osteoarthritis due to mechanical and inflammatory factors. The gold-standard treatment of end-stage knee and hip osteoarthritis is total joint arthroplasty (TJA). Weight loss decreases progression of osteoarthritis and complications following TJA in patients with obesity. Bariatric surgery allows significant, sustained weight loss and comorbidity resolution in patients with morbid obesity. Existing data describing bariatric surgery on TJA outcomes are limited but suggest a benefit to bariatric surgery prior to TJA. Further studies are needed to determine optimal risk stratification, bariatric procedure selection, and timing of bariatric surgery relative to TJA.
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MESH Headings
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Knee/methods
- Bariatric Surgery/methods
- Comorbidity
- Global Health
- Humans
- Obesity, Morbid/epidemiology
- Obesity, Morbid/surgery
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/surgery
- Weight Loss
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Affiliation(s)
- Katelyn M Mellion
- Department of Medical Education, Advanced Gastrointestinal Minimally Invasive Surgery and Bariatric Fellowship, Gundersen Health System, 1900 South Avenue C05-001, La Crosse, WI 54601, USA
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, 1900 South Avenue C05-001, La Crosse, WI 54601, USA.
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KURT M, ÖNER AY, UÇAR M, ALADAĞ KURT S. The relationship between patellofemoral arthritis and fat tissue volume, body mass index and popliteal artery intima-media thickness through 3T knee MRI. Turk J Med Sci 2019; 49:844-853. [PMID: 31121997 PMCID: PMC7018204 DOI: 10.3906/sag-1811-166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background/aim Evaluating the relationship of patellar chondromalacia with obesity, infrapatellar fat pad (IFP) volume and popliteal artery intima-media thickness (IMT). Materials and methods A total of203 patients with different degree of patellar chondromalacia (103 male, 100 female) and 52 control subjects (19 male, 33 female) were included and grouped according to sex, age, body surface area (BSA), body mass index (BMI) and patellar chondromalacia classification. All measurements were completed with 3T magnetic resonance imaging (MRI). Articular cartilage and IFP volume were measured in saggital plane using double echo steady state (DESS) and DIXON sequences, respectively. Patellar cartilage damage was graded using modified outerbridge classification, and the relations among cartilage volume and BMI, BSA, IFP, IMT were statistically assessed. Results Popliteal artery IMT showed an independent association with the prevalence of cartilage defects and IFP volumes (P ˂ 0.001). There was an association between BMI and IFP volumes (P ˂ 0.001). However, no differences were observed between IFP volume and different chondromalacia groups. When IFP measurements were corrected using individual BMI and BSA values, a positive correlation was found between control and advanced chondromalacia groups (P ˂ 0.001). Conclusion This study demonstrates the relationship among obesity, IMT and chondromalacia and highlights this potential circle to develop effective treatments and inhibit the progression of chondromalacia.
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Affiliation(s)
- Mehmet KURT
- Department of Radiology, Van Lokman Hekim Private Hospital, VanTurkey
| | - Ali Yusuf ÖNER
- Department of Radiology, Faculty of Medicine, Gazi University, AnkaraTurkey
| | - Murat UÇAR
- Department of Radiology, Faculty of Medicine, Gazi University, AnkaraTurkey
| | - Seda ALADAĞ KURT
- Department of Radiology, Van Training and Research Hospital, VanTurkey
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Masiero S, Vittadini F, Ferroni C, Bosco A, Serra R, Frigo AC, Frizziero A. The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:243-252. [PMID: 28940031 DOI: 10.1007/s00484-017-1445-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 05/21/2023]
Abstract
Osteoarthritis (OA) is the most common form of arthritis clinically characterized by joint pain, functional limitation, and reduced quality of life. Several studies have shown a clear link between obesity and higher risk of knee OA. According to the multifactorial OA pathogenesis, the management of this condition requires a multidisciplinary approach. The objective of this study is to evaluate hydrokinesitherapy effects in thermal setting in obese patients with knee OA. Fifty-three patients were assessed for eligibility, of which 33 refused the treatment, while 10 patients dropped out after the enrollment for personal reasons or inability to adhere to the program. Ten patients (8 females, 2 males, mean age of 59.4 years) with obesity (range BMI 30-45 kg/m2) and knee OA (II-III grade of Kellgren-Lawrence scale) treated with hydrokinetic therapy in thermal water (two sessions per week for 8 consecutive weeks) completed the study. Primary outcome measure was pain (VAS). Secondary outcomes were clinical knee evaluation (range of motion-ROM, lower-limb muscle strength), WOMAC, and Lequesne Algofunctional Index. Patellar tendon and peri-articular soft tissue ultrasound evaluation and gait analysis at baseline (T0), at the end of treatment (T1), and at 6 months of follow-up (T2) were performed. Significant decrease on VAS pain during walking on a flat surface and going up/down stairs was reached from baseline at T1 (p = 0.0039; p = 0.0098) and was maintained at T2 (p = 0.00954) exclusively for VAS pain during walking on a flat surface. WOMAC score showed a significant reduction between T0 and T1 (p = 0.0137) and between T0 and T2 (p = 0.006438), as ROM evaluations. Kinematic path assessment did not show significant results in individual gait steps, except for the space-time variables of the average speed and the values of ground reaction force (GRF) obtained with force platforms. Hydrokinesitherapy in thermal environment in obese patients with knee OA may determine pain relief, joint function improvement, and walking speed increase until 6 months of follow-up.
