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Wörner EA, Kaynak M, van Riet R, The B, Eygendaal D. Intraoperative arthroscopic classification tool for posterolateral elbow instability. JSES Int 2023; 7:2600-2604. [PMID: 37969525 PMCID: PMC10638556 DOI: 10.1016/j.jseint.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Introducing and implementing an arthroscopic classification tool for posterolateral elbow instability. Methods Thirty arthroscopies were performed on 30 patients, and all recordings were collected, blinded, and labeled. Three orthopedic surgeons reviewed and scored all 30 recordings three times with a period of at least seven days in between to analyze the intraobserver and interobserver reliability. The classification consisted of five different grades. Results Indications for elbow arthroscopy included impingement (n = 7), osteochondritis dissecans (n = 5), pain (n = 7), osteoarthritis (n = 6), and other (n = 5). The kappa value for intrarater reliability was 0.71, indicating good reliability, while the kappa value for inter-rater reliability was 0.38 indicating fair reliability. Conclusion This new classification is a tool for an arthroscopic assessment of PLRI and can be used as a standardized grading system for further research and communication between orthopedic surgeons. We demonstrated good intrarater reliability (k = 0.71) with fair inter-rater reliability (k = 0.38). However, further research is necessary to study the clinical significance.
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Affiliation(s)
- Elisabeth A. Wörner
- Department of Orthopaedic Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Mustafa Kaynak
- Department of Orthopaedic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Roger van Riet
- Department of Orthopaedic Surgery, AZ Monica hospital, Deurne, Belgium
| | - Bertram The
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
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Jambor AN, Shelton EM, Kijowski R, Henak CR, Campagnola PJ. Assessing collagen alterations in enzymatic degradation models of osteoarthritis via second harmonic generation microscopy. Osteoarthritis Cartilage 2021; 29:1590-1599. [PMID: 34454101 PMCID: PMC8542598 DOI: 10.1016/j.joca.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 07/30/2021] [Accepted: 08/16/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Structural changes in the collagen II architecture of osteoarthritis (OA) are poorly understood, which is a large shortcoming in the early diagnosis of this disease. Though degradation can be simulated by enzymes including trypsin and bacterial collagenase, the specific structural features of each digestion and their relationship to naturally occurring OA remain unclear. EXPERIMENTAL DESIGN We used collagen sensitive/specific Second Harmonic Generation (SHG) microscopy in conjunction with optical scattering measurements to probe the resulting architecture changes in bovine knee cartilage upon trypsin and collagenase degradation. Image features extracted from SHG images were used to train a linear discriminant (LD) model capable of classifying enzymatic degradation, which was then applied to human cartilage with varied modified Mankin histological scores. RESULTS The treatment of cartilage with these enzymes resulted in more disorganized collagen structure, where this effect was greatest with collagenase treatment. Using the LD model, we classified the control and degraded tissues in the three zones with >92% accuracy, showing that these enzymes have distinct activity on the collagen assembly. Application of the LD model to human cartilage indicated that collagenase effects were more representative of in vivo degeneration and were also consistent with damage beginning at the articular surface and progressing into deeper zones. CONCLUSIONS SHG and optical scattering measurements successfully delineate trypsin and collagenase degradation and suggest that collagen alterations in human OA are better simulated by the latter mechanism. These results lay the groundwork for using high-resolution SHG and optical scattering as an earlier diagnostic tool than is currently available.
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Affiliation(s)
- Alexander N. Jambor
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA
| | - Emily M. Shelton
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA,Department of Physics, University of Wisconsin-Madison, 1150 University Ave, Madison, WI 53706, USA
| | - Richard Kijowski
- Department of Radiology, 600 Highland Ave, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Corinne R. Henak
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA,Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI 53706, USA,,
| | - Paul J. Campagnola
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Dr, Madison, WI 53706, USA,,
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Near-Infrared Spectroscopy for Mapping of Human Meniscus Biochemical Constituents. Ann Biomed Eng 2020; 49:469-476. [PMID: 32720092 PMCID: PMC7773612 DOI: 10.1007/s10439-020-02578-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022]
Abstract
Degenerative changes in meniscus are diagnosed during surgery by means of mechanical testing and visual evaluation. This method is qualitative and highly subjective, providing very little information on the internal state of the meniscus. Thus, there is need for novel quantitative methods that can support decision-making during arthroscopic surgery. In this study, we investigate the potential of near-infrared spectroscopy (NIRS) for mapping the biochemical constituents of human meniscus, including water, uronic acid, and hydroxyproline contents. Partial least squares regression models were developed using data from 115 measurement locations of menisci samples extracted from 7 cadavers and 11 surgery patient donors. Model performance was evaluated using an independent test set consisting of 55 measurement locations within a meniscus sample obtained from a separate cadaver. The correlation coefficient of calibration (ρtraining), test set (ρtest), and root-mean-squared error of test set (RMSEP) were as follows: water (ρtraining = 0.61, ρtest = 0.39, and RMSEP = 2.27 percentage points), uronic acid (ρtraining = 0.68, ρtest = 0.69, and RMSEP = 6.09 basis points), and hydroxyproline (ρtraining = 0.84, ρtest = 0.58, and error = 0.54 percentage points). In conclusion, the results suggest that NIRS could enable rapid arthroscopic mapping of changes in meniscus biochemical constituents, thus providing means for quantitative assessment of meniscus degeneration.
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Dataset on equine cartilage near infrared spectra, composition, and functional properties. Sci Data 2019; 6:164. [PMID: 31471536 PMCID: PMC6717194 DOI: 10.1038/s41597-019-0170-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022] Open
Abstract
Near infrared (NIR) spectroscopy is a well-established technique that is widely employed in agriculture, chemometrics, and pharmaceutical engineering. Recently, the technique has shown potential in clinical orthopaedic applications, for example, assisting in the diagnosis of various knee-related diseases (e.g., osteoarthritis) and their pathologies. NIR spectroscopy (NIRS) could be especially useful for determining the integrity and condition of articular cartilage, as the current arthroscopic diagnostics is subjective and unreliable. In this work, we present an extensive dataset of NIRS measurements for evaluating the condition, mechanical properties, structure, and composition of equine articular cartilage. The dataset contains NIRS measurements from 869 different locations across the articular surfaces of five equine fetlock joints. A comprehensive library of reference values for each measurement location is also provided, including results from a mechanical indentation testing, digital densitometry imaging, polarized light microscopy, and Fourier transform infrared spectroscopy. The published data can either be used as a model of human cartilage or to advance equine veterinary research.
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Arthroscopic Determination of Cartilage Proteoglycan Content and Collagen Network Structure with Near-Infrared Spectroscopy. Ann Biomed Eng 2019; 47:1815-1826. [PMID: 31062256 PMCID: PMC6647474 DOI: 10.1007/s10439-019-02280-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/24/2019] [Indexed: 11/24/2022]
Abstract
Conventional arthroscopic evaluation of articular cartilage is subjective and insufficient for assessing early compositional and structural changes during the progression of post-traumatic osteoarthritis. Therefore, in this study, arthroscopic near-infrared (NIR) spectroscopy is introduced, for the first time, for in vivo evaluation of articular cartilage thickness, proteoglycan (PG) content, and collagen orientation angle. NIR spectra were acquired in vivo and in vitro from equine cartilage adjacent to experimental cartilage repair sites. As reference, digital densitometry and polarized light microscopy were used to evaluate superficial and full-thickness PG content and collagen orientation angle. To relate NIR spectra and cartilage properties, ensemble neural networks, each with two different architectures, were trained and evaluated by using Spearman’s correlation analysis (ρ). The ensemble networks enabled accurate predictions for full-thickness reference properties (PG content: ρin vitro, Val= 0.691, ρin vivo= 0.676; collagen orientation angle: ρin vitro, Val= 0.626, ρin vivo= 0.574) from NIR spectral data. In addition, the networks enabled reliable prediction of PG content in superficial (25%) cartilage (ρin vitro, Val= 0.650, ρin vivo= 0.613) and cartilage thickness (ρin vitro, Val= 0.797, ρin vivo= 0.596). To conclude, NIR spectroscopy could enhance the detection of initial cartilage degeneration and thus enable demarcation of the boundary between healthy and compromised cartilage tissue during arthroscopic surgery.
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Makovicka JL, Patel KA, Hassebrock JD, Hartigan DE, Wong M, Chhabra A. Arthroscopic Evaluation of Knee Cartilage Using Optical Reflection Spectroscopy. Arthrosc Tech 2019; 8:e399-e405. [PMID: 31110939 PMCID: PMC6510670 DOI: 10.1016/j.eats.2018.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/28/2018] [Indexed: 02/03/2023] Open
Abstract
Articular cartilage is critical for painless and low-friction range of motion; however, disruption of articular cartilage, particularly in the knee joint, is common. Treatment options are based on the size and depth of the chondral defect, as well as involvement of subchondral bone. The gold standard for evaluation of articular cartilage is with arthroscopy, but it is limited by its ability to objectively judge the depth and severity of chondral damage. Optical reflection spectroscopy has been introduced to objectively assess the thickness of cartilage. We present a technique to systematically evaluate the articular cartilage of the knee using BioOptico optical reflection spectroscopy (Arthrex) to better evaluate those with visible chondral and subchondral defects.
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Affiliation(s)
| | - Karan A. Patel
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, U.S.A
| | | | | | - Michael Wong
- Department of Orthopedics, Ochsner Clinical School, New Orleans, Louisiana, U.S.A
| | - Anikar Chhabra
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona, U.S.A.,Address correspondence to Anikar Chhabra, M.D., Department of Orthopedic Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, Arizona 85054, U.S.A.
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Affiliation(s)
- Casey Slattery
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
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Arthroscopic near infrared spectroscopy enables simultaneous quantitative evaluation of articular cartilage and subchondral bone in vivo. Sci Rep 2018; 8:13409. [PMID: 30194446 PMCID: PMC6128946 DOI: 10.1038/s41598-018-31670-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/23/2018] [Indexed: 01/24/2023] Open
Abstract
Arthroscopic assessment of articular tissues is highly subjective and poorly reproducible. To ensure optimal patient care, quantitative techniques (e.g., near infrared spectroscopy (NIRS)) could substantially enhance arthroscopic diagnosis of initial signs of post-traumatic osteoarthritis (PTOA). Here, we demonstrate, for the first time, the potential of arthroscopic NIRS to simultaneously monitor progressive degeneration of cartilage and subchondral bone in vivo in Shetland ponies undergoing different experimental cartilage repair procedures. Osteochondral tissues adjacent to the repair sites were evaluated using an arthroscopic NIRS probe and significant (p < 0.05) degenerative changes were observed in the tissue properties when compared with tissues from healthy joints. Artificial neural networks (ANN) enabled reliable (ρ = 0.63–0.87, NMRSE = 8.5–17.2%, RPIQ = 1.93–3.03) estimation of articular cartilage biomechanical properties, subchondral bone plate thickness and bone mineral density (BMD), and subchondral trabecular bone thickness, bone volume fraction (BV), BMD, and structure model index (SMI) from in vitro spectral data. The trained ANNs also reliably predicted the properties of an independent in vitro test group (ρ = 0.54–0.91, NMRSE = 5.9–17.6%, RPIQ = 1.68–3.36). However, predictions based on arthroscopic NIR spectra were less reliable (ρ = 0.27–0.74, NMRSE = 14.5–24.0%, RPIQ = 1.35–1.70), possibly due to errors introduced during arthroscopic spectral acquisition. Adaptation of NIRS could address the limitations of conventional arthroscopy through quantitative assessment of lesion severity and extent, thereby enhancing detection of initial signs of PTOA. This would be of high clinical significance, for example, when conducting orthopaedic repair surgeries.
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Park A, Lutsky K, Matzon J, Leinberry C, Chapman T, Beredjiklian PK. An Evaluation of the Reliability of Wrist Arthroscopy in the Assessment of Tears of the Triangular Fibrocartilage Complex. J Hand Surg Am 2018; 43:545-549. [PMID: 29602654 DOI: 10.1016/j.jhsa.2018.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 01/15/2018] [Accepted: 02/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Wrist arthroscopy is generally considered the reference standard in the diagnosis of triangular fibrocartilage complex (TFCC) injuries. There is a paucity of data examining the reliability of wrist arthroscopy as a diagnostic modality for TFCC injuries. The goal of this study was to evaluate the interobserver and intraobserver reliability of the diagnosis of TFCC pathology during wrist arthroscopy. METHODS Twenty-five intraoperative digital videos were captured by the senior author during diagnostic and surgical arthroscopy of the wrist joint for known or suspected articular pathology. The senior author (P.K.B.) confirmed TFCC resilience on visual inspection and ballottement (trampoline effect) to make the diagnosis. Two videos were excluded for poor quality and inadequate visualization. Three hand surgeons subsequently reviewed the remaining 23 videos in a blinded fashion at 2 time points separated by 4 weeks. The reviewers determined if the trampoline test was positive and if a TFCC tear was present. Tears were classified using a morphologic classification. Statistical measures of reliability including percentage agreement and κ coefficients were calculated. RESULTS Agreement between observers for the presence or absence of a tear was 66.7%. The average intraobserver agreement regarding the presence or absence of a tear was 67.4% The kappa value for interobserver agreement was 0.33, whereas the intrarater agreement was 0.88. The 3 reviewers identified an average of 11.3 positive trampoline tests. Agreement between observers for a positive trampoline test was 65.2%. The average percentage of intraobserver agreement regarding a positive trampoline test was 49.3%. In cases where all 3 reviewers agreed on the presence of a TFCC tear, the agreement regarding tear location was 76.6%. CONCLUSIONS Wrist arthroscopy remains instrumental in the treatment of TFCC tears. However, given that inter-rater reliability in the assessment of these tears is probably too low, reconsideration should be given to arthroscopy as the reference standard in the diagnosis of these tears. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Andrew Park
- Department of Orthopaedic Surgery, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Kevin Lutsky
- Department of Orthopaedic Surgery, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Jonas Matzon
- Department of Orthopaedic Surgery, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Charlie Leinberry
- Department of Orthopaedic Surgery, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Talia Chapman
- Department of Orthopaedic Surgery, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Pedro K Beredjiklian
- Department of Orthopaedic Surgery, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA.
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Lee DW, Yeom CH, Kim DH, Kim TM, Kim JG. Prevalence and Predictors of Patellofemoral Osteoarthritis after Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft. Clin Orthop Surg 2018; 10:181-190. [PMID: 29854341 PMCID: PMC5964266 DOI: 10.4055/cios.2018.10.2.181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/15/2018] [Indexed: 01/09/2023] Open
Abstract
Background The present study aimed to evaluate the prevalence of patellofemoral osteoarthritis (PFOA) and identify the factors that affect PFOA development after single-bundle anterior cruciate ligament (ACL) reconstruction with hamstring autograft. We hypothesized that detecting these factors could be helpful in establishment of a rehabilitation strategy to focus on the modifiable factors. Methods Of the 324 patients who underwent primary ACL reconstruction between January 2010 and June 2013, 92 patients who were available for follow-up for a minimum of 36 months after the surgery and underwent second-look arthroscopy were enrolled. Subjective assessments and clinical outcome evaluation were conducted. Arthroscopic cartilage evaluation was done using the Outerbridge classification. Univariable and multivariable logistic regression analyses were used. Results Ninety-two patients were evaluated at an average of 38.9 ± 5.4 months of follow-up. PFOA above grade 2 was observed in 19 patients (20.7%) at the second-look arthroscopy. Of them, three patients with pre-existing PFOA (3.3%) showed progression of the Outerbridge grade, and 16 (17.4%) had newly developed PFOA. According to the multivariable logistic regression analysis, isokinetic extensor deficit at 60°/sec at the last follow-up (odds ratio [OR], 2.193; 95% confidence interval [CI], 1.081 to 12.439; p = 0.031), age at primary surgery (OR, 1.118; 95% CI, 1.019 to 1.227; p = 0.018), and concurrent meniscectomy at primary surgery (OR, 0.091; 95% CI, 1.012 to 1.177; p = 0.023) were the significant predictors of PFOA development. Conclusions Significant predictors of PFOA after ACL reconstruction with hamstring autograft were decreased quadriceps strength at last follow-up, increased age, and concurrent meniscectomy at primary surgery. Quadriceps weakness as a modifiable factor should be considered in the establishment of a rehabilitation strategy to prevent PFOA after ACL reconstruction, especially in older age.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Cheol Hynn Yeom
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Du Han Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Tae Min Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea
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Saltzman BM, Meyer MA, Leroux TS, Gilelis ME, Debot M, Yanke AB, Cole BJ. The Influence of Full-Thickness Chondral Defects on Outcomes Following Meniscal Allograft Transplantation: A Comparative Study. Arthroscopy 2018; 34:519-529. [PMID: 29103840 DOI: 10.1016/j.arthro.2017.08.282] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare a series of patients who underwent meniscus allograft transplantation (MAT) with full-thickness chondral defects (FTD) with those with no chondral defect (ND) with regard to the following: change in patient-reported outcomes (PROs) from baseline to 2-year follow-up and baseline to the final follow-up (including comparisons to minimal clinically important differences), complications and complication rates, reoperations and reoperation rates/timing, and failures and time to failure (revision MAT or conversion to total knee arthroplasty). METHODS Patients who underwent isolated medial or lateral MAT between September 1997 and March 2013 with a minimum of 2 years of follow-up were retrospectively identified and split into 2 groups based on the presence or absence of FTD (femoral condyle or tibial plateau) identified intraoperatively after debridement to allow for a better understanding of the lesion characteristics (when applicable): ND (Outerbridge grade 0/I) or FTD (Outerbridge grade IV). Patients with osteochondritis dissecans were eligible for inclusion, as were those with isolated single lesions, multiple lesions, or bipolar lesions. Those with a moderate Outerbridge grade (II and III)-whether treated or neglected-were excluded given the poorer reliability of grading intermediate lesions. Indications for MAT included those patients with subjective complaints (persistent joint-line pain) and objective findings (previous meniscectomy or nonviable meniscus state with pain localized to the affected compartment) of functional meniscal deficiency. All lateral MAT patients used a bridge-in-slot surgical technique, as did most medial MAT patients (few patients with earlier surgical dates received a keyhole technique). All FTD were treated concurrently at the time of index MAT with cartilage restoration procedures (microfracture, autologous chondrocyte implantation, DeNovo particulate cartilage grafting, or osteochondral auto/allografting). Reoperations, failures (revision MAT or conversion to arthroplasty), and PRO deltas were reported comparing baseline to 2-year follow-up and baseline to the final follow-up. Intergroup comparisons were made using Bonferroni-adjusted independent sample t-tests for continuous variables and χ-square for categorical variables. RESULTS A total of 91 patients (22 ND and 69 FTD) were identified and followed for a mean 4.48 ± 2.63 and 3.84 ± 2.47 years, respectively. There were no significant between-group differences in age, body mass index, or number of prior surgeries. The mean chondral lesion size in the FTD group was 4.43 ± 2.5 cm2. Concomitant anterior cruciate ligament reconstruction was performed significantly more in ND-group patients than FTD-group patients (8 [38.1%] vs 8 [11.8%], P = .004). There were no differences between ND-group and FTD-group patients in concomitant realignment procedures performed (2 [9.1%] vs 7 [10.1%], P = .986), or prior ligament reconstruction (9 [40.9%] vs 18 [26.1%], P = .111) or realignment procedure (0 [0%] vs 0 [0%]). FTD-group patients underwent concomitant osteochondral allograft (69.6%), autologous chondrocyte implantation (18.8%), microfracture (13.0%), osteochondral autograft (4.3%), or DeNovo juvenile particulate cartilage implantation (1.4%). A comparison of the patient groups found no statistically significant differences in PROs preoperatively (P > .003 for all). Intergroup comparisons of both the 2-year and final follow-up delta PRO scores showed no statistically (P > .003 for all) or clinically (number of PROs meeting minimal clinically important differences) significant differences. One complication occurred (fractured hardware) in the FTD-group patients (1.3%). There were no differences in the number of subsequent surgeries (revision MAT: ND, 2 (10.0%) vs FTD, 8 (12.9%); P = .845) or failures (conversion to total knee arthroplasty: ND, 1 (5.0%) vs FTD, 2 (3.3%); P = .646). CONCLUSIONS When comparing a patient series with FTD who underwent MAT with a patient series with ND, there were no differences in the change in individual PROs from preoperative to the final follow-up. Similarly, there were no differences in complications or failure between those with ND or FTD diagnosed intraoperatively. The results of the current study suggest that chondral damage identified and treated by cartilage restoration means at the time of MAT may not affect the clinical outcomes of MAT. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Bryan M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Maximilian A Meyer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Timothy S Leroux
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew E Gilelis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Margot Debot
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Nebelung S, Sondern B, Jahr H, Tingart M, Knobe M, Thüring J, Kuhl C, Truhn D. Non-invasive T1ρ mapping of the human cartilage response to loading and unloading. Osteoarthritis Cartilage 2018; 26:236-244. [PMID: 29175373 DOI: 10.1016/j.joca.2017.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 09/21/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To define the physiological response to sequential loading and unloading in histologically intact human articular cartilage using serial T1ρ mapping, as T1ρ is considered to indicate the tissue's macromolecular content. METHOD 18 macroscopically intact cartilage-bone samples were obtained from the central lateral femoral condyles of 18 patients undergoing total knee replacement. Serial T1ρ mapping was performed on a clinical 3.0-T MRI system using a modified prostate coil. Spin-lock multiple gradient-echo sequences prior to, during and after standardized indentation loading (displacement controlled, strain 20%) were used to obtain seven serial T1ρ maps: unloaded (δ0), quasi-statically loaded (indentation1-indentation3) and under subsequent relaxation (relaxation1-relaxation3). After manual segmentation, zonal and regional regions-of-interest were defined. ROI-specific relative changes were calculated and statistically assessed using paired t-tests. Histological (Mankin classification) and biomechanical (unconfined compression) evaluations served as references. RESULTS All samples were histologically and biomechanically grossly intact (Mankin sum: 1.8 ± 1.2; Young's Modulus: 0.7 ± 0.4 MPa). Upon loading, T1ρ consistently increased throughout the entire sample thickness, primarily subpistonally (indentation1 [M ± SD]: 9.5 ± 7.8% [sub-pistonal area, SPA] vs 4.2 ± 5.8% [peri-pistonal area, PPA]; P < 0.001). T1ρ further increased with ongoing loading (indentation3: 14.1 ± 8.1 [SPA] vs 7.7 ± 5.9% [PPA]; P < 0.001). Even upon unloading (i.e., relaxation), T1ρ persistently increased in time. CONCLUSION Serial T1ρ-mapping reveals distinct and complex zonal and regional changes in articular cartilage as a function of loading and unloading. Thereby, longitudinal adaptive processes in hyaline cartilage become evident, which may be used for the tissue's non-invasive functional characterization by T1ρ.
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Affiliation(s)
- S Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - B Sondern
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - H Jahr
- Department of Orthopaedics, Aachen University Hospital, Aachen, Germany.
| | - M Tingart
- Department of Orthopaedics, Aachen University Hospital, Aachen, Germany.
| | - M Knobe
- Department of Orthopaedic Trauma, Aachen University Hospital, Aachen, Germany.
| | - J Thüring
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - C Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
| | - D Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, Aachen, Germany.
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Svärd T, Lakovaara M, Pakarinen H, Haapea M, Kiviranta I, Lammentausta E, Jurvelin J, Tervonen O, Ojala R, Nieminen M. Quantitative MRI of Human Cartilage In Vivo: Relationships with Arthroscopic Indentation Stiffness and Defect Severity. Cartilage 2018; 9:46-54. [PMID: 29219019 PMCID: PMC5724675 DOI: 10.1177/1947603516684592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the association of cartilage defect severity, as determined by the International Cartilage Repair Society (ICRS) grading with indentation stiffness and T2 relaxation time of magnetic resonance imaging (MRI), a biomarker for the integrity of articular cartilage. Design Twenty-one patients scheduled for arthroscopic were included in the study. Prior to arthroscopy, subjects underwent quantitative MRI of articular cartilage, namely T2 relaxation time mapping at 1.5 T. Within 2 months, subjects underwent arthroscopy, which also included ICRS grading and measurement of arthroscopic indentation stiffness. Arthroscopic evaluations and T2 mapping at anterior, central, and posterior medial and lateral femoral condyles were correlated using a colocalization scheme. Differences in Young's modulus, as derived by indentation tests, and T2 times between ICRS grades were analyzed using Mann-Whitney's U or Kruskal-Wallis H tests. The correlation between modulus and T2 times was analyzed using Spearman's rank correlation coefficients. Results Modulus and T2 showed significant topographical variation. In the anterior region of interest (ROI) on the medial condyle the modulus showed a negative association with ICRS grade ( P = 0.040) and the T2 times were longer in ICRS grade 2 compared with grades 0 and 1 ( P = 0.047). Similar, but nonsignificant associations were found in the central ROI on the medial condyle. No significant correlations were observed between the indentation modulus and T2 times. Conclusions Cartilage degeneration is identified both with mechanical indentation and T2 mapping in MRI. However, in this study, indentation stiffness and T2 relaxation time in vivo, were not associated.
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Affiliation(s)
- Tuomas Svärd
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Tuomas Svärd, Department of Diagnostic Radiology, Oulu University Hospital, POB 50, Oulu, Oulun lääni 90029, Finland.
| | | | - Harri Pakarinen
- Department of Orthopaedic Surgery, Oulu University Hospital, Oulu, Oulun lääni, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Oulun lääni, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eveliina Lammentausta
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland
| | - Jukka Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Osmo Tervonen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Oulun lääni, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Oulun lääni, Finland
| | | | - Miika Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Oulun lääni, Finland,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Oulun lääni, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Oulun lääni, Finland
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14
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Trisolino G, Favero M, Lazzaro A, Martucci E, Strazzari A, Belluzzi E, Goldring SR, Goldring MB, Punzi L, Grigolo B, Olivotto E. Is arthroscopic videotape a reliable tool for describing early joint tissue pathology of the knee? Knee 2017; 24:1374-1382. [PMID: 28823808 DOI: 10.1016/j.knee.2017.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/22/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to assess the reliability of the videotape scoring system collected during knee arthroscopy for meniscal tears, and to test the consistency with intra-operative findings. METHODS Fifty-seven patients undergoing arthroscopic treatment of meniscal tears were included in the analysis. The cartilage damage was assessed intra-operatively, at six sites, using the Outerbridge scoring system. The meniscal tears were graded according to the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification. The presence of synovial inflammation was scored, at four different sites, according to the macro-score method. The total cartilage, meniscal and synovial scores were calculated for each knee by the sum of the maximum grade of the lesions at each anatomic site. In order to assess the reliability of the arthroscopic scoring system, the videotapes recorded during the arthroscopy were reviewed by two independent observers one year after the surgery and compared with the scores completed by the surgeon during the operation. RESULTS The total cartilage score showed substantial inter-rater and intra-rater reliability, and moderate consistency with the intra-operative score provided by the surgeon. The total meniscal score showed substantial inter-rater and intra-rater reliability, and good consistency with the intra-operative findings. The total synovial score showed substantial inter-rater agreement, substantial intra-rater reliability, and moderate consistency with intra-operative findings. CONCLUSIONS The videotape scoring system provided a reliable and reproducible system for recording the intra-operative state of the whole joint pathology in patients undergoing arthroscopic treatment of meniscal tears.
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Affiliation(s)
- Giovanni Trisolino
- Reconstructive Hip and Knee Joint Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy; Pediatric Orthopedic and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Padova, Italy; Laboratory of Immunorheumatology and Tissue Regeneration/RAMSES, Rizzoli Orthopedic Research Institute, Bologna, Italy.
| | - Antonello Lazzaro
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Ermanno Martucci
- Reconstructive Hip and Knee Joint Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alessandro Strazzari
- Reconstructive Hip and Knee Joint Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Elisa Belluzzi
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Padova, Italy
| | | | | | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine, University Hospital of Padova, Padova, Italy
| | - Brunella Grigolo
- Laboratory of Immunorheumatology and Tissue Regeneration/RAMSES, Rizzoli Orthopedic Research Institute, Bologna, Italy
| | - Eleonora Olivotto
- Laboratory of Immunorheumatology and Tissue Regeneration/RAMSES, Rizzoli Orthopedic Research Institute, Bologna, Italy
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15
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Ala-Myllymäki J, Danso EK, Honkanen JTJ, Korhonen RK, Töyräs J, Afara IO. Optical spectroscopic characterization of human meniscus biomechanical properties. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-10. [PMID: 29275548 DOI: 10.1117/1.jbo.22.12.125008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
This study investigates the capacity of optical spectroscopy in the visible (VIS) and near-infrared (NIR) spectral ranges for estimating the biomechanical properties of human meniscus. Seventy-two samples obtained from the anterior, central, and posterior locations of the medial and lateral menisci of 12 human cadaver joints were used. The samples were subjected to mechanical indentation, then traditional biomechanical parameters (equilibrium and dynamic moduli) were calculated. In addition, strain-dependent fibril network modulus and permeability strain-dependency coefficient were determined via finite-element modeling. Subsequently, absorption spectra were acquired from each location in the VIS (400 to 750 nm) and NIR (750 to 1100 nm) spectral ranges. Partial least squares regression, combined with spectral preprocessing and transformation, was then used to investigate the relationship between the biomechanical properties and spectral response. The NIR spectral region was observed to be optimal for model development (83.0%≤R2≤90.8%). The percentage error of the models are: Eeq (7.1%), Edyn (9.6%), Eϵ (8.4%), and Mk (8.9%). Thus, we conclude that optical spectroscopy in the NIR range is a potential method for rapid and nondestructive evaluation of human meniscus functional integrity and health in real time during arthroscopic surgery.
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Affiliation(s)
- Juho Ala-Myllymäki
- University of Eastern Finland, Department of Applied Physics, Kuopio, Finland
- Kuopio University Hospital, Diagnostic Imaging Center, Kuopio, Finland
| | - Elvis K Danso
- Colorado State University, Department of Mechanical Engineering, Fort Collins, Colorado, United States
| | | | - Rami K Korhonen
- University of Eastern Finland, Department of Applied Physics, Kuopio, Finland
- Kuopio University Hospital, Diagnostic Imaging Center, Kuopio, Finland
| | - Juha Töyräs
- University of Eastern Finland, Department of Applied Physics, Kuopio, Finland
- Kuopio University Hospital, Diagnostic Imaging Center, Kuopio, Finland
| | - Isaac O Afara
- University of Eastern Finland, Department of Applied Physics, Kuopio, Finland
- Kuopio University Hospital, Diagnostic Imaging Center, Kuopio, Finland
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16
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Nebelung S, Rath B, Tingart M, Kuhl C, Schrading S. [Chondral and osteochondral defects : Representation by imaging methods]. DER ORTHOPADE 2017; 46:894-906. [PMID: 28936540 DOI: 10.1007/s00132-017-3472-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Morphological imaging of cartilage at high resolution allows the differentiation of chondral and osteochondral lesions. Nowadays, magnetic resonance imaging is the principal diagnostic tool in the assessment of cartilage structure and composition. Conventional radiography, computed tomography, ultrasound or optical coherence tomography are adjunct diagnostic modalities in the assessment of cartilage pathologies. The present article discusses the up-to-date diagnostic practice of cartilage imaging in terms of its scientific basis and current clinical status, requirements, techniques and image interpretation. Innovations in the field such as functional MRI are discussed as well due to their mid- to long-term clinical perspective.
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Affiliation(s)
- S Nebelung
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - B Rath
- Klinik für Orthopädie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - M Tingart
- Klinik für Orthopädie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - C Kuhl
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - S Schrading
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
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17
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Monitoring osteoarthritis progression using near infrared (NIR) spectroscopy. Sci Rep 2017; 7:11463. [PMID: 28904358 PMCID: PMC5597588 DOI: 10.1038/s41598-017-11844-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023] Open
Abstract
We demonstrate in this study the potential of near infrared (NIR) spectroscopy as a tool for monitoring progression of cartilage degeneration in an animal model. Osteoarthritic degeneration was artificially induced in one joint in laboratory rats, and the animals were sacrificed at four time points: 1, 2, 4, and 6 weeks (3 animals/week). NIR spectra were acquired from both (injured and intact) knees. Subsequently, the joint samples were subjected to histological evaluation and glycosaminoglycan (GAG) content analysis, to assess disease severity based on the Mankin scoring system and to determine proteoglycan loss, respectively. Multivariate spectral techniques were then employed for classification (principal component analysis and support vector machines) and prediction (partial least squares regression) of the samples’ Mankin scores and GAG content from their NIR spectra. Our results demonstrate that NIR spectroscopy is sensitive to degenerative changes in articular cartilage, and is capable of distinguishing between mild (weeks 1&2; Mankin <=2) and advanced (weeks 4&6; Mankin =>3) cartilage degeneration. In addition, the spectral data contains information that enables estimation of the tissue’s Mankin score (error = 12.6%, R2 = 86.2%) and GAG content (error = 7.6%, R2 = 95%). We conclude that NIR spectroscopy is a viable tool for assessing cartilage degeneration post-injury, such as, post-traumatic osteoarthritis.
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18
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Sarin JK, Rieppo L, Brommer H, Afara IO, Saarakkala S, Töyräs J. Combination of optical coherence tomography and near infrared spectroscopy enhances determination of articular cartilage composition and structure. Sci Rep 2017; 7:10586. [PMID: 28878384 PMCID: PMC5587743 DOI: 10.1038/s41598-017-10973-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/17/2017] [Indexed: 01/28/2023] Open
Abstract
Conventional arthroscopic evaluation of articular cartilage is subjective and poorly reproducible. Therefore, implementation of quantitative diagnostic techniques, such as near infrared spectroscopy (NIRS) and optical coherence tomography (OCT), is essential. Locations (n = 44) with various cartilage conditions were selected from mature equine fetlock joints (n = 5). These locations and their surroundings were measured with NIRS and OCT (n = 530). As a reference, cartilage proteoglycan (PG) and collagen contents, and collagen network organization were determined using quantitative microscopy. Additionally, lesion severity visualized in OCT images was graded with an automatic algorithm according to International Cartilage Research Society (ICRS) scoring system. Artificial neural network with variable selection was then employed to predict cartilage composition in the superficial and deep zones from NIRS data, and the performance of two models, generalized (including all samples) and condition-specific models (based on ICRS-grades), was compared. Spectral data correlated significantly (p < 0.002) with PG and collagen contents, and collagen orientation in the superficial and deep zones. The combination of NIRS and OCT provided the most reliable outcome, with condition-specific models having lower prediction errors (9.2%) compared to generalized models (10.4%). Therefore, the results highlight the potential of combining both modalities for comprehensive evaluation of cartilage during arthroscopy.
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Affiliation(s)
- Jaakko K Sarin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland. .,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Lassi Rieppo
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Harold Brommer
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Isaac O Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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19
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Afara IO, Singh S, Moody H, Zhang L, Oloyede A. Characterization of Articular Cartilage Recovery and Its Correlation with Optical Response in the Near-Infrared Spectral Range. Cartilage 2017; 8:307-316. [PMID: 28618866 PMCID: PMC5625859 DOI: 10.1177/1947603516662502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES In this study, we examine the capacity of a new parameter, based on the recovery response of articular cartilage, to distinguish between healthy and damaged tissues. We also investigate whether or not this new parameter correlates with the near-infrared (NIR) optical response of articular cartilage. DESIGN Normal and artificially degenerated (proteoglycan-depleted) bovine cartilage samples were nondestructively probed using NIR spectroscopy. Subsequently they were subjected to a load and unloading protocol, and the recovery response was logged during unloading. The recovery parameter, elastic rebound ( ER), is based on the strain energy released as the samples underwent instantaneous elastic recovery. RESULTS Our results reveal positive relationship between the rebound parameter and cartilage proteoglycan content (normal samples: 2.20 ± 0.10 N mm; proteoglycan-depleted samples: 0.50 ± 0.04 N mm for 1 hour of enzymatic treatment and 0.13 ± 0.02 N mm for 4 hours of enzymatic treatment). In addition, multivariate analysis using partial least squares regression was employed to investigate the relationship between ER and NIR spectral data. The results reveal significantly high correlation ( R2cal = 98.35% and R2val = 79.87%; P < 0.0001), with relatively low error (14%), between the recovery and optical response of cartilage in the combined NIR regions 5,450 to 6,100 cm-1 and 7,500 to 12,500 cm-1. CONCLUSION We conclude that ER can indicate the mechanical condition and state of health of articular cartilage. The correlation of ER with cartilage optical response in the NIR range could facilitate real-time evaluation of the tissue's integrity during arthroscopic surgery and could also provide an important tool for cartilage assessment in tissue engineering and regeneration research.
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Affiliation(s)
- Isaac Oluwaseun Afara
- Department of Electrical and Computer Engineering, Faculty of Engineering, Elizade University, Ilara-Mokin, Ondo, Nigeria,School of Chemistry, Physics, and Mechanical Engineering, Institute of Health and Biomedical Innovation, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia,Research and Innovation Centre, Elizade University, Ilara-Mokin, Ondo State, Nigeria,Isaac Oluwaseun Afara, Department of Electrical and Computer Engineering, Elizade University, Ilara-Mokin, Ondo, Nigeria.
| | - Sanjleena Singh
- Central Analytical Research Facility, Institute of Future Environment, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hayley Moody
- School of Chemistry, Physics, and Mechanical Engineering, Institute of Health and Biomedical Innovation, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Adekunle Oloyede
- School of Chemistry, Physics, and Mechanical Engineering, Institute of Health and Biomedical Innovation, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia,Research and Innovation Centre, Elizade University, Ilara-Mokin, Ondo State, Nigeria
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20
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Dwyer T, Martin CR, Kendra R, Sermer C, Chahal J, Ogilvie-Harris D, Whelan D, Murnaghan L, Nauth A, Theodoropoulos J. Reliability and Validity of the Arthroscopic International Cartilage Repair Society Classification System: Correlation With Histological Assessment of Depth. Arthroscopy 2017; 33:1219-1224. [PMID: 28162918 DOI: 10.1016/j.arthro.2016.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/27/2016] [Accepted: 12/05/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the interobserver reliability of the International Cartilage Repair Society (ICRS) grading system of chondral lesions in cadavers, to determine the intraobserver reliability of the ICRS grading system comparing arthroscopy and video assessment, and to compare the arthroscopic ICRS grading system with histological grading of lesion depth. METHODS Eighteen lesions in 5 cadaveric knee specimens were arthroscopically graded by 7 fellowship-trained arthroscopic surgeons using the ICRS classification system. The arthroscopic video of each lesion was sent to the surgeons 6 weeks later for repeat grading and determination of intraobserver reliability. Lesions were biopsied, and the depth of the cartilage lesion was assessed. Reliability was calculated using intraclass correlations. RESULTS The interobserver reliability was 0.67 (95% confidence interval, 0.5-0.89) for the arthroscopic grading, and the intraobserver reliability with the video grading was 0.8 (95% confidence interval, 0.67-0.9). A high correlation was seen between the arthroscopic grading of depth and the histological grading of depth (0.91); on average, surgeons graded lesions using arthroscopy a mean of 0.37 (range, 0-0.86) deeper than the histological grade. CONCLUSIONS The arthroscopic ICRS classification system has good interobserver and intraobserver reliability. A high correlation with histological assessment of depth provides evidence of validity for this classification system. CLINICAL RELEVANCE As cartilage lesions are treated on the basis of the arthroscopic ICRS classification, it is important to ascertain the reliability and validity of this method.
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Affiliation(s)
- Tim Dwyer
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; Mt Sinai Hospital, Toronto, Ontario, Canada.
| | - C Ryan Martin
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | | | | | - Jaskarndip Chahal
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada
| | - Darrell Ogilvie-Harris
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada
| | - Daniel Whelan
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada
| | - Lucas Murnaghan
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada
| | - Aaron Nauth
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - John Theodoropoulos
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; Mt Sinai Hospital, Toronto, Ontario, Canada
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21
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Sarin JK, Brommer H, Argüelles D, Puhakka PH, Inkinen SI, Afara IO, Saarakkala S, Töyräs J. Multimodality scoring of chondral injuries in the equine fetlock joint ex vivo. Osteoarthritis Cartilage 2017; 25:790-798. [PMID: 27965140 DOI: 10.1016/j.joca.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We investigate the potential of a prototype multimodality arthroscope, combining ultrasound, optical coherence tomography (OCT) and arthroscopic indentation device, for assessing cartilage lesions, and compare the reliability of this approach with conventional arthroscopic scoring ex vivo. DESIGN Areas of interest (AIs, N = 43) were selected from equine fetlock joints (N = 5). Blind-coded AIs were independently scored by two equine surgeons employing International Cartilage Repair Society (ICRS) scoring system via conventional arthroscope and multimodality arthroscope, in which high-frequency ultrasound and OCT catheters were attached to an arthroscopic indentation device. In addition, cartilage stiffness was measured with the indentation device, and lesions in OCT images scored using custom-made automated software. Measurements and scorings were performed twice in two separate rounds. Finally, the scores were compared to histological ICRS scores. RESULTS OCT and arthroscopic examinations showed the highest average agreements (55.2%) between the scoring by surgeons and histology scores, whereas ultrasound had the lowest (50.6%). Average intraobserver agreements of surgeons and interobserver agreements between rounds were, respectively, for conventional arthroscope (68.6%, 69.8%), ultrasound (68.6%, 68.6%), OCT (65.1%, 61.7%) and automated software (65.1%, 59.3%). CONCLUSIONS OCT imaging supplemented with the automated software provided the most reliable lesion scoring. However, limited penetration depth of light limits the clinical potential of OCT in assessing human cartilage thickness; thus, the combination of OCT and ultrasound could be optimal for reliable diagnostics. Present findings suggest imaging and quantitatively analyzing the entire articular surface to eliminate surgeon-related variation in the selection of the most severe lesion to be scored.
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Affiliation(s)
- J K Sarin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - H Brommer
- Department of Equine Sciences, Utrecht University, Utrecht, The Netherlands.
| | - D Argüelles
- Veterinary Teaching Hospital, School of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
| | - P H Puhakka
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - S I Inkinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - I O Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Department of Electrical and Computer Engineering, Elizade University, Ondo, Nigeria.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
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22
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Abstract
Background Chondromalacia patellae is a very common disorder. Although magnetic resonance imaging (MRI) is widely used to investigate patellar cartilage lesions, there is no descriptive MRI-based grading system for chondromalacia patellae. Purpose To propose a new MRI grading system for chondromalacia patellae with corresponding high resolution images which might be useful in precisely reporting and comparing knee examinations in routine daily practice and used in predicting natural course and clinical outcome of the patellar cartilage lesions. Material and Methods High resolution fat-saturated proton density (FS PD) images in the axial plane with corresponding T2 mapping images were reviewed. A detailed MRI grading system covering the deficiencies of the existing gradings has been set and presented on these images. Two experienced observers blinded to clinical data examined 44 knee MR images and evaluated patellar cartilage changes according to the proposed grading system. Inter- and intra-rater validity testing using kappa statistics were calculated. Results A descriptive and detailed grading system with corresponding FS PD and T2 mapping images has been presented. Inter-rater agreement was 0.80 (95% confidence interval [CI], 0.71-0.89). Intra-rater agreements were 0.83 (95% CI, 0.74-0.91) for observer A and 0.79 (95% CI, 0.70-0.88) for observer B (k-values). Conclusion We present a new MRI grading system for chondromalacia patellae with corresponding images and good inter- and intra-rater agreement which might be useful in reporting and comparing knee MRI examinations in daily practice and may also have the potential for using more precisely predicting prognosis and clinical outcome of the patients.
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Affiliation(s)
- Ali Özgen
- Department of Radiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Neslihan Taşdelen
- Department of Radiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Zeynep Fırat
- Department of Radiology, Yeditepe University Hospital, Istanbul, Turkey
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23
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Goebel L, Orth P, Cucchiarini M, Pape D, Madry H. Macroscopic cartilage repair scoring of defect fill, integration and total points correlate with corresponding items in histological scoring systems - a study in adult sheep. Osteoarthritis Cartilage 2017; 25:581-588. [PMID: 27789340 DOI: 10.1016/j.joca.2016.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/15/2016] [Accepted: 10/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To correlate osteochondral repair assessed by validated macroscopic scoring systems with established semiquantitative histological analyses in an ovine model and to test the hypothesis that important macroscopic individual categories correlate with their corresponding histological counterparts. METHODS In the weight-bearing portion of medial femoral condyles (n = 38) of 19 female adult Merino sheep (age 2-4 years; weight 70 ± 20 kg) full-thickness chondral defects were created (size 4 × 8 mm; International Cartilage Repair Society (ICRS) grade 3C) and treated with Pridie drilling. After sacrifice, 1520 blinded macroscopic observations from three observers at 2-3 time points including five different macroscopic scoring systems demonstrating all grades of cartilage repair where correlated with corresponding categories from 418 blinded histological sections. RESULTS Categories "defect fill" and "total points" of different macroscopic scoring systems correlated well with their histological counterparts from the Wakitani and Sellers scores (all P ≤ 0.001). "Integration" was assessed in both histological scoring systems and in the macroscopic ICRS, Oswestry and Jung scores. Here, a significant relationship always existed (0.020 ≤ P ≤ 0.049), except for Wakitani and Oswestry (P = 0.054). No relationship was observed for the "surface" between histology and macroscopy (all P > 0.05). CONCLUSIONS Major individual morphological categories "defect fill" and "integration", and "total points" of macroscopic scoring systems correlate with their corresponding categories in elementary and complex histological scoring systems. Thus, macroscopy allows to precisely predict key histological aspects of articular cartilage repair, underlining the specific value of macroscopic scoring for examining cartilage repair.
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Affiliation(s)
- L Goebel
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, D-66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Straße, Building 37, D-66421 Homburg/Saar, Germany.
| | - P Orth
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, D-66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Straße, Building 37, D-66421 Homburg/Saar, Germany.
| | - M Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, D-66421 Homburg/Saar, Germany.
| | - D Pape
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, 78, Rue d'Eich, 1460 Luxembourg, Luxembourg.
| | - H Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrberger Straße, Building 37, D-66421 Homburg/Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Straße, Building 37, D-66421 Homburg/Saar, Germany.
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Omoumi P, Michoux N, Larbi A, Lacoste L, Lecouvet FE, Perlepe V, Vande Berg BC. Multirater agreement for grading the femoral and tibial cartilage surface lesions at CT arthrography and analysis of causes of disagreement. Eur J Radiol 2017; 88:95-101. [DOI: 10.1016/j.ejrad.2016.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/21/2016] [Accepted: 12/24/2016] [Indexed: 10/20/2022]
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25
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Nebelung S, Sondern B, Oehrl S, Tingart M, Rath B, Pufe T, Raith S, Fischer H, Kuhl C, Jahr H, Truhn D. Functional MR Imaging Mapping of Human Articular Cartilage Response to Loading. Radiology 2017; 282:464-474. [DOI: 10.1148/radiol.2016160053] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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26
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Lewallen EA, Bonin CA, Li X, Smith J, Karperien M, Larson AN, Lewallen DG, Cool SM, Westendorf JJ, Krych AJ, Leontovich AA, Im HJ, van Wijnen AJ. The synovial microenvironment of osteoarthritic joints alters RNA-seq expression profiles of human primary articular chondrocytes. Gene 2016; 591:456-64. [PMID: 27378743 PMCID: PMC5989726 DOI: 10.1016/j.gene.2016.06.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/30/2016] [Indexed: 11/20/2022]
Abstract
Osteoarthritis (OA) is a disabling degenerative joint disease that prompts pain and has limited treatment options. To permit early diagnosis and treatment of OA, a high resolution mechanistic understanding of human chondrocytes in normal and diseased states is necessary. In this study, we assessed the biological effects of OA-related changes in the synovial microenvironment on chondrocytes embedded within anatomically intact cartilage from joints with different pathological grades by next generation RNA-sequencing (RNA-seq). We determined the transcriptome of primary articular chondrocytes derived from anatomically unaffected knees and ankles, as well as from joints affected by OA. The GALAXY bioinformatics platform was used to facilitate biological interpretations. Comparisons of patient samples by k-means, hierarchical clustering and principal component analyses together reveal that primary chondrocytes exhibit OA grade-related differences in gene expression, including genes involved in cell-adhesion, ECM production and immune response. We conclude that diseased synovial microenvironments in joints with different histopathological OA grades directly alter gene expression in chondrocytes. One ramification of this finding is that anatomically intact cartilage from OA joints is not an ideal source of healthy chondrocytes, nor should these specimens be used to generate a normal baseline for the molecular characterization of diseased joints.
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Affiliation(s)
- Eric A Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Carolina A Bonin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Xin Li
- Jesse Brown VA Medical Center, Chicago, IL, United States.
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States.
| | - Marcel Karperien
- Department of Developmental Bioengineering, University of Twente, Enschede, The Netherlands.
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Simon M Cool
- Department of Orthopedic Surgery, National University of Singapore, Singapore.
| | - Jennifer J Westendorf
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN, United States.
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Alexey A Leontovich
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
| | - Hee-Jeong Im
- Jesse Brown VA Medical Center, Chicago, IL, United States; Department of Biochemistry, Rush University, Chicago, IL, United States; Department of Orthopedic Surgery, Rush University, Chicago, IL, United States; Department of Internal Medicine, Rush University, Chicago, IL, United States.
| | - Andre J van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States.
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Association between quantitative MRI and ICRS arthroscopic grading of articular cartilage. Knee Surg Sports Traumatol Arthrosc 2016; 24:2046-54. [PMID: 25209205 DOI: 10.1007/s00167-014-3286-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 08/27/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the association of quantitative magnetic resonance imaging (qMRI) parameters with arthroscopic grading of cartilage degeneration. Arthroscopy of the knee is considered to be the gold standard of osteoarthritis diagnostics; however, it is operator-dependent and limited to the evaluation of the articular surface. qMRI provides information on the quality of articular cartilage and its changes even at early stages of a disease. METHODS qMRI techniques included T 1 relaxation time, T 2 relaxation time, and delayed gadolinium-enhanced MRI of cartilage mapping at 3 T in ten patients. Due to a lack of generally accepted semiquantitative scoring systems for evaluating severity of cartilage degeneration during arthroscopy, the International Cartilage Repair Society (ICRS) classification system was used to grade the severity of cartilage lesions. qMRI parameters were statistically compared to arthroscopic grading conducted with the ICRS classification system. RESULTS qMRI parameters were not linearly related to arthroscopic grading. Spearman's correlation coefficients between qMRI and arthroscopic grading were not significant. The relative differences in qMRI parameters of superficial and deep cartilage varied with degeneration, suggesting different macromolecular alterations in different cartilage zones. CONCLUSIONS Results suggest that loss of cartilage and the quality of remaining tissue in the lesion site may not be directly associated with each other. The severity of cartilage degeneration may not be revealed solely by diagnostic arthroscopy, and thus, qMRI can have a role in the investigation of cartilage degeneration.
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Widhalm HK, Seemann R, Hamboeck M, Mittlboeck M, Neuhold A, Friedrich K, Hajdu S, Widhalm K. Osteoarthritis in morbidly obese children and adolescents, an age-matched controlled study. Knee Surg Sports Traumatol Arthrosc 2016; 24:644-52. [PMID: 24841943 DOI: 10.1007/s00167-014-3068-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 05/05/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Main objective of this study was to investigate the association of pain and early cartilage lesions in morbidly obese children and adolescents. METHODS A total of 57 subjects were included in the study. Morbidly obese patients (n = 39) were subdivided into two groups: Group A: (11 males and 9 females, 14.2 ± 2.7 years) with permanent knee pain; and Group B: (10 males and 9 females, 14.4 ± 2.2 years) without permanent or without any knee pain. Group C (8 males and 10 females, 15.0 ± 2.9 years) included age-matched children and adolescents of normal weight. MRI examinations were performed in all subjects, and an extensive analysis of the images was conducted according to the condition of the cartilage surface and the meniscus. Patients' subjective health was assessed by means of four well-known knee scores (IKDC, KOOS, Tegner/Lysholm, and VAS). Nonparametric Jonckheere-Terpstra test was used to test the trend of the natural order between the three groups. RESULTS In 38 of 39 morbidly obese children and adolescents, in at least one region of the knee, a marked cartilage lesion could be shown by MRI. Group A showed significantly (p < 0.001) more cartilage lesions (mean 3.7) compared to Group B (mean 2.8) and Group C (mean 0.8). IKDC, and all the KOOS subunits, showed significantly (p < 0.001, p Bonferroni < 0.001) increasing scores from Group A to B to C, in addition to KOOS symptoms. CONCLUSIONS Morbid obesity causes early lesions of the knee cartilage, even in young patients. Significantly, more patients with reported pain show more severe damages.
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Affiliation(s)
- H K Widhalm
- Department of Trauma Surgery, Center for Joints and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - R Seemann
- Department of Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
| | - M Hamboeck
- Department of Trauma Surgery, Center for Joints and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - M Mittlboeck
- Department of Medical Statistics, Medical University of Vienna, Vienna, Austria.
| | - A Neuhold
- Department of Radiology, Private Hospital Rudolfinerhaus, Vienna, Austria.
| | - K Friedrich
- Department of Radiology, Medical University of Vienna, Vienna, Austria.
| | - S Hajdu
- Department of Trauma Surgery, Center for Joints and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - K Widhalm
- Department of Pediatrics, Paracelsus Private Medical University, Salzburg, Austria.
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Nebelung S, Brill N, Müller F, Tingart M, Pufe T, Merhof D, Schmitt R, Jahr H, Truhn D. Towards Optical Coherence Tomography-based elastographic evaluation of human cartilage. J Mech Behav Biomed Mater 2016; 56:106-119. [DOI: 10.1016/j.jmbbm.2015.11.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/21/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
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Ala-Myllymäki J, Honkanen JTJ, Töyräs J, Afara IO. Optical spectroscopic determination of human meniscus composition. J Orthop Res 2016; 34:270-8. [PMID: 26267333 DOI: 10.1002/jor.23025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/31/2015] [Indexed: 02/04/2023]
Abstract
This study investigates the correlation between the composition of human meniscus and its absorption spectrum in the visible (VIS) and near infrared (NIR) spectral range. Meniscus samples (n = 24) were obtained from nonarthritic knees of human cadavers with no history of joint diseases. Specimens (n = 72) were obtained from three distinct sections of the meniscus, namely; anterior, center, posterior. Absorption spectra were acquired from each specimen in the VIS and NIR spectral range (400-1,100 nm). Following spectroscopic probing, the specimens were subjected to biochemical analyses to determine the matrix composition, that is water, hydroxyproline, and uronic acid contents. Multivariate analytical techniques, including principal component analysis (PCA) and partial least squares (PLS) regression, were then used to investigate the correlation between the matrix composition and it spectral response. Our results indicate that the optical absorption of meniscus matrix is related to its composition, and this relationship is optimal in the NIR spectral range (750-1,100 nm). High correlations (R(2) (uronic) = 86.9%, R(2) (water) = 83.8%, R(2) (hydroxyproline) = 81.7%, p < 0.0001) were obtained between the spectral predicted and measured meniscus composition, thus suggesting that spectral data in the NIR range can be utilized for estimating the matrix composition of human meniscus. In conclusion, optical spectroscopy, particularly in the NIR spectral range, is a potential method for evaluating the composition of human meniscus. This presents a promising technique for rapid and nondestructive evaluation of meniscus integrity in real-time during arthroscopic surgery.
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Affiliation(s)
- Juho Ala-Myllymäki
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Juuso T J Honkanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | - Isaac O Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
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Becher C, Ricklefs M, Willbold E, Hurschler C, Abedian R. Electromechanical Assessment of Human Knee Articular Cartilage with Compression-Induced Streaming Potentials. Cartilage 2016; 7:62-9. [PMID: 26958318 PMCID: PMC4749748 DOI: 10.1177/1947603515599191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To assess the electromechanical properties of human knee articular cartilage with compression-induced streaming potentials for reliability among users and correlation with macroscopic and histological evaluation tools and sulfated glycosaminoglycan (sGAG) content. METHODS Streaming potentials are induced in cartilage in response to loading when mobile positive ions in the interstitial fluid temporarily move away from negatively charged proteoglycans. Streaming potential integrals (SPIs) were measured with an indentation probe on femoral condyles of 10 human knee specimens according to a standardized location scheme. Interobserver reliability was measured using an interclass correlation coefficient (ICC). The learning curves of 3 observers were evaluated by regression analysis. At each SPI measurement location the degradation level of the tissue was determined by means of the International Cartilage Repair Society (ICRS) score, Mankin score, and sGAG content. RESULTS The computed ICC was 0.77 (0.70-0.83) indicating good to excellent linear agreement of SPI values among the 3 users. A significant positive linear correlation of the learning index values was observed for 2 of the 3 users. Statistically significant negative correlations between SPI and both ICRS and Mankin scores were observed (r = 0.502, P < 0.001, and r = 0.255, P = 0.02, respectively). No correlation was observed between SPI and sGAG content (r = 0.004, P = 0.973). CONCLUSIONS SPI values may be used as a quantitative means of cartilage evaluation with sufficient reliability among users. Due to the significant learning curve, adequate training should be absolved before routine use of the technique.
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Affiliation(s)
- Christoph Becher
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany,Christoph Becher, Department of Orthopedic Surgery, Hannover Medical School, 1-7 Anna-von-Borries-Straße, 30625 Hannover, Germany.
| | - Marcel Ricklefs
- Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Elmar Willbold
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Reza Abedian
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
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Puhakka PH, Te Moller NCR, Afara IO, Mäkelä JTA, Tiitu V, Korhonen RK, Brommer H, Virén T, Jurvelin JS, Töyräs J. Estimation of articular cartilage properties using multivariate analysis of optical coherence tomography signal. Osteoarthritis Cartilage 2015; 23:2206-2213. [PMID: 26057849 DOI: 10.1016/j.joca.2015.05.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/27/2015] [Accepted: 05/26/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim was to investigate the applicability of multivariate analysis of optical coherence tomography (OCT) information for determining structural integrity, composition and mechanical properties of articular cartilage. DESIGN Equine osteochondral samples (N = 65) were imaged with OCT, and their total attenuation and backscattering coefficients (μt and μb) were measured. Subsequently, the Mankin score, optical density (OD) describing the fixed charge density, light absorbance in amide I region (Aamide), collagen orientation, permeability, fibril network modulus (Ef) and non-fibrillar matrix modulus (Em) of the samples were determined. Partial least squares (PLS) regression model was calculated to predict tissue properties from the OCT signals of the samples. RESULTS Significant correlations between the measured and predicted mean collagen orientation (R(2) = 0.75, P < 0.0001), permeability (R(2) = 0.74, P < 0.0001), mean OD (R(2) = 0.73, P < 0.0001), Mankin scores (R(2) = 0.70, P < 0.0001), Em (R(2) = 0.50, P < 0.0001), Ef (R(2) = 0.42, P < 0.0001), and Aamide (R(2) = 0.43, P < 0.0001) were obtained. Significant correlation was also found between μb and Ef (ρ = 0.280, P = 0.03), but not between μt and any of the determined properties of articular cartilage (P > 0.05). CONCLUSION Multivariate analysis of OCT signal provided good estimates for tissue structure, composition and mechanical properties. This technique may significantly enhance OCT evaluation of articular cartilage integrity, and could be applied, for example, in delineation of degenerated areas around cartilage injuries during arthroscopic repair surgery.
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Affiliation(s)
- P H Puhakka
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland.
| | - N C R Te Moller
- Department of Equine Sciences, Utrecht University, Utrecht, Netherlands.
| | - I O Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - J T A Mäkelä
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - V Tiitu
- School of Medicine, Institute of Biomedicine, Anatomy, University of Eastern Finland, Kuopio, Finland.
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - H Brommer
- Department of Equine Sciences, Utrecht University, Utrecht, Netherlands.
| | - T Virén
- Cancer Center, Kuopio University Hospital, Kuopio, Finland.
| | - J S Jurvelin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland.
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Löw S, Erne H, Schütz A, Eingartner C, Spies CK. The required minimum length of video sequences for obtaining a reliable interobserver diagnosis in wrist arthroscopies. Arch Orthop Trauma Surg 2015; 135:1771-7. [PMID: 26423659 DOI: 10.1007/s00402-015-2339-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the relationship between video length for wrist arthroscopy and interobserver reliability. MATERIALS AND METHODS 100 consecutive wrist arthroscopies were documented by long and short videos of the radiocarpal and the midcarpal joints. The long videos were about twice as long as the short videos. They were presented randomly to two independent and blinded examiners. Their diagnoses were compared to the diagnoses made by the surgeon who performed the arthroscopies. Kappa coefficients were calculated. RESULTS Kappa statistics were inconsistent and did not show that the long video provided an obvious advantage over the short video. The Kappa coefficients of the two examiners for the assessment of the cartilage status were 0.524 and 0.700 for the long videos and 0.465 and 0.639 for the short videos, respectively. The examiners diagnosed twice as many false-positive cartilage lesions on short videos than on long videos. The assessment of ligament lesions was more accurate on long than on short videos. CONCLUSIONS The results confirmed the hypothesis that the reproducibility of diagnoses based on video documents was influenced by the length of the video sequences. Therefore, it may be advisable for video documentation to be done diligently. The video sequence of the radiocarpal joint should last about 60 s, and that of a midcarpal joint should last about 45 s. Videos of difficult joints should last appropriately longer. LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Steffen Löw
- Section of Hand Surgery, Division of Trauma and Orthopedic Surgery, Caritas Krankenhaus, Uhlandstraße 7, 97980, Bad Mergentheim, Germany.
| | - Holger Erne
- Department for Plastic and Hand Surgery, Klinikum rechts der Isar TUM, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Alexander Schütz
- Sporthopaedicum, Hildegard-von Bingen-Str. 1, 93053, Regensburg, Germany.
| | - Christoph Eingartner
- Section of Hand Surgery, Division of Trauma and Orthopedic Surgery, Caritas Krankenhaus, Uhlandstraße 7, 97980, Bad Mergentheim, Germany.
| | - Christian K Spies
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstrabe 29, 74906, Bad Rappenau, Germany.
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Reliability of 3 Different Arthroscopic Classifications for Chondral Damage of the Acetabulum. Arthroscopy 2015; 31:1492-6. [PMID: 25887376 DOI: 10.1016/j.arthro.2015.02.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 02/03/2015] [Accepted: 02/17/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the interobserver and intraobserver reliability of 3 chondral damage classifications used to assess articular cartilage damage during hip arthroscopy. METHODS A prospective multicenter study was performed during April and May 2013. Inclusion criteria were all patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) and had evidence of chondral damage at the time of surgery. Intra-articular recordings were obtained during the operation in a standardized way. These recordings were obtained from 2 different hospitals in 2 countries by 3 different surgeons. Four fellowship-trained orthopaedic surgeons, with at least 2 years postfellowship experience in hip arthroscopy, independently analyzed the recordings 2 times in randomized order and 4 months apart. They classified the lesions according to the Outerbridge, Beck, and Haddad classifications of chondral damage. The values obtained were used for interobserver and intraobserver analysis. Percentage of agreement and weighted Cohen κ values were calculated. RESULTS Absolute agreement between observers was present in 12.5% of the cases for the Outerbridge classification, in 20% of the cases for the Beck classification, and in 40% of the cases for the Haddad classification. For interobserver reliability, the average weighted Cohen κ values were 0.28 (95% confidence interval [CI], 0.16 to 0.39), 0.33 (95% CI, 0.24 to 0.41), and 0.47 (95% CI, 0.42 to 0.51) for the Outerbridge, Beck, and Haddad classification systems, respectively. For intraobserver reliability, the mean Cohen κ values were 0.62, 0.63, and 0.68 for the Outerbridge, Beck, and Haddad classification systems, respectively. CONCLUSIONS In our series, the Haddad classification had the best interobserver reliability. There was no difference in the intraobserver reliability among the 3 classifications studied. LEVEL OF EVIDENCE Level III, diagnostic study of nonconsecutive patients (without consistently applied reference gold standard).
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Kumar R, Grønhaug KM, Davies CL, Drogset JO, Lilledahl MB. Nonlinear optical microscopy of early stage (ICRS Grade-I) osteoarthritic human cartilage. BIOMEDICAL OPTICS EXPRESS 2015; 6:1895-903. [PMID: 26137389 PMCID: PMC4467725 DOI: 10.1364/boe.6.001895] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 05/16/2023]
Abstract
In a synovial joint, the articular cartilage is directly affected during the progression of Osteoarthritis (OA). The characterization of early stage modification in extra-cellular matrix of cartilage is essential for detection as well as understanding the progression of disease. The objective of this study is to demonstrate the potential and capability of nonlinear optical microscopy for the morphological investigation of early stage osteoarthritic cartilage. ICRS Grade-I cartilage sections were obtained from the femoral condyle of the human knee. The surface of articular cartilage was imaged by second harmonic generation and two-photon excited fluorescence microscopy. Novel morphological features like microsplits and wrinkles were observed, which would otherwise not be visible in other clinical imaging modalities (e.g., CT, MRI, ultrasound and arthroscope. The presence of superficial layer with distinct collagen fibrils parallel to the articular surface in 4 specimens out of 14 specimens, indicates that different phases of OA within ICRS Grade-I can be detected by SHG microscopy. All together, the observed novel morphologies in early stage osteoarthritic cartilage indicates that SHG microscopy might be a significant tool for the assessment of cartilage disorder.
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Affiliation(s)
- Rajesh Kumar
- Department of Physics, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim,
Norway
| | - Kirsten M. Grønhaug
- Orthopaedic Department, Levanger Hospital, Kirkegata 2, N-7600 Levanger,
Norway
| | - Catharina L. Davies
- Department of Physics, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim,
Norway
| | - Jon O. Drogset
- Department of Orthopaedic Surgery, Trondheim University Hospital, N-7491 Trondheim,
Norway
| | - Magnus B. Lilledahl
- Department of Physics, Norwegian University of Science and Technology (NTNU), N-7491, Trondheim,
Norway
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Matava MJ, Arciero RA, Baumgarten KM, Carey JL, DeBerardino TM, Hame SL, Hannafin JA, Miller BS, Nissen CW, Taft TN, Wolf BR, Wright RW. Multirater agreement of the causes of anterior cruciate ligament reconstruction failure: a radiographic and video analysis of the MARS cohort. Am J Sports Med 2015; 43:310-9. [PMID: 25537942 PMCID: PMC4447190 DOI: 10.1177/0363546514560880] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction failure occurs in up to 10% of cases. Technical errors are considered the most common cause of graft failure despite the absence of validated studies. Limited data are available regarding the agreement among orthopaedic surgeons regarding the causes of primary ACL reconstruction failure and accuracy of graft tunnel placement. HYPOTHESIS Experienced knee surgeons have a high level of interobserver reliability in the agreement about the causes of primary ACL reconstruction failure, anatomic graft characteristics, and tunnel placement. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Twenty cases of revision ACL reconstruction were randomly selected from the Multicenter ACL Revision Study (MARS) database. Each case included the patient's history, standardized radiographs, and a concise 30-second arthroscopic video taken at the time of revision demonstrating the graft remnant and location of the tunnel apertures. All 20 cases were reviewed by 10 MARS surgeons not involved with the primary surgery. Each surgeon completed a 2-part questionnaire dealing with each surgeon's training and practice, as well as the placement of the femoral and tibial tunnels, condition of the primary graft, and the surgeon's opinion as to the causes of graft failure. Interrater agreement was determined for each question with the kappa coefficient and the prevalence-adjusted, bias-adjusted kappa (PABAK). RESULTS The 10 reviewers have been in practice an average of 14 years and have performed at least 25 ACL reconstructions per year, and 9 were fellowship trained in sports medicine. There was wide variability in agreement among knee experts as to the specific causes of ACL graft failure. When participants were specifically asked about technical error as the cause for failure, interobserver agreement was only slight (PABAK = 0.26). There was fair overall agreement on ideal femoral tunnel placement (PABAK = 0.55) but only slight agreement on whether a femoral tunnel was too anterior (PABAK = 0.24) and fair agreement on whether it was too vertical (PABAK = 0.46). There was poor overall agreement for ideal tibial tunnel placement (PABAK = 0.17). CONCLUSION This study suggests that more objective criteria are needed to accurately determine the causes of primary ACL graft failure as well as the ideal femoral and tibial tunnel placement in patients undergoing revision ACL reconstruction.
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Afara IO, Moody H, Singh S, Prasadam I, Oloyede A. Spatial mapping of proteoglycan content in articular cartilage using near-infrared (NIR) spectroscopy. BIOMEDICAL OPTICS EXPRESS 2015; 6:144-54. [PMID: 25657883 PMCID: PMC4317110 DOI: 10.1364/boe.6.000144] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 11/28/2014] [Accepted: 11/30/2014] [Indexed: 05/18/2023]
Abstract
Diagnosis of articular cartilage pathology in the early disease stages using current clinical diagnostic imaging modalities is challenging, particularly because there is often no visible change in the tissue surface and matrix content, such as proteoglycans (PG). In this study, we propose the use of near infrared (NIR) spectroscopy to spatially map PG content in articular cartilage. The relationship between NIR spectra and reference data (PG content) obtained from histology of normal and artificially induced PG-depleted cartilage samples was investigated using principal component (PC) and partial least squares (PLS) regression analyses. Significant correlation was obtained between both data (R(2) = 91.40%, p<0.0001). The resulting correlation was used to predict PG content from spectra acquired from whole joint sample, this was then employed to spatially map this component of cartilage across the intact sample. We conclude that NIR spectroscopy is a feasible tool for evaluating cartilage contents and mapping their distribution across mammalian joint.
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Affiliation(s)
- Isaac O. Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio,
Finland
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane,
Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane,
Australia
| | - Hayley Moody
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane,
Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane,
Australia
| | - Sanjleena Singh
- Central Analytical Research Facility, Queensland University of Technology, Brisbane,
Australia
| | - Indira Prasadam
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane,
Australia
| | - Adekunle Oloyede
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane,
Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane,
Australia
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Peck CN, Childs J, McLauchlan GJ. Inferior outcomes of total knee replacement in early radiological stages of osteoarthritis. Knee 2014; 21:1229-32. [PMID: 25205527 DOI: 10.1016/j.knee.2014.08.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 08/17/2014] [Accepted: 08/19/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee replacement (TKR) for osteoarthritis (OA) is a common and successful operation; the severity of radiographic changes plays a key role as to when it should be performed. This study investigates whether an early radiological grade of OA has an adverse effect on the outcome of TKR in patients with arthroscopically confirmed OA. METHODS Between January 2006 and January 2011 data was collected prospectively on all patients undergoing a primary TKR for OA. We included all patients with a Kellgren-Lawrence score of two or less on their pre-operative radiograph who had had an arthroscopy to confirm significant OA. Our primary outcomes were the Oxford Knee Score (OKS) and a satisfaction rating. RESULTS Over the study period 1708 primary TKRs were performed in 1381 patients. We identified 44 TKRs in 43 patients with a Kellgren-Lawrence score of two or less on their pre-operative radiograph. In this group the mean age was 63 years, 66% were female and the mean BMI was 31.7 kg/m(2). At a mean follow-up of 37 months the mean OKS was only 30 points compared to 36 in all TKRs performed over the same period (p=0.0004). Only 68% were either satisfied or very satisfied. Eight knees (18%) underwent further surgery, three (6.8%) of which were revision procedures, compared to a revision rate of 1.6% in all patients. CONCLUSION The outcomes of TKR in patients with early radiological changes of OA are inferior to those with significant radiological changes and should be performed with caution. LEVEL OF EVIDENCE Level IV case-series.
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Affiliation(s)
- C N Peck
- Department of Orthopaedic Surgery, Chorley District Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, United Kingdom.
| | - J Childs
- Department of Orthopaedic Surgery, Chorley District Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, United Kingdom
| | - G J McLauchlan
- Department of Orthopaedic Surgery, Chorley District Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, United Kingdom
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Farrell M, Heller J, Solano M, Fitzpatrick N, Sparrow T, Kowaleski M. Does Radiographic Arthrosis Correlate With Cartilage Pathology in Labrador Retrievers Affected by Medial Coronoid Process Disease? Vet Surg 2014; 43:155-65. [DOI: 10.1111/j.1532-950x.2014.12092.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 03/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Jane Heller
- Department of Epidemiology and Public Health; School of Animal and Veterinary Studies; Charles Sturt University; Wagga Wagga Australia
| | | | | | - Tim Sparrow
- Fitzpatrick Referrals; Eashing United Kingdom
| | - Mike Kowaleski
- Tufts Cummings School of Veterinary Medicine; North Grafton Massachusetts
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McGoverin CM, Lewis K, Yang X, Bostrom MPG, Pleshko N. The contribution of bone and cartilage to the near-infrared spectrum of osteochondral tissue. APPLIED SPECTROSCOPY 2014; 68:1168-75. [PMID: 25197817 PMCID: PMC4235673 DOI: 10.1366/13-07327] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Near-infrared (NIR) spectroscopy has been used to assess hyaline cartilage quality in human and animal osteochondral tissues. However, due to the lack of NIR signal from bone phosphate and the relatively deep penetration depth of the radiation, the separate contributions of cartilage and bone to the spectral signatures have not been well defined. The objectives of the current study were (1) to improve the understanding of the contributions of bone and cartilage to NIR spectra acquired from osteochondral tissue and (2) to assess the ability of this nondestructive method to predict cartilage thickness and modified Mankin grade of human tibial plateau articular cartilage. Near-infrared spectra were acquired from samples of bovine bone and cartilage with varying thicknesses and from 22 tibial plateaus harvested from patients undergoing knee replacement surgery. The spectra were recorded from regions of the tibial plateaus with varying degrees of degradation, and the cartilage thickness and modified Mankin grade of these regions were assessed histologically. The spectra from bone and cartilage samples of known thicknesses were investigated to identify spectral regions that were distinct for these two tissues. Univariate and multivariate linear regression methods were used to correlate modified Mankin grade and cartilage thickness with NIR spectral changes. The ratio of the NIR absorbances associated with water at 5270 and 7085 cm(-1) was the best differentiator of cartilage and bone spectra. The NIR prediction models for thickness and Mankin grade calculated using partial least squares regression were more accurate than were univariate-based prediction models, with a root mean square errors of cross-validation of 0.42 mm (for thickness) and 1.3 (for modified Mankin grade). We conclude that NIR spectroscopy may be used to simultaneously assess articular cartilage thickness and modified Mankin grade, based in part on differences in spectral contributions from bone and cartilage.
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Affiliation(s)
- Cushla M. McGoverin
- Department of Bioengineering, College of Engineering, Temple University, 1947 North 12 St., Philadelphia, PA 19122
| | - Karl Lewis
- Department of Bioengineering, College of Engineering, Temple University, 1947 North 12 St., Philadelphia, PA 19122
| | - Xu Yang
- Research Division, Hospital for Special Surgery, 535 East 70 St., New York, NY 10021
| | - Mathias P. G. Bostrom
- Research Division, Hospital for Special Surgery, 535 East 70 St., New York, NY 10021
| | - Nancy Pleshko
- Department of Bioengineering, College of Engineering, Temple University, 1947 North 12 St., Philadelphia, PA 19122
- Research Division, Hospital for Special Surgery, 535 East 70 St., New York, NY 10021
- Corresponding Author: Nancy Pleshko, PhD, Department of Bioengineering, College of Engineering, Temple University, 1947 North 12 St., Philadelphia, PA 19122, Phone: 215-204-4280,
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Spahn G, Felmet G, Hofmann GO. Traumatic and degenerative cartilage lesions: arthroscopic differentiation using near-infrared spectroscopy (NIRS). Arch Orthop Trauma Surg 2013; 133:997-1002. [PMID: 23636317 DOI: 10.1007/s00402-013-1747-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cartilage lesions or defects are the most common finding during knee arthroscopy. During arthroscopy, it is often difficult to differentiate between degenerative and traumatic cartilage lesions. The study aimed to determine the impact of near-infrared spectroscopy (NIRS) on the distinction between traumatic and degenerative cartilage lesions in the medial femoral condyle (MFC). It was hypothesized that NIRS as able to distinguish between traumatic and degenerative cartilage lesions. MATERIALS AND METHODS Arthroscopic evaluation was performed in six patients who had undergone anterior cruciate ligament (ACL) reconstruction and in six patients who had undergone high tibial osteotomy (HTO). In both groups, a grade III cartilage lesion was present within the MFC. NIRS evaluation was performed with a special probe (arthrospec-one, Arthrospec GmbH, Jena, Germany). NIRS measurements produced semi-quantitative values ranging from 0 (heavily degenerated cartilage) to 100 (completely intact cartilage). RESULTS The mean near-infrared-light absorption within the traumatic lesions in the MFC of the ACL group was 71.5 (range 61-80). In the HTO patients, this value was significantly (p < 0.001) lower at 31.7 (range 31-33). The margin of the MFC outside the lesion in the ACL group had the same adsorption as the lesion (p = 0.549). CONCLUSION After an injury, cartilage has a normal or nearly normal absorbance on near-infrared-light. Thus, it is possible to distinguish intraoperatively between traumatic and degenerative lesions. In addition, our results demonstrate that evaluating cartilage with NIRS is a dependable method for improving the diagnosis of significant chondral lesions.
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Affiliation(s)
- Gunter Spahn
- Center of Trauma and Orthopaedic Surgery Eisenach, Sophienstr 16, 99817 Eisenach, Germany.
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Return to sport in Australian football league footballers after hip arthroscopy and midterm outcome. Arthroscopy 2013; 29:1188-94. [PMID: 23809453 DOI: 10.1016/j.arthro.2013.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 04/22/2013] [Accepted: 05/06/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the return to sport in a series of professional athletes in a single sport (Australian Rules Football), operated on arthroscopically for hip joint pathology. METHODS We performed a retrospective review of the senior author's surgical database starting in 2003. All of the patients who were Australian Football League (AFL) professional players with a minimum of 2 years' follow-up were included. Intra-articular pathologies were identified and treated. All patients were prospectively assessed with the modified Harris Hip Score (MHHS) and the Non-Arthritic Hip Score (NAHS). In addition, information about the active participation of the patients in their teams and return to professional sport was obtained from AFL registers and team physicians. RESULTS Since 2003, the senior author has operated on 36 male professional AFL players; 26 of 27 with at least 2 years' follow-up were available for review. The mean age at the time of surgery was 22.1 years (range, 16 to 30 years), and 8 patients had bilateral pathology; therefore 34 hips were operated on. This report refers to those 26 players and 34 hips. All but 1 of the patients returned to play professionally. By the last survey (October 2011), 16 patients (62%) were still playing professional AFL football, and they have been playing for a mean of 52.5 months after surgery. Ten patients had retired from professional football, but they had all returned to play professionally after surgery. Only one of them retired for causes related to hip disability. There was a significant improvement in preoperative outcome scores. The MHHS and NAHS improved from 83.6 to 98 and from 85.3 to 97.1, respectively, in the players who were still playing (P < .05). Rim lesions were present in 33 hips (97%). Femoral osteochondroplasty was performed in 26 hips (76%). CONCLUSIONS Arthroscopic treatment of intra-articular pathologies in professional athletes resulted in a 96% rate of return to elite-level sport and a durable increase in the MHHS and NAHS. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Hirvasniemi J, Kulmala KAM, Lammentausta E, Ojala R, Lehenkari P, Kamel A, Jurvelin JS, Töyräs J, Nieminen MT, Saarakkala S. In vivo comparison of delayed gadolinium-enhanced MRI of cartilage and delayed quantitative CT arthrography in imaging of articular cartilage. Osteoarthritis Cartilage 2013; 21:434-42. [PMID: 23274105 DOI: 10.1016/j.joca.2012.12.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/23/2012] [Accepted: 12/16/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) and delayed quantitative computed tomography (CT) arthrography (dQCTA) to each other, and their association to arthroscopy. Additionally, the relationship between dGEMRIC with intravenous (dGEMRIC(IV)) and intra-articular contrast agent administration (dGEMRIC(IA)) was determined. DESIGN Eleven patients with knee pain were scanned at 3 T MRI and 64-slice CT before arthroscopy. dQCTA was performed at 5 and 45 min after intra-articular injection of ioxaglate. Both dGEMRIC(IV) and dGEMRIC(IA) were performed at 90 min after gadopentetate injection. dGEMRIC indices and change in relaxation rates (ΔR(1)) were separately calculated for dGEMRIC(IV) and dGEMRIC(IA). dGEMRIC and dQCTA parameters were calculated for predetermined sites at the knee joint that were International Cartilage Repair Society (ICRS) graded in arthroscopy. RESULTS dQCTA normalized with the contrast agent concentration in synovial fluid (SF) and dGEMRIC(IV) correlated significantly, whereas dGEMRIC(IA) correlated with the normalized dQCTA only when dGEMRIC(IA) was also normalized with the contrast agent concentration in SF. Correlation was strongest between normalized dQCTA at 45 min and ΔR(1,IV) (r(s) = 0.72 [95% CI 0.56-0.83], n = 49, P < 0.01) and ΔR(1,IA) normalized with ΔR(1) in SF (r(s) = 0.70 [0.53-0.82], n = 52, P < 0.01). Neither dGEMRIC nor dQCTA correlated with arthroscopic grading. dGEMRIC(IV) and non-normalized dGEMRIC(IA) were not related while ΔR(1,IV) correlated with normalized ΔR(1,IA) (r(s) = 0.52 [0.28-0.70], n = 50, P < 0.01). CONCLUSIONS This study suggests that dQCTA is in best agreement with dGEMRIC(IV) at 45 min after CT contrast agent injection. dQCTA and dGEMRIC were not related to arthroscopy, probably because the remaining cartilage is analysed in dGEMRIC and dQCTA, whereas in arthroscopy the absence of cartilage defines the grading. The findings indicate the importance to take into account the contrast agent concentration in SF in dQCTA and dGEMRIC(IA).
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Affiliation(s)
- J Hirvasniemi
- Department of Medical Technology, University of Oulu, Oulu, Finland.
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Zhang M, Min Z, Rana N, Liu H. Accuracy of magnetic resonance imaging in grading knee chondral defects. Arthroscopy 2013; 29:349-56. [PMID: 22906758 DOI: 10.1016/j.arthro.2012.04.138] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 04/06/2012] [Accepted: 04/10/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the accuracy of routine magnetic resonance imaging (MRI) in the grading of knee cartilage lesions through a meta-analysis. METHODS A search of English-language literature published before February 2012 was carried out in PubMed. Articles using arthroscopy as a gold standard, a 6-knee region dividing method, and a 5-level grading system were included in our meta-analysis. After data extraction, a bivariate mixed-effects model and hierarchical weighted symmetric summary receiver operating curve were used to pool the results of diagnostic tests. A sensitivity analysis was conducted to explore the potential sources of heterogeneity. RESULTS Overall, 8 studies were included in the meta-analysis. The overall sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio were 75% (95% confidence interval [CI], 62% to 84%), 94% (95% CI, 89% to 97%), 47 (95% CI, 18 to 122), 12.5 (95% CI, 6.5 to 24.2), and 0.27 (95% CI, 0.17 to 0.42), respectively. There was substantial heterogeneity among the results. Sensitivity analysis showed the inconsistency of 2 studies. However, eliminating the 2 studies had no significant impact on the overall results. CONCLUSIONS Our results showed that MRI was effective in discriminating normal morphologic cartilage from disease but was less sensitive in detecting knee chondral lesions (higher than grade 1). The negative results of MRI should not prevent a diagnostic arthroscopy. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and II studies.
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Affiliation(s)
- Ming Zhang
- Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Non-destructive evaluation of articular cartilage defects using near-infrared (NIR) spectroscopy in osteoarthritic rat models and its direct relation to Mankin score. Osteoarthritis Cartilage 2012; 20:1367-73. [PMID: 22820498 DOI: 10.1016/j.joca.2012.07.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 06/29/2012] [Accepted: 07/12/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to demonstrate the potential of near-infrared (NIR) spectroscopy for categorizing cartilage degeneration induced in animal models. METHOD Three models of osteoarthritic degeneration were induced in laboratory rats via one of the following methods: (1) menisectomy (MSX); (2) anterior cruciate ligament transection (ACLT); and (3) intra-articular injection of mono-ido-acetate (1 mg) (MIA), in the right knee joint, with 12 rats per model group. After 8 weeks, the animals were sacrificed and tibial knee joints were collected. A custom-made near-infrared (NIR) probe of diameter 5 mm was placed on the cartilage surface and spectral data were acquired from each specimen in the wave number range 4,000-12,500 cm(-1). Following spectral data acquisition, the specimens were fixed and Safranin-O staining was performed to assess disease severity based on the Mankin scoring system. Using multivariate statistical analysis based on principal component analysis and partial least squares regression, the spectral data were then related to the Mankin scores of the samples tested. RESULTS Mild to severe degenerative cartilage changes were observed in the subject animals. The ACLT models showed mild cartilage degeneration, MSX models moderate, and MIA severe cartilage degenerative changes both morphologically and histologically. Our result demonstrates that NIR spectroscopic information is capable of separating the cartilage samples into different groups relative to the severity of degeneration, with NIR correlating significantly with their Mankin score (R(2) = 88.85%). CONCLUSION We conclude that NIR is a viable tool for evaluating articular cartilage health and physical properties such as change in thickness with degeneration.
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Nepple JJ, Larson CM, Smith MV, Kim YJ, Zaltz I, Sierra RJ, Clohisy JC. The reliability of arthroscopic classification of acetabular rim labrochondral disease. Am J Sports Med 2012; 40:2224-9. [PMID: 22926746 DOI: 10.1177/0363546512457157] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The results of surgical treatment for femoroacetabular impingement have been increasingly reported, and more advanced intra-articular disease has been identified as an important predictive factor of outcome. Yet, the reliability of arthroscopic hip disease classification has not been well defined. Purpose/ HYPOTHESIS To determine the intraobserver and interobserver reliability of the Beck classification of labral and articular cartilage disease (anterior-superior acetabular rim) encountered in hip arthroscopy. Secondly, we identified the sources of poor reliability that may be improved with future disease classification schemes. Our hypothesis was that the Beck classification of labral and chondral lesions would demonstrate substantial reliability, while the differentiation of early forms of disease would be a common source of disagreement. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Four experienced hip arthroscopists reviewed standardized arthroscopic videos of 40 cases. Arthroscopic findings at the anterior-superior acetabular rim were classified using the Beck classification of labral and articular cartilage disease. Repeat classification of videos was performed at least 2 weeks later. The reliability of arthroscopic classification was defined using the average weighted Cohen κ values and agreement rates. RESULTS Arthroscopic classification of labral disease using the Beck classification demonstrated moderate to substantial interobserver reliability (average κ = .62; range, .48-.78) and an overall agreement rate of 81.7%. Intraobserver reliability showed a similar level of reliability (average κ = .65; agreement rate, 80.6%). The differentiation between labral degeneration and labral detachment was a common source of disagreement. Similarly, the Beck classification of articular cartilage disease had moderate to substantial interobserver reliability (average κ = .65; range, .49-.78) and overall agreement rate of 57.5%. Intraobserver reliability showed a slightly better level of reliability (average κ = .80; agreement rate, 77.5%). The differentiation between articular cartilage malacia and debonding was a common source of disagreement. CONCLUSION The arthroscopic classification of acetabular rim disease with the Beck classification has substantial interobserver reliability. This level of reliability is similar to previously reported arthroscopic disease classifications in the knee and shoulder and seems appropriate for future outcome reporting. Future classifications that eliminate common sources of disagreement may further improve the reliability.
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Affiliation(s)
- Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
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Grogan SP, Sovani S, Pauli C, Chen J, Hartmann A, Colwell CW, Lotz MK, D'Lima DD. Effects of perfusion and dynamic loading on human neocartilage formation in alginate hydrogels. Tissue Eng Part A 2012; 18:1784-92. [PMID: 22536910 DOI: 10.1089/ten.tea.2011.0506] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Dynamic loading and perfusion culture environments alone are known to enhance cartilage extracellular matrix (ECM) production in dedifferentiated articular chondrocytes. In this study, we explored whether a combination of these factors would enhance these processes over a free-swelling (FS) condition using adult human articular chondrocytes embedded in 2% alginate. The alginate constructs were placed into a bioreactor for perfusion (P) only (100 μL/per minute) or perfusion and dynamic compressive loading (PL) culture (20% for 1 h, at 0.5 Hz), each day. Control FS alginate gels were maintained in six-well static culture. Gene expression analysis was conducted on days 7 and 14, while cell viability, immunostaining, and mechanical property testing were performed on day 14 only. Total glycosaminoglycan (GAG) content and GAG synthesis were assessed after 14 days. Col2a1 mRNA expression levels were significantly higher (at least threefold; p<0.05) in both bioreactor conditions compared with FS by days 7 and 14. For all gene studies, no significant differences were seen between P and PL treatments. Aggrecan mRNA levels were not significantly altered in any condition although both GAG/DNA and (35)S GAG incorporation studies indicated higher GAG retention and synthesis in the FS treatment. Collagen type II protein deposition was low in all samples, link protein distribution was more diffuse in FS condition, and aggrecan deposition was located in the outer regions of the alginate constructs in both bioreactor conditions, yet more uniformly in the FS condition. Catabolic gene expression (matrix metalloproteinase 3 [MMP3] and inducible nitric oxide synthase [iNOS]) was higher in bioreactor conditions compared with FS, although iNOS expression levels decreased to approximately fourfold less than the FS condition by day 14. Our data indicate that conditions created in the bioreactor enhanced both anabolic and catabolic responses, similar to other loading studies. Perfusion was sufficient alone to promote this dual response. PL increased the deposition of aggrecan surrounding cells compared with the other conditions; however, overall low GAG retention in the bioreactor system was likely due to both perfusion and catabolic conditions created. Optimal conditions, which permit appropriate anabolic and catabolic processes for accumulation of ECM and tissue remodeling for neocartilage development, specifically for humans, are needed.
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Affiliation(s)
- Shawn P Grogan
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA 92037, USA
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BROWN CAMERONPETER. ISSUES AND ADVANCES IN THE EARLY STAGE DIAGNOSIS OF OSTEOARTHRITIS. INTERNATIONAL JOURNAL OF NANOSCIENCE 2011. [DOI: 10.1142/s0219581x10006508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With the progress of localized treatment procedures such as unicompartmental knee replacement, chondrocyte implantation and osteochondral grafting, it has become important to develop a means of assessing early stage cartilage and bone degradation. This review outlines the recent advances in arthroscopic tools, and discusses the major problems and issues faced in developing effective assessment methods. The central problem in joint tissue assessment is to discriminate degradation from the wide variation in normal tissue. This discrimination, however, is far from being realized by current methodologies, and is compounded by the difficulty in correlating structural features with pain and mobility in the joint. In response to these findings, an argument is provided for a new direction in quantitative tissue evaluation using an integrated chemical, structural, and functional approach, and the importance of structure–function–pain relationships.
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Affiliation(s)
- CAMERON PETER BROWN
- Facoltà di Scienze, Università di Roma II, Via Della Ricerca Scientifica 00133 Roma, Italy
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Widhalm HK, Marlovits S, Welsch GH, Dirisamer A, Neuhold A, van Griensven M, Seemann R, Vécsei V, Widhalm K. Obesity-related juvenile form of cartilage lesions: a new affliction in the knees of morbidly obese children and adolescents. Eur Radiol 2011; 22:672-81. [DOI: 10.1007/s00330-011-2281-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 07/10/2011] [Accepted: 07/18/2011] [Indexed: 01/12/2023]
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Lasmar NP, Lasmar RCP, Vieira RB, de Oliveira JR, Scarpa AC. ASSESSMENT OF THE REPRODUCIBILITY OF THE OUTERBRIDGE AND FSA CLASSIFICATIONS FOR CHONDRAL LESIONS OF THE KNEE. Rev Bras Ortop 2011; 46:266-9. [PMID: 27047818 PMCID: PMC4799221 DOI: 10.1016/s2255-4971(15)30193-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 07/01/2010] [Indexed: 11/30/2022] Open
Abstract
Objective: To assess the reproducibility of the Outerbridge and the French Society of Arthroscopy classifications between different observers, and to establish a comparison between them. Method: Thirty videos on randomly selected knee arthroscopy procedures demonstrating chondral lesions were used. These were classified by six observers: two third-year orthopedics residents and four orthopedic surgeons, of whom two were knee surgery specialists. The intraobserver and interobserver reliability was evaluated by means of the kappa index. Results: The result from the complete evaluation on the Outerbridge classification with all the observers gave a kappa index of 0.434411. For the classification proposed by the French Society of Arthroscopy, the kappa index was 0.45166. Conclusion: The Outerbridge and French Society of Arthroscopy classifications for chondral lesions are moderately reproducible between observers. Comparing the two classifications, the proposal from the French Society of Arthroscopy was shown to be more reproducible, and the authors suggest that this classification should be used preferentially in clinical practice for evaluations on chondral lesions of the knee.
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Affiliation(s)
- Neylor Pace Lasmar
- Head of the Orthopedics and Traumatology Service, São José University Hospital, Minas Gerais School of Medical Sciences, Belo Horizonte (HUSJ-FCMMG-BH) and Titular Professor and Chair of Orthopedics and Traumatology, Minas Gerais School of Medical Sciences; Former President of SBOT
| | - Rodrigo Campos Pace Lasmar
- Member of the Knee Surgery Service, São José University Hospital, Minas Gerais School of Medical Sciences, Belo Horizonte (HUSJ-FCMMG-BH) and Adjunct Professor of Orthopedics and Traumatology, Minas Gerais School of Medical Science
| | - Rodrigo Barreiros Vieira
- Member of the Knee Surgery Service, São José University Hospital, Minas Gerais School of Medical Sciences, Belo Horizonte (HUSJ-FCMMG-BH) and Head of the Medical Department of Clube Atlético Mineiro; Physician of the Brazilian National Soccer Team
| | - Juraci Rosa de Oliveira
- Member of the Knee Surgery Service, São José University Hospital, Minas Gerais School of Medical Sciences, Belo Horizonte (HUSJ-FCMMG-BH) and Head of the Medical Department of Clube Atlético Mineiro; Physician of the Brazilian National Soccer Team
| | - André Campos Scarpa
- Orthopedist (R4) in the Knee Surgery Service, São José University Hospital, Minas Gerais School of Medical Sciences, Belo Horizonte (HUSJ-FCMMG-BH)
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