1
|
Wang H, Li Z, Li Q, Sommer S, Chen T, Sun Y, Wei H, Yan F, Lu Y. Comparing the Effect of Mechanical Loading on Deep and Superficial Cartilage Using Quantitative UTE MRI. J Magn Reson Imaging 2024; 59:2048-2057. [PMID: 37728325 DOI: 10.1002/jmri.28980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The biomechanical properties of deep and superficial cartilage may be different, yet in vivo MRI validation is required. PURPOSE To compare the effect of mechanical loading on deep and superficial cartilage in young healthy adults using ultrashort echo time (UTE)-T2* mapping. STUDY TYPE Prospective, intervention. SUBJECTS Thirty-one healthy adults (54.8% females, median age = 23 years). FIELD STRENGTH/SEQUENCE 3-T, PD-FS, and UTE sequences with four echo times (TEs = 0.1, 0.5, 2.8, and 4.0 msec; 0.6 mm isotropic spatial resolution) of the left knee, acquired before and after loading exercise. ASSESSMENT Quantitative UTE-T2* maps of the entire knee were generated using UTE images of four TEs. In deep and superficial cartilage of patella, medial and lateral femur, medial and lateral tibia cartilage (PC, MFC, LFC, MTC, and LTC), which were segmented manually, cartilage thickness and T2* values before and after loading were measured, extracted, taken averages of, and compared. Scan-rescan repeatability was evaluated. Body weight and body mass index (BMI) data were collected. Physical activity levels were evaluated using International Physical Activity Questionnaire. STATISTICAL TESTS Paired sample t-tests, paired Wilcoxon Mann-Whitney tests, Pearson and Spearman correlation analyses, Kruskal-Wallis tests with post-hoc Bonferroni correction. A P-value <0.05 was considered statistically significant. RESULTS The scan-rescan repeatability was good (RMSA-CV < 10%). After exercise, deep cartilage exhibited no significant differences in cartilage thickness (PPC = 0.576, PMTC = 0.991, PMFC = 0.899, PLTC = 0.861, PLFC = 0.290) and T2* values (PPC = 0.914, PMTC = 0.780, PMFC = 0.754, PLTC = 0.327, PLFC = 0.811), which both significantly decreased in superficial PC, MFC, LFC, and MTC. The T2* values of superficial MTC and deep MFC were moderately correlated with higher body weight (ρ = 0.431) and lower BMI (ρ = -0.499), respectively. DATA CONCLUSION Deep and superficial cartilage may respond differently to mechanical loading as assessed by UTE-T2*. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 3.
Collapse
Affiliation(s)
- Hanqi Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhihui Li
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Li
- MR Collaborations, Siemens Healthineers Ltd., Shanghai, China
| | - Stefan Sommer
- Siemens Healthineers International AG, Zurich, Switzerland
- Swiss Center for Musculoskeletal Imaging (SCMI), Balgrist Campus, Zurich, Switzerland
- Advanced Clinical Imaging Technology (ACIT), Siemens Healthineers International AG, Lausanne, Switzerland
| | - Tongtong Chen
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Sun
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Lu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
2
|
Wong TT, Igbinoba Z, Tokaria R, Quarterman P, Fung M, Jaramillo D, Jambawalikar SR. UTE T2* cartilage mapping in the hip: a pilot study assessing cartilage in patients with femoroacetabular impingement. Acta Radiol 2024; 65:350-358. [PMID: 38130123 DOI: 10.1177/02841851231218252] [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] [Indexed: 12/23/2023]
Abstract
BACKGROUND UTE T2* cartilage mapping use in patients undergoing femoroacetabular impingement (FAI) has been lacking but may allow the detection of early cartilage damage. PURPOSE To assess the reproducibility of UTE T2* cartilage mapping and determine the difference in UTE T2* values between FAI and asymptomatic patients and to evaluate the correlation between UTE T2* values and patient-reported symptoms. MATERIAL AND METHODS Prospective evaluation of both hips (7 FAI and 7 asymptomatic patients). Bilateral hip 3-T MRI scans with UTE T2* cartilage maps were acquired. A second MRI scan was acquired 1-9 months later. Cartilage was segmented into anterosuperior, superior, and posterosuperior regions. Assessment was made of UTE T2* reproducibility (ICC). Mean UTE T2* values in patients were compared (t-tests) and correlation was made with patient-reported outcomes (Spearman's). RESULTS ICCs of mean UTE T2* were as follows: acetabular, 0.82 (95% CI=0.50-0.95); femoral, 0.76 (95% CI=0.35-0.92). Significant strong correlation was found between mean acetabular UTE T2* values and iHOT12 (ρ = -0.63) and moderate correlation with mHHS (ρ = -0.57). There was no difference in mean UTE T2* values between affected vs. non-affected FAI hips. FAI-affected hips had significantly higher values in acetabulum vs. asymptomatic patients (13.47 vs. 12.55 ms). There was no difference in mean femoral cartilage values between the FAI-affected hips vs. asymptomatic patients. The posterosuperior femoral region had a higher mean value in non-affected FAI hips vs. asymptomatic patients (12.60 vs. 11.53 ms). CONCLUSION UTE T2* cartilage mapping had excellent reproducibility. Affected FAI hips had higher mean acetabular UTE T2* values than asymptomatic patients. Severity of patient-reported symptoms correlates with UTE T2* acetabular cartilage values.
Collapse
Affiliation(s)
- Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Zenas Igbinoba
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Rumana Tokaria
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | | | - Maggie Fung
- General Electric (GE) Healthcare, New York, NY, USA
| | - Diego Jaramillo
- Department of Radiology, Division of Pediatric Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Sachin R Jambawalikar
- Department of Radiology, Division of Physics, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
3
|
Löffler MT, Akkaya Z, Bhattacharjee R, Link TM. Biomarkers of Cartilage Composition. Semin Musculoskelet Radiol 2024; 28:26-38. [PMID: 38330968 DOI: 10.1055/s-0043-1776429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Magnetic resonance imaging (MRI) has significantly advanced the understanding of osteoarthritis (OA) because it enables visualization of noncalcified tissues. Cartilage is avascular and nurtured by diffusion, so it has a very low turnover and limited capabilities of repair. Consequently, prevention of structural and detection of premorphological damage is key in maintaining cartilage health. The integrity of cartilage composition and ultrastructure determines its mechanical properties but is not accessible to morphological imaging. Therefore, various techniques of compositional MRI with and without use of intravenous contrast medium have been developed. Spin-spin relaxation time (T2) and spin-lattice relaxation time constant in rotating frame (T1rho) mapping, the most studied cartilage biomarkers, were included in the recent standardization effort by the Quantitative Imaging Biomarkers Alliance (QIBA) that aims to make compositional MRI of cartilage clinically feasible and comparable. Additional techniques that are less frequently used include ultrashort echo time with T2*, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), glycosaminoglycan concentration by chemical exchange-dependent saturation transfer (gagCEST), sodium imaging, and diffusion-weighted MRI.
Collapse
Affiliation(s)
- Maximilian T Löffler
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Zehra Akkaya
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
- Department of Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Rupsa Bhattacharjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| |
Collapse
|
4
|
Slawig A, Rothe M, Deistung A, Bohndorf K, Brill R, Graf S, Weng AM, Wohlgemuth WA, Gussew A. Ultra-short echo time (UTE) MR imaging: A brief review on technical considerations and clinical applications. ROFO-FORTSCHR RONTG 2023. [PMID: 37995735 DOI: 10.1055/a-2193-1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND With the availability of MRI sequences with ultrashort echo times (UTE sequences), a signal can be gained from tissue, which was formerly only indirectly accessible. While already extensively employed in various research settings, the widespread transition of UTE imaging to clinical practice is just starting. METHODS Based on a systematic literature search as well as knowledge gained through annual participation in conferences dedicated to advances in MRI, this review aims to give a brief overview of technical considerations and challenges of UTE imaging and summarizes the major areas of application of UTE imaging. RESULTS UTE is already employed in clinical practice for structural lung imaging as well as the characterization of tissue composition and its alterations in selected musculoskeletal, cardiovascular, or neurodegenerative diseases. In specific contexts it can replace CT examinations with ionizing radiation and is especially attractive for pediatric patients and longitudinal monitoring of disease progression and treatment. CONCLUSION UTE imaging provides an interesting and very valuable tool for various clinical purposes and promises a multitude of new insights into tissue properties. While some challenges remain, ongoing adoption in the clinical routine can be expected, as UTE approaches provide a new contrast and capture a signal in tissue formerly invisible on MR imaging. KEY POINTS · UTE imaging gains relevance in clinical settings. · UTE imaging is employed for the characterization of tissue composition and its alterations in selected musculoskeletal, cardiovascular, or neurodegenerative diseases. · UTE imaging is employed in the clinical routine for structural lung imaging. · UTE imaging promises a multitude of new insights into tissue properties.
Collapse
Affiliation(s)
- Anne Slawig
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Maik Rothe
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Andreas Deistung
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Klaus Bohndorf
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
| | - Richard Brill
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
| | - Simon Graf
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Andreas Max Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Wurzburg, Wurzburg, Germany
| | - Walter A Wohlgemuth
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Alexander Gussew
- University Clinic and Outpatient Clinic for Radiology, University Hospital Halle, Germany
- Halle MR Imaging Core Facility, Medical faculty, Martin Luther University Halle Wittenberg, Halle, Germany
| |
Collapse
|
5
|
Cheng KY, Moazamian D, Ma Y, Jang H, Jerban S, Du J, Chung CB. Clinical application of ultrashort echo time (UTE) and zero echo time (ZTE) magnetic resonance (MR) imaging in the evaluation of osteoarthritis. Skeletal Radiol 2023; 52:2149-2157. [PMID: 36607355 PMCID: PMC10323038 DOI: 10.1007/s00256-022-04269-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
Novel compositional magnetic resonance (MR) imaging techniques have allowed for both the qualitative and quantitative assessments of tissue changes in osteoarthritis, many of which are difficult to characterize on conventional MR imaging. Ultrashort echo time (UTE) and zero echo time (ZTE) MR imaging have not been broadly implemented clinically but have several applications that leverage contrast mechanisms for morphologic evaluation of bone and soft tissue, as well as biochemical assessment in various stages of osteoarthritis progression. Many of the musculoskeletal tissues implicated in the initiation and progression of osteoarthritis are short T2 in nature, appearing dark as signal has already decayed to its minimum when image sampling starts. UTE and ZTE MR imaging allow for the qualitative and quantitative assessments of these short T2 tissues (bone, tendon, calcified cartilage, meniscus, and ligament) with both structural and functional reference standards described in the literature [1-3]. This review will describe applications of UTE and ZTE MR imaging in musculoskeletal tissues focusing on its role in knee osteoarthritis. While the review will address tissue-specific applications of these sequences, it is understood that osteoarthritis is a whole joint process with involvement and interdependence of all tissues. KEY POINTS: • UTE MR imaging allows for the qualitative and quantitative evaluation of short T2 tissues (bone, calcified cartilage, and meniscus), enabling identification of both early degenerative changes and subclinical injuries that may predispose to osteoarthritis. • ZTE MR imaging allows for the detection of signal from bone, which has some of the shortest T2 values, and generates tissue contrast similar to CT, potentially obviating the need for CT in the assessment of osseous features of osteoarthritis.
Collapse
Affiliation(s)
- Karen Y Cheng
- Department of Radiology, University of California, San Diego, CA, USA
| | - Dina Moazamian
- Department of Radiology, University of California, San Diego, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, CA, USA
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, CA, USA.