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Affiliation(s)
| | | | | | - Anna Bosco
- Universita degli Studi di Padova, Padua, Italy
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Hussain SM, Tan MC, Stathakopoulos K, Cicuttini FM, Wang Y, Chou L, Urquhart DM, Wluka AE. How Are Obesity and Body Composition Related to Patellar Cartilage? A Systematic Review. J Rheumatol 2017; 44:1071-1082. [DOI: 10.3899/jrheum.151384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 02/06/2023]
Abstract
Objective.The aim of this review was to systematically examine the evidence for an association between measures of obesity [weight and body mass index (BMI)] and body composition (fat mass and fat-free mass) and patellar cartilage, assessed using magnetic resonance imaging.Methods.Three electronic databases (MEDLINE, EMBASE, and CINAHL) were searched up to April 2016 using full text and MeSH terms to identify studies examining the associations between obesity and body composition, and patellar cartilage. Two independent reviewers extracted the data and assessed the methodological quality of included studies.Results.Seventeen studies were included: 5 cross-sectional, 10 cohort studies measuring outcomes at 2 timepoints, and 2 longitudinal studies assessing outcome only at the timepoint. Eleven studies were of high or moderate quality. In asymptomatic middle-aged adults, elevated body weight and BMI were systematically associated with worse patellofemoral cartilage scores. There was more consistent evidence for patellar cartilage defects than patellar cartilage volume, particularly in women. Increased BMI was also consistently associated with increased cartilage loss in longitudinal studies, although not all attained statistical significance.Conclusion.There is a need for more high-quality research to confirm these findings and to better explain the relative contributions of metabolic and biomechanical factors to the initiation of patellofemoral osteoarthritis, to devise effective strategies to manage this common and disabling condition.
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Sakellariou G, Conaghan PG, Zhang W, Bijlsma JWJ, Boyesen P, D'Agostino MA, Doherty M, Fodor D, Kloppenburg M, Miese F, Naredo E, Porcheret M, Iagnocco A. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis 2017; 76:1484-1494. [DOI: 10.1136/annrheumdis-2016-210815] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/25/2017] [Accepted: 03/05/2017] [Indexed: 11/04/2022]
Abstract
The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot; imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms; the role of imaging in differential diagnosis; the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs; CR as the first-choice imaging modality; consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.
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Hart HF, Barton CJ, Khan KM, Riel H, Crossley KM. Is body mass index associated with patellofemoral pain and patellofemoral osteoarthritis? A systematic review and meta-regression and analysis. Br J Sports Med 2016; 51:781-790. [DOI: 10.1136/bjsports-2016-096768] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 01/25/2023]
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Tilinca M, Pop TS, Bățagă T, Zazgyva A, Niculescu M. Obesity and Knee Arthroscopy – a Review. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Obesity is currently a global epidemic, often referred to as “globesity”, impacting the life of millions worldwide. A risk factor for many diseases, obesity can also be linked to developing intra-articular lesions of the knee, affecting the menisci, ligaments and cartilage. Furthermore, obesity has been shown to influence the outcome of surgical interventions, including those of the musculoskeletal system. Although many studies addressed the relationship of obesity and joint replacement, articles relating to arthroscopy and obesity, and knee arthroscopy in particular, are a bit scarcer. The majority of data suggest that an increase in BMI leads to a similar increase in the rates of intra- and postoperative complications, and most authors agree that a higher body mass index can influence both the procedure itself and its outcomes, including the subjective results reported by the patients. Still, some studies show different results, especially in patients that are overweight or with low-grade obesity, where the outcomes are comparable to those of the non-obese population. Thus, it can be concluded that obesity is an important patient characteristic that needs to be taken into consideration when planning, performing, and assessing the results of knee arthroscopy.
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Affiliation(s)
- Mariana Tilinca
- Department of Cell and Molecular Biology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Tudor Sorin Pop
- Department of Orthopedics and Traumatology I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Tiberiu Bățagă
- Department of Orthopedics and Traumatology II, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Ancuța Zazgyva
- Department of Cell and Molecular Biology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Str. Gheorghe Marinescu nr. 38 540139, Romania
| | - Marius Niculescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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Selfe J, Janssen J, Callaghan M, Witvrouw E, Sutton C, Richards J, Stokes M, Martin D, Dixon J, Hogarth R, Baltzopoulos V, Ritchie E, Arden N, Dey P. Are there three main subgroups within the patellofemoral pain population? A detailed characterisation study of 127 patients to help develop targeted intervention (TIPPs). Br J Sports Med 2016; 50:873-80. [PMID: 26834185 PMCID: PMC4975826 DOI: 10.1136/bjsports-2015-094792] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/04/2022]
Abstract
Background Current multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible. Method The exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests. Results 130 participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean body mass index 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7–60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive and patients frequently fell into multiple subgroups. Using hierarchical clustering and latent profile analysis three subgroups were identified using 6 of the 7 clinical tests. These subgroups were given the following nomenclature: (1) ‘strong’, (2) ‘weak and tighter’ and (3) ‘weak and pronated foot’. Conclusions We conclude that three subgroups of patellofemoral patients may exist based on the results of six clinical tests which are feasible to perform in routine clinical practice. Further research is needed to validate these findings in other data sets and, if supported by external validation, to see if targeted interventions for these subgroups improve patient outcomes.
