1
|
Riedl M, Banke IJ, Goronzy J, Sobau C, Steimer O, Thier S, Zinser W, Henssler L, Alt V, Fickert S. Patients with Small Acetabular Cartilage Defects Caused by Femoroacetabular Impingement Do Not Benefit from Microfracture. J Clin Med 2022; 11:6283. [PMID: 36362511 PMCID: PMC9658426 DOI: 10.3390/jcm11216283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE According to current recommendations, large cartilage defects of the hip over 2 cm2 are suggested to undergo autologous chondrocyte transplantation (ACT), while small defects should be treated with microfracture. We investigated if patients with small chondral defects of the hip joint (≤100 mm2) actually benefit from microfracture. DESIGN In this retrospective multicenter cohort study 40 patients with focal acetabular cartilage defects smaller than 100 mm2 and of ICRS grade ≥2 caused by femoroacetabular impingement were included. Twenty-six unrandomized patients underwent microfracture besides treatment of the underlying pathology; in 14 patients cartilage lesions were left untreated during arthroscopy. Over a mean follow-up of 28.8 months patient-reported outcome was determined using the iHOT33 (international hip outcome tool) and the VAS (visual analog scale) for pain. RESULTS The untreated group showed a statistically significant improvement of the iHOT33 after 12 (p = 0.005), 24 (p = 0.019), and 36 months (p = 0.002) compared to the preoperative score, whereas iHOT33 in the microfracture group did not reveal statistically significant changes over time. There was no significant difference between both groups on any time point. Regarding pain both groups did not show a significant improvement over time in the VAS. CONCLUSION The subjective outcome of patients with small cartilage defects of the hip (≤100 mm2) improves 12 months after arthroscopic FAIS surgery without any cartilage treatment. However, no improvement could be seen after microfracture. Therefore, a reserved surgical treatment for small cartilage defects of the hip under preservation of the subchondral bone is recommended especially if a simultaneous impingement correction is performed.
Collapse
Affiliation(s)
- Moritz Riedl
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
- Sporthopaedicum Straubing, 94315 Straubing, Germany
| | - Ingo J. Banke
- Clinic of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Jens Goronzy
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, 01307 Dresden, Germany
| | | | - Oliver Steimer
- Clinic of Orthopedics, Saarland University Medical Center, 66421 Homburg, Germany
| | - Steffen Thier
- Sportchirurgie Heidelberg, ATOS Clinic Heidelberg, 69115 Heidelberg, Germany
| | - Wolfgang Zinser
- Department of Orthopaedic Surgery and Traumatology, St. Vinzenz Hospital, 46535 Dinslaken, Germany
| | - Leopold Henssler
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Stefan Fickert
- Sporthopaedicum Straubing, 94315 Straubing, Germany
- Department of Orthopedic Surgery and Traumatology, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| |
Collapse
|
2
|
McKinney JR, Sussman MS, Moineddin R, Amirabadi A, Rayner T, Doria AS. Accuracy of magnetic resonance imaging for measuring maturing cartilage: A phantom study. Clinics (Sao Paulo) 2016; 71:404-11. [PMID: 27464298 PMCID: PMC4946528 DOI: 10.6061/clinics/2016(07)09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 04/15/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the accuracy of magnetic resonance imaging measurements of cartilage tissue-mimicking phantoms and to determine a combination of magnetic resonance imaging parameters to optimize accuracy while minimizing scan time. METHOD Edge dimensions from 4 rectangular agar phantoms ranging from 10.5 to 14.5 mm in length and 1.25 to 5.5 mm in width were independently measured by two readers using a steel ruler. Coronal T1 spin echo (T1 SE), fast spoiled gradient-recalled echo (FSPGR) and multiplanar gradient-recalled echo (GRE MPGR) sequences were used to obtain phantom images on a 1.5-T scanner. RESULTS Inter- and intra-reader reliability were high for both direct measurements and for magnetic resonance imaging measurements of phantoms. Statistically significant differences were noted between the mean direct measurements and the mean magnetic resonance imaging measurements for phantom 1 when using a GRE MPGR sequence (512x512 pixels, 1.5-mm slice thickness, 5:49 min scan time), while borderline differences were noted for T1 SE sequences with the following parameters: 320x320 pixels, 1.5-mm slice thickness, 6:11 min scan time; 320x320 pixels, 4-mm slice thickness, 6:11 min scan time; and 512x512 pixels, 1.5-mm slice thickness, 9:48 min scan time. Borderline differences were also noted when using a FSPGR sequence with 512x512 pixels, a 1.5-mm slice thickness and a 3:36 min scan time. CONCLUSIONS FSPGR sequences, regardless of the magnetic resonance imaging parameter combination used, provided accurate measurements. The GRE MPGR sequence using 512x512 pixels, a 1.5-mm slice thickness and a 5:49 min scan time and, to a lesser degree, all tested T1 SE sequences produced suboptimal accuracy when measuring the widest phantom.