- Department of Radiology, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
| |
Collapse
|
6
|
Garcia SA, Pamukoff DN, Johnson AK, Palmieri-Smith RM. Joint and Limb Loading during Gait in Adults with ACL Reconstruction: Comparison between Single-Step and Cumulative Load Metrics. Med Sci Sports Exerc 2023; 55:1706-1716. [PMID: 37126038 PMCID: PMC10524219 DOI: 10.1249/mss.0000000000003201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE Individuals with anterior cruciate ligament reconstruction (ACLR) generally exhibit limb underloading behaviors during walking, but most research focuses on per-step comparisons. Cumulative loading metrics offer unique insight into joint loading as magnitude, duration, and total steps are considered, but few studies have evaluated if cumulative loads are altered post-ACLR. Here, we evaluated if underloading behaviors are apparent in ACLR limbs when using cumulative load metrics and how load metrics change in response to walking speed modifications. METHODS Treadmill walking biomechanics were evaluated in 21 participants with ACLR at three speeds (self-selected (SS); 120% SS and 80% SS). Cumulative loads per step and per kilometer were calculated using knee flexion and adduction moment (KFM and KAM) and vertical ground reaction force (GRF) impulses. Traditional magnitude metrics for KFM, KAM, and GRF were also calculated. RESULTS The ACLR limb displayed smaller KFM and GRF in early and late stances, but larger KFM and GRF during midstance compared with the contralateral limb ( P < 0.01). Only GRF cumulative loads (per step and per kilometer) were reduced in the ACLR limb ( P < 0.01). In response to speed modifications, load magnitudes generally increased with speed. Conversely, cumulative load metrics (per step and per kilometer) decreased at faster speeds and increased at slow speeds ( P < 0.01). CONCLUSIONS Patients with ACLR underload their knee in the sagittal plane per step, but cumulatively over the course of many steps/distance, this underloading phenomenon was not apparent. Furthermore, cumulative load increased at slower speeds, opposite to what is identified with traditional single-step metrics. Assessing cumulative load metrics may offer additional insight into how load outcomes may be impacted in injured populations or in response to gait modifications.
Collapse
Affiliation(s)
- Steven A. Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI
| | | | - Alexa K. Johnson
- School of Kinesiology, University of Michigan, Ann Arbor, MI
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI
| | - Riann M. Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, MI
- Orthopedic Rehabilitation & Biomechanics (ORB) Laboratory, University of Michigan, Ann Arbor, MI
| |
Collapse
|
7
|
Schache AG, Sritharan P, Culvenor AG, Patterson BE, Perraton LG, Bryant AL, Guermazi A, Morris HG, Whitehead TS, Crossley KM. Patellofemoral joint loading and early osteoarthritis after ACL reconstruction. J Orthop Res 2023; 41:1419-1429. [PMID: 36751892 PMCID: PMC10946851 DOI: 10.1002/jor.25504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/21/2022] [Accepted: 12/07/2022] [Indexed: 02/09/2023]
Abstract
Patellofemoral joint (PFJ) osteoarthritis is common following anterior cruciate ligament reconstruction (ACLR) and may be linked with altered joint loading. However, little is known about the cross-sectional and longitudinal relationship between PFJ loading and osteoarthritis post-ACLR. This study tested if altered PFJ loading is associated with prevalent and worsening early PFJ osteoarthritis post-ACLR. Forty-six participants (mean ± 1 SD age 26 ± 5 years) approximately 1-year post-ACLR underwent magnetic resonance imaging (MRI) and biomechanical assessment of their reconstructed knee. Trunk and lower-limb kinematics plus ground reaction forces were recorded during the landing phase of a standardized forward hop. These data were input into a musculoskeletal model to calculate the PFJ contact force. Follow-up MRI was completed on 32 participants at 5-years post-ACLR. Generalized linear models (Poisson regression) assessed the relationship between PFJ loading and prevalent early PFJ osteoarthritis (i.e., presence of a PFJ cartilage lesion at 1-year post-ACLR) and worsening PFJ osteoarthritis (i.e., incident/progressive PFJ cartilage lesion between 1- and 5-years post-ACLR). A lower peak PFJ contact force was associated with prevalent early PFJ osteoarthritis at 1-year post-ACLR (n = 14 [30.4%]; prevalence ratio: 1.37; 95% confidence interval [CI]: 1.02-1.85) and a higher risk of worsening PFJ osteoarthritis between 1- and 5-years post-ACLR (n = 9 [28.1%]; risk ratio: 1.55, 95% CI: 1.13-2.11). Young adults post-ACLR who exhibited lower PFJ loading during hopping were more likely to have early PFJ osteoarthritis at 1-year and worsening PFJ osteoarthritis between 1- and 5-years. Clinical interventions aimed at mitigating osteoarthritis progression may be beneficial for those with signs of lower PFJ loading post-ACLR.
Collapse
Affiliation(s)
- Anthony G. Schache
- La Trobe Sports & Exercise Medicine Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Prasanna Sritharan
- La Trobe Sports & Exercise Medicine Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Adam G. Culvenor
- La Trobe Sports & Exercise Medicine Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Brooke E. Patterson
- La Trobe Sports & Exercise Medicine Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Luke G. Perraton
- Department of PhysiotherapyMonash UniversityMelbourneVictoriaAustralia
| | - Adam L. Bryant
- Centre for Health, Exercise & Sports MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Ali Guermazi
- Department of RadiologyBoston University School of MedicineBostonMassachusettsUSA
| | - Hayden G. Morris
- Park Clinic OrthopaedicsSt Vincent's Private HospitalMelbourneVictoriaAustralia
| | | | - Kay M. Crossley
- La Trobe Sports & Exercise Medicine Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| |
Collapse
|
8
|
Zhang M, Liu C, Lin H, Wang H, Qin L, Zhang Z, Liu C, Lu Y, Yan F, Zhang Y, Wei H. Age-Related Changes in the Spatial Variation of Magnetic Susceptibility of Human Articular Cartilage. J Magn Reson Imaging 2023; 58:198-207. [PMID: 36322382 DOI: 10.1002/jmri.28513] [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: 05/21/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) has shown great potential for revealing the layer structure of articular cartilage based on the laminar susceptibility difference at different depths. However, more information is needed on the effects of age on the spatial distribution of magnetic susceptibility in human cartilage. PURPOSE To assess the ability of QSM to quantify the age-related differences in depth-wise cartilage susceptibility values in healthy populations. STUDY TYPE Prospective. POPULATION A total of 94 healthy asymptomatic subjects in three age cohorts: 19-30 (n = 36, 20 males), 31-50 (n = 45, 27 males), and 51-66 years (n = 13, 7 males). FIELD STRENGTH/SEQUENCE 3D gradient echo sequences at 3.0 T. ASSESSMENT Four cartilage compartments were analyzed, including the central lateral/medial femur (cLF/cMF) and the lateral/medial tibia (LT/MT). The spatial susceptibility profile and the corresponding 95% confidence interval (CI) of each age cohort were obtained as functions of the normalized distance from the bone-cartilage interface to the cartilage surface (cartilage depth from 0.0 to 1.0). STATISTICAL TESTS The relationship between age and cartilage thickness of each cartilage subregion was tested by Pearson correlation with P < 0.05 considered significant. Cartilage depths with separations of 95% CIs were considered to have significant susceptibility differences between two age cohorts with a Bonferroni-corrected P < 0.05. RESULTS The cartilage thickness did not change significantly with age (P value range: 0.06-0.85). Susceptibilities were significantly higher in the 51-66-year-olds compared with the 31-50-year-olds in the deep layer of cMF (cartilage depth: 0.0-0.22) and LT (0.05-0.28). Susceptibilities were significantly higher in the 51-66-year-olds compared with the 19-30-year-olds near the cartilage-bone interface of cMF (0.0-0.34), cLF (0.0-0.28), and LT (0.0-0.58). There were also significantly higher susceptibilities in the 31-50-year-olds compared with the 19-30-year-olds in the deeper regions of cMF (0.26-0.57), cLF (0.0-0.40), and LT (0.07-0.80). DATA CONCLUSION Age-related susceptibility changes in the deeper regions of knee cartilage were observed using QSM. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Ming Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chenglei Liu
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin Lin
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanqi Wang
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Le Qin
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyong Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chunlei Liu
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
| | - Yong Lu
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyao Zhang
- School of Information and Science and Technology, ShanghaiTech University, Shanghai, China
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
9
|
Flannery SW, Murray MM, Badger GJ, Ecklund K, Kramer DE, Fleming BC, Kiapour AM. Early MRI-based quantitative outcomes are associated with a positive functional performance trajectory from 6 to 24 months post-ACL surgery. Knee Surg Sports Traumatol Arthrosc 2023; 31:1690-1698. [PMID: 35704062 PMCID: PMC9751233 DOI: 10.1007/s00167-022-07000-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Quantitative magnetic resonance imaging (qMRI) has been used to determine the failure properties of ACL grafts and native ACL repairs and/or restorations. How these properties relate to future clinical, functional, and patient-reported outcomes remain unknown. The study objective was to investigate the relationship between non-contemporaneous qMRI measures and traditional outcome measures following Bridge-Enhanced ACL Restoration (BEAR). It was hypothesized that qMRI parameters at 6 months would be associated with clinical, functional, and/or patient-reported outcomes at 6 months, 24 months, and changes from 6 to 24 months post-surgery. METHODS Data of BEAR patients (n = 65) from a randomized control trial of BEAR versus ACL reconstruction (BEAR II Trial; NCT02664545) were utilized retrospectively for the present analysis. Images were acquired using the Constructive Interference in Steady State (CISS) sequence at 6 months post-surgery. Single-leg hop test ratios, arthrometric knee laxity values, and International Knee Documentation Committee (IKDC) subjective scores were determined at 6 and 24 months post-surgery. The associations between traditional outcomes and MRI measures of normalized signal intensity, mean cross-sectional area (CSA), volume, and estimated failure load of the healing ACL were evaluated based on bivariate correlations and multivariable regression analyses, which considered the potential effects of age, sex, and body mass index. RESULTS CSA (r = 0.44, p = 0.01), volume (r = 0.44, p = 0.01), and estimated failure load (r = 0.48, p = 0.01) at 6 months were predictive of the change in single-leg hop ratio from 6 to 24 months in bivariate analysis. CSA (βstandardized = 0.42, p = 0.01), volume (βstandardized = 0.42, p = 0.01), and estimated failure load (βstandardized = 0.48, p = 0.01) remained significant predictors when considering the demographic variables. No significant associations were observed between MRI variables and either knee laxity or IKDC when adjusting for demographic variables. Signal intensity was also not significant at any timepoint. CONCLUSION The qMRI-based measures of CSA, volume, and estimated failure load were predictive of a positive functional outcome trajectory from 6 to 24 months post-surgery. These variables measured using qMRI at 6 months post-surgery could serve as prospective markers of the functional outcome trajectory from 6 to 24 months post-surgery, aiding in rehabilitation programming and return-to-sport decisions to improve surgical outcomes and reduce the risk of reinjury. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Sean W Flannery
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Martha M Murray
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Gary J Badger
- Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Kirsten Ecklund
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dennis E Kramer
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Ata M Kiapour
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
| |
Collapse
|
10
|
Flannery SW, Beveridge JE, Proffen BL, Walsh EG, Kramer DE, Murray MM, Kiapour AM, Fleming BC. Predicting anterior cruciate ligament failure load with T 2* relaxometry and machine learning as a prospective imaging biomarker for revision surgery. Sci Rep 2023; 13:3524. [PMID: 36864112 PMCID: PMC9981601 DOI: 10.1038/s41598-023-30637-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
Non-invasive methods to document healing anterior cruciate ligament (ACL) structural properties could potentially identify patients at risk for revision surgery. The objective was to evaluate machine learning models to predict ACL failure load from magnetic resonance images (MRI) and to determine if those predictions were related to revision surgery incidence. It was hypothesized that the optimal model would demonstrate a lower mean absolute error (MAE) than the benchmark linear regression model, and that patients with a lower estimated failure load would have higher revision incidence 2 years post-surgery. Support vector machine, random forest, AdaBoost, XGBoost, and linear regression models were trained using MRI T2* relaxometry and ACL tensile testing data from minipigs (n = 65). The lowest MAE model was used to estimate ACL failure load for surgical patients at 9 months post-surgery (n = 46) and dichotomized into low and high score groups via Youden's J statistic to compare revision incidence. Significance was set at alpha = 0.05. The random forest model decreased the failure load MAE by 55% (Wilcoxon signed-rank test: p = 0.01) versus the benchmark. The low score group had a higher revision incidence (21% vs. 5%; Chi-square test: p = 0.09). ACL structural property estimates via MRI may provide a biomarker for clinical decision making.