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Affiliation(s)
- James Selfe
- University of Central Lancashire, Preston, Lancashire, UK
| | - Jessie Janssen
- University of Central Lancashire, Preston, Lancashire, UK
| | - Michael Callaghan
- Institute for Inflammation and Repair, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Erik Witvrouw
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chris Sutton
- University of Central Lancashire, Preston, Lancashire, UK
| | - Jim Richards
- University of Central Lancashire, Preston, Lancashire, UK
| | - Maria Stokes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | | | | | | | - Elizabeth Ritchie
- Department of Physiotherapy, Harrogate & District NHS Foundation Trust, Harrogate District Hospital, Harrogate, North Yorkshire, UK
| | - Nigel Arden
- University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Paola Dey
- University of Central Lancashire, Preston, Lancashire, UK
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Vastus medialis fat infiltration - a modifiable determinant of knee cartilage loss. Osteoarthritis Cartilage 2015; 23:2150-2157. [PMID: 26162807 DOI: 10.1016/j.joca.2015.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 05/29/2015] [Accepted: 06/29/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is growing interest in the role of intramuscular fat and how it may influence clinical outcomes. Vastus medialis (VM) is a functionally important quadriceps muscle that helps to stabilise the knee joint. This longitudinal study examined the determinants of VM fat infiltration and whether VM fat infiltration influenced knee cartilage volume. METHODS 250 participants without any diagnosed arthropathy were assessed at baseline between 2005 and 2008, and 197 participants at follow-up between 2008 and 2010. Ambulatory and sporting activity were assessed and magnetic resonance imaging (MRI) was used to determine knee cartilage volume and VM fat infiltration. RESULTS Age, female gender, BMI and weight were positively associated with baseline VM fat infiltration (P ≤ 0.03), while ambulatory and sporting activity were negatively associated with VM fat infiltration (P ≤ 0.05). After adjusting for confounders, a reduction in VM fat infiltration was associated with a reduced annual loss of medial tibial (β = -10 mm(3); 95% CI -19 to 0 mm(3); P = 0.04) and patella (β = -18 mm(3); 95% CI -36 to 0 mm(3); P = 0.04) cartilage volume. CONCLUSION This community-based study of healthy adults has shown that VM fat infiltration can be modified by lifestyle factors including weight loss and exercise, and reducing fat infiltration in VM has beneficial effect on knee cartilage preservation. The findings suggest that modifying VM fat infiltration via lifestyle interventions may have the potential to reduce the risk of knee OA.
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Early cartilage abnormalities at the hip are associated with obesity and body composition measures - a 3.0T MRI community-based study. Arthritis Res Ther 2015; 17:107. [PMID: 25897761 PMCID: PMC4462003 DOI: 10.1186/s13075-015-0618-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 04/07/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Although obesity is a risk factor for hip osteoarthritis (OA), the role of body composition, if any, is unclear. This study examines whether the body mass index (BMI) and body composition are associated with hip cartilage changes using magnetic resonance imaging (MRI) in community-based adults. Methods 141 community-based participants with no clinical hip disease, including OA, had BMI and body composition (fat mass and fat free mass) measured at baseline (1990 to 1994), and BMI measured and 3.0 T MRI performed at follow-up (2009–2010). Femoral head cartilage volume was measured and femoral head cartilage defects were scored in the different hip regions. Results For females, baseline BMI (β = −26 mm3, 95% Confidence interval (CI) -47 to −6 mm3, p = 0.01) and fat mass (β = −11 mm3, 95% CI −21 to −1 mm3, p = 0.03) were negatively associated with femoral head cartilage volume. Also, while increased baseline fat mass was associated with an increased risk of cartilage defects in the central superolateral region of the femoral head (Odds Ratio (OR) = 1.08, 95% CI 1.00–1.15, p = 0.04), increased baseline fat free mass was associated with a reduced risk of cartilage defects in this region (OR = 0.82, 95% CI 0.67–0.99; p = 0.04). For males, baseline fat free mass was associated with increased femoral head cartilage volume (β = 40 mm3, 95% CI 6 to 74 mm3, p = 0.02). Conclusions Increased fat mass was associated with adverse hip cartilage changes for females, while increased fat free mass was associated with beneficial cartilage changes for both genders. Further work is required to determine whether modifying body composition alters the development of hip OA.
