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Potter HG. Beyond the AJR: MRI-Based CT Analysis of Spondyloarthropathy. AJR Am J Roentgenol 2024. [PMID: 38656113 DOI: 10.2214/ajr.24.31309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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Sacher SE, Baral EC, Wright TM, Bauer TW, Li Q, Padgett DE, Potter HG, Koff MF. Association of Total Hip Arthroplasty Flexural Rigidity With Magnetic Resonance Imaging and Histological Findings. J Arthroplasty 2024:S0883-5403(24)00192-X. [PMID: 38428693 DOI: 10.1016/j.arth.2024.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Modular connections in total hip arthroplasty (THA) offer surgical advantages, but can contribute to implant fretting and corrosion due to micromotion at the head-stem interface. Previous studies implicated lower flexural rigidity as a key contributing factor to THA corrosion and fretting, but none associated flexural rigidity with direct histological evaluation or magnetic resonance imaging (MRI) outcomes. The purpose of this study was to determine how implant flexural rigidity is associated with MRI imaging metrics and histopathological outcomes in patients who have a failed THA. METHODS Patients requiring revision THA surgery underwent preoperative MRIs with 3-dimensional multispectral imaging techniques to suppress metal artifacts. The MRI images were graded for adverse local tissue reactions. For each hip, trunnion flexural rigidity was measured from the retrieved femoral stem, and a periprosthetic tissue sample was retrieved and evaluated using semiquantitative histology. Generalized linear models and analyses of variance were used to assess associations between flexural rigidity and MRI and histology outcomes. RESULTS A total of 106 THA stems were retrieved (46 women and 60 men, age: 68 years (range, 60 to 73 years). After adjustment for length of implantation, flexural rigidity was negatively correlated with histologic aseptic lymphocyte-dominant vasculitis-associated lesion severity (β = -26.27, P = .018), Fujishiro lymphocyte grading (β = -13.4, P = .039), perivascular lymphocyte layers (β = -17.8, P = .022), the grade of tissue organization (β = -22.5, P = .009), the presence of diffuse synovitis (β = -66.5, P = .003), and the presence of lymphoid aggregates (β = -75.9, P = .022). No association was found between MRI metrics and flexural rigidity. CONCLUSIONS Among these implants, decreased trunnion stiffness was associated with increased histologic features of adverse host-mediated soft tissue reactions.
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Affiliation(s)
- Sara E Sacher
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Elexis C Baral
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Timothy M Wright
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Thomas W Bauer
- Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, New York, New York
| | - Qian Li
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Douglas E Padgett
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Hollis G Potter
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Matthew F Koff
- Hospital for Special Surgery, Department of Radiology, New York, New York
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Broberg JS, Koff MF, Howard JL, Lanting BA, Potter HG, Teeter MG. A multimodal assessment of cementless tibial baseplate fixation using radiography, radiostereometric analysis, and magnetic resonance imaging. J Orthop Res 2024; 42:100-108. [PMID: 37442642 DOI: 10.1002/jor.25662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/22/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023]
Abstract
Fixation in cementless total knee arthroplasty is provided by osseous integration. Radiography, radiostereometric analysis (RSA), and magnetic resonance imaging (MRI) were used simultaneously to investigate fixation. Relationships between RSA-measured implant micromotions and MRI-evaluated osseous integration at the component-bone interface were assessed in 10 patients up to 6 months postoperation. Supine MRI (using multispectral imaging sequences) and RSA exams were performed to evaluate osseous integration and measure longitudinal migration, respectively. Inducible displacement was measured from standing RSA exams. Radiolucent lines were detected on conventional radiographs. Of 10 patients, 6 had fibrous membranes detected on MRI. No fluid or osteolytic interfaces were found, and no components were scored loose. Of 10 patients, 6 had radiolucent lines detected. Average maximum total point motion (MTPM) for longitudinal migration at 6 months was 0.816 mm (range 0.344-1.462 mm). Average MTPM for inducible displacement at 6 months was 1.083 mm (range 0.553-1.780 mm). Fictive points located in fibrous-classified baseplate quadrants had greater longitudinal migration than fictive points located in baseplate quadrants with normal interfaces at 2 weeks (p = 0.031), 6 weeks (p = 0.046), and 3 months (p = 0.047), and greater inducible displacements at 3 months (p = 0.011) and 6 months (p = 0.045). Greater early micromotion may be associated with the presence of fibrous membranes at the component-bone interface. Clinical significance: This multimodal imaging study contributes knowledge of the fixation of modern cementless TKA, supporting the notion that osseous integration is important for optimal implant fixation.
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Affiliation(s)
- Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
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Nosrat C, Gao KT, Bhattacharjee R, Pedoia V, Koff MF, Gold GE, Potter HG, Majumdar S. Multiparametric MRI of Knees in Collegiate Basketball Players: Associations With Morphological Abnormalities and Functional Deficits. Orthop J Sports Med 2023; 11:23259671231216490. [PMID: 38107843 PMCID: PMC10722938 DOI: 10.1177/23259671231216490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 12/19/2023] Open
Abstract
Background Rates of cartilage degeneration in asymptomatic elite basketball players are significantly higher compared with the general population due to excessive loads on the knee. Compositional quantitative magnetic resonance imaging (qMRI) techniques can identify local biochemical changes of macromolecules observed in cartilage degeneration. Purpose/Hypothesis The purpose of this study was to utilize multiparametric qMRI to (1) quantify how T1ρ and T2 relaxation times differ based on the presence of anatomic abnormalities and (2) correlate T1ρ and T2 with self-reported functional deficits. It was hypothesized that prolonged relaxation times will be associated with knees with MRI-graded abnormalities and knees belonging to basketball players with greater self-reported functional deficits. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 75 knees from National Collegiate Athletic Association Division I basketball players (40 female, 35 male) were included in this multicenter study. All players completed the Knee injury and Osteoarthritis Outcome Score (KOOS) and had bilateral knee MRI scans taken. T1ρ and T2 were calculated on a voxel-by-voxel basis. The cartilage surfaces were segmented into 6 compartments: lateral femoral condyle, lateral tibia, medial femoral condyle, medial tibia (MT), patella (PAT), and trochlea (TRO). Lesions from the MRI scans were graded for imaging abnormalities, and statistical parametric mapping was performed to study cross-sectional differences based on MRI scan grading of anatomic knee abnormalities. Pearson partial correlations between relaxation times and KOOS subscore values were computed, obtaining r value statistical parametric mappings and P value clusters. Results Knees without patellar tendinosis displayed significantly higher T1ρ in the PAT compared with those with patellar tendinosis (average percentage difference, 10.4%; P = .02). Significant prolongation of T1ρ was observed in the MT, TRO, and PAT of knees without compared with those with quadriceps tendinosis (average percentage difference, 12.7%, 13.3%, and 13.4%, respectively; P ≤ .05). A weak correlation was found between the KOOS-Symptoms subscale values and T1ρ/T2. Conclusion Certain tissues that bear the brunt of impact developed tendinosis but spared cartilage degeneration. Whereas participants reported minimal functional deficits, their high-impact activities resulted in structural damage that may lead to osteoarthritis after their collegiate careers.
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Affiliation(s)
- Cameron Nosrat
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Kenneth T. Gao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Rupsa Bhattacharjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Matthew F. Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Garry E. Gold
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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Davidson EJ, Figgie C, Nguyen J, Pedoia V, Majumdar S, Potter HG, Koff MF. Chondral Injury Associated With ACL Injury: Assessing Progressive Chondral Degeneration With Morphologic and Quantitative MRI Techniques. Sports Health 2023:19417381231205276. [PMID: 37876228 DOI: 10.1177/19417381231205276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are associated with a risk of post-traumatic osteoarthritis due to chondral damage. Magnetic resonance imaging (MRI) techniques provide excellent visualization and assessment of cartilage and can detect subtle and early chondral damage. This is often preceding clinical and radiographic post-traumatic osteoarthritis. HYPOTHESIS Morphologic and quantitative MRI techniques can assess early and progressive degenerative chondral changes after acute ACL injury. STUDY DESIGN Prospective longitudinal cohort. LEVEL OF EVIDENCE Level 3. METHODS Sixty-five participants with acute unilateral ACL injuries underwent bilateral knee MRI scans within 1 month of injury. Fifty-seven participants presented at 6 months, while 54 were evaluated at 12 months. MRI morphologic evaluation using a modified Noyes score assessed cartilage signal alteration, chondral damage, and subchondral bone status. Quantitative T1ρ and T2 mapping at standardized anatomic locations in both knees was assessed. Participant-reported outcomes at follow-up time points were recorded. RESULTS Baseline Noyes scores of MRI detectable cartilage damage were highest in the injured knee lateral tibial plateau (mean 2.5, standard error (SE) 0.20, P < 0.01), followed by lateral femoral condyle (mean 2.1, SE 0.18, P < 0.01), which progressed after 1 year. Longitudinal prolongation at 12 months in the injured knees was significant for T1ρ affecting the medial and lateral femoral condyles (P < 0.01) and trochlea (P < 0.01), whereas T2 values were prolonged for medial and lateral femoral condyles (P < 0.01) and trochlea (P < 0.01). The contralateral noninjured knees also demonstrated T1ρ and T2 prolongation in the medial and lateral compartment chondral subdivisions. Progressive chondral damage occurred despite improved patient-reported outcomes. CONCLUSION After ACL injury, initial and sustained chondral damage predominantly affects the lateral tibiofemoral compartment, but longitudinal chondral degeneration also occurred in other compartments of the injured and contralateral knee. CLINICAL RELEVANCE Early identification of chondral degeneration post-ACL injury using morphological and quantitative MRI techniques could enable interventions to be implemented early to prevent or delay PTOA.