Collapse
Affiliation(s)
- Sean W Flannery
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Coro West, Suite 402, 1 Hoppin St, Providence, RI, 02903, USA
| | - Jillian E Beveridge
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Coro West, Suite 402, 1 Hoppin St, Providence, RI, 02903, USA
| | - Benedikt L Proffen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward G Walsh
- Department of Neuroscience, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Dennis E Kramer
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha M Murray
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ata M Kiapour
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Coro West, Suite 402, 1 Hoppin St, Providence, RI, 02903, USA.
| |
Collapse
|
11
|
Flannery SW, Barnes DA, Costa MQ, Menghini D, Kiapour AM, Walsh EG, Kramer DE, Murray MM, Fleming BC. Automated segmentation of the healed anterior cruciate ligament from T 2 * relaxometry MRI scans. J Orthop Res 2023; 41:649-656. [PMID: 35634860 PMCID: PMC9708947 DOI: 10.1002/jor.25390] [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: 01/13/2022] [Revised: 05/16/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023]
Abstract
Collagen organization of the anterior cruciate ligament (ACL) can be evaluated using T2 * relaxometry. However, T2 * mapping requires manual image segmentation, which is a time-consuming process and prone to inter- and intra- segmenter variability. Automating segmentation would address these challenges. A model previously trained using Constructive Interference in Steady State (CISS) scans was applied to T2 * segmentation via transfer learning. It was hypothesized that there would be no significant differences in the model's segmentation performance between T2 * and CISS, structural measures versus ground truth manual segmentation, and reliability versus independent and retest manual segmentation. Transfer learning was conducted using 54 T2 * scans of the ACL. Segmentation performance was assessed with Dice coefficient, precision, and sensitivity, and structurally with T2 * value, volume, subvolume proportions, and cross-sectional area. Model performance relative to independent manual segmentation and repeated segmentation by the ground truth segmenter (retest) were evaluated on a random subset. Segmentation performance was analyzed with Mann-Whitney U tests, structural measures with Wilcoxon signed-rank tests, and performance relative to manual segmentation with repeated-measures analysis of variance/Tukey tests (α = 0.05). T2 * segmentation performance was not significantly different from CISS on all measures (p > 0.35). No significant differences were detected in structural measures (p > 0.50). Automatic segmentation performed as well as the retest on all segmentation measures, whereas independent segmentations were lower than retest and/or automatic segmentation (p < 0.023). Structural measures were not significantly different between segmenters. The automatic segmentation model performed as well on the T2 * sequence as on CISS and outperformed independent manual segmentation while performing as well as retest segmentation.
Collapse
Affiliation(s)
- Sean W. Flannery
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Dominique A. Barnes
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Meggin Q. Costa
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Danilo Menghini
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ata M. Kiapour
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward G. Walsh
- Department of Neuroscience, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Dennis E. Kramer
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| |
Collapse
|
12
|
Mabrouk AM, Abd El Raaof MM, Hemaida TW, Bassiouny AM. Degenerative changes through MR cartilage mapping in anterior cruciate ligament-reconstructed knees. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023; 54:38. [DOI: 10.1186/s43055-022-00952-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/27/2022] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
Anterior cruciate ligament (ACL) injury increases risk for post traumatic knee osteoarthritis. ACL injury causes lack of knee stability and frequently requires ACL-reconstruction (ACLR) in order to restore functional and anatomical joint stability. Magnetic resonance imaging with T2 mapping sequence is used to quantify the amount of water content in articular cartilage hence; it is considered a better tool and more beneficial than radiographic based assessment in early detection even before being symptomatic. The aim of work is to estimate the incidence of subclinical degenerative changes that happened early in patients who underwent ACL reconstruction and to identify the correlations of T2 mapping values with patients' BMI, meniscal state/operations, ACL graft assessment and presence of ACLR related complications.
Results
The study was conducted upon 71 patients, divided into 61 anterior cruciate ligament reconstructed knees and 10 control cases using 1.5 T MRI. Assessment of cartilage sub-compartment T2 values and comparison with average normal cartilage T2 values obtained from the control group. Multiple correlations of the grade of articular cartilage degeneration within anterior cruciate ligament reconstructed knees with Body Mass Index (BMI), time of operation as well associated meniscal operations and anterior cruciate ligament graft complications.
Conclusions
Adding the T2 cartilage mapping sequence improves the ability to detect subclinical early degenerative articular cartilage changes in patients who underwent anterior cruciate ligament reconstruction, taking into consideration the relation of the patients' BMI, previous meniscal injuries/operation, ACL graft status and related graft complications with the T2 cartilage mapping values.
Collapse
|
13
|
Lombardi AF, Guma M, Chung CB, Chang EY, Du J, Ma YJ. Ultrashort echo time magnetic resonance imaging of the osteochondral junction. NMR IN BIOMEDICINE 2023; 36:e4843. [PMID: 36264245 PMCID: PMC9845195 DOI: 10.1002/nbm.4843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Osteoarthritis is a common chronic degenerative disease that causes pain and disability with increasing incidence worldwide. The osteochondral junction is a dynamic region of the joint that is associated with the early development and progression of osteoarthritis. Despite the substantial advances achieved in the imaging of cartilage and application to osteoarthritis in recent years, the osteochondral junction has received limited attention. This is primarily related to technical limitations encountered with conventional MR sequences that are relatively insensitive to short T2 tissues and the rapid signal decay that characterizes these tissues. MR sequences with ultrashort echo time (UTE) are of great interest because they can provide images of high resolution and contrast in this region. Here, we briefly review the anatomy and function of cartilage, focusing on the osteochondral junction. We also review basic concepts and recent applications of UTE MR sequences focusing on the osteochondral junction.
Collapse
Affiliation(s)
- Alecio F. Lombardi
- Department of Radiology, University of California San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
| | - Monica Guma
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
- Department of Medicine, University of California San Diego, CA, United States
| | - Christine B. Chung
- Department of Radiology, University of California San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
| | - Eric Y. Chang
- Department of Radiology, University of California San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
| | - Jiang Du
- Department of Radiology, University of California San Diego, CA, United States
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, CA, United States
| |
Collapse
|
14
|
Flannery SW, Walsh EG, Sanborn RM, Chrostek CA, Costa MQ, Kaushal SG, Murray MM, Fleming BC, Kiapour AM. Reproducibility and postacquisition correction methods for quantitative magnetic resonance imaging of the anterior cruciate ligament (ACL). J Orthop Res 2022; 40:2908-2913. [PMID: 35266588 PMCID: PMC9463398 DOI: 10.1002/jor.25319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Quantitative magnetic resonance imaging has been used to evaluate the structural integrity of knee joint structures. However, variations in acquisition parameters between scanners pose significant challenges. Understanding the effect of small differences in acquisition parameters for quantitative sequences is vital to the validity of cross-institutional studies, and for the harmonization of large, heterogeneous datasets to train machine learning models. The study objective was to assess the reproducibility of T2 * relaxometry and the constructive interference in steady-state sequence (CISS) across scanners, with minimal hardware-necessitated changes to acquisition parameters. It was hypothesized that there would be no significant differences between scanners in anterior cruciate ligament T2 * relaxation times and CISS signal intensities (SI). Secondarily, it was hypothesized that differences could be corrected by rescaling the SI distribution to harmonize between scanners. Seven volunteers were scanned on 3T Prisma and Tim Trio scanners (Siemens). Three correction methods were evaluated for T2 *: inverse echo time scaling, z-scoring, and Nyúl histogram matching. For CISS, scans were normalized to cortical bone, scaled by the background noise ratio, and log-transformed. Before correction, significant mean differences of 6.0 ± 3.2 ms (71.8%; p = 0.02) and 0.49 ± 0.15 units (40.7%; p = 0.02) for T2 * and CISS across scanners were observed, respectively. After rescaling, T2 * differences decreased to 2.6 ± 2.7 ms (23.9%; p = 0.03), 1.3 ± 2.5 ms (10.9%; p = 0.13), and 1.27 ± 3.0 ms (19.6%; p = 0.40) for inverse echo time, z-scoring, and Nyúl, respectively, while CISS decreased to 0.01 ± 0.11 units (4.0%; p = 0.87). These findings suggest that small acquisition parameter differences may lead to large changes in T2 * and SI values that must be reconciled to compare data across magnets.
Collapse
Affiliation(s)
- Sean W. Flannery
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Edward G. Walsh
- Department of Neuroscience, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Ryan M. Sanborn
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Cynthia A. Chrostek
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Meggin Q. Costa
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Shankar G. Kaushal
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha M. Murray
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Ata M. Kiapour
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Werner DM, Golightly YM, Tao M, Post A, Wellsandt E. Environmental Risk Factors for Osteoarthritis: The Impact on Individuals with Knee Joint Injury. Rheum Dis Clin North Am 2022; 48:907-930. [PMID: 36333003 DOI: 10.1016/j.rdc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteoarthritis is a debilitating chronic condition involving joint degeneration, impacting over 300 million people worldwide. This places a high social and economic burden on society. The knee is the most common joint impacted by osteoarthritis. A common cause of osteoarthritis is traumatic joint injury, specifically injury to the anterior cruciate ligament. The purpose of this review is to detail the non-modifiable and modifiable risk factors for osteoarthritis with particular focus on individuals after anterior cruciate ligament injury. After reading this, health care providers will better comprehend the wide variety of factors linked to osteoarthritis.
Collapse
Affiliation(s)
- David M Werner
- Office of Graduate Studies, Medical Sciences Interdepartmental Area, University of Nebraska Medical Center, 987815 Nebraska Medical Center, Omaha, NE 68198-7815, USA; Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA.
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center Omaha, NE 68198-4035, USA
| | - Matthew Tao
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Austin Post
- College of Medicine, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA; Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, 984420 Nebraska Medical Center, Omaha, NE 68198-4420, USA
| |
Collapse
|
16
|
Su J, Wan H, Pang Y, Lu Y, Liang J, Yan Z, Xu S, Sun T. Trans-Posterior Cruciate Ligament All-Inside Root Repair Versus Partial Meniscectomy for Medial Meniscus Posterior Root Tears: Comparison of Semiquantitative and Quantitative MRI Outcomes in Cartilage Degeneration and Osteoarthritic Progression. Cartilage 2022; 13:19476035221114242. [PMID: 35932104 PMCID: PMC9364209 DOI: 10.1177/19476035221114242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To perform conventional, morphological, and T2 mapping compositional MRI imaging to assess the cartilage degeneration and osteoarthritic progression in patients with medial meniscus posterior root tears (MMPRTs) who underwent trans-posterior cruciate ligament (PCL) all-inside repair or partial meniscectomy. DESIGN Patients with MMPRTs after trans-PCL all-inside repair (group AR) or partial meniscectomy (group PM) between 2015 and 2018 were retrospectively identified. Preoperative and postoperative conventional MRI were collected to assess medial meniscus extrusion (MME) and the whole-organ magnetic resonance imaging score (WORMS). Postoperative morphological MRI and T2 mapping compositional MRI were collected to evaluate the quantitative cartilage thickness/volume and cartilage composition. RESULTS The final cohort consisted of 21 patients in group AR and 22 patients in group PM, with no differences in demographic data and baseline patient characteristics between the 2 groups. Group AR demonstrated less progression of articular cartilage wear (P < 0.05) and decreased meniscal extrusion (P = 0.008) than group PM at the final follow-up. In addition, group AR demonstrated less extracellular matrix degeneration in the cartilage subregion of the medial compartment (P < 0.05) than group PM with lower T2 relaxation times in the superficial layer of the articular cartilage. CONCLUSION Trans-PCL all-inside repair of MMPRTs could delay the initial cartilage deterioration and morphological cartilage degeneration compared with partial meniscectomy. However, the amount of residual meniscal extrusion is clinically important, and an improved root repair fixation method should be investigated.