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Cucchiarini M, Henrionnet C, Mainard D, Pinzano A, Madry H. New trends in articular cartilage repair. J Exp Orthop 2015; 2:8. [PMID: 26914876 PMCID: PMC4544617 DOI: 10.1186/s40634-015-0026-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/25/2015] [Indexed: 12/31/2022] Open
Abstract
Damage to the articular cartilage is an important, prevalent, and unsolved clinical issue for the orthopaedic surgeon. This review summarizes innovative basic research approaches that may improve the current understanding of cartilage repair processes and lead to novel therapeutic options. In this regard, new aspects of cartilage tissue engineering with a focus on the choice of the best-suited cell source are presented. The importance of non-destructive cartilage imaging is highlighted with the recent availability of adapted experimental tools such as Second Harmonic Generation (SHG) imaging. Novel insights into cartilage pathophysiology based on the involvement of the infrapatellar fat pad in osteoarthritis are also described. Also, recombinant adeno-associated viral vectors are discussed as clinically adapted, efficient tools for potential gene-based medicines in a variety of articular cartilage disorders. Taken as a whole, such advances in basic research in diverse fields of articular cartilage repair may lead to the development of improved therapies in the clinics for an improved, effective treatment of cartilage lesions in a close future.
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Affiliation(s)
- Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Bldg 37, Kirrbergerstr. 1, D-66421, Homburg, Germany. .,Cartilage Net of the Greater Region, Homburg, Germany.
| | - Christel Henrionnet
- Cartilage Net of the Greater Region, Homburg, Germany. .,Ingénierie Moléculaire et Physiopathologie Articulaire, Unité Mixte de Recherches 7365 Centre National de la Recherche Scientifique, Université de Lorraine, F-54505, Vandoeuvre Lès Nancy, France.
| | - Didier Mainard
- Cartilage Net of the Greater Region, Homburg, Germany. .,Ingénierie Moléculaire et Physiopathologie Articulaire, Unité Mixte de Recherches 7365 Centre National de la Recherche Scientifique, Université de Lorraine, F-54505, Vandoeuvre Lès Nancy, France.
| | - Astrid Pinzano
- Cartilage Net of the Greater Region, Homburg, Germany. .,Ingénierie Moléculaire et Physiopathologie Articulaire, Unité Mixte de Recherches 7365 Centre National de la Recherche Scientifique, Université de Lorraine, F-54505, Vandoeuvre Lès Nancy, France.
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Bldg 37, Kirrbergerstr. 1, D-66421, Homburg, Germany. .,Cartilage Net of the Greater Region, Homburg, Germany. .,Department of Orthopaedic Surgery, Saarland University Medical Center and Saarland University, D-66421, Homburg/Saar, Germany.
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Francin PJ, Abot A, Guillaume C, Moulin D, Bianchi A, Gegout-Pottie P, Jouzeau JY, Mainard D, Presle N. Association between adiponectin and cartilage degradation in human osteoarthritis. Osteoarthritis Cartilage 2014; 22:519-26. [PMID: 24462671 DOI: 10.1016/j.joca.2014.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 01/03/2014] [Accepted: 01/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Conflicting findings raise questions about the role of adiponectin in osteoarthritis (OA). The current study aimed to investigate in OA patients the association between the production of adiponectin and the grade of cartilage destruction, and to provide functional evidence for a potential role of adiponectin in OA. DESIGN The expression of adiponectin was examined by immunohistochemistry in cartilage obtained from healthy individuals (n = 2; ages 56 and 41 years; 1 male and 1 female) and OA patients (n = 11; ages 64-79 years; 2 male and 9 female). The association between its production in chondrocytes and the grade of cartilage destruction was established on full-depth cartilage biopsies. The functional activity of adiponectin in OA cartilage was determined from the relation between the expression of adiponectin, its receptor, cartilage-specific components and factors involved in matrix degradation, and from the chondrocyte response to the full-length or the globular form of adiponectin. RESULTS Adiponectin was not detected in healthy cartilage. Conversely, the adipokine was up-regulated in damaged tissue, but no strong association with the grade of cartilage destruction was found. We showed a positive correlation between adiponectin and mPGES or MMP-13 while AdipoR1 was related to the expression of type 2 collagen, aggrecan and Sox9. The full-length form of adiponectin but not the globular isoform, stimulated the production of PGE2 and MMP-13 activity in cultured human chondrocytes. CONCLUSIONS The elevated level of adiponectin found in chondrocytes from OA patients might contribute to matrix remodelling during OA, the full-length isoform being the single active form.