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Affiliation(s)
| | | | - Joseph Nguyen
- HSS MRI Laboratory, Hospital for Special Surgery, New York
| | - Valentina Pedoia
- University of California San Francisco, San Francisco, California
| | | | | | - Matthew F Koff
- HSS MRI Laboratory, Hospital for Special Surgery, New York
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Sacher SE, Koff MF, Tan ET, Burge A, Potter HG. The role of advanced metal artifact reduction MRI in the diagnosis of periprosthetic joint infection. Skeletal Radiol 2023:10.1007/s00256-023-04483-5. [PMID: 37875571 PMCID: PMC11039568 DOI: 10.1007/s00256-023-04483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
Identification and diagnosis of periprosthetic joint infection (PJI) are challenging, requiring a multi-disciplinary approach involving clinical evaluation, laboratory tests, and imaging studies. MRI is advantageous to alternative imaging techniques due to superior soft tissue contrast and absence of ionizing radiation. However, the presence of metallic implants can cause signal loss and artifacts. Metal artifact suppression (MARS) MRI techniques have been developed that mitigate metal artifacts and improve periprosthetic soft tissue visualization. This paper provides a review of the various MARS MRI techniques, their clinical applicability and accuracy in PJI diagnosis and evaluation, and current challenges and future perspectives.
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Affiliation(s)
- Sara E Sacher
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA.
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Alissa Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY, 10021, USA.
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Dickerson DA, Fortier LA, Nauman EA, Potter HG, Quinlan C. Novel Osteochondral Biotemplate Improves Long-term Cartilage Repair Compared With Microfracture in an Ovine Model. Am J Sports Med 2023; 51:3288-3303. [PMID: 37602735 DOI: 10.1177/03635465231189808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Current cartilage repair therapies do not re-create the complex mechanical interface between cartilage and bone, which is critical for long-term repair durability. New biomaterial designs that include hard tissue-soft tissue interface structures offer promise to improve clinical outcomes. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the efficacy and safety of a naturally derived osteochondral biotemplate with a novel contiguous hard tissue-soft tissue interface in an ovine model as a regenerative solution for articular cartilage defects. It was hypothesized that the osteochondral biotemplate would produce structurally superior repair tissue compared with microfracture over a 13-month period. STUDY DESIGN Controlled laboratory study. METHODS Osteochondral biotemplates were manufactured from porcine cancellous bone. Skeletally mature sheep (N = 30) were randomly allocated to 3 groups: early healing stage (euthanasia at 4 months), 6-month treatment, and 13-month treatment. In the early healing stage group, an 8 mm-diameter by 5 mm-deep osteochondral defect was created on the medial femoral condyle and treated at the time of iatrogenic injury with an osteochondral biotemplate. The contralateral limb received the same treatment 2 months later. In the 6- and 13-month treatment groups, 1 limb received the same osteochondral procedure as the early healing stage group. In the contralateral limb, an 8 mm-diameter, full-thickness cartilage defect (1-2 mm deep) was created and treated with microfracture. Cartilage repair and integration were quantitatively and qualitatively assessed with gross inspection, histological evaluation, and magnetic resonance imaging (MRI). Wilcoxon signed-rank and McNemar tests were used to compare the treatments. RESULTS At 6 and 13 months after treatment, the biotemplate was not present histologically. At 13 months, the biotemplate treatment demonstrated statistically higher histological scores than microfracture for integration with surrounding cartilage (biotemplate: 74 ± 31; microfracture: 28 ± 39; P = .03), type 2 collagen (biotemplate: 72 ± 33; microfracture: 40 ± 38; P = .02), total cartilage (biotemplate: 71 ± 9; microfracture: 59 ± 9; P = .01), and total integration (biotemplate: 85 ± 15; microfracture: 66 ± 20; P = .04). The osteochondral biotemplate treatment produced a notable transient nonneutrophilic inflammatory response that appeared to approach resolution at 13 months. MRI results were not statistically different between the 2 treatments. CONCLUSION Even with the inflammatory response, after 13 months, the osteochondral biotemplate outperformed microfracture in cartilage regeneration and demonstrated superiority in integration between the repair tissue and host tissue as well as integration between the newly formed cartilage and the underlying bone. CLINICAL RELEVANCE This work has demonstrated the clinical potential of a novel biomaterial template to regenerate the complex mechanical interface between cartilage and the subchondral bone.
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Affiliation(s)
- Darryl A Dickerson
- Department of Mechanical and Materials Engineering, Florida International University, Miami, Florida, USA
| | - Lisa A Fortier
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
| | - Eric A Nauman
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Cassandra Quinlan
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
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Sneag DB, Abel F, Potter HG, Fritz J, Koff MF, Chung CB, Pedoia V, Tan ET. MRI Advancements in Musculoskeletal Clinical and Research Practice. Radiology 2023; 308:e230531. [PMID: 37581501 PMCID: PMC10477516 DOI: 10.1148/radiol.230531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 08/16/2023]
Abstract
Over the past decades, MRI has become increasingly important for diagnosing and longitudinally monitoring musculoskeletal disorders, with ongoing hardware and software improvements aiming to optimize image quality and speed. However, surging demand for musculoskeletal MRI and increased interest to provide more personalized care will necessitate a stronger emphasis on efficiency and specificity. Ongoing hardware developments include more powerful gradients, improvements in wide-bore magnet designs to maintain field homogeneity, and high-channel phased-array coils. There is also interest in low-field-strength magnets with inherently lower magnetic footprints and operational costs to accommodate global demand in middle- and low-income countries. Previous approaches to decrease acquisition times by means of conventional acceleration techniques (eg, parallel imaging or compressed sensing) are now largely overshadowed by deep learning reconstruction algorithms. It is expected that greater emphasis will be placed on improving synthetic MRI and MR fingerprinting approaches to shorten overall acquisition times while also addressing the demand of personalized care by simultaneously capturing microstructural information to provide greater detail of disease severity. Authors also anticipate increased research emphasis on metal artifact reduction techniques, bone imaging, and MR neurography to meet clinical needs.
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Affiliation(s)
- Darryl B. Sneag
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Frederik Abel
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Hollis G. Potter
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Jan Fritz
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Matthew F. Koff
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Christine B. Chung
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Valentina Pedoia
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
| | - Ek T. Tan
- From the Department of Radiology and Imaging, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021 (D.B.S., F.A., H.G.P., M.F.K.,
E.T.T.); Department of Radiology, New York University Grossman School of
Medicine, New York, NY (J.F.); Department of Radiology, University of California
San Diego, La Jolla, Calif (C.B.C.); Radiology Service, Veterans Affairs San
Diego Healthcare System, La Jolla, Calif (C.B.C.); and Department of Radiology
and Biomedical Imaging, University of California San Francisco, San Francisco,
Calif (V.P.)
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Ciamillo SA, Pownder SL, Potter HG, Stefanovski D, Nixon AJ, Ortved KF. Correlation of Arthroscopic Grading and Optical Coherence Tomography as Markers of Early Repair and Predictors of Later Healing Evident on MRI and Histomorphometric Assessment of Cartilage Defects Implanted with Chondrocytes Overexpressing IGF-I. Cartilage 2023; 14:210-219. [PMID: 36864720 PMCID: PMC10416204 DOI: 10.1177/19476035231154508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE Injury of articular cartilage is common, and due to the poor intrinsic capabilities of chondrocytes, it can precipitate joint degradation and osteoarthritis (OA). Implantation of autologous chondrocytes into cartilaginous defects has been used to bolster repair. Accurate assessment of the quality of repair tissue remains challenging. This study aimed to investigate the utility of noninvasive imaging modalities, including arthroscopic grading and optical coherence tomography (OCT) for assessment of early cartilage repair (8 weeks), and MRI to determine long-term healing (8 months). DESIGN Large (15 mm diameter), full-thickness chondral defects were created on both lateral trochlear ridges of the femur in 24 horses. Defects were implanted with autologous chondrocytes transduced with rAAV5-IGF-I, autologous chondrocytes transduced with rAAV5-GFP, naïve autologous chondrocytes, or autologous fibrin. Healing was evaluated at 8 weeks post-implantation using arthroscopy and OCT, and at 8 months post-implantation using MRI, gross pathology, and histopathology. RESULTS OCT and arthroscopic scoring of short-term repair tissue were significantly correlated. Arthroscopy was also correlated with later gross pathology and histopathology of repair tissue at 8 months post-implantation, while OCT was not correlated. MRI was not correlated with any other assessment variable. CONCLUSIONS This study indicated that arthroscopic inspection and manual probing to develop an early repair score may be a better predictor of long-term cartilage repair quality following autologous chondrocyte implantation. Furthermore, qualitative MRI may not provide additional discriminatory information when assessing mature repair tissue, at least in this equine model of cartilage repair.