Collapse
Affiliation(s)
- Jiarong Su
- Arthritis Clinic and Research Center,
Peking University People’s Hospital, Beijing, China
| | | | - Yingchang Pang
- Arthritis Clinic and Research Center,
Peking University People’s Hospital, Beijing, China
| | - Yanli Lu
- Beijing Longfu Hospital, Beijing,
China
| | - Jiaming Liang
- Arthritis Clinic and Research Center,
Peking University People’s Hospital, Beijing, China
| | | | - Sibo Xu
- Arthritis Clinic and Research Center,
Peking University People’s Hospital, Beijing, China
| | - Tiezheng Sun
- Arthritis Clinic and Research Center,
Peking University People’s Hospital, Beijing, China,Tiezheng Sun, Arthritis Clinic and Research
Center, Peking University People’s Hospital, 11 Xizhimen South Street, Xicheng
District, Beijing 100044, China.
| |
Collapse
|
17
|
Ligamentization of the reconstructed ACL differs between the intraarticular and intraosseous regions: A quantitative assessment using UTE-T2* mapping. PLoS One 2022; 17:e0271935. [PMID: 35867680 PMCID: PMC9307199 DOI: 10.1371/journal.pone.0271935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of this study was to prospectively observe the trends of ultrashort echo time (UTE)-T2* values for the intraarticular and intraosseous regions of reconstructed anterior cruciate ligaments from 6 to 12 months after anterior cruciate ligament reconstruction by using UTE-T2* mapping, and to investigate the changes and differences over time in each region. Methods Ten patients underwent UTE-T2* mapping of the operated knee at 6, 9, and 12 months after anterior cruciate ligament reconstruction. The UTE-T2* values of intraarticular and intraosseous regions of reconstructed anterior cruciate ligaments at 6, 9, and 12 months postoperatively were statistically compared. Results The UTE-T2* values of the intraarticular region at 6 months postoperatively were significantly higher than those at 9 and 12 months. There were no significant differences in the UTE-T2* values at 6, 9, and 12 months postoperatively in the intraosseous region. At 6 months postoperatively, the UTE-T2* values of the intraarticular region were significantly higher than those of the intraosseous region. The UTE-T2* values of the intraosseous region at the tibia were significantly lower than those of the other sites at any postoperative time point. Conclusions According to UTE-T2*mapping-based findings, histological maturation of reconstructed ACLs is faster in the intraosseous region than in the intraarticular region. In particular, the intraarticular region is still undergoing rapid histologic changes at 6 months postoperatively, and its tissue structure is less substantial than normal. The findings of this study may provide clues to determine the optimal timing for safe return to sports in terms of ligamentaization of reconstructed ACLs.
Collapse
|
18
|
Su X, Zhang Y, Gao Q, Liang Z, Wan L, Zhang L, Tang G. Preliminary study on the assessment of early cartilage degeneration by quantitative ultrashort echo time magnetic resonance imaging in vivo. Quant Imaging Med Surg 2022; 12:3803-3812. [PMID: 35782245 PMCID: PMC9246734 DOI: 10.21037/qims-21-1181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/14/2022] [Indexed: 12/31/2023]
Abstract
BACKGROUND To investigate the feasibility of quantitative ultrashort echo time magnetic resonance imaging (UTE-MRI) techniques for assessing early cartilage degeneration in vivo. METHODS A total of 46 patients with knee pain due to osteoarthritis (OA) as the main complaint were recruited into the study. We performed MRI examinations with different quantitative UTE-MRI techniques, including UTE-based magnetization transfer (MT), UTE-adiabaticT1ρ, and UTE-T2* mapping on a 3.0T clinical magnetic resonance (MR) scanner (MR750; GE Healthcare, Milwaukee, WI, USA). Three regions of interest (ROIs) were manually drawn on the medial and lateral femoral condyles and the corresponding medial and lateral tibial plateaus, respectively. A total of 561 ROIs (12 ROIs for each knee) were finally included and divided into 3 groups according to the MRI Osteoarthritis Knee Score (MOAKS): normal (MOAKS 0, n=175), mild degeneration (MOAKS 1, n=283), and moderate degeneration (MOAKS 2, n=103). One-way analysis of variance (ANOVA) and Tamhane's T2 test were used to compare the differences of quantitative UTE-biomarkers among different groups. The analysis of Spearman's correlation was used to assess the correlation between the UTE-biomarkers and MOAKS grading. The diagnostic efficacy of different quantitative UTE-MRI techniques for detecting mild cartilage degeneration was evaluated using the receiver operating characteristic (ROC) curve. RESULTS The UTE-MT ratio (UTE-MTR) and the UTE-adiabatic T1ρ values had a moderate correlation with the MOAKS grading (r=-0.523, P<0.001; r=0.531, P<0.001, respectively), while the UTE-T2* was weakly correlated with the MOAKS grading (r=-0.396, P<0.001). For the normal group (MOAKS 0) and the mild group (MOAKS 1), the UTE-MTR values were 21.09%±3.03% and 17.30%±3.22%, respectively. The UTE-adiabatic T1ρ values were 30.43±6.26 ms and 35.05±8.78 ms for the normal group (MOAKS 0) and the mild group (MOAKS 1), respectively. With respect to the UTE-T2* values, the normal group (MOAKS 0) values were 21.49±3.96 ms and the mild group (MOAKS 1) values were 19.86±3.08 ms. All the differences between the 2 groups of the 3 UTE-MRI values were significant. The AUCs of the UTE-MTR, UTE-adiabatic T1ρ, and UTE-T2* mapping were 0.794, 0.732, and 0.651, respectively. CONCLUSIONS The quantitative UTE-MRI techniques (UTE-MT, UTE-adiabatic T1ρ, and UTE-T2* mapping) show great promise for assessing the early degeneration of articular cartilage in vivo, and the UTE-MT and UTE-adiabatic T1ρ values show better diagnostic efficacy than UTE-T2* mapping.
Collapse
Affiliation(s)
- Xiaolian Su
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yixuan Zhang
- Department of Radiology, Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Cangzhou, China
| | - Qiuming Gao
- Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zonghui Liang
- Department of Radiology, Shanghai Jing’an District Central Hospital, Shanghai, China
| | - Lidi Wan
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lin Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
19
|
Wu LL, Liu LH, Rao SX, Wu PY, Zhou JJ. Ultrashort time-to-echo T2* and T2* relaxometry for evaluation of lumbar disc degeneration: a comparative study. BMC Musculoskelet Disord 2022; 23:524. [PMID: 35650645 PMCID: PMC9161611 DOI: 10.1186/s12891-022-05481-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background To compare potential of ultrashort time-to-echo (UTE) T2* mapping and T2* values from T2*-weighted imaging for assessing lumbar intervertebral disc degeneration (IVDD),with Pfirrmann grading as a reference standard. Methods UTE-T2* and T2* values of 366 lumbar discs (L1/2-L5/S1) in 76 subjects were measured in 3 segmented regions: anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus. Lumbar intervertebral discs were divided into 3 categories based on 5-level Pfirrmann grading: normal (Pfirrmann grade I),early disc degeneration (Pfirrmann grades II-III), and advanced disc degeneration (Pfirrmann grades IV-V). Regional differences between UTE-T2* and T2* relaxometry and correlation with degeneration were statistically analyzed. Results UTE-T2* and T2*value correlated negatively with Pfirrmann grades (P < 0.001). In NP, correlations with Pfirrmann grade were high with UTE-T2* values (r = − 0.733; P < 0.001) and moderate with T2* values (r = -0.654; P < 0.001). Diagnostic accuracy of detecting early IVDD was better with UTE-T2* mapping than T2* mapping (P < 0.05),with receiver operating characteristic analysis area under the curve of 0.715–0.876. Conclusions UTE-T2* relaxometry provides another promising magnetic resonance imaging sequence for quantitatively evaluate lumbar IVDD and was more accurate than T2*mapping in the earlier stage degenerative process.
Collapse
Affiliation(s)
- Li-Lan Wu
- Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Li-Heng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, shanghai, China.,Shanghai Institute of Medical Imaging, shanghai, China
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, shanghai, China.,Shanghai Institute of Medical Imaging, shanghai, China
| | | | - Jian-Jun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, shanghai, China. .,Shanghai Institute of Medical Imaging, shanghai, China.
| |
Collapse
|
20
|
Wong TT, Quarterman P, Lynch TS, Rasiej MJ, Jaramillo D, Jambawalikar SR. Feasibility of ultrashort echo time (UTE) T2* cartilage mapping in the hip: a pilot study. Acta Radiol 2022; 63:760-766. [PMID: 33926266 DOI: 10.1177/02841851211011563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrashort echo time (UTE) T2* is sensitive to molecular changes within the deep calcified layer of cartilage. Feasibility of its use in the hip needs to be established to determine suitability for clinical use. PURPOSE To establish feasibility of UTE T2* cartilage mapping in the hip and determine if differences in regional values exist. MATERIAL AND METHODS MRI scans with UTE T2* cartilage maps were prospectively acquired on eight hips. Hip cartilage was segmented into whole and deep layers in anterosuperior, superior, and posterosuperior regions. Quantitative UTE T2* maps were analyzed (independent one-way ANOVA) and reliability was calculated (ICC). RESULTS UTE T2* mean values (anterosuperior, superior, posterosuperior): full femoral layer (19.55, 18.43, 16.84 ms) (P=0.004), full acetabular layer (19.37, 17.50, 16.73 ms) (P=0.013), deep femoral layer (18.68, 17.90, 15.74 ms) (P=0.010), and deep acetabular layer (17.81, 16.18, 15.31 ms) (P=0.007). Values were higher in anterosuperior compared to posterosuperior regions (mean difference; 95% confidence interval [CI]): full femur layer (2.71 ms; 95% CI 0.91-4.51: P=0.003), deep femur layer (2.94 ms; 95% CI 0.69-5.19; P=0.009), full acetabular layer (2.63 ms 95% CI 0.55-4.72; P=0.012), and deep acetabular layer (2.50 ms; 95% CI 0.69-4.30; P=0.006). Intra-reader (ICC 0.89-0.99) and inter-reader reliability (ICC 0.63-0.96) were good to excellent for the majority of cartilage layers. CONCLUSION UTE T2* cartilage mapping was feasible in the hip with mean values in the range of 16.84-19.55 ms in the femur and 16.73-19.37 ms in the acetabulum. Significantly higher values were present in the anterosuperior region compared to the posterosuperior region.