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Affiliation(s)
- P-J Francin
- UMR 7365 CNRS-Universite de Lorraine, Biopôle de l'Universite de Lorraine, campus Biologie-Sante, Avenue de la forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
| | - A Abot
- UMR 7365 CNRS-Universite de Lorraine, Biopôle de l'Universite de Lorraine, campus Biologie-Sante, Avenue de la forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
| | - C Guillaume
- UMR 7365 CNRS-Universite de Lorraine, Biopôle de l'Universite de Lorraine, campus Biologie-Sante, Avenue de la forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
| | - D Moulin
- UMR 7365 CNRS-Universite de Lorraine, Biopôle de l'Universite de Lorraine, campus Biologie-Sante, Avenue de la forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
| | - A Bianchi
- UMR 7365 CNRS-Universite de Lorraine, Biopôle de l'Universite de Lorraine, campus Biologie-Sante, Avenue de la forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
| | - P Gegout-Pottie
- UMR 7365 CNRS-Universite de Lorraine, Biopôle de l'Universite de Lorraine, campus Biologie-Sante, Avenue de la forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
| | - J-Y Jouzeau
- UMR 7365 CNRS-Universite de Lorraine, Biopôle de l'Universite de Lorraine, campus Biologie-Sante, Avenue de la forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
| | - D Mainard
- UMR 7365 CNRS-Universite de Lorraine, Biopôle de l'Universite de Lorraine, campus Biologie-Sante, Avenue de la forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
| | - N Presle
- UMR 7365 CNRS-Universite de Lorraine, Biopôle de l'Universite de Lorraine, campus Biologie-Sante, Avenue de la forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
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16
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Crossley KM. Is patellofemoral osteoarthritis a common sequela of patellofemoral pain? Br J Sports Med 2014; 48:409-10. [DOI: 10.1136/bjsports-2014-093445] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Frontal plane knee and hip kinematics during sit-to-stand and proximal lower extremity strength in persons with patellofemoral osteoarthritis: a pilot study. J Appl Biomech 2013; 30:82-94. [PMID: 23878206 DOI: 10.1123/jab.2012-0244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Increased joint stress and malalignment are etiologic factors in osteoarthritis. Static tibiofemoral frontal plane malalignment is associated with patellofemoral osteoarthritis (PFOA). Patellofemoral joint stress is increased by activities such as sit-to-stand (STS); this stress may be even greater if dynamic frontal plane tibiofemoral malalignment occurs. If hip muscle or quadriceps weakness is present in persons with PFOA, aberrant tibiofemoral frontal plane movement may occur, with increased patellofemoral stress. No studies have investigated frontal plane tibiofemoral and hip kinematics during STS in persons with PFOA or the relationship of hip muscle and quadriceps strength to these motions. Eight PFOA and seven control subjects performed STS from a stool during three-dimensional motion capture. Hip muscle and quadriceps strength were measured as peak isometric force. The PFOA group demonstrated increased peak tibial abduction angles during STS, and decreased hip abductor, hip extensor, and quadriceps peak force versus controls. A moderate inverse relationship between peak tibial abduction angle and peak hip abductor force was present. No difference between groups was found for peak hip adduction angle or peak hip external rotator force. Dynamic tibiofemoral malalignment and proximal lower extremity weakness may cause increased patellofemoral stress and may contribute to PFOA incidence or progression.
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Karvonen-Gutierrez CA, Harlow SD, Jacobson J, Mancuso P, Jiang Y. The relationship between longitudinal serum leptin measures and measures of magnetic resonance imaging-assessed knee joint damage in a population of mid-life women. Ann Rheum Dis 2013; 73:883-9. [PMID: 23576710 DOI: 10.1136/annrheumdis-2012-202685] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Serum leptin measures are associated with radiographic knee osteoarthritis, but no studies have examined leptin levels with respect to different measures of knee joint damage from MRI. METHODS Participants in the Michigan Study of Women's Health Across the Nation underwent bilateral knee MRIs at follow-up visit 11 for assessment of cartilage defects, bone marrow lesions, osteophytes, meniscal tears, synovitis and joint effusion. Serum leptin measures were available from baseline, follow-up visits 1 and 3-7. RESULTS Baseline serum leptin levels were associated with greater odds of having more severe knee joint damage at follow-up visit 11 after adjustment for age, smoking status, menopause status and body mass index residuals. The greatest effect was observed for osteophytes; a 5 ng/ml increase in baseline leptin was associated with 24% higher odds of having larger osteophytes (95% CI 1.17 to 1.32). Correlations with baseline serum leptin were greatest for MRI-assessed osteophytes (r=0.41), followed by effusion (r=0.32), synovitis (r=0.30), cartilage defects (r=0.28), bone marrow lesions (r=0.24) and meniscal abnormalities (r=0.21). CONCLUSIONS Leptin levels 10 years prior to MRI assessment were associated with the presence of cartilage defects, bone marrow lesions, osteophytes, meniscal tears, synovitis and effusion among a population of middle-aged women. Understanding the role that leptin plays in the joint degradation process is critical for development of more targeted interventions for osteoarthritis.