Collapse
Affiliation(s)
- Jennifer R McKinney
- University of Toronto, The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto/ON, Canada
| | - Marshall S Sussman
- The University Health Network, Toronto General Hospital, Department of Medical Imaging, Toronto/ON, Canada
| | - Rahim Moineddin
- University of Toronto, Department of Family and Community Medicine, Toronto/ON, Canada
| | - Afsaneh Amirabadi
- University of Toronto, The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto/ON, Canada
| | - Tammy Rayner
- University of Toronto, The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto/ON, Canada
| | - Andrea S Doria
- University of Toronto, The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto/ON, Canada
- The University Health Network, Toronto General Hospital, Department of Medical Imaging, Toronto/ON, Canada
- E-mail:
| |
Collapse
|
3
|
Deligianni X, Bär P, Scheffler K, Trattnig S, Bieri O. Water-selective excitation of short T2
species with binomial pulses. Magn Reson Med 2013; 72:800-5. [DOI: 10.1002/mrm.24978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/05/2013] [Accepted: 09/11/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Xeni Deligianni
- Department of Radiology; Division of Radiological Physics, University of Basel Hospital; Basel Switzerland
| | - Peter Bär
- MR Center of Excellence, Department of Radiology; Medical University Vienna; Vienna Austria
| | - Klaus Scheffler
- High-Field Magnetic Resonance Center; Max-Planck Institute for Biological Cybernetics; Tübingen Germany
- Department of Biomedical Magnetic Resonance; University Hospital Tübingen; Tübingen Germany
| | - Siegfried Trattnig
- MR Center of Excellence, Department of Radiology; Medical University Vienna; Vienna Austria
| | - Oliver Bieri
- Department of Radiology; Division of Radiological Physics, University of Basel Hospital; Basel Switzerland
| |
Collapse
|
4
|
Comparison between different implementations of the 3D FLASH sequence for knee cartilage quantification. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2011; 25:305-12. [PMID: 22167383 DOI: 10.1007/s10334-011-0296-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 11/10/2011] [Accepted: 11/29/2011] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare several sequence implementations of the 3D FLASH sequence in the context of quantitative cartilage imaging. MATERIALS AND METHODS Test-retest coronal fast low angle shot (FLASH) sequences with water excitation were acquired in knees of 12 healthy participants, using two 1.5 T scanners from the same manufacturer. On one of the scanners, the FLASH was additionally compared with a FLASH VIBE, 75% with 100% slice resolution, a non-selective with a conventional spatial pulse, and "asymmetric echo allowed" with "not allowed". RESULTS Implementations of the FLASH showed systematic differences of up to 3.3%, but these were not statistically significant. Precision errors were similar between protocols, but tended to be smallest for the FLASH VIBE with 100% slice resolution (0.6-6.7%). In the medial tibia cartilage volume and thickness differed significantly (P < 0.01; 6.2 and 5.9%) between the two scanners. CONCLUSION Using a validated FLASH sequence, one can reduce slice resolution to 75% and allow asymmetric echo without sacrificing precision, in order to reduce the total acquisition time. However, in longitudinal studies, the scanner and the specific sequence implementation should be kept constant between baseline and follow-up, in order to avoid systematic off-sets in the measurements.
Collapse
|
5
|
Kose KC, Cebesoy O, Ergan V, Maralcan G, Altinel L, Songur A, Kuru I. Talonavicular joint approach to the talar body: a cadaver study. Foot Ankle Int 2008; 29:601-5. [PMID: 18549757 DOI: 10.3113/fai.2008.0601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lesions of the talar dome or tumors within the talar body may require an open approach with medial or lateral malleolar osteotomies. The aim of this study was to evaluate the possibility and feasibility of a new minimally invasive approach without osteotomy, using the talonavicular joint (TJ) as the entry portal for lesions of the talar body. MATERIALS AND METHODS Nine cadaveric feet were used for this study. Using the TJ and a 5-mm skin incision we aimed to reach the superolateral, superomedial, inferolateral and inferomedial corners of the talar body under fluoroscopy. A 2-mm Kirshner wire and a 4-mm cannulated drill bit were used to reach the desired target area and an angled curette was used for curettage after reaching the target. The proximity of vascular structures to the entry portal was noted. The talar and navicular joint surfaces were checked for any damage. The articular areas of the talar heads and the defect areas were measured. RESULTS All 4 targets and even the posterior talus could be reached by this approach. The nearest neurovascular structures were the saphenous vein and the saphenous nerve. The navicular cartilage was not damaged in any specimen. The talar defect area corresponded to only 3.3% of the talar head cartilaginous area. CONCLUSION The TJ approach can be used to reach lesions in all regions of the talar body without the need for an osteotomy. A mini-incision may be used to retract the saphenous nerve and vein. Damage to the talar head cartilage is minimal with this approach which requires no special equipments. CLINICAL RELEVANCE This study shows that talar dome lesions can be reached with a minimally invasive method.
Collapse
Affiliation(s)
- Kamil Cagri Kose
- Afyon Kocatepe Universitesi, Tip Fakultesi Ortopedi ve Travmatoloji AD, Afyon, Turkey.
| | | | | | | | | | | | | |
Collapse
|
6
|
Lin HY, Raman SV, Chung YC, Simonetti OP. Rapid phase-modulated water excitation steady-state free precession for fat suppressed cine cardiovascular MR. J Cardiovasc Magn Reson 2008; 10:22. [PMID: 18477396 PMCID: PMC2429911 DOI: 10.1186/1532-429x-10-22] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 05/13/2008] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this article is to describe a steady-state free precession (SSFP) sequence for fat suppressed cine cardiovascular magnetic resonance (CMR). A rapid phase-modulated binomial water excitation (WE) pulse is utilized to minimize repetition time and acquisition time. METHODS Three different water-excitation pulses were combined with cine-SSFP for evaluation. The frequency response of each sequence was simulated and examined in phantom imaging studies. The ratio of fat to water signal amplitude was measured in phantoms to evaluate the fat suppression capabilities of each method. Six volunteers underwent CMR of the heart at 1.5T to compare retrospectively-gated cine-SSFP with and without water excitation. The ratio of fat to myocardium signal amplitude was measured for conventional cine-SSFP and phase-modulated WE-SSFP. The proposed WE-SSFP method was tested in one patient referred for CMR to characterize a cardiac mass. RESULTS AND DISCUSSION The measured frequency response in a phantom corresponded to the numerical Bloch equation simulation demonstrating the widened stop-band around the fat resonant frequency for all water-excitation pulses tested. In vivo measurements demonstrated that a rapid, phase-modulated water excitation pulse significantly reduced the signal amplitude ratio of fat to myocardium from 6.92 +/- 2.9 to 0.8 +/- 0.13 (mean +/- SD) without inducing any perceptible artifacts in SSFP cine CMR. CONCLUSION Fat suppression can be achieved in SSFP cine CMR while maintaining steady-state equilibrium using rapid, phase modulated, binomial water-excitation pulses.
Collapse
Affiliation(s)
- Hung-Yu Lin
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
- Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Subha V Raman
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
- Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | | | - Orlando P Simonetti
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
- Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
7
|
von Engelhardt LV, Kraft CN, Pennekamp PH, Schild HH, Schmitz A, von Falkenhausen M. The evaluation of articular cartilage lesions of the knee with a 3-Tesla magnet. Arthroscopy 2007; 23:496-502. [PMID: 17478280 DOI: 10.1016/j.arthro.2006.12.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 12/13/2006] [Accepted: 12/21/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE This prospective study was performed to investigate whether 3-Tesla magnetic resonance imaging (MRI) provides an accurate assessment of the articular cartilage in clinical practice. METHODS Forty patients with persistent knee pain and suspected cartilage lesions underwent 3-T MRI shortly before arthroscopy with the following sequences: axial/coronal/sagittal proton density-weighted turbo spin echo with spectral fat suppression, axial/sagittal 3-dimensional T1-weighted gradient echo with selective water excitation, and axial T2-weighted gradient echo (Intera 3.0T; Philips Medical Systems, Best, The Netherlands). Knee cartilage surfaces were divided into 6 regions; lesions detected on MRI were classified into stages I to IV and compared with the arthroscopic grading. RESULTS For the 240 cartilage surfaces evaluated, the sensitivities, specificities, positive predictive values, and negative predictive values of 3-T MRI were 74%, 95%, 74%, and 95%, respectively, for the detection of grade IV lesions; 63%, 90%, 60%, and 91%, respectively, for grade III lesions; 62%, 90%, 57%, and 92%, respectively, for grade II lesions; and 29%, 95%, 39%, and 92%, respectively, for grade I lesions. CONCLUSIONS In these preliminary clinical studies 3-T MRI provided convincing visualization of the hyaline cartilage with comparatively good diagnostic values. Nonetheless, it must be pointed out that the positive predictive values were low for all grades of lesions. Thus, when 3-T MRI suggests a cartilage defect, the probability that the arthroscopic finding corresponds exactly to the MRI result is between 39% and 74%. Therefore, the value of arthroscopy for a detailed assessment and grading of a cartilage disorder with regard to definitive planning of a therapeutic procedure cannot be replaced by 3-T MRI. LEVEL OF EVIDENCE Level I, testing of previously developed diagnostic criteria in a series of consecutive patients with universally applied gold standard.
Collapse
Affiliation(s)
- Lars Victor von Engelhardt
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
| | | | | | | | | | | |
Collapse
|
8
|
Jaremko JL, Cheng RWT, Lambert RGW, Habib AF, Ronsky JL. Reliability of an efficient MRI-based method for estimation of knee cartilage volume using surface registration. Osteoarthritis Cartilage 2006; 14:914-22. [PMID: 16644245 DOI: 10.1016/j.joca.2006.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 03/05/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To aid in detection of osteoarthritis (OA) progression in serial magnetic resonance (MR) scans, we assessed feasibility and accuracy of rapid 3D image registration of the tibial plateau in normal and arthritic subjects, and inter-scan reliability of semi-automated cartilage volume measurement from these images. DESIGN Two T1 fat-suppressed knee MR scans were obtained 2 weeks apart in healthy adults (n = 9, age 23-48 years). Four scans of each of three patients with established OA were obtained over 2 years. At baseline, the tibial surface was digitized by semi-automated edge detection and medial tibial plateau cartilage volume was calculated from high-intensity voxels within a manually drawn region of interest (ROI). In subsequent scans, the digitized tibial surface was registered to the baseline location by photogrammetric 3D coordinate transformation, and cartilage volume was automatically recalculated by reuse of the ROI. We measured registration accuracy by root mean square (RMS) distance between registered tibial surfaces. RESULTS In normals, RMS distance between tibial surfaces in baseline and subsequent scans was 1/3 voxel length (0.121 mm), and medial tibial plateau cartilage volumes varied by 1.4+/-3.2%. Despite change in cartilage volumes by up to 20% over 2 years in arthritic patients, surface registration accuracy was unaffected (0.122 mm). User-supervised processing time was 15 min at baseline and 7 min in subsequent scans. CONCLUSION Tibial surfaces on magnetic resonance imaging (MRI) can be rapidly and accurately co-registered, even in arthritic knees, allowing direct visualization of changes over time. Compared to most current methods, cartilage volume measurement in registered images is faster and has equivalent inter-scan reliability in initially normal subjects.
Collapse
Affiliation(s)
- J L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine, University of Alberta, Edmonton, Canada.
| | | | | | | | | |
Collapse
|
9
|
Mohr A. The value of water-excitation 3D FLASH and fat-saturated PDw TSE MR imaging for detecting and grading articular cartilage lesions of the knee. Skeletal Radiol 2003; 32:396-402. [PMID: 12719928 DOI: 10.1007/s00256-003-0635-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2002] [Revised: 01/10/2003] [Accepted: 02/12/2003] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of water-excitation (WE) 3D FLASH and fat-saturated (FS) proton density-weighted (PDw) TSE MR imaging for detecting, grading, and sizing articular cartilage lesions of the knee. DESIGN AND PATIENTS A total of 26 patients underwent MR imaging prior to arthroscopy with the following sequences: (1) WE 3D FLASH: 28/11 ms, scan time: 4 min 58 s, flip angle: 40 degrees; (2) FS PDw TSE: 3433/15 ms, scan time: 6 min 15 s, flip angle: 180 degrees. Grade and size of the detected lesions were quantified and compared with the results of arthroscopy for each compartment. RESULTS The sensitivity, specificity, positive and negative predictive values, and accuracy for detecting cartilage lesions were 46%, 92%, 81%, 71% and 74% for WE 3D FLASH and 91%, 98%, 96%, 94% and 95% for FS PDw TSE MR imaging. WE 3D FLASH correlated significantly with arthroscopy for grading on the patella ( P<0.0001) and the femoral trochlea ( P=0.02) and for sizing on the femoral trochlea ( P=0.03). FS PDw correlated significantly ( P<0.0001) with arthroscopy for grading and sizing on all compartments. CONCLUSION FS PDw TSE is an accurate method for detecting, grading and sizing articular cartilage lesions of the knee and yielded superior results relative to WE 3D FLASH MR imaging.
Collapse
Affiliation(s)
- Andreas Mohr
- Department of Radiology, University of California San Francisco, 350 Parnassus Avenue, Suite 150, San Francisco, CA 94117-1349, USA.
| |
Collapse
|