Collapse
Affiliation(s)
- Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
| | | | - Thomas S Lynch
- Department of Orthopedics, The Center for Shoulder, Elbow, and Sports Medicine, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
| | - Michael J Rasiej
- Department of Radiology, Division of Musculoskeletal Radiology, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
| | - Diego Jaramillo
- Department of Radiology, Division of Pediatric Radiology, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
| | - Sachin R Jambawalikar
- Department of Radiology, Division of Physics, New York Presbyterian Hospital – Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
21
|
Wellsandt E, Kallman T, Golightly Y, Podsiadlo D, Dudley A, Vas S, Michaud K, Tao M, Sajja B, Manzer M. Knee joint unloading and daily physical activity associate with cartilage T2 relaxation times 1 month after ACL injury. J Orthop Res 2022; 40:138-149. [PMID: 33783030 PMCID: PMC8478972 DOI: 10.1002/jor.25034] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/14/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is prevalent after anterior cruciate ligament (ACL) injury, but mechanismsunderlying its development are poorly understood. The purpose of this study was to determine if gait biomechanics and daily physical activity (PA) associate with cartilage T2 relaxation times, a marker of collagen organization and water content, 1 month after ACL injury. Twenty-seven participants (15-35 years old) without chondral lesions completed magnetic resonance imaging, three-dimensional gait analysis, and 1 week of PA accelerometry. Interlimb differences and ratios were calculated for gait biomechanics and T2 relaxation times, respectively. Multiple linear regression models adjusted for age, sex, and concomitant meniscus injury were used to determine the association between gait biomechanics and PA with T2 relaxation times, respectively. Altered knee adduction moment (KAM) impulse, less knee flexion excursion (kEXC) and higher daily step counts accounted for 35.8%-65.8% of T2 relaxation time variation in the weightbearing and posterior cartilage of the medial and lateral compartment (all p ≤ .011). KAM impulse was the strongest factor for T2 relaxation times in all models (all p ≤ .001). Lower KAM impulse associated with longer T2 relaxation times in the injured medial compartment (β = -.720 to -.901) and shorter T2 relaxation in the lateral compartment (β = .713 to .956). At 1 month after ACL injury, altered KAM impulse, less kEXC, and higher PA associated with longer T2 relaxation times, which may indicate poorer cartilage health. Statement of Clinical Significance: Gait biomechanics and daily PA are modifiable targets that may improve cartilage health acutely after ACL injury and slow progression to OA.
Collapse
Affiliation(s)
- Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA,Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tyler Kallman
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Yvonne Golightly
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Podsiadlo
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Andrew Dudley
- Department of Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Stephanie Vas
- Department of Clinical Diagnostic and Therapeutic Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaleb Michaud
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA,Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USA
| | - Matthew Tao
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA,Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Balasrinivasa Sajja
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa Manzer
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
22
|
Afsahi AM, Sedaghat S, Moazamian D, Afsahi G, Athertya JS, Jang H, Ma YJ. Articular Cartilage Assessment Using Ultrashort Echo Time MRI: A Review. Front Endocrinol (Lausanne) 2022; 13:892961. [PMID: 35692400 PMCID: PMC9178905 DOI: 10.3389/fendo.2022.892961] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/14/2022] [Indexed: 01/05/2023] Open
Abstract
Articular cartilage is a major component of the human knee joint which may be affected by a variety of degenerative mechanisms associated with joint pathologies and/or the aging process. Ultrashort echo time (UTE) sequences with a TE less than 100 µs are capable of detecting signals from both fast- and slow-relaxing water protons in cartilage. This allows comprehensive evaluation of all the cartilage layers, especially for the short T2 layers which include the deep and calcified zones. Several ultrashort echo time (UTE) techniques have recently been developed for both morphological imaging and quantitative cartilage assessment. This review article summarizes the current catalog techniques based on UTE Magnetic Resonance Imaging (MRI) that have been utilized for such purposes in the human knee joint, such as T1, T2∗ , T1ρ, magnetization transfer (MT), double echo steady state (DESS), quantitative susceptibility mapping (QSM) and inversion recovery (IR). The contrast mechanisms as well as the advantages and disadvantages of these techniques are discussed.
Collapse
Affiliation(s)
- Amir Masoud Afsahi
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Sam Sedaghat
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Dina Moazamian
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Ghazaleh Afsahi
- Department of Biotechnology Research, BioSapien, San Diego, CA, United States
| | - Jiyo S. Athertya
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- *Correspondence: Ya-Jun Ma,
| |
Collapse
|
23
|
Williams JR, Neal K, Alfayyadh A, Lennon K, Capin JJ, Khandha A, Manal K, Potter HG, Snyder-Mackler L, Buchanan TS. Knee cartilage T 2 relaxation times 3 months after ACL reconstruction are associated with knee gait variables linked to knee osteoarthritis. J Orthop Res 2022; 40:252-259. [PMID: 33783867 PMCID: PMC8481340 DOI: 10.1002/jor.25043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis development after ACL reconstruction (ACLR) is not well understood. Investigators have examined associations between knee biomechanical alterations and quantitative MRI (qMRI) variables, reflective of cartilage health, 12-60 months following ACLR; however, none have done so early after surgery. As part of an exploratory study, 45 individuals (age, 23 ± 7 years) underwent motion analysis during walking and qMRI 3 months after ACLR. For each limb, peak knee adduction moment (pKAM) and peak knee flexion moment (pKFM) were determined using inverse dynamics and peak medial compartment force was calculated using a neuromusculoskeletal model. T2 relaxation times in the medial compartment and linear regressions were used to determine the associations between gait variables and deep and superficial cartilage T2 relaxation times in six regions. pKAM was positively associated with deep layer T2 relaxation times within the femoral central and posterior regions when examined in the involved limb and from an interlimb difference perspective (involved limb - uninvolved limb). After adjusting for age, the association between interlimb difference of pKAM and interlimb difference of deep layer T2 relaxation times in the tibial central region became significant (p = .043). Interlimb difference of pKFM was negatively associated with interlimb difference of deep layer T2 relaxation times within the femoral central and posterior regions. These associations suggest that degenerative pathways leading to osteoarthritis may be detectable as early as 3 months after reconstruction. Preventative therapeutic techniques may need to be employed early in the rehabilitation process to prevent cartilage degradation.
Collapse
Affiliation(s)
- Jack R. Williams
- Department of Mechanical Engineering, University of
Delaware, Newark, DE
| | - Kelsey Neal
- Department of Mechanical Engineering, University of
Delaware, Newark, DE
| | | | - Kendra Lennon
- Department of Physical Therapy, University of Delaware,
Newark, DE
| | - Jacob J. Capin
- Biomechanics and Movement Science, University of Delaware,
Newark, DE,Department of Physical Therapy, University of Delaware,
Newark, DE,Physical Therapy Program, Department of Physical Medicine
and Rehabilitation, University of Colorado, Aurora, CO,Eastern Colorado VA Geriatric Research Education and
Clinical Center (GRECC), Aurora, CO
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of
Delaware, Newark, DE
| | - Kurt Manal
- Kinesiology and Applied Physiology, University of Delaware,
Newark, DE
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special
Surgery, New York, NY
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware,
Newark, DE,Department of Physical Therapy, University of Delaware,
Newark, DE,Department of Biomedical Engineering, University of
Delaware, Newark, DE
| | - Thomas S. Buchanan
- Department of Mechanical Engineering, University of
Delaware, Newark, DE,Biomechanics and Movement Science, University of Delaware,
Newark, DE,Department of Biomedical Engineering, University of
Delaware, Newark, DE
| |
Collapse
|
24
|
Chu CR. Can we afford to ignore the biology of joint healing and graft incorporation after ACL reconstruction? J Orthop Res 2022; 40:55-64. [PMID: 34314066 DOI: 10.1002/jor.25145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction is successful at restoring stability to return ACL injured patients to high-demand work, sports, and recreational activities. The development of posttraumatic osteoarthritis (OA) in roughly half of patients just 10-15 years after ACLR highlight the need to improve clinical care pathways. Graft failure and reinjury rates, which further increase OA risk, also remain high for younger and more active patients. The biological components of joint recovery and graft incorporation, therefore, impact short- and long-term clinical outcomes. Biochemical and magnetic resonance imaging (MRI) data show substantial compromise of articular cartilage metabolism and matrix composition after ACL injury and reconstructive surgery suggesting a potential need for activity modulation in early recovery. Furthermore, joint recovery is variable with compositional MRI studies showing progressive cartilage degeneration 1 and 2 years after ACLR. Biopsy and MRI studies also show high variability in ACL graft characteristics within the 1st year after ACLR followed by continued graft maturation into the 2nd year and beyond. To improve the care of ACL injured patients, there is a critical need for clinical attention and scientific inquiry into timing the reintroduction of higher load activities in relationship to neuromuscular recovery, joint biology, and graft maturation. In addition to symptomatic and mechanical recovery, development and validation of biological markers for joint and cartilage homeostasis as well as ACL graft healing are needed for personalized decision making on rehabilitation needs, reduction of OA risk, and resumption of athletic, recreational, and vocational activities.
Collapse
Affiliation(s)
- Constance R Chu
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Livermore, California, USA
| |
Collapse
|
25
|
Flannery SW, Kiapour AM, Edgar DJ, Murray MM, Beveridge JE, Fleming BC. A transfer learning approach for automatic segmentation of the surgically treated anterior cruciate ligament. J Orthop Res 2022; 40:277-284. [PMID: 33458865 PMCID: PMC8285460 DOI: 10.1002/jor.24984] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
Quantitative magnetic resonance imaging enables quantitative assessment of the healing anterior cruciate ligament or graft post-surgery, but its use is constrained by the need for time consuming manual image segmentation. The goal of this study was to validate a deep learning model for automatic segmentation of repaired and reconstructed anterior cruciate ligaments. We hypothesized that (1) a deep learning model would segment repaired ligaments and grafts with comparable anatomical similarity to intact ligaments, and (2) automatically derived quantitative features (i.e., signal intensity and volume) would not be significantly different from those obtained by manual segmentation. Constructive Interference in Steady State sequences were acquired of ACL repairs (n = 238) and grafts (n = 120). A previously validated model for intact ACLs was retrained on both surgical groups using transfer learning. Anatomical performance was measured with Dice coefficient, sensitivity, and precision. Quantitative features were compared to ground truth manual segmentation. Automatic segmentation of both surgical groups resulted in decreased anatomical performance compared to intact ACL automatic segmentation (repairs/grafts: Dice coefficient = .80/.78, precision = .79/.78, sensitivity = .82/.80), but neither decrease was statistically significant (Kruskal-Wallis: Dice coefficient p = .02, precision p = .09, sensitivity p = .17; Dunn post-hoc test for Dice coefficient: repairs/grafts p = .054/.051). There were no significant differences in quantitative features between the ground truth and automatic segmentation of repairs/grafts (0.82/2.7% signal intensity difference, p = .57/.26; 1.7/2.7% volume difference, p = .68/.72). The anatomical similarity performance and statistical similarities of quantitative features supports the use of this automated segmentation model in quantitative magnetic resonance imaging pipelines, which will accelerate research and provide a step towards clinical applicability.
Collapse
Affiliation(s)
- Sean W. Flannery
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Ata M. Kiapour
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - David J. Edgar
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Martha M. Murray
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jillian E. Beveridge
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| |
Collapse
|
26
|
Hu Y, Wu Q, Qiao Y, Zhang P, Dai W, Tao H, Chen S. Disturbances in Metabolic Pathways and the Identification of a Potential Biomarker Panel for Early Cartilage Degeneration in a Rabbit Anterior Cruciate Ligament Transection Model. Cartilage 2021; 13:1376S-1387S. [PMID: 32441117 PMCID: PMC8804857 DOI: 10.1177/1947603520921434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to assess the association between synovial fluid (SF) metabolites and magnetic resonance imaging (MRI) measurements of cartilage biochemical composition to identify potential SF biomarkers for detecting the early onset of cartilage degeneration in a rabbit model. METHODS Both knees of 12 New Zealand White rabbits were used. The anterior cruciate ligament transection (ACLT) model was performed on right knees, and the sham surgery on left knees. MRI UTE-T2* scanning and SF sample collection were performed on ACLT knees at 4 and 8 weeks postsurgery and on sham surgery knees at 4 weeks postsurgery. Ultra-performance liquid chromatography-mass spectrometry and multivariate statistical analysis were used to distinguish samples in three groups. Pathway and receiver operating characteristic analyses were utilized to identify potential metabolite biomarkers. RESULTS There were 12 knees in sham surgery models, 11 in ACLT models at 4 weeks postsurgery, and 10 in ACLT models at 8 weeks postsurgery. UTE-T2* values for the lateral tibia cartilage showed significant decreases over the study period. Levels of 103 identified metabolites in SF were markedly different among three groups. Furthermore, 24 metabolites were inversely correlated with UTE-T2* values of the lateral tibia cartilage, while hippuric acid was positively correlated with UTE-T2* values of the lateral tibia cartilage. Among 25 potential markers, N1-acetylspermidine, 2-amino-1,3,4-octadecanetriol, l-phenylalanine, 5-hydroxy-l-tryptophan, and l-tryptophan were identified as potential biomarkers with high area under the curve values and Pearson correlation coefficients. CONCLUSION Five differential metabolites in SF were found as potential biomarkers for the early detection of cartilage degeneration in the rabbit ACLT model.