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Associations between measures of adiposity over 10 years and patella cartilage in population-based asymptomatic women. Int J Obes (Lond) 2013; 37:1586-9. [PMID: 23567928 DOI: 10.1038/ijo.2013.42] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/19/2013] [Accepted: 02/28/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) most commonly affects the patellofemoral compartment of the knee, and is a major cause of pain and disability. Structural changes that evolve prior to the onset of symptoms can be visualised using magnetic resonance imaging (MRI). There is little known information about the role of adiposity on the early structural changes in the patella cartilage in younger, asymptomatic adult females. METHODS One hundred and sixty asymptomatic women (20-49 years) participating in the Geelong Osteoporosis Study underwent knee MRI (2006-8). Weight and body mass index (BMI) were measured 10 years prior (1994-7, baseline) and at the time of MRI (current), with change over the period calculated (current-baseline). Relationships between measures of adiposity and patella cartilage volume and defects were examined. RESULTS After adjustment for age and patella bone volume, there was a reduction of 13 ml (95% confidence interval (95% CI), -25.7, -0.55) in patella cartilage volume for every 1 unit increase in current BMI, and a reduction of 27 ml (95% CI -52.6, -1.5) per BMI unit increase over 10 years (P=0.04 for both). No significant association was observed between baseline BMI and patella cartilage volume (P=0.16). Increased baseline and current weight and BMI were associated with increased prevalence of patella cartilage defects (all P<0.001). CONCLUSIONS Adiposity and weight gain during midlife are associated with detrimental structural change at the patella in young to middle-aged healthy non-osteoarthritic women. Maintaining a healthy weight and avoiding weight gain in younger asymptomatic women may be important in the prevention of patellofemoral OA.
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Baum T, Joseph GB, Nardo L, Virayavanich W, Arulanandan A, Alizai H, Carballido-Gamio J, Nevitt MC, Lynch J, McCulloch CE, Link TM. Correlation of magnetic resonance imaging-based knee cartilage T2 measurements and focal knee lesions with body mass index: thirty-six-month followup data from a longitudinal, observational multicenter study. Arthritis Care Res (Hoboken) 2013; 65:23-33. [PMID: 22623435 DOI: 10.1002/acr.21741] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 05/07/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare magnetic resonance imaging (MRI)-based knee cartilage T2 measurements and focal knee lesions and 36-month changes in these parameters among knees of normal controls and knees of normal weight, overweight, and obese subjects with risk factors for knee osteoarthritis (OA). METHODS A total of 267 subjects ages 45-55 years from the Osteoarthritis Initiative database were analyzed in this study. Two hundred thirty-one subjects had risk factors for knee OA, but no radiographic OA (Kellgren/Lawrence score ≤1) at baseline. Thirty-six subjects were normal controls. Subjects with OA risk factors were stratified in 3 groups: normal weight (n = 78), overweight (n = 84), and obese (n = 69). All subjects underwent 3T MRI of the right knee at baseline and after 36 months. Focal knee lesions were assessed and cartilage T2 measurements (mean T2 and T2 texture analysis) were performed. RESULTS The baseline prevalence and severity of meniscal and cartilage lesions were highest in obese subjects and lowest in normal controls (P < 0.05). Obese subjects had the highest mean T2 values and the most heterogeneous cartilage (as assessed by T2 texture analysis), while normal controls had the lowest mean T2 values and the most homogeneous cartilage at baseline (P < 0.05). Increased body mass index (BMI) was significantly (P < 0.05) associated with greater progression of cartilage lesions and constantly elevated cartilage T2 entropy over 36 months. CONCLUSION In preclinical OA, increased BMI is associated with more severe cartilage degeneration as assessed by both morphologic and quantitative MRI measurements.
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Affiliation(s)
- Thomas Baum
- University of California, San Francisco, San Francisco, CA 94107, USA.
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21
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Ding C, Stannus O, Cicuttini F, Antony B, Jones G. Body fat is associated with increased and lean mass with decreased knee cartilage loss in older adults: a prospective cohort study. Int J Obes (Lond) 2012; 37:822-7. [PMID: 22907692 DOI: 10.1038/ijo.2012.136] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the associations between body composition at baseline and knee cartilage loss over 2.9 years in older adults. METHODS A total of 395 randomly selected subjects (mean 62 years, range 51-81, 50% female) were studied at baseline and 2.9 years later. T1-weighted fat-suppressed magnetic resonance imaging of the right knee was performed to determine knee cartilage volume and tibial bone area at baseline and follow-up. Height, weight and radiographic osteoarthritis were measured by standard protocols at baseline. Fat mass and lean mass were measured by dual-energy X-ray absorptiometry at baseline. RESULTS Tibial cartilage volume decreased by 2.0-2.7% per annum. In multivariable analysis, annual change in medial cartilage volume was negatively and significantly associated with body mass index (β: -0.14% per kg m(-2), 95% confidence interval (CI): -0.25%, -0.02%), percentage total body fat (β: -0.19% per %, 95% CI: -0.30%, -0.07%) and percentage trunk fat (β: -0.10% per %, 95% CI: -0.19%, -0.02%), and positively associated with percentage lean mass (β: 0.20% per %, 95% CI: 0.08%, 0.32%). Change in lateral tibial cartilage volume was also significantly associated with percentage total body fat (β: -0.11% per %, 95% CI: -0.21%, -0.001%) and total lean mass (β: 0.13% per kg, 95% CI: 0.04%, 0.22%). These were independent of sex and age even though both were also significant predictors. CONCLUSIONS Body fat adversely affects tibial cartilage loss over time, whereas lean mass is protective. Strategies aimed at reducing body fat but increasing lean mass may reduce knee cartilage loss in older people.