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Affiliation(s)
- Sarah A. Ciamillo
- New Bolton Center, Department of Clinical Studies, University of Pennsylvania, Kennett Square, PA, USA
| | | | | | - Darko Stefanovski
- New Bolton Center, Department of Clinical Studies, University of Pennsylvania, Kennett Square, PA, USA
| | - Alan J. Nixon
- Department of Clinical Sciences, Cornell University, Ithaca, NY, USA
| | - Kyla F. Ortved
- New Bolton Center, Department of Clinical Studies, University of Pennsylvania, Kennett Square, PA, USA
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Ramirez DC, Ren R, Burge AJ, Potter HG, Su E, Bauer TW. Exuberant Rice Body Formation Associated with Adverse Local Tissue Reaction After Hip Resurfacing Arthroplasty: A Case Report and Review of the Literature. JBJS Case Connect 2023; 13:01709767-202306000-00006. [PMID: 37053362 DOI: 10.2106/jbjs.cc.22.00524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
CASE A 65-year-old man with osteoarthritis of the hip developed a soft-tissue mass of the inferior gluteal region 3 years after metal-on-metal resurfacing hip arthroplasty. Clinical and imaging findings suggested an adverse local tissue reaction. Intraoperatively, nearly 1 liter of intra-articular fibrinous loose bodies (rice bodies) was removed, and histology showed features of an adaptive immune response. The patient had no evidence of an autoimmune disease or mycobacterial infection. CONCLUSION To our knowledge, this is the first reported case of florid rice bodies associated with a metal-on-metal hip arthroplasty and adverse local tissue reaction.
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Affiliation(s)
- Daniel C Ramirez
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Renee Ren
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement (ARJR), Hospital for Special Surgery, New York, New York
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Edwin Su
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement (ARJR), Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
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Debbi EM, Mayman DJ, Sapountzis N, Hawes J, Cororaton AD, Potter HG, Haas SB, Chalmers BP. Significantly Worse Fixation of Cemented Patellar Components on Multiacquisition Variable-Resonance Image Combination Magnetic Resonance Imaging Compared to Femoral and Tibial Components: A Cause for Concern? J Arthroplasty 2023; 38:S368-S373. [PMID: 36801475 DOI: 10.1016/j.arth.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The etiology of anterior knee pain after total knee arthroplasty (TKA) remains unclear. Few studies have examined patellar fixation quality. The purpose of the present study was to evaluate the patellar cement-bone interface after TKA on magnetic resonance imaging (MRI) and to correlate the patella fixation grade with the incidence of anterior knee pain. METHODS We retrospectively reviewed 279 knees undergoing metal artifact reduction MRI for either anterior or generalized knee pain at least 6 months after cemented, posterior-stabilized TKA with patellar resurfacing with one implant manufacturer. MRI cement-bone interfaces and percent-integration of the patella, femur, and tibia were assessed by a fellowship-trained senior musculoskeletal radiologist. The grade and character of the patella interface were compared to the femur and tibia. Regression analyses were used to determine the association between patella integration with anterior knee pain. RESULTS There were more patellar components with ≥75% zones of fibrous tissue (50%) compared to the femur (18%) or tibia (5%) (P < .001). There were a greater number of patellar implants with poor cement integration (18%) compared to the femur (1%) or tibia (1%) (P < .001). MRI findings showed more evidence of patellar component loosening (8%) compared to the femur (1%) or tibia (1%) (P < .001). Anterior knee pain was correlated with worse patella cement integration (P = .01), with women predicted to have better integration (P < .001). CONCLUSION The quality of the patellar cement-bone interface after TKA is worse compared to the femoral or tibial component interface. Poor patellar cement-bone interface may be a source of anterior knee pain after TKA, but further investigation is required.
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Affiliation(s)
- Eytan M Debbi
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Nicolas Sapountzis
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Joseph Hawes
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Agnes D Cororaton
- Biostatistics Core, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Steven B Haas
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Green DW, Hidalgo Perea S, Kelly AM, Potter HG. Bone Marrow Edema Injury Patterns in the Pediatric Knee: An MRI Study. HSS J 2023; 19:107-112. [PMID: 36776513 PMCID: PMC9837404 DOI: 10.1177/15563316221092320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/21/2021] [Indexed: 02/14/2023]
Abstract
Background Symptomatic pediatric patients referred for magnetic resonance imaging (MRI) commonly present with traumatic bone marrow edema (BME) patterns. Purpose We sought to associate discrete MRI patterns of BME with specific injury mechanisms in pediatric knee injuries to classify injury patterns by anatomical location of the BME. We aimed to group these into 6 patterns: patellar dislocation, extensor mechanism overload, hyperextension, single compartment impaction, ligament avulsion/translation, and direct contusion. Methods We retrospectively reviewed 314 MRIs performed with a standard protocol on symptomatic patients aged 3 to 18 years at 1 institution. Our analysis included images, reports, and traumatic BME patterns. A musculoskeletal radiologist and orthopedic surgeon independently assigned 1 of the 6 injury patterns to each scan. Results After exclusion criteria were applied to the 314 MRIs, 62 (19.7%) remained, 40 boys and 22 girls. The average age was of 12.2 years. The most frequent injury patterns were patellar dislocation (n = 22, 35%) and extensor mechanism overload (n = 14, 22%). κ value associated with pattern determination was .766, indicating substantial concordance. Bone marrow edema signal intensity on fat-suppressed sequences was classified as severe in 92% of cases. Conclusions The strength of pediatric knee ligaments and tendons relative to epiphyseal bone may contribute to a high rate of BME injury patterns seen on MRI in symptomatic pediatric patients. We found that pediatric BME could be classified into 6 specific injury patterns, which might be useful to clinicians in recognizing mechanisms of injury. Further clinical studies are needed to assess the clinical differences in both short-term and long-term outcomes of the BME patterns described.
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Affiliation(s)
- Daniel W. Green
- Division of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Sofia Hidalgo Perea
- Division of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Anne M. Kelly
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G. Potter
- Division of Radiology & Imaging, Hospital for Special Surgery, New York, NY, USA
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Gao MA, Tan ET, Neri JP, Li Q, Burge AJ, Potter HG, Koch KM, Koff MF. Diffusion-weighted MRI of total hip arthroplasty for classification of synovial reactions: A pilot study. Magn Reson Imaging 2023; 96:108-115. [PMID: 36496096 PMCID: PMC9929560 DOI: 10.1016/j.mri.2022.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conventional quantitative diffusion-weighted imaging (DWI) is sensitive to changes in tissue microstructure, but its application to evaluating patients with orthopaedic hardware has generally been limited due to metallic susceptibility artifacts. The apparent diffusion coefficient (ADC) and T2-values from a multi-spectral imaging (MSI) DWI combined with 2D multi-spectral imaging with a 2D periodically rotated overlapping parallel lines with enhanced reconstruction (2D-MSI PROPELLER DWI) based sequence and a MAVRIC based T2 mapping sequence, respectively, may mitigate the artifact and provide additional quantitative information on synovial reactions in individuals with total hip arthroplasty (THA). The aim of this pilot study is to utilize a 2D-MSI PROPELLER DWI and a MAVRIC-based T2 mapping to evaluate ADC and T2-values of synovial reactions in patients with THA. METHODS Coronal morphologic MRIs from THA patients underwent evaluation of the synovium and were assigned a synovial classification of 'normal', or 'grouped abnormal' (consisting of sub-groups 'infection', 'polymeric', 'metallosis', 'adverse local tissue reaction' [ALTR], or 'non-specific') and type of synovial reaction present (fluid-like, solid-like, or mixed). Regions of interest (ROIs) were placed in synovial reactions for measurement of ADC and T2-values, obtained from the 2D-MSI PROPELLER DWI and T2-MAVRIC sequences, respectively. A one-way analysis of variance (ANOVA) and Kruskal-Wallis rank sum tests were used to compare the differences in ADC and T2-values across the different synovial reaction classifications. A Kruskal-Wallis test was used to compare the ROI areas for the ADC and T2-values. A principal component analysis (PCA) was performed to evaluate the possible effects of ADC values, size of the ADC ROI, T2-values, and size of the T2 ROI with respect to synovial reaction classification. RESULTS Differences of ADC and T2 among the individual synovial reactions were not found. A difference of ADC between 'normal' and 'grouped abnormal' synovial reactions was also not detected even as the ADC area of 'grouped abnormal' synovial reactions were significantly larger (p = 0.02). The 'grouped abnormal' synovial reactions had significantly shorter T2-values than 'normal' synovial reactions (p = 0.02), and that the T2 area of 'grouped abnormal' synovial reactions were significantly larger (p = 0.01). A larger ROI area on the T2-maps was observed in the mixed synovial reaction type as compared to the fluid-like reaction type area (p = 0.01). Heterogeneity was noted in calculated ADC and T2 maps. PCA analysis revealed obvious clustering by the 'normal' and 'grouped abnormal' classifications. CONCLUSIONS 2D-MSI PROPELLER DWI and MAVRIC-T2 generate quantitative images of periprosthetic tissues within clinically feasible scan times. The combination of derived ADC and T2-values with area of synovial reaction may aid in differentiating normal from abnormal synovial reactions between types of synovial reactions in patients with THA.
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Affiliation(s)
- Madeleine A Gao
- Hospital of Special Surgery, 535 East 70(th) Street, New York, NY 10021, United States of America
| | - Ek T Tan
- Hospital of Special Surgery, 535 East 70(th) Street, New York, NY 10021, United States of America
| | - John P Neri
- Hospital of Special Surgery, 535 East 70(th) Street, New York, NY 10021, United States of America
| | - Qian Li
- Hospital of Special Surgery, 535 East 70(th) Street, New York, NY 10021, United States of America
| | - Alissa J Burge
- Hospital of Special Surgery, 535 East 70(th) Street, New York, NY 10021, United States of America
| | - Hollis G Potter
- Hospital of Special Surgery, 535 East 70(th) Street, New York, NY 10021, United States of America
| | - Kevin M Koch
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, United States of America
| | - Matthew F Koff
- Hospital of Special Surgery, 535 East 70(th) Street, New York, NY 10021, United States of America.
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14
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Sacher SE, Neri JP, Gao MA, Argentieri EC, Potter HG, Koch KM, Koff MF. MAVRIC based T2 mapping assessment of infrapatellar fat pad scarring in patients with total knee arthroplasty. J Orthop Res 2022; 41:1299-1309. [PMID: 36262013 PMCID: PMC10113607 DOI: 10.1002/jor.25472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/06/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
The infrapatellar fat pad (IPFP) has been implicated as a source of postoperative knee pain. Imaging the IPFP is challenging in patients with total knee arthroplasty (TKA) due to metallic susceptibility artifact. Multi-Acquisition Variable-Resonance Image Combination (MAVRIC)-based T2 Mapping has been developed to mitigate this artifact and can generate quantitative T2 data. Objectives of this study were to (1) measure T2 values of the IPFP in patients with TKAs using a MAVRIC based T2 mapping technique and (2) determine if IPFP T2 values are related to the degree of fat pad scarring or clinical magnetic resonance imaging (MRI) findings. Twenty-eight subjects (10 males, 18 females, Age: 66 + 7.2 years [Mean ± standard deviations]) undergoing clinical MRIs were sequentially recruited. Morphological imaging and quantitative T2 mapping sequences were performed on a clinical 1.5 T scanner. The morphologic images were graded for the presence and severity of fat pad scarring and clinical outcomes. T2 values were calculated in the total fat pad volume, a normal regions of interest (ROI), and an abnormal ROI. T2 values were shortened in the total IPFP volume (p = 0.001) and within abnormal regions (p = 0.003) in subjects with more severe IPFP scarring. The difference between T2 values in normal-abnormal regions was greater in subjects with severe versus no scarring (+1426.1%, p = 0.008). T2 values were elevated in patients with MRI findings of osteolysis (+32.3%, p = 0.02). These findings indicate that MAVRIC-based T2 Mapping may be used as a quantitative biomarker of postoperative IPFP scarring in individuals following TKA.
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Affiliation(s)
- Sara E Sacher
- Hospital for Special Surgery, New York, New York, USA
| | - John P Neri
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | - Kevin M Koch
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Mosich GM, Potter HG, Koff MF, Sacher SE, Mishu M, Westrich GH. Multiacquisition Variable-Resonance Image Combination Magnetic Resonance Imaging to Study Detailed Bone Apposition and Fixation of Cementless Knee System Compared to Cemented Total Knee Replacements. Arthroplast Today 2022; 17:126-131. [PMID: 36082282 PMCID: PMC9445226 DOI: 10.1016/j.artd.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Gina M. Mosich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F. Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Sara E. Sacher
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Mithun Mishu
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H. Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
- Corresponding author. Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. Tel.: +1 212 606 1510.
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Koff MF, Gao MA, Neri JP, Chiu YF, Lin BQ, Burge AJ, Su E, Padgett DE, Potter HG. Reply to the Letter to the Editor: Adverse Local Tissue Reactions are Common in Asymptomatic Individuals After Hip Resurfacing Arthroplasty: Interim Report from a Prospective Longitudinal Study. Clin Orthop Relat Res 2022; 480:1427-1429. [PMID: 35503436 PMCID: PMC9191283 DOI: 10.1097/corr.0000000000002229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/12/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Matthew F. Koff
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Madeleine A. Gao
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - John P. Neri
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Yu-fen Chiu
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Bin Q. Lin
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Alissa J. Burge
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Edwin Su
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Douglas E. Padgett
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G. Potter
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
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Landy DC, Baral EC, Potter HG, Chiu YF, Sculco PK, Sculco TP, Wright TM, Koff MF. Magnetic Resonance Imaging Synovial Classification Is Associated With Revision Indication and Polyethylene Insert Damage. J Arthroplasty 2022; 37:S342-S349. [PMID: 35240284 DOI: 10.1016/j.arth.2022.02.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with total knee arthroplasty (TKA) stiffness are commonly presumed to have arthrofibrosis though no specific test exists. In patients undergoing revision TKA, we asked the following question: (1) Do patients who are revised for stiffness display a synovial reaction on MRI that is different than patients revised for other reasons? (2) Do these patients have a different magnitude of polyethylene insert damage than patients revised for other reasons? and (3) Is the MRI synovial classification associated with polyethylene insert damage? METHODS Patients undergoing revision TKA for stiffness had a preoperative MRI performed, and the synovium was classified on MRI in a blinded fashion as arthrofibrosis, focal scarring, polymeric reaction, infection, or abnormal. At surgery, the polyethylene inserts were removed, and graded by 2 reviewers for total surface damage. RESULTS Revision indication and MRI synovial classification were associated (P < .0001), with a greater proportion of patients assigned an MRI classification of arthrofibrosis revised for arthrofibrosis and a greater proportion of patients assigned a polymeric classification revised for aseptic loosening. Patients assigned an MRI synovial classification of polymeric had the greatest damage to the tibial insert (P < .0001), and patients revised for the clinical indication of aseptic loosening had the greatest damage to the tibial insert (P < .0001). CONCLUSION Synovial grading on MRI is strongly associated with revision indication and polyethylene insert damage. In patients with stiffness in the absence of another complication, MRI can be a helpful diagnostic adjuvant in confirming the diagnosis of stiffness.
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Affiliation(s)
- David C Landy
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Elexis C Baral
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Hollis G Potter
- Department of Radiology and Imaging, MRI Research Laboratory, Hospital for Special Surgery, New York, NY
| | - Yu-Fen Chiu
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Thomas P Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Matthew F Koff
- Department of Radiology and Imaging, MRI Research Laboratory, Hospital for Special Surgery, New York, NY
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Lin J, Sofka CM, Demetracopoulos CA, Potter HG. The Utility of Isotropic 3D Magnetic Resonance Imaging in Assessing Painful Total Ankle Replacements. Foot & Ankle Orthopaedics 2022; 7:24730114221094840. [PMID: 35520474 PMCID: PMC9067051 DOI: 10.1177/24730114221094840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ji Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | | | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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Endo Y, Burge AJ, Koff MF, Lin B, Westrich GH, Boettner F, Chiu YF, Potter HG. Diagnostic Performance of MRI for Component Loosening in Total Knee Arthroplasty Compared with Radiography. Radiology 2022; 304:128-136. [PMID: 35315718 DOI: 10.1148/radiol.204458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Because loosening of total knee arthroplasty (TKA) occurs due to poor osseous integration at component-bone interfaces, interface assessment may be helpful in diagnosing loosening at MRI. Purpose To determine interreader reproducibility for characterizing component interfaces and diagnosing loosening and to evaluate the diagnostic performance of MRI for diagnosing loosening after TKA compared with radiography. Materials and Methods Consecutive knees with TKA that underwent revision between July 2018 and June 2019 and were imaged at MRI and radiography were included in this retrospective study. Interface type (normal, fibrous membrane, fluid, or osteolysis), percent integration (<33%, 33%-66%, or >66%), and presence of bone marrow edema pattern were assessed. Loosening was diagnosed at MRI if no or almost no normal interface was present. Sensitivity and specificity were compared with radiographs by using surgical findings as reference. Gwet agreement coefficient evaluated interreader reproducibility between two readers and multivariable logistic regression assessed risk factors for loosening. Results Among 116 knees in 114 patients (mean age, 63 years ± 10 [SD]; 59 women), 61 of 116 knees (52.6%) had at least one loose component. Interreader reproducibility of MRI was substantial to excellent (Gwet agreement coefficient, 0.67-0.96). Loosening was associated with fluid interface (odds ratio [OR], 20.1; 95% CI: 5.7, 70.9) or osteolysis (OR, 3.1; 95% CI: 1.8, 5.3), absence of any normal interface (OR, 11.8; 95% CI: 6.3, 22.2), poor (<33%) osseous integration (OR, 20.4; 95% CI: 9.7, 42.6), and bone marrow edema pattern (OR, 4.7; 95% CI: 2.8, 7.8). Sensitivity and specificity of MRI for loosening were 84% (27 of 32; 95% CI: 72, 97) and 85% (71 of 84; 95% CI: 77, 92) for the patellar, 31% (eight of 26; 95% CI: 13, 49) and 100% (90 of 90; 95% CI: 100, 100) for the femoral, and 81% (22 of 27; 95% CI: 66, 96) and 98% (87 of 89; 95% CI: 95, 100) for the tibial component, respectively. MRI had higher sensitivity (84% vs 31%; P < .001) but lower specificity (85% vs 96%; P = .003) for patellar component loosening than did radiography, respectively, whereas no evidence of a difference was found for femoral (sensitivity and specificity, MRI vs radiography: 31% vs 46% [P = .20] and 100% vs 99% [P > .99], respectively) or tibial (sensitivity and specificity, MRI vs radiography: 81% vs 70% [P = .16] and 98% vs 97% [P = .32], respectively) component loosening. Conclusion MRI demonstrated substantial to excellent interreader reproducibility and higher sensitivity than did radiography for diagnosing patellar component loosening after total knee arthroplasty. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Yoshimi Endo
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Alissa J Burge
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Matthew F Koff
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Bin Lin
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Geoffrey H Westrich
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Friedrich Boettner
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Yu-Fen Chiu
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Hollis G Potter
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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Williams JR, Neal K, Alfayyadh A, Lennon K, Capin JJ, Khandha A, Manal K, Potter HG, Snyder-Mackler L, Buchanan TS. Knee cartilage T 2 relaxation times 3 months after ACL reconstruction are associated with knee gait variables linked to knee osteoarthritis. J Orthop Res 2022; 40:252-259. [PMID: 33783867 PMCID: PMC8481340 DOI: 10.1002/jor.25043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis development after ACL reconstruction (ACLR) is not well understood. Investigators have examined associations between knee biomechanical alterations and quantitative MRI (qMRI) variables, reflective of cartilage health, 12-60 months following ACLR; however, none have done so early after surgery. As part of an exploratory study, 45 individuals (age, 23 ± 7 years) underwent motion analysis during walking and qMRI 3 months after ACLR. For each limb, peak knee adduction moment (pKAM) and peak knee flexion moment (pKFM) were determined using inverse dynamics and peak medial compartment force was calculated using a neuromusculoskeletal model. T2 relaxation times in the medial compartment and linear regressions were used to determine the associations between gait variables and deep and superficial cartilage T2 relaxation times in six regions. pKAM was positively associated with deep layer T2 relaxation times within the femoral central and posterior regions when examined in the involved limb and from an interlimb difference perspective (involved limb - uninvolved limb). After adjusting for age, the association between interlimb difference of pKAM and interlimb difference of deep layer T2 relaxation times in the tibial central region became significant (p = .043). Interlimb difference of pKFM was negatively associated with interlimb difference of deep layer T2 relaxation times within the femoral central and posterior regions. These associations suggest that degenerative pathways leading to osteoarthritis may be detectable as early as 3 months after reconstruction. Preventative therapeutic techniques may need to be employed early in the rehabilitation process to prevent cartilage degradation.
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Affiliation(s)
- Jack R. Williams
- Department of Mechanical Engineering, University of
Delaware, Newark, DE
| | - Kelsey Neal
- Department of Mechanical Engineering, University of
Delaware, Newark, DE
| | | | - Kendra Lennon
- Department of Physical Therapy, University of Delaware,
Newark, DE
| | - Jacob J. Capin
- Biomechanics and Movement Science, University of Delaware,
Newark, DE,Department of Physical Therapy, University of Delaware,
Newark, DE,Physical Therapy Program, Department of Physical Medicine
and Rehabilitation, University of Colorado, Aurora, CO,Eastern Colorado VA Geriatric Research Education and
Clinical Center (GRECC), Aurora, CO
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of
Delaware, Newark, DE
| | - Kurt Manal
- Kinesiology and Applied Physiology, University of Delaware,
Newark, DE
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special
Surgery, New York, NY
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware,
Newark, DE,Department of Physical Therapy, University of Delaware,
Newark, DE,Department of Biomedical Engineering, University of
Delaware, Newark, DE
| | - Thomas S. Buchanan
- Department of Mechanical Engineering, University of
Delaware, Newark, DE,Biomechanics and Movement Science, University of Delaware,
Newark, DE,Department of Biomedical Engineering, University of
Delaware, Newark, DE
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21
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Koff MF, Gao MA, Neri JP, Chiu YF, Lin BQ, Burge AJ, Su E, Padgett DE, Potter HG. Adverse Local Tissue Reactions are Common in Asymptomatic Individuals After Hip Resurfacing Arthroplasty: Interim Report from a Prospective Longitudinal Study. Clin Orthop Relat Res 2021; 479:2633-2650. [PMID: 34232144 PMCID: PMC8726542 DOI: 10.1097/corr.0000000000001882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The evaluation of the natural history prevalence of adverse local tissue reactions (ALTRs) using MRI has focused only on metal-on-metal (MoM) bearing surfaces without comparison to nonMoM bearing surfaces. QUESTIONS/PURPOSES To determine (1) the longitudinal changes and differences in blood metal ion levels in patients with hip resurfacing arthroplasty (HRA), ceramic-on-ceramic (CoC) THA, and metal-on-polyethylene (MoP) THA compared with those undergoing ceramic-on-polyethylene (CoP) THA; (2) how the longitudinal change of synovial reaction classification in patients with HRA, CoC THA, and MoP THA compares with those undergoing CoP THA, and whether there is an association between the presence of an ALTR or metallosis on MRI with corresponding patient-reported outcomes, or the presence of capsular dehiscence; and (3) differences in blood metal ion levels between patients undergoing HRA with an ALTR or metallosis on MRI and those with HRA without these conditions. METHODS Between March 2014 and February 2019, 22,723 patients underwent primary HRA and THA at one center. Patients received an HRA based on their desired athletic level after surgery and the presence of normal acetabular and proximal femoral bone morphology without osteopenia or osteoporosis. Two percent (342 of 22,723) of patients were contacted to participate, and 71% (243 of 342 hips in 206 patients) were enrolled for analysis at baseline. The patients underwent arthroplasty for degenerative joint disease, and 25 patients withdrew over the course of the study. We included patients who were more than 1 year postarthroplasty. All participants had an MRI examination and blood serum ion testing and completed a Hip Disability and Osteoarthritis Outcome Score survey annually for four years (baseline, year 1, year 2, year 3). Morphologic and susceptibility-reduced MR images were evaluated by a single radiologist not involved in the care of patients for the presence and classification of synovitis (Gwet AC1: 0.65 to 0.97), synovial thickness, and volume (coefficient of repeatability: 1.8 cm3). Linear mixed-effects models were used to compare the mean synovial thickness, synovial volume, and Hip Disability and Osteoarthritis Outcome Score subscales between bearing surfaces at each timepoint and within each bearing surface over time. Marginal Cox proportional hazards models were used to compare the time to and the risk of developing ALTR only, metallosis only, and ALTR or metallosis between bearing surfaces. All models were adjusted for age, sex, BMI, and length of implantation based on known confounders for hip arthroplasty. Adjustment for multiple comparisons was performed using the Dunnett-Hsu method. RESULTS Patients with unilateral HRA had higher cobalt and chromium serum ion levels (baseline: 1.8 ± 0.8 ppb, year 1: 2.0 ± 1.5 ppb, year 2: 2.1 ± 1.2 ppb, year 3: 1.6 ± 0.7 ppb) than those with unilateral CoP bearings (baseline: 0.0 ± 0.1 ppb, year 1: 0.1 ± 0.3 ppb, year 2: 0.0 ± 0.2 ppb, year 3: 0.0 ± 0.0 ppb) at all timepoints (p < 0.001 for each time point). More patients who received an HRA developed ALTR or metallosis on MRI than did patients with CoP bearings (hazard ratio 4.8 [95% confidence interval 1.2 to 18.4]; p = 0.02). There was no association between the longitudinal change of synovial reaction to ALTR or metallosis on MRI with patient-reported outcomes. In addition, there was no association between the presence of dehiscence at baseline and the subsequent development of ALTR or metallosis, as seen on MRI. There were elevated cobalt (4.7 ± 3.5 ppb) and chromium (4.7 ± 2.6 ppb) serum levels in patients with unilateral HRA who had an ALTR or metallosis present on MRI at year 1 compared with patients without an ALTR or metallosis on MRI (cobalt: 1.8 ± 1.0 ppb, mean difference 4.7 ppb [95% CI 3.3 to 6.0]; p < 0.001; chromium: 2.3 ± 0.5 ppb, mean difference 3.6 ppb [95% CI 2.2 to 5.0]; p < 0.001) as well as for chromium at year 3 (3.9 ± 2.4 ppb versus 2.2 ± 1.1 ppb, mean difference 1.3 ppb [95% CI 0.3 to 2.4]; p = 0.01). CONCLUSION We found a higher proportion of ALTR or metallosis on MRI in patients with HRA compared with patients with CoP, even when patient self-assessed symptomatology of those with an ALTR or metallosis on MRI was not different than the absence of these features. MRI detected ALTRs in high-function patients, emphasizing that an annual clinical assessment dependent on survey or blood ion testing alone may not detect soft tissue complications. The results of this study are in line with prior consensus recommendations of using MRI as part of a routine follow-up protocol for this patient population. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Matthew F. Koff
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Madeleine A. Gao
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - John P. Neri
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Yu-fen Chiu
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Bin Q. Lin
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Alissa J. Burge
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Edwin Su
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Douglas E. Padgett
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G. Potter
- MRI Research Laboratory, Hospital for Special Surgery, New York, NY, USA
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22
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Wang D, Nawabi DH, Krych AJ, Jones KJ, Nguyen J, Elbuluk AM, Farshad-Amacker NA, Potter HG, Williams RJ. Synthetic Biphasic Scaffolds versus Microfracture for Articular Cartilage Defects of the Knee: A Retrospective Comparative Study. Cartilage 2021; 13:1002S-1013S. [PMID: 32046514 PMCID: PMC8808844 DOI: 10.1177/1947603520903418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the results of a biphasic synthetic scaffold (TruFit, Smith & Nephew) to microfracture for the treatment of knee cartilage defects and identify patient- and lesion-specific factors that influence outcomes. DESIGN Prospectively collected data from 132 patients (mean age, 41.8 years; 69% male) with isolated chondral or osteochondral femoral defects treated with biphasic synthetic scaffolds (n = 66) or microfracture (n = 66) were reviewed. Clinical outcomes were evaluated longitudinally over 5 years with the Short Form-36 (SF-36), Activities of Daily Living of the Knee Outcome Survey (KOS-ADL), International Knee Documentation Committee (IKDC), and Marx Activity Scale. Cartilage-sensitive magnetic resonance imaging (MRI) was performed to evaluate osseous integration and cartilage fill in a subgroup of patients. Multivariate regression analysis was used to identify predictors of clinical outcomes within the scaffold group. RESULTS Both groups demonstrated clinically significant improvements in knee clinical scores over 5 years (P < 0.01). There were no significant differences in KOS-ADL and IKDC scores between groups up to 5 years postoperatively. Marx activity level scores in the microfracture group declined over time, while significant improvements in activity level scores were observed in the scaffold group over 5 years (P < 0.01). Good-quality tissue fill and cartilage isointensity were more often observed in the scaffold group compared with the microfracture group, particularly with longer time intervals. Increasing age, high body mass index, prior microfracture, and traumatic etiology were predictors for inferior outcomes in the scaffold group. CONCLUSIONS Activity level and MRI appearance following treatment of cartilage lesions with the biphasic synthetic scaffold were superior to microfracture over time in this nonrandomized, retrospective comparison.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery,
University of California Irvine, Orange, CA, USA,Dean Wang, UC Irvine Health, 101 The City
Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA.
| | - Danyal H. Nawabi
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Aaron J. Krych
- Department of Orthopaedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David
Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Nguyen
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Ameer M. Elbuluk
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | | | - Hollis G. Potter
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | - Riley J. Williams
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
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23
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Potter HG. CORR Insights®: What Is the Best Way for Patients to Take Photographs of Medical Images (Radiographs, CT, and MRI) Using a Smartphone? Clin Orthop Relat Res 2021; 479:2236-2238. [PMID: 34014855 PMCID: PMC8445551 DOI: 10.1097/corr.0000000000001786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/30/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Hollis G Potter
- H. G. Potter, Chair, Department of Radiology and Imaging, Hospital for Special Surgery, Professor of Radiology, Weill Medical College of Cornell University, New York, NY, USA
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24
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Motovilova E, Tan ET, Taracila V, Vincent JM, Grafendorfer T, Shin J, Potter HG, Robb FJL, Sneag DB, Winkler SA. Stretchable self-tuning MRI receive coils based on liquid metal technology (LiquiTune). Sci Rep 2021; 11:16228. [PMID: 34376703 PMCID: PMC8355233 DOI: 10.1038/s41598-021-95335-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/23/2021] [Indexed: 01/14/2023] Open
Abstract
Magnetic resonance imaging systems rely on signal detection via radiofrequency coil arrays which, ideally, need to provide both bendability and form-fitting stretchability to conform to the imaging volume. However, most commercial coils are rigid and of fixed size with a substantial mean offset distance of the coil from the anatomy, which compromises the spatial resolution and diagnostic image quality as well as patient comfort. Here, we propose a soft and stretchable receive coil concept based on liquid metal and ultra-stretchable polymer that conforms closely to a desired anatomy. Moreover, its smart geometry provides a self-tuning mechanism to maintain a stable resonance frequency over a wide range of elongation levels. Theoretical analysis and numerical simulations were experimentally confirmed and demonstrated that the proposed coil withstood the unwanted frequency detuning typically observed with other stretchable coils (0.4% for the proposed coil as compared to 4% for a comparable control coil). Moreover, the signal-to-noise ratio of the proposed coil increased by more than 60% as compared to a typical, rigid, commercial coil.
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Affiliation(s)
- Elizaveta Motovilova
- grid.5386.8000000041936877XDepartment of Radiology, Weill Cornell Medicine, New York, NY 10065 USA ,grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | - Ek Tsoon Tan
- grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | - Victor Taracila
- grid.418143.b0000 0001 0943 0267GE Healthcare, Aurora, OH USA
| | - Jana M. Vincent
- grid.418143.b0000 0001 0943 0267GE Healthcare, Aurora, OH USA
| | | | - James Shin
- grid.5386.8000000041936877XDepartment of Radiology, Weill Cornell Medicine, New York, NY 10065 USA
| | - Hollis G. Potter
- grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | | | - Darryl B. Sneag
- grid.239915.50000 0001 2285 8823Department of Radiology, Hospital for Special Surgery, New York, NY 10021 USA
| | - Simone A. Winkler
- grid.5386.8000000041936877XDepartment of Radiology, Weill Cornell Medicine, New York, NY 10065 USA
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25
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Wickiewicz TL, Warren RF, Imhauser CW, Potter HG. Posterior Tibial Slope in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft: Letter to the Editor. Am J Sports Med 2021; 49:NP52-NP53. [PMID: 34347549 DOI: 10.1177/03635465211025274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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26
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Cheung J, Neri JP, Gao MA, Lin B, Burge AJ, Potter HG, Koch KM, Koff MF. Clinical Feasibility of Multi-Acquisition Variable-Resonance Image Combination-Based T2 Mapping near Hip Arthroplasty. HSS J 2021; 17:165-173. [PMID: 34421426 PMCID: PMC8361595 DOI: 10.1177/1556331621994801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022]
Abstract
Background: Hip arthroplasty is increasingly prevalent, and early detection of complications can improve outcomes. Quantitative magnetic resonance imaging (qMRI) methods using multi-acquisition variable-resonance image combination (MAVRIC) may allow for the assessment of soft tissues in close proximity to hip arthroplasty devices. Question/Purposes: We sought to determine the clinical feasibility of MAVRIC-based T2 mapping as a qMRI approach for assessing synovial reactions in patients with a hip arthroplasty device. We hypothesized that there would be differences in T2 metrics by synovial type, clinical impression, and clinical findings related to synovitis. Methods: We conducted a cross-sectional study of 141 subjects with 171 hip arthroplasties with greater than 1 year post-implantation. We enrolled subjects who had had a primary total hip arthroplasty or hip resurfacing arthroplasty between May 2019 and March 2020, excluding those with a revision hip arthroplasty and those with standard safety contraindications for receiving an MRI. Institutional standard 2D fast spin echo (FSE), short-tau inversion recovery (STIR), and susceptibility-reduced MAVRIC morphological MR images were acquired for each hip and followed by a dual-echo acquisition MAVRIC T2 mapping sequence. Results: While 131 subjects (81%) were classified as having a "normal" synovial reaction, significantly longer T2 values were found for fluid synovial reactions compared with mixed reactions. In addition, subjects with synovial dehiscence and decompression present had T2 prolongation. Larger synovial volumes were found in subjects with low-signal intensity deposits. Conclusions: MAVRIC-based T2 mapping is clinically feasible and there are significant quantitative differences based on type of synovial reaction. Patients undergoing hip arthroscopy revision surgery will warrant comparison of T2 values with direct histologic assessment of a tissue sample obtained intraoperatively. The approach used in this study may be used for a quantitative evaluation and monitoring of soft tissues around metal implants.
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Affiliation(s)
- Jacky Cheung
- MRI Laboratory, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - John P. Neri
- MRI Laboratory, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Madeleine A. Gao
- MRI Laboratory, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Bin Lin
- MRI Laboratory, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Alissa J. Burge
- MRI Laboratory, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G. Potter
- MRI Laboratory, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Kevin M. Koch
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Matthew F. Koff
- MRI Laboratory, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA,Matthew F. Koff, PhD, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA.
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27
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Gao KT, Pedoia V, Young KA, Kogan F, Koff MF, Gold GE, Potter HG, Majumdar S. Multiparametric MRI characterization of knee articular cartilage and subchondral bone shape in collegiate basketball players. J Orthop Res 2021; 39:1512-1522. [PMID: 32910520 PMCID: PMC8359246 DOI: 10.1002/jor.24851] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging (MRI) is commonly used to evaluate the morphology of the knee in athletes with high-knee impact; however, complex repeated loading of the joint can lead to biochemical and structural degeneration that occurs before visible morphological changes. In this study, we utilized multiparametric quantitative MRI to compare morphology and composition of articular cartilage and subchondral bone shape between young athletes with high-knee impact (basketball players; n = 40) and non-knee impact (swimmers; n = 25). We implemented voxel-based relaxometry to register all cases to a single reference space and performed a localized compositional analysis of T 1ρ - and T 2 -relaxation times on a voxel-by-voxel basis. Additionally, statistical shape modeling was employed to extract differences in subchondral bone shape between the two groups. Evaluation of cartilage composition demonstrated a significant prolongation of relaxation times in the medial femoral and tibial compartments and in the posterolateral femur of basketball players in comparison to relaxation times in the same cartilage compartments of swimmers. The compositional analysis also showed depth-dependent differences with prolongation of the superficial layer in basketball players. For subchondral bone shape, three total modes were found to be significantly different between groups and related to the relative sizes of the tibial plateaus, intercondylar eminences, and the curvature and concavity of the patellar lateral facet. In summary, this study identified several characteristics associated with a high-knee impact which may expand our understanding of local degenerative patterns in this population.
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Affiliation(s)
- Kenneth T. Gao
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Valentina Pedoia
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Feliks Kogan
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Matthew F. Koff
- Department of Radiology and ImagingHospital for Special SurgeryNew York CityNew YorkUSA
| | - Garry E. Gold
- Department of RadiologyStanford UniversityStanfordCaliforniaUSA
| | - Hollis G. Potter
- Department of Radiology and ImagingHospital for Special SurgeryNew York CityNew YorkUSA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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28
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Cornman-Homonoff J, Kishore SA, Waddell BS, Kesler J, Mandl LA, Westrich GH, Potter HG, Trost DW. Genicular Artery Embolization for Refractory Hemarthrosis following Total Knee Arthroplasty: Technique, Safety, Efficacy, and Patient-Reported Outcomes. J Vasc Interv Radiol 2021; 32:1128-1135. [PMID: 33961990 DOI: 10.1016/j.jvir.2021.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/22/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the safety and efficacy of genicular artery embolization for treatment of refractory hemarthrosis following total knee arthroplasty. MATERIAL AND METHODS Patients who underwent genicular artery embolization with spherical embolics between January 2010 and March 2020 at a single institution were included if they had undergone total knee arthroplasty and subsequently experienced recurrent hemarthrosis. Technical success was defined as the significant reduction or elimination of the hyperemic blush. Clinical success was defined as the absence of clinical evidence of further hemarthrosis. Clinical follow-up was performed 7-14 days after the procedure and at 3-month intervals thereafter via a telephone interview. A total of 117 embolizations, comprising 82 initial, 28 first repeat, and 7 second repeat, were performed. RESULTS An average of 2.5 arteries was treated per procedure. The superior lateral genicular artery was the most frequently embolized. The most utilized embolic size was 100-300 μm. Follow-up was available for all patients, with a median duration of 21.5 months. 65.9%, 25.6%, and 8.5% of patients underwent 1, 2, and 3 treatments, respectively. Complications occurred following 12.8% of treatments, of which the most common was transient cutaneous ischemia. Technical success was achieved in all cases. Clinical success was achieved in 56%, 79%, and 85% of patients following the first, second, and third treatment, respectively. 83% of patients reported being either satisfied or very satisfied with the overall result. CONCLUSIONS Targeted genicular artery embolization with spherical embolics is an effective treatment for recurrent hemarthrosis with infrequent serious complications. Repeat embolization should be considered in cases of recurrence following initial therapy.
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Affiliation(s)
- Joshua Cornman-Homonoff
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York.
| | - Sirish A Kishore
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bradford S Waddell
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jacqueline Kesler
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Lisa A Mandl
- Department of Medicine, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - David W Trost
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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29
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Potter HG. CORR Insights®: What Is the Correlation Among dGEMRIC, T1p, and T2* Quantitative MRI Cartilage Mapping Techniques in Developmental Hip Dysplasia? Clin Orthop Relat Res 2021; 479:1025-1027. [PMID: 33497065 PMCID: PMC8083799 DOI: 10.1097/corr.0000000000001645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/28/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Hollis G Potter
- H. G. Potter, Chairman, Department of Radiology and Imaging, Professor of Radiology, Hospital for Special Surgery, New York, NY, USA
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30
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Pownder SL, Hayashi K, Lin BQ, Meyers KN, Caserto BG, Breighner RE, Potter HG, Koff MF. Differences in the magnetic resonance imaging parameter T2* may be identified during the course of canine patellar tendon healing: a pilot study. Quant Imaging Med Surg 2021; 11:1234-1246. [PMID: 33816163 DOI: 10.21037/qims-20-684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Previous studies have utilized ultrashort echo (UTE) magnetic resonance imaging (MRI), and derived T2* maps, to evaluate structures with highly ordered collagen structures such as tendon. T2* maps may provide a noninvasive means to assess tendon damage and healing. This pilot study evaluated the longitudinal relationship of an induced mechanical strain on the patellar tendon with corresponding UTE T2* metrics, histologic and biomechanical evaluation at two post-operative time points. Methods A total of 27 patellar tendons in male Beagles were surgically subjected to stretching by a small diameter (SmD) or a large diameter (LgD) diameter rod to induce damage due to strain, and evaluated at 4- and 8-week intervals using quantitative MRI (qMRI), biomechanical testing, and histology. A separate set of 16 limbs were used as controls. Results The tendons experienced a 67% and 17% prolongation of short T2* values as compared to controls at 4 and 8 weeks post-operatively, respectively. Histologic analysis displayed a trend of increased collagen disruption at 4 weeks followed by presence of greater organization at 8 weeks. Biomechanical evaluation found a reduction of tendon modulus and failure strain at both time points, and an increase in cross-sectional area at 4 weeks as compared to controls. Conclusions These findings display tendon healing in response to an imposed strain and present the utility of qMRI to evaluate longitudinal differences of patellar tendon T2* values in a model of induced subclinical tendon damage. The qMRI technique of UTE provides a means to non-invasively evaluate the healing process of a mechanically damaged tendon.
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Affiliation(s)
- Sarah L Pownder
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Kei Hayashi
- Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Bin Q Lin
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | | | | | | | - Hollis G Potter
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F Koff
- MRI Laboratory, Hospital for Special Surgery, New York, NY, USA
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Rubin EB, Mazzoli V, Black MS, Young K, Desai AD, Koff MF, Sreedhar A, Kogan F, Safran MR, Vincentini DJ, Knox KA, Yamada T, McCabe A, Majumdar S, Potter HG, Gold GE. Effects of the Competitive Season and Off-Season on Knee Articular Cartilage in Collegiate Basketball Players Using Quantitative MRI: A Multicenter Study. J Magn Reson Imaging 2021; 54:840-851. [PMID: 33763929 DOI: 10.1002/jmri.27610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Injuries to the articular cartilage in the knee are common in jumping athletes, particularly high-level basketball players. Unfortunately, these are often diagnosed at a late stage of the disease process, after tissue loss has already occurred. PURPOSE/HYPOTHESIS To evaluate longitudinal changes in knee articular cartilage and knee function in National Collegiate Athletic Association (NCAA) basketball players and their evolution over the competitive season and off-season. STUDY TYPE Longitudinal, multisite cohort study. POPULATION Thirty-two NCAA Division 1 athletes: 22 basketball players and 10 swimmers. FIELD STRENGTH/SEQUENCE Bilateral magnetic resonance imaging (MRI) using a combined T1ρ and T2 magnetization-prepared angle-modulated portioned k-space spoiled gradient-echo snapshots (MAPSS) sequence at 3T. ASSESSMENT We calculated T2 and T1ρ relaxation times to compare compositional cartilage changes between three timepoints: preseason 1, postseason 1, and preseason 2. Knee Osteoarthritis Outcome Scores (KOOS) were used to assess knee health. STATISTICAL TESTS One-way variance model hypothesis test, general linear model, and chi-squared test. RESULTS In the femoral articular cartilage of all athletes, we saw a global decrease in T2 and T1ρ relaxation times during the competitive season (all P < 0.05) and an increase in T2 and T1ρ relaxation times during the off-season (all P < 0.05). In the basketball players' femoral cartilage, the anterior and central compartments respectively had the highest T2 and T1ρ relaxation times following the competitive season and off-season. The basketball players had significantly lower KOOS measures in every domain compared with the swimmers: Pain (P < 0.05), Symptoms (P < 0.05), Function in Daily Living (P < 0.05), Function in Sport/Recreation (P < 0.05), and Quality of Life (P < 0.05). CONCLUSION Our results indicate that T2 and T1ρ MRI can detect significant seasonal changes in the articular cartilage of basketball players and that there are regional differences in the articular cartilage that are indicative of basketball-specific stress on the femoral cartilage. This study demonstrates the potential of quantitative MRI to monitor global and regional cartilage health in athletes at risk of developing cartilage problems. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 2.
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Affiliation(s)
- Elka B Rubin
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Valentina Mazzoli
- Department of Radiology, Stanford University, Stanford, California, USA.,Musculoskeletal Research Laboratory, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Marianne S Black
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Katherine Young
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Arjun D Desai
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Ashwin Sreedhar
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Dominic J Vincentini
- Stanford Department of Athletics, Stanford University, Stanford, California, USA
| | - Katelin A Knox
- Stanford Department of Athletics, Stanford University, Stanford, California, USA
| | - Tomoo Yamada
- Stanford Department of Athletics, Stanford University, Stanford, California, USA
| | - Andrew McCabe
- Santa Clara Department of Athletics, Santa Clara University, Santa Clara, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA
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Tan ET, Queler SC, Lin B, Endo Y, Burge AJ, Sternberg J, Potter HG, Sneag DB. Improved nerve conspicuity with water-weighting and denoising in two-point Dixon magnetic resonance neurography. Magn Reson Imaging 2021; 79:103-111. [PMID: 33753136 DOI: 10.1016/j.mri.2021.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND T2-weighted, two-point Dixon fast-spin-echo (FSE) is an effective technique for magnetic resonance neurography (MRN) that can provide quantitative assessment of muscle denervation. Low signal-to-noise ratio and inadequate fat suppression, however, can impede accurate interpretation. PURPOSE To quantify effects of principal component analysis (PCA) denoising on tissue signal intensities and fat fraction (FF) and to determine qualitative image quality improvements from both denoising and water-weighting (WW) algorithms to improve nerve conspicuity and fat suppression. STUDY TYPE Prospective. SUBJECTS Twenty-one subjects undergoing MR neurography evaluation (11/10 male/female, mean age = 46.3±13.7 years) with 60 image volumes. Twelve subjects (23 image volumes) were determined to have muscle denervation based on diffusely elevated T2 signal intensity. FIELD STRENGTH/SEQUENCE 3 T, 2D, two-point Dixon FSE. ASSESSMENT Qualitative assessment included overall image quality, nerve conspicuity, fat suppression, pulsation and ringing artifacts by 3 radiologists separately on a three-point scale (1 = poor, 2 = average, 3 = excellent). Quantitative measurements for FF and signal intensity relative to normal muscle were made for nerve, abnormal muscle and subcutaneous fat. STATISTICAL TESTS Linear and ordinal regression models were used for quantitative and qualitative comparisons, respectively; 95% confidence intervals (CIs) and p-values for pairwise comparisons were adjusted using the Holm-Bonferroni method. Inter-rater agreement was assessed using Gwet's agreement coefficient (AC2). RESULTS Simulations showed PCA-denoising reduced FF error from 2.0% to 1.0%, and from 7.6% to 3.1% at noise levels of 10% and 30%, respectively. In human subjects, PCA-denoising did not change signal levels and FF quantitatively. WW decreased fat signal significantly (-83.6%, p < 0.001). Nerve conspicuity was improved by WW (odds ratio, OR = 5.8, p < 0.001). Fat suppression was improved by both PCA (OR = 3.6, p < 0.001) and WW (OR = 2.2, p < 0.001). Overall image quality was improved by PCA + WW (OR = 1.7, p = 0.04). CONCLUSIONS WW and PCA-denoising improved nerve conspicuity and fat suppression in MR neurography. Denoising can potentially provide improved accuracy of FF maps for assessing fat-infiltrated muscle.
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Affiliation(s)
- Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
| | - Sophie C Queler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Julia Sternberg
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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Marom N, Kleeblad LJ, Ling D, Nwachukwu BU, Marx RG, Potter HG, Pearle AD. Pre-operative Static Anterior Tibial Translation Assessed on MRI Does Not Influence Return to Sport or Satisfaction After Anterior Cruciate Ligament Reconstruction. HSS J 2020; 16:475-481. [PMID: 33380982 PMCID: PMC7749907 DOI: 10.1007/s11420-019-09724-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND It has been suggested that the degree of anterior tibial translation (ATT) as measured passively on imaging studies (static ATT) after an anterior cruciate ligament (ACL) injury may influence outcomes after ACL reconstruction. However, there is a lack of evidence supporting these suggestions. QUESTIONS/PURPOSES The purpose of this retrospective prognostic study was to assess the predictive value of pre-operative static ATT in knees with ACL injury on return to sport and in satisfaction after ACL reconstruction. Our hypothesis was that greater static ATT would be associated with lower rates of return to sport and lower levels of satisfaction. METHODS Patients treated with ACL reconstruction were identified from an institutional registry and assigned to one of three groups according to their ACL injury type: acute ACL injury, chronic ACL injury, and failed ACL reconstruction. ATT in each knee compartment was measured using magnetic resonance imaging, and a retrospective telephone questionnaire was used to investigate post-ACL reconstruction return to sport and subjects' satisfaction. RESULTS One hundred thirty patients (52 acute with ACL injury, 29 with chronic ACL injury, and 49 with failed ACL reconstruction) completed the questionnaire, with a mean follow-up of 5.67 years. Ninety-seven patients (74.6%) returned to their primary sport, of whom 63 (65%) returned to the same level of sport. The mean time to return to sport was 10.1 months (range, 2 to 24 months). Overall, 113 patients (87%) were either very satisfied or satisfied with their outcomes. No difference in medial or lateral ATT was found between patients who returned to sport and those who did not. The failed-ACL reconstruction group had significantly lower rates of return to sport than did acutely and chronically injured patients (60.4% versus 88.5% and 75.9%, respectively). CONCLUSION The degree of pre-operative ATT in an ACL-deficient knee was not correlated with return to sport or satisfaction after ACL reconstruction. In this study cohort, only failed-ACL reconstruction patients undergoing revision ACL reconstruction were significantly less likely to return to their main sport. They were also less likely to return to sport at their pre-operative level, if they did return to sport.
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Affiliation(s)
- Niv Marom
- Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Laura J. Kleeblad
- Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Daphne Ling
- Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | | | - Robert G. Marx
- Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Hollis G. Potter
- Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Andrew D. Pearle
- Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
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Balazs GC, Greditzer HG, Wang D, Marom N, Potter HG, Rodeo SA, Marx RG, Williams RJ. Non-treatment of stable ramp lesions does not degrade clinical outcomes in the setting of primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:3576-3586. [PMID: 32358631 DOI: 10.1007/s00167-020-06017-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes of various methods of treatment of stable and unstable ramp lesions compared to patients with no meniscal pathology at the time of primary ACL reconstruction. METHODS All patients with a preoperative MRI performed at our facility who were enrolled in an institutional ACL registry and 1-year clinical follow-up were identified. A musculoskeletal radiologist reviewed preoperative MRI scans for evidence of a ramp lesion. Ramp lesions were classified as stable if a peripheral tear of the posterior horn of the medial meniscus was identified by MRI, but did not displace into the medial compartment with anteriorly directed probing at the time of surgery. Ramp lesions were classified as unstable if a tear was identified by preoperative MRI at the meniscocapsular junction and the meniscus was displaceable into the medial compartment with probing. Reoperation rates for ACL graft failure or recurrent medial meniscus pathology were collected. Patient-reported outcome scores (IKDC, SF12 PCS, SF12 MCS, and Marx Activity scale) were recorded at baseline and final follow-up. RESULTS A total of 162 patients were included in the analysis with median 2-year (range 1-5 years) clinical follow-up. Patients with a repaired unstable ramp lesion had a significantly higher likelihood of reoperation for recurrent medial meniscus pathology than patients without meniscal pathology at the time of index surgery. Patients with an untreated stable ramp lesion had a similar rate of reoperation when compared to patients without meniscal pathology. At final follow-up, there was no difference between groups in IKDC score, SF12 PCS/MCS, or Marx activity score or change in any score. CONCLUSIONS Patients with untreated stable ramp lesions have similar clinical outcomes at median 2-year (range 1-5 years) follow-up when compared to patients without a ramp lesion. Treatment of stable ramp lesions at the time of ACL reconstruction does not have clinical benefit. LEVEL OF EVIDENCE III.
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Affiliation(s)
- George C Balazs
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
| | - Harry G Greditzer
- Department of Radiology, Hospital for Special Surgery, New York, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, USA
| | - Niv Marom
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Department of Radiology, Hospital for Special Surgery, New York, USA
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Robert G Marx
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Riley J Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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Jones RM, Sharma A, Hotchkiss R, Sperling JW, Hamburger J, Ledig C, O’Toole R, Gardner M, Venkatesh S, Roberts MM, Sauvestre R, Shatkhin M, Gupta A, Chopra S, Kumaravel M, Daluiski A, Plogger W, Nascone J, Potter HG, Lindsey RV. Assessment of a deep-learning system for fracture detection in musculoskeletal radiographs. NPJ Digit Med 2020; 3:144. [PMID: 33145440 PMCID: PMC7599208 DOI: 10.1038/s41746-020-00352-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022] Open
Abstract
Missed fractures are the most common diagnostic error in emergency departments and can lead to treatment delays and long-term disability. Here we show through a multi-site study that a deep-learning system can accurately identify fractures throughout the adult musculoskeletal system. This approach may have the potential to reduce future diagnostic errors in radiograph interpretation.
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Affiliation(s)
- Rebecca M. Jones
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | - Anuj Sharma
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | - Robert Hotchkiss
- Hospital for Special Surgery, 523 East 72nd St, New York, NY 10021 USA
| | | | - Jackson Hamburger
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | - Christian Ledig
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | - Robert O’Toole
- University of Maryland Medical System, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201 USA
| | - Michael Gardner
- Stanford University, 450 Broadway St, Redwood City, CA 94063 USA
| | - Srivas Venkatesh
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | | | - Romain Sauvestre
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | - Max Shatkhin
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | - Anant Gupta
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | - Sumit Chopra
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | - Manickam Kumaravel
- The University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX 77030 USA
| | - Aaron Daluiski
- Hospital for Special Surgery, 523 East 72nd St, New York, NY 10021 USA
| | - Will Plogger
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
| | - Jason Nascone
- University of Maryland Medical System, 22 South Greene Street, Baltimore, MD 21201 USA
| | - Hollis G. Potter
- Hospital for Special Surgery, 523 East 72nd St, New York, NY 10021 USA
| | - Robert V. Lindsey
- Imagen Technologies, Inc., 151 West 26th Street, Suite 1001, New York, NY 10001 USA
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Alamanda VK, Demartino I, Potter HG, Koff MF, Lin B, Muskat A, Westrich GH. Multiacquisition Variable-Resonance Image Combination Magnetic Resonance Imaging Used to Study Detailed Bone Apposition and Fixation of an Additively Manufactured Cementless Acetabular Shell