Collapse
Affiliation(s)
- Yiwen Hu
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Qian Wu
- Shanghai Center for Bioinformation Technology & Shanghai Engineering Research Center of Pharmaceutical Translation, Shanghai Industrial Technology Institute, Shanghai, China
| | - Yang Qiao
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Peng Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wentao Dai
- Shanghai Center for Bioinformation Technology & Shanghai Engineering Research Center of Pharmaceutical Translation, Shanghai Industrial Technology Institute, Shanghai, China
| | - Hongyue Tao
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
27
|
Shimomura K, Hamada H, Hart DA, Ando W, Nishii T, Trattnig S, Nehrer S, Nakamura N. Histological Analysis of Cartilage Defects Repaired with an Autologous Human Stem Cell Construct 48 Weeks Postimplantation Reveals Structural Details Not Detected by T2-Mapping MRI. Cartilage 2021; 13:694S-706S. [PMID: 33511856 PMCID: PMC8808920 DOI: 10.1177/1947603521989423] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to elucidate the efficacy of T2-mapping MRI and correlation with histology for the evaluation of tissue repair quality following the first-in-human implantation of an autologous tissue engineered construct. DESIGN We directly compared the results of T2-mapping MRI of cartilage repair tissue with the histology of a biopsy specimen from the corresponding area at 48 weeks postoperatively in 5 patients who underwent the implantation of a scaffold-free tissue-engineered construct generated from autologous synovial mesenchymal stem cells to repair an isolated cartilage lesion. T2 values and histological scores were compared at each of 2 layers of equally divided halves of the repair tissue (upper and lower zones). RESULTS Histology showed that the repair tissue in the upper zone was dominated by fibrous tissue and the ratio of hyaline-like matrix increased with the depth of the repair tissue. There were significant differences between upper and lower zones in histological scores. Conversely, there were no detectable statistically significant differences in T2 value detected among zones of the repair tissue, but zonal differences were detected in corresponding healthy cartilage. Accordingly, there were no correlations detected between histological scores and T2 values for each repair cartilage zone. CONCLUSION Discrepancies in the findings between T2 mapping and histology suggest that T2 mapping was limited in ability to detect details in the architecture and composition of the repair cartilage.
Collapse
Affiliation(s)
- Kazunori Shimomura
- Department of Orthopaedic Surgery, Osaka
University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical
Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - David A. Hart
- McCaig Institute for Bone & Joint
Health, University of Calgary, Calgary, Alberta, Canada
| | - Wataru Ando
- Department of Orthopaedic Medical
Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Nishii
- Department of Orthopaedic Surgery, Osaka
General Medical Center, Osaka, Japan
| | - Siegfried Trattnig
- High Field MR Center, Department of
Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna,
Austria,Christian Doppler Laboratory for
Clinical Molecular MR Imaging (MOLIMA), Department of Biomedical Imaging and
Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Nehrer
- Faculty of Health and Medicine,
Department for Health Sciences, Medicine and Research, Center for Regenerative
Medicine, Danube University Krems, Krems, Austria
| | - Norimasa Nakamura
- Department of Orthopaedic Surgery, Osaka
University Graduate School of Medicine, Osaka, Japan,Institute for Medical Science in Sports,
Osaka Health Science University, Osaka, Japan,Global Center for Medical Engineering
and Informatics, Osaka University, Osaka, Japan,Norimasa Nakamura, Institute for Medical
Science in Sports, Osaka Health Science University, 1-9-27, Tenma, Kita-ku,
Osaka City, Osaka, 530-0043, Japan.
| |
Collapse
|
28
|
Okuda M, Kobayashi S, Toyooka K, Yoshimizu R, Nakase J, Hayashi H, Ueda Y, Gabata T. Quantitative differentiation of tendon and ligament using magnetic resonance imaging ultrashort echo time T2* mapping of normal knee joint. Acta Radiol 2021; 63:1489-1496. [PMID: 34558315 DOI: 10.1177/02841851211043834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ligaments and tendons are difficult to differentiate on conventional magnetic resonance imaging (MRI). Ligaments and tendons are different histologically, and tendon graft ligamentization is known to occur after anterior cruciate ligament (ACL) reconstruction. PURPOSE To quantify and differentiate the ultrashort echo time T2* (UTE-T2*) values of normal knee ligaments and tendons using a 1.5-T MRI scanner. MATERIAL AND METHODS The right knees of 12 healthy volunteers (6 men, 6 women; mean age = 30.8 ± 9.6 years) were scanned using a UTE-T2* sequence and the UTE-T2* values of the proximal, middle, and distal portions of the ACL, posterior cruciate ligament (PCL), and patellar tendon (PT) were evaluated. Two doctors manually drew the regions of interest four times and intra- and inter-observer reliability were evaluated by intraclass correlation coefficients. RESULTS The UTE-T2* values of ACL at the proximal, middle, distal, and mean were 12.0 ± 2.3, 11.3 ± 2.3, 12.3 ± 2.6, and 11.9 ± 2.4 ms, respectively. The UTE-T2* values of the PCL at each site were 6.9 ± 1.5, 9.0 ± 1.8, 8.8 ± 2.4, and 8.3 ± 2.1 ms, respectively. The UTE-T2* values of the PT at each site were 7.1 ± 1.7, 4.3 ± 1.7, 4.3 ± 1.8, and 5.2 ± 2.1 ms, respectively. Both intra- and inter-observer reliability showed high agreement rates. There were significant differences among the ACL mean, PCL mean, and PT mean, with a P value <0.01 in all cases. CONCLUSION This study confirms that UTE-T2* mapping can quantify the ACL, PCL, and PT, and tendons and ligaments can be differentiated using the UTE-T2* values in normal volunteer knee joints.
Collapse
Affiliation(s)
- Miho Okuda
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Satoshi Kobayashi
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazu Toyooka
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Hayashi
- Division of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Yu Ueda
- MR Clinical Science, Philips Japan, Minato-ku, Japan
| | - Toshifumi Gabata
- Department of Radiology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
29
|
A Pilot Study on Feasibility of Ultrashort Echo Time T2* Cartilage Mapping in the Sacroiliac Joints. J Comput Assist Tomogr 2021; 45:717-721. [PMID: 34347705 DOI: 10.1097/rct.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Assess feasibility of ultrashort echo time (UTE) T2* cartilage mapping in sacroiliac (SI) joints. METHODS Prospective magnetic resonance imagings with UTE T2* cartilage maps obtained on 20 SI joints in 10 subjects. Each joint was segmented into thirds by 2 radiologists. The UTE T2* maps were analyzed; reliability and differences in UTE T2* values between radiologists were assessed. RESULTS Mean UTE T2* value was 10.44 ± 0.60 ms. No difference between right/left SI joints (median, 10.52 vs 10.45 ms; P = 0.940), men/women (median, 10.34 vs. 10.57 ms; P = 0.174), or different anatomic regions (median range 10.55-10.69 ms; P = 0.805). Intraclass correlation coefficients were 0.94 to 0.99 (intraobserver) and 0.91 to 0.96 (interobserver). Mean bias ± standard deviation on Bland-Altman was -0.137 ± 0.196 ms (limits of agreement -0.521 and 0.247) without proportional bias (β = 0.148, P = 0.534). CONCLUSIONS The UTE T2* cartilage mapping in the SI joints is feasible with high reader reliability.
Collapse
|
30
|
Chu CR, Williams AA, Erhart-Hledik JC, Titchenal MR, Qian Y, Andriacchi TP. Visualizing pre-osteoarthritis: Integrating MRI UTE-T2* with mechanics and biology to combat osteoarthritis-The 2019 Elizabeth Winston Lanier Kappa Delta Award. J Orthop Res 2021; 39:1585-1595. [PMID: 33788306 DOI: 10.1002/jor.25045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a leading cause of pain and disability for which disease-modifying treatments remain lacking. This is because the symptoms and radiographic changes of OA occur after the onset of likely irreversible changes. Defining and treating earlier disease states are therefore needed to delay or to halt OA progression. Taking this concept a step further, studying OA pathogenesis before disease onset by characterizing potentially reversible markers of increased OA risk to identify a state of "pre-osteoarthritis (pre-OA)" shifts the paradigm towards OA prevention. The purpose of this review is to summarize the 42 studies comprising the 2019 Kappa Delta Elizabeth Lanier Award where conceptualization of a systems-based definition for "pre-osteoarthritis (pre-OA)" was followed by demonstration of potentially reversible markers of heightened OA risk in patients after anterior cruciate ligament (ACL) injury and reconstruction. In the process, these efforts contributed a new magnetic resonance imaging method of ultrashort echo time (UTE) enhanced T2* mapping to visualize joint tissue damage before the development of irreversible changes. The studies presented here support a transformative approach to OA that accounts for interactions between mechanical, biological, and structural markers of OA risk to develop and evaluate new treatment strategies that can delay or prevent the onset of clinical disease. This body of work was inspired by and performed for patients. Shifting the paradigm from attempting to modify symptomatic radiographic OA towards monitoring and reversing markers of "pre-OA" opens the door for transforming the clinical approach to OA from palliation to prevention.
Collapse
Affiliation(s)
- Constance R Chu
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Ashley A Williams
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jennifer C Erhart-Hledik
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Yongxian Qian
- Center for Biomedical Imaging, New York University, New York, New York, USA
| | - Thomas P Andriacchi
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| |
Collapse
|
31
|
Potter HG. CORR Insights®: What Is the Correlation Among dGEMRIC, T1p, and T2* Quantitative MRI Cartilage Mapping Techniques in Developmental Hip Dysplasia? Clin Orthop Relat Res 2021; 479:1025-1027. [PMID: 33497065 PMCID: PMC8083799 DOI: 10.1097/corr.0000000000001645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/28/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Hollis G Potter
- H. G. Potter, Chairman, Department of Radiology and Imaging, Professor of Radiology, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
32
|
Xue YP, Ma YJ, Wu M, Jerban S, Wei Z, Chang EY, Du J. Quantitative 3D Ultrashort Echo Time Magnetization Transfer Imaging for Evaluation of Knee Cartilage Degeneration In Vivo. J Magn Reson Imaging 2021; 54:1294-1302. [PMID: 33894091 DOI: 10.1002/jmri.27659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Recent studies suggest that macromolecular fraction (MMF) derived from three-dimensional ultrashort echo time magnetization transfer (UTE-MT) imaging is insensitive to the magic angle effect. However, its clinical use in osteoarthritis (OA) remains to be investigated. PURPOSE To investigate the feasibility of 3D UTE-MT-derived MMF in differentiating normal from degenerated cartilage. STUDY TYPE Prospective. SUBJECTS Sixty-two participants (54.8 ± 16.7 years, 30 females) with and without OA, plus two healthy volunteers (mean age 35.0 years) for reproducibility test. FIELD STRENGTH/SEQUENCE 3 T/UTE-MT sequence. ASSESSMENT A 3D UTE-MT sequence was employed to calculate MMF based on a two-pool model. Kellgren-Lawrence (KL) grade and Whole-Organ Magnetic Resonance Imaging Score (WORMS) were evaluated by three experienced musculoskeletal radiologists. KL grade was condensed into three groups: KL0, KL1-2, and KL3-4. WORMS was regrouped based on extent of lesion (extent group) and depth of lesion (depth group), respectively. The performance of MMF at evaluating the degeneration of cartilage was assessed via Spearman's correlation coefficient and the area under the curve (AUC) calculated according to the receiver-operating characteristic curve. STATISTICAL TESTS After normality check, one-way analysis of variance was used to evaluate the performance. Tukey-Kramer test was performed for post hoc testing. RESULTS MMF showed significant negative correlations with KL grade (r = -0.53, P < 0.05) and WORMS (r = -0.49, P < 0.05). Significantly lower MMFs were found in subjects with greater KL grade (11.8 ± 0.8% for KL0; 10.9 ± 0.9% for KL1-2; 10.6 ± 1.1% for KL3-4; P < 0.05) and in cartilage with greater extent (12.1 ± 1.6% for normal cartilage; 10.9 ± 1.6% for regional lesions; 9.6 ± 1.7% for diffuse lesions; P < 0.05) and depth (12.1 ± 1.6% for normal cartilage; 10.6 ± 1.6% for partial-thickness lesions; 8.8 ± 1.7% for full-thickness lesions; P < 0.05) of lesions. AUC values of MMF for doubtful-minimal OA (KL1-2) and mild cartilage degradation (WORMS1-2) were 0.8 and 0.7, respectively. DATA CONCLUSION This study highlights the clinical potential of MMF in the detection of early OA. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
Collapse
Affiliation(s)
- Yan-Ping Xue
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Mei Wu
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Saeed Jerban
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Zhao Wei
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, La Jolla, California, USA.,Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
33
|
Flannery SW, Kiapour AM, Edgar DJ, Murray MM, Fleming BC. Automated magnetic resonance image segmentation of the anterior cruciate ligament. J Orthop Res 2021; 39:831-840. [PMID: 33241856 PMCID: PMC8005419 DOI: 10.1002/jor.24926] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023]
Abstract
The objective of this study was to develop an automated segmentation method for the anterior cruciate ligament that is capable of facilitating quantitative assessments of the ligament in clinical and research settings. A modified U-Net fully convolutional network model was trained, validated, and tested on 246 Constructive Interference in Steady State magnetic resonance images of intact anterior cruciate ligaments. Overall model performance was assessed on the image set relative to an experienced (>5 years) "ground truth" segmenter in two domains: anatomical similarity and the accuracy of quantitative measurements (i.e., signal intensity and volume) obtained from the automated segmentation. To establish model reliability relative to manual segmentation, a subset of the imaging data was resegmented by the ground truth segmenter and two additional segmenters (A, 6 months and B, 2 years of experience), with their performance evaluated relative to the ground truth. The final model scored well on anatomical performance metrics (Dice coefficient = 0.84, precision = 0.82, and sensitivity = 0.85). The median signal intensities and volumes of the automated segmentations were not significantly different from ground truth (0.3% difference, p = .9; 2.3% difference, p = .08, respectively). When the model results were compared with the independent segmenters, the model predictions demonstrated greater median Dice coefficient (A = 0.73, p = .001; B = 0.77, p = NS) and sensitivity (A = 0.68, p = .001; B = 0.72, p = .003). The model performed equivalently well to retest segmentation by the ground truth segmenter on all measures. The quantitative measures extracted from the automated segmentation model did not differ from those of manual segmentation, enabling their use in quantitative magnetic resonance imaging pipelines to evaluate the anterior cruciate ligament.
Collapse
Affiliation(s)
- Sean W. Flannery
- Center for Biomedical Engineering, Brown University,
Providence, RI,Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Ata M. Kiapour
- Department of Orthopaedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - David J. Edgar
- Center for Biomedical Engineering, Brown University,
Providence, RI,Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s
Hospital, Harvard Medical School, Boston, MA
| | - Braden C. Fleming
- Center for Biomedical Engineering, Brown University,
Providence, RI,Department of Orthopaedics, Warren Alpert Medical School of
Brown University/Rhode Island Hospital, Providence, RI
| |
Collapse
|
34
|
Wirth W, Eckstein F, Culvenor AG, Hudelmaier MI, Stefan Lohmander L, Frobell RB. Early anterior cruciate ligament reconstruction does not affect 5 year change in knee cartilage thickness: secondary analysis of a randomized clinical trial. Osteoarthritis Cartilage 2021; 29:518-526. [PMID: 33549723 DOI: 10.1016/j.joca.2021.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/30/2020] [Accepted: 01/20/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare 5-year change in femorotibial cartilage thickness in 121 young, active adults with an acute anterior cruciate ligament (ACL) tear randomized to a strategy of structured rehabilitation plus early ACL reconstruction (ACLR) or structured rehabilitation plus optional delayed ACLR. DESIGN 62 patients were randomized to early ACLR, 59 to optional delayed ACLR. Magnetic resonance imaging (MRI) was acquired within 4 weeks of injury, at two- and 5-years follow-up. Main outcome was 5-year change in overall femorotibial cartilage thickness. Secondary outcomes included the location-independent cartilage ChangeScore, summarizing thinning and thickening in 16 femorotibial subregions. An exploratory as-treated comparison was performed additionally. RESULTS Baseline and at least one follow-up MRI were available for 117 patients. Over 5 years, a comparable increase in overall femorotibial cartilage thickness was observed for patients randomized to early ACLR (n = 59) and patients randomized to optional delayed ACLR (n = 58, adjusted mean difference: -5 μm, 95% CI: [-118, 108]μm). However, the location-independent cartilage ChangeScore was greater in those treated with early ACLR than in patients treated with optional delayed ACLR (adjusted mean difference: 403 μm [119, 687]μm). As-treated analysis showed no between-group differences for the main outcome, while the location-independent cartilage ChangeScore was greater for patients treated with early (adjusted mean difference: 632 μm [268, 996]μm) or delayed ACLR (adjusted mean difference: 449 μm [108, 791]μm) than for patients treated with rehabilitation alone. CONCLUSIONS In young active adults with acute ACL-injury, choice of treatment strategy for the injured ACL did not modify the magnitude of 5-year change in overall femorotibial cartilage thickness. TRIAL REGISTRATION ISRCTN84752559.
Collapse
Affiliation(s)
- W Wirth
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - F Eckstein
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - A G Culvenor
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - M I Hudelmaier
- Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria.
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
| | - R B Frobell
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
| |
Collapse
|
35
|
Williams AA, Erhart-Hledik JC, Asay JL, Mahtani GB, Titchenal MR, Lutz AM, Andriacchi TP, Chu CR. Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:675-683. [PMID: 33507800 DOI: 10.1177/0363546520982608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral joint degeneration and dysfunction after anterior cruciate ligament reconstruction (ACLR) are increasingly recognized as contributors to poor clinical outcomes. PURPOSE To determine if greater deep cartilage matrix disruption at 2 years after ACLR, as assessed by elevated patellofemoral magnetic resonance imaging (MRI) ultrashort echo time-enhanced T2* (UTE-T2*), is correlated with (1) worse patient-reported knee function and pain and (2) gait metrics related to patellofemoral tracking and loading, such as greater external rotation of the tibia at heel strike, reduced knee flexion moment (as a surrogate of quadriceps function), and greater knee flexion angle at heel strike. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS MRI UTE-T2* relaxation times in patellar and trochlear deep cartilage were compared with patient-reported outcomes and ambulatory gait metrics in 60 patients with ACLR at 2 years after reconstruction. ACLR gait metrics were compared with those of 60 uninjured reference patients matched by age, body mass index, and sex. ACLR UTE-T2* values were compared with those of 20 uninjured reference patients. RESULTS Higher trochlear UTE-T2* values were associated with worse Knee injury and Osteoarthritis Outcome Scores (KOOS) Sport/Recreation subscale scores (rho = -0.32; P = .015), and showed a trend for association with worse KOOS Pain subscale scores (rho = -0.26; P = .045). At 2 years after ACLR, greater external rotation of the tibia at heel strike was associated with higher patellar UTE-T2* values (R = 0.40; P = .002); greater knee flexion angle at heel strike was associated with higher trochlear UTE-T2* values (rho = 0.39; P = .002); and greater knee flexion moment showed a trend for association with higher trochlear UTE-T2* values (rho = 0.30; P = .019). Patellar cartilage UTE-T2* values, knee flexion angle at heel strike, and external rotation of the tibia at heel strike were all elevated in ACLR knees as compared with reference knees (P = .029, .001, and .044, respectively). CONCLUSION Patellofemoral deep cartilage matrix disruption, as assessed by MRI UTE-T2*, was associated with reduced sports and recreational function and with gait metrics reflective of altered patellofemoral loading. As such, the findings provide new mechanistic information important to improving clinical outcomes related to patellofemoral dysfunction after ACLR.
Collapse
Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jennifer C Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jessica L Asay
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Gordhan B Mahtani
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Amelie M Lutz
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Thomas P Andriacchi
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| |
Collapse
|
36
|
A Useful Combination of Quantitative Ultrashort Echo Time MR Imaging and a Probing Device for Biomechanical Evaluation of Articular Cartilage. BIOSENSORS-BASEL 2021; 11:bios11020052. [PMID: 33671280 PMCID: PMC7921930 DOI: 10.3390/bios11020052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 02/07/2023]
Abstract
In this study, we combined quantitative ultrashort echo time (UTE) magnetic resonance (MR) imaging and an investigation by a probing device with tri-axial force sensor to seek correlations with mechanical properties of human patellar cartilage for in situ evaluation of biomechanical properties. Cartilage blocks (15 × 20 × 5 mm3) were dissected from the patella of six donors; 5 mm square regions of interest from the cartilage blocks were imaged using UTE-MR imaging sequences (T2* and magnetization transfer ratio (MTR)), and mechanical properties were measured using a micro indentation device. Then, the vertical reaction force on the cartilage surface was measured while push-probing forward 3 mm with the probing device at a 30° tilt to the horizontal plane. The results showed a positive correlation between stiffness/elastic modulus and each predictor variable (UTE-T2* (r = 0.240 and 0.255, respectively, UTE-MTR (r = 0.378 and 0.379, respectively), and probing device force (r = 0.426 and 0.423, respectively). Furthermore, multiple linear regression analysis showed the combination of the three predictors had stronger correlation (adjusted r2 = 0.314 (stiffness), 0.323 (elastic), respectively). Our results demonstrate the potential for these non- and less- invasive methods for in situ evaluation of the mechanical properties of cartilage tissue.
Collapse
|
37
|
Risk of Subsequent Knee Arthroplasty After Sports Medicine Procedures. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00125. [PMID: 32852917 PMCID: PMC7430232 DOI: 10.5435/jaaosglobal-d-20-00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Approximately 10% of men and 13% of women older than the age of 60 are affected by symptomatic osteoarthritis of the knee. Anatomic repair or reconstruction after knee injury has been a central tenet of surgical treatment to reduce the risk of osteoarthritis. The purpose of this study was to examine common sports medicine procedures of the knee and determine the proportion of patients who subsequently undergo total knee arthroplasty (TKA). METHODS The MarketScan database was queried from the period of January 2007 through December 2016. Patients were identified, who underwent a procedure of the knee, as defined by Current Procedural Terminology codes relating to nonarthroplasty procedures of the knee. Patients in whom laterality could not be confirmed or underwent another ipsilateral knee procedure before TKA were excluded from this study. The primary outcome of this study was the overall rate of TKA after index knee surgery. Time from index procedure to TKA was a secondary outcome. A multivariate regression analysis was used to control for covariates such as age, sex, and comorbidity status. RESULTS A total of 843,749 patients underwent one of the 13 common sports medicine procedures of the knee. The procedure with the highest unadjusted rate of subsequent TKA was arthroscopic osteochondral allograft (5.81%), whereas anterior cruciate ligament (ACL) reconstruction with meniscus repair demonstrated the lowest rate of subsequent TKA (0.01%). When adjusting for confounding factors, the regression analysis identified meniscal transplantation (odds ratio [OR] = 3.06, P < 0.0001) as having the highest risk of subsequent TKA, followed by osteochondral autograft (OR = 1.74, P = 0.0424) and arthroscopic osteochondral allograft (OR = 1.49, P < 0.0001). ACL reconstruction with meniscus repair (OR = 0.02, P < 0.0001), ACL reconstruction alone (OR = 0.17, P < 0.0001), ACL with meniscectomy (OR = 0.20, P < 0.0001), and meniscal repair (OR = 0.65, P < 0.0001) had the lowest rate of subsequent TKA. ACL reconstruction with meniscus repair had the longest period from index procedure to TKA at 2827 days. CONCLUSION ACL reconstruction and meniscus preservation demonstrated an extremely low rate of conversion to TKA when compared with patients who needed salvage interventions such as meniscus and cartilage transplantation. None of the salvage interventions delayed the need for a TKA. Meniscal transplantation had the highest risk of all procedures of going on to a TKA.
Collapse
|
38
|
Chen AJ, Tatarski RL, Perry J, Quatman CE, Hewett TE, Di Stasi S. Single-leg hop mechanics are correlated with self-reported knee function early after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2020; 73:35-45. [PMID: 31931397 DOI: 10.1016/j.clinbiomech.2019.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/23/2019] [Accepted: 12/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biomechanical changes that persist after anterior cruciate ligament (ACL) injury may impact short- and long-term outcomes. Understanding the relationship of biomechanics during a dynamic task and patient reported function can better identify patients who are most vulnerable to sub-optimal long-term outcomes, such as osteoarthritis (OA). The purpose of this study was to determine whether hip and knee biomechanics during single-leg hop landing were significantly correlated with the Knee injury and Osteoarthritis Outcome Score (KOOS), and whether symptomatic knees displayed altered biomechanics relative to asymptomatic knees. METHODS Hip and knee biomechanics during the landing phase of a single-leg hop of thirty subjects with ACLR were analyzed. Subjects were also classified as symptomatic or asymptomatic based on their KOOS results. Correlation analyses and group comparisons between symptomatic and asymptomatic subjects were conducted. FINDINGS KOOS Symptoms, Pain, and Sport subscales were significantly correlated with frontal and sagittal plane hip and knee biomechanics. Furthermore, those with symptomatic knees demonstrated greater hip and knee flexion angles, and greater hip flexion moments. INTERPRETATION These results indicate that biomechanics associated with ACLR during a single-leg hop are correlated with worse KOOS outcomes. However, these correlations may be due to symptoms of the recovery from ACLR rather than those of OA. The results of this study may help to identify rehabilitation opportunities for patients at risk for worse long-term outcomes after ACLR.
Collapse
Affiliation(s)
- Albert J Chen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States.
| | - Rachel L Tatarski
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
| | - Jennifer Perry
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Carmen E Quatman
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Timothy E Hewett
- Orthopedic Biomechanics Laboratories and Sports Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Division of Physical Therapy, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
39
|
Lansdown DA, Ma CB. Clinical Utility of Advanced Imaging of the Knee. J Orthop Res 2020; 38:473-482. [PMID: 31498473 DOI: 10.1002/jor.24462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
Advanced imaging modalities, including computed tomography, magnetic resonance imaging (MRI), and dynamic fluoroscopic imaging, allow for a comprehensive evaluation of the knee joint. Compositional sequences for MRI can allow for an evaluation of the biochemical properties of cartilage, meniscus, and ligament that offer further insight into pathology that may not be apparent on conventional clinical imaging. Advances in image processing, shape modeling, and dynamic studies also offer a novel way to evaluate common conditions and to monitor patients after treatment. The purpose of this article is to review advanced imaging modalities of the knee and their current and anticipated future applications to clinical practice. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:473-482, 2020.
Collapse
Affiliation(s)
- Drew A Lansdown
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California
| | - C Benjamin Ma
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California
| |
Collapse
|
40
|
Shultz SJ, Schmitz RJ, Cameron KL, Ford KR, Grooms DR, Lepley LK, Myer GD, Pietrosimone B. Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14-16, 2019, Greensboro, NC. J Athl Train 2019; 54:970-984. [PMID: 31461312 PMCID: PMC6795093 DOI: 10.4085/1062-6050-54.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Kenneth L. Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | | | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, and Departments of Pediatrics and Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| |
Collapse
|
41
|
Chu CR. Concepts Important to Secondary Prevention of Posttraumatic Osteoarthritis. J Athl Train 2019; 54:987-988. [PMID: 31437015 DOI: 10.4085/1062-6050-54.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Constance R Chu
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA
| |
Collapse
|
42
|
Chu CR, Williams AA. Quantitative MRI UTE-T2* and T2* Show Progressive and Continued Graft Maturation Over 2 Years in Human Patients After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2019; 7:2325967119863056. [PMID: 31448301 PMCID: PMC6693027 DOI: 10.1177/2325967119863056] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Noninvasive quantitative magnetic resonance imaging (MRI) measures to assess
anterior cruciate ligament (ACL) graft maturity are needed to help inform
return to high-demand activities and to evaluate the effectiveness of new
treatments to accelerate ACL graft maturation. Quantitative MRI ultrashort
echo time T2* (UTE-T2*) and T2* mapping captures short T2 signals arising
from collagen-associated water in dense regular connective tissues, such as
tendon, ligament, and maturing grafts, which are invisible to conventional
MRI. Hypothesis: Quantitative MRI UTE-T2* and T2* mapping is sensitive to ACL graft changes
over the first 2 years after ACL reconstruction (ACLR). Study Design: Case series; Level of evidence, 4. Methods: A total of 32 patients (18 men; mean ± SD age, 30 ± 9 years) undergoing
unilateral ACLR and 30 uninjured age-matched controls (18 men; age, 30 ± 9
years) underwent 3-T MRI examination. Patients who underwent ACLR were
imaged at 6 weeks, 6 months, and 1 and 2 years postoperatively. Two separate
ACLR cohorts were scanned with 2 MRI platforms at 2 institutions. Twelve
ACLR knees were scanned with a 3-dimensional acquisition-weighted stack of
spirals UTE sequence on a Siemens scanner, and 20 ACLR knees were scanned
with a 3-dimensional Cones UTE sequence on a GE scanner. UTE-T2* or T2* maps
were calculated for the intra-articular portion of the ACL graft. Results: Mean ACL graft UTE-T2* and T2* decreased from 1 to 2 years after ACLR. ACL
graft T2* increased 25% to 30% during the first 6 months (P
< .013) to a level not different from that of uninjured native ACL
(P > .4), stabilized between 6 months and 1 year
(P ≥ .999), and then decreased 19% between 1 and 2
years after ACLR (P = .027). At 6-month follow-up, ACL
graft UTE-T2* differed from that of tendon (P < .02) but
not uninjured native ACL (P > .7) and showed the
greatest variability among patients. Conclusion: UTE-T2* mapping suggested substantial changes within the graft during the
first 6 months postsurgery. T2* and UTE-T2* mapping showed relatively stable
graft composition from 6 months to 1 year, consistent with remodeling,
followed by decreases from 1 to 2 years, suggestive of continuing
maturation. MRI UTE-T2* and T2* mapping demonstrated potential clinical
utility as noninvasive quantitative imaging metrics for evaluation of human
ACL grafts.
Collapse
Affiliation(s)
- Constance R Chu
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Redwood City, California, USA
| | - Ashley A Williams
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Redwood City, California, USA
| |
Collapse
|
43
|
DeFrate LE, Kim-Wang SY, Englander ZA, McNulty AL. Osteoarthritis year in review 2018: mechanics. Osteoarthritis Cartilage 2019; 27:392-400. [PMID: 30597275 PMCID: PMC6489451 DOI: 10.1016/j.joca.2018.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review recent biomechanics literature focused on the interactions between biomechanics and articular cartilage health, particularly focused on macro-scale and human studies. DESIGN A literature search was conducted in PubMed using the search terms (biomechanics AND osteoarthritis) OR (biomechanics AND cartilage) OR (mechanics AND osteoarthritis) OR (mechanics AND cartilage) for publications from April 2017 to April 2018. RESULTS Abstracts from the 559 articles generated from the literature search were reviewed. Due to the wide range of topics, 62 full texts with a focus on in vivo biomechanical studies were included for further discussion. Several overarching themes in the recent literature were identified and are summarized, including 1) new methods to detect early osteoarthritis (OA) development, 2) studies describing healthy and OA cartilage and biomechanics, 3) ACL injury and OA development, 4) meniscus injury and OA development, and 5) OA prevention, treatment, and management. CONCLUSIONS Mechanical loading is a critical factor in the maintenance of joint health. Abnormal mechanical loading can lead to the onset and progression of OA. Thus, recent studies have utilized various biomechanical models to better describe the etiology of OA development and the subsequent effects of OA on the mechanics of joint tissues and whole body biomechanics.
Collapse
Affiliation(s)
- Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Sophia Y. Kim-Wang
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Zoë A. Englander
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Amy L. McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Pathology, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| |
Collapse
|
44
|
Williams AA, Titchenal MR, Do BH, Guha A, Chu CR. MRI UTE-T2* shows high incidence of cartilage subsurface matrix changes 2 years after ACL reconstruction. J Orthop Res 2019; 37:370-377. [PMID: 30030866 DOI: 10.1002/jor.24110] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/13/2018] [Indexed: 02/06/2023]
Abstract
Alteration of deep cartilage matrix has been observed following anterior cruciate ligament (ACL) injury, evidenced by elevated MRI UTE-T2* values measured in small, 2-D cartilage regions of interest. This Level I diagnostic study seeks to more thoroughly evaluate deep cartilage matrix changes to medial tibiofemoral UTE-T2* maps 2 years after ACL reconstruction and examine the relative utilities of 3-D compared to 2-D assessments of cartilage UTE-T2* maps. Thirty-eight ACL-reconstructed and 20 uninjured subjects underwent MRI UTE-T2* mapping. "Small" single mid-sagittal 2-D and larger 3-D "tread mark" regions of interest were manually segmented and found to be correlated in medial cartilage (r > 0.58, p < 0.005). 3-D analyses of UTE-T2* maps showed differences to medial tibial cartilage between ACL-reconstructed and uninjured subjects (p = 0.007) that were not detected by smaller 2-D regions (p > 0.46). Quantitative comparisons show 14/38 (37%) ACL-reconstructed subjects have values >2 standard deviations higher than uninjured controls. Among a subset of ACL-reconstructed subjects with no morphologic MRI evidence of medial tibiofemoral cartilage or meniscal pathology (n = 12), elevated UTE-T2* values in "small" 2-D femoral (p = 0.011), but not larger 3-D tread mark regions of interest (p > 0.13), were observed. These data show the utility of 2-D UTE-T2* assessments of mid-sagittal weight-bearing regions of medial femoral cartilage for identifying subclinical deep cartilage matrix changes 2 years after ACLR. Clinical Significance: Mid-sagittal single slice 2-D UTE-T2* mapping may be an efficient means to assess medial femoral cartilage for subsurface matrix changes early after ACL reconstruction while 3-D assessments provide additional sensitivity to changes in the medial tibial plateau. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:370-377, 2019.
Collapse
Affiliation(s)
- Ashley A Williams
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Matthew R Titchenal
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Bao H Do
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Radiology, Stanford University, Stanford, California
| | - Aditi Guha
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC 6342, Redwood City, California 94063
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| |
Collapse
|
45
|
|
46
|
Affiliation(s)
| | | | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Sports Health Associate Editor for Imaging, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|