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Affiliation(s)
- C Ding
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
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Wang Y, Wluka AE, Jones G, Ding C, Cicuttini FM. Use magnetic resonance imaging to assess articular cartilage. Ther Adv Musculoskelet Dis 2012; 4:77-97. [PMID: 22870497 PMCID: PMC3383521 DOI: 10.1177/1759720x11431005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) enables a noninvasive, three-dimensional assessment of the entire joint, simultaneously allowing the direct visualization of articular cartilage. Thus, MRI has become the imaging modality of choice in both clinical and research settings of musculoskeletal diseases, particular for osteoarthritis (OA). Although radiography, the current gold standard for the assessment of OA, has had recent significant technical advances, radiographic methods have significant limitations when used to measure disease progression. MRI allows accurate and reliable assessment of articular cartilage which is sensitive to change, providing the opportunity to better examine and understand preclinical and very subtle early abnormalities in articular cartilage, prior to the onset of radiographic disease. MRI enables quantitative (cartilage volume and thickness) and semiquantitative assessment of articular cartilage morphology, and quantitative assessment of cartilage matrix composition. Cartilage volume and defects have demonstrated adequate validity, accuracy, reliability and sensitivity to change. They are correlated to radiographic changes and clinical outcomes such as pain and joint replacement. Measures of cartilage matrix composition show promise as they seem to relate to cartilage morphology and symptoms. MRI-derived cartilage measurements provide a useful tool for exploring the effect of modifiable factors on articular cartilage prior to clinical disease and identifying the potential preventive strategies. MRI represents a useful approach to monitoring the natural history of OA and evaluating the effect of therapeutic agents. MRI assessment of articular cartilage has tremendous potential for large-scale epidemiological studies of OA progression, and for clinical trials of treatment response to disease-modifying OA drugs.
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Quantitative cartilage imaging in knee osteoarthritis. ARTHRITIS 2010; 2011:475684. [PMID: 22046518 PMCID: PMC3200067 DOI: 10.1155/2011/475684] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 10/25/2010] [Indexed: 02/01/2023]
Abstract
Quantitative measures of cartilage morphology (i.e., thickness) represent potentially powerful surrogate endpoints in osteoarthritis (OA). These can be used to identify risk factors of structural disease progression and can facilitate the clinical efficacy testing of structure modifying drugs in OA. This paper focuses on quantitative imaging of articular cartilage morphology in the knee, and will specifically deal with different cartilage morphology outcome variables and regions of interest, the relative performance and relationship between cartilage morphology measures, reference values for MRI-based knee cartilage morphometry, imaging protocols for measurement of cartilage morphology (including those used in the Osteoarthritis Initiative), sensitivity to change observed in knee OA, spatial patterns of cartilage loss as derived by subregional analysis, comparison of MRI changes with radiographic changes, risk factors of MRI-based cartilage loss in knee OA, the correlation of MRI-based cartilage loss with clinical outcomes, treatment response in knee OA, and future directions of the field.
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Lan TY, Lin WP, Jiang CC, Chiang H. Immediate effect and predictors of effectiveness of taping for patellofemoral pain syndrome: a prospective cohort study. Am J Sports Med 2010; 38:1626-30. [PMID: 20505056 DOI: 10.1177/0363546510364840] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Taping has been used to treat patellofemoral pain syndrome for more than 20 years, but its effectiveness is still controversial. PURPOSE This study was undertaken to investigate the effect and predictors of effectiveness of taping in the treatment of patellofemoral pain syndrome. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 118 consecutive patients with patellofemoral pain syndrome were recruited; 100 of them completed this study. Patient sex, age, body mass index, Q angle, lateral patellar displacement, and lateral patellofemoral angle were recorded/measured. One therapist applied adhesive tape to each patient by the McConnell method. Patients scored their pain level on a 100-mm visual analog scale during stepping down from an 8-in platform, before and after taping. The change of score was evaluated by paired t test. Patients with a visual analog scale score decrease of 20 mm or more after taping were considered responsive, and the others were considered nonresponsive. The influences of the aforementioned factors, plus pretaping visual analog scale score, on the effectiveness of taping were analyzed by multivariate logistic regression. RESULTS The overall mean visual analog scale score decreased significantly after taping (from 49.0 to 29.3 mm; P < .001). There were 66 patients in the responsive group and 34 in nonresponsive group. Among the factors, body mass index, lateral patellofemoral angle, and Q angle were significant predictors of effectiveness. The responsive group had significantly smaller mean lateral patellofemoral angle, larger mean Q angle, and larger mean pretaping visual analog scale score than the nonresponsive group. CONCLUSION Taping was an effective treatment for patellofemoral pain syndrome, but was less effective in patients with higher body mass index, larger lateral patellofemoral angle, and smaller Q angle.
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Affiliation(s)
- Tsung-Yu Lan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, 7 Chungsan South Road, Taipei, Taiwan
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Pallu S, Francin PJ, Guillaume C, Gegout-Pottie P, Netter P, Mainard D, Terlain B, Presle N. Obesity affects the chondrocyte responsiveness to leptin in patients with osteoarthritis. Arthritis Res Ther 2010; 12:R112. [PMID: 20534145 PMCID: PMC2911905 DOI: 10.1186/ar3048] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/19/2010] [Accepted: 06/09/2010] [Indexed: 02/08/2023] Open
Abstract
Introduction Increasing evidence support the regulatory role of leptin in osteoarthritis (OA). As high circulating concentrations of leptin disrupt the physiological function of the adipokine in obese individuals, the current study has been undertaken to determine whether the elevated levels of leptin found in the joint from obese OA patients also induce changes in the chondrocyte response to leptin. Methods Chondrocytes isolated from OA patients with various body mass index (BMI) were treated with 20, 100 or 500 ng/ml of leptin. The expression of cartilage-specific components (aggrecan, type 2 collagen), as well as regulatory (IGF-1, TGFβ, MMP-13, TIMP 2) or inflammatory (COX-2, iNOS, IL-1) factors was investigated by real-time PCR to evaluate chondrocyte responsiveness to leptin. Furthermore, the effect of body mass index (BMI) on leptin signalling pathways was analyzed with an enzyme-linked immunosorbent assay for STATs activation. Results Leptin at 20 ng/ml was unable to modulate gene expression in chondrocytes, except for MMP-13 in obese OA patients. Higher leptin levels induced the expression of IGF-1, type 2 collagen, TIMP-2 and MMP-13. However, the activity of the adipokine was shown to be critically dependent on both the concentration and the BMI of the patients with a negative association between the activation of regulated genes and BMI for 100 ng/ml of adipokine, but a positive association between chondrocyte responsiveness and BMI for the highest leptin dose. In addition, the gene encoding MMP-13 was identified as a target of leptin for chondrocytes originated from obese patients while mRNA level of TIMP-2 was increased in leptin-treated chondrocytes collected from normal or overweight patients. The adipokine at 500 ng/ml triggered signal transduction through a STAT-dependent pathway while 100 ng/ml of leptin failed to activate STAT 3 but induced STAT 1α phosphorylation in chondrocytes obtained from obese patients. Conclusions The current study clearly showed that characteristics of OA patients and more expecially obesity may affect the responsiveness of cultured chondrocytes to leptin. In addition, the BMI-dependent effect of leptin for the expression of TIMP-2 and MMP-13 may explain why obesity is associated with an increased risk for OA.
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Affiliation(s)
- Stéphane Pallu
- UMR S658 INSERM, Hôpital Porte Madeleine, 1 Rue Porte Madeleine, BP 2439, 45032 Orléans, France
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Roemer FW, Eckstein F, Guermazi A. Magnetic resonance imaging-based semiquantitative and quantitative assessment in osteoarthritis. Rheum Dis Clin North Am 2010; 35:521-55. [PMID: 19931802 DOI: 10.1016/j.rdc.2009.08.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Whole organ magnetic resonance imaging (MRI)-based semiquantitative (SQ) assessment of knee osteoarthritis (OA), based on reliable scoring methods and expert reading, has become a powerful research tool in OA. SQ morphologic scoring has been applied to large observational cross-sectional and longitudinal epidemiologic studies as well as interventional clinical trials. SQ whole organ scoring analyzes all joint structures that are potentially relevant as surrogate outcome measures of OA and potential disease modification, including cartilage, subchondral bone, osteophytes, intra- and periarticular ligaments, menisci, synovial lining, cysts, and bursae. Resources needed for SQ scoring rely on the MRI protocol, image quality, experience of the expert readers, method of documentation, and the individual scoring system that will be applied. The first part of this article discusses the different available OA whole organ scoring systems, focusing on MRI of the knee, and also reviews alternative approaches. Rheumatologists are made aware of artifacts and differential diagnoses when applying any of the SQ scoring systems. The second part focuses on quantitative approaches in OA, particularly measurement of (subregional) cartilage loss. This approach allows one to determine minute changes that occur relatively homogeneously across cartilage structures and that are not apparent to the naked eye. To this end, the cartilage surfaces need to be segmented by trained users using specialized software. Measurements of knee cartilage loss based on water-excitation spoiled gradient recalled echo acquisition in the steady state, fast low-angle shot, or double-echo steady-state imaging sequences reported a 1% to 2% decrease in cartilage thickness annually, and a high degree of spatial heterogeneity of cartilage thickness changes in femorotibial subregions between subjects. Risk factors identified by quantitative measurement technology included a high body mass index, meniscal extrusion and meniscal tears, knee malalignment, advanced radiographic OA grade, bone marrow alterations, and focal cartilage lesions.
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Affiliation(s)
- Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd floor, 820 Harrison Avenue, Boston, MA 02118, USA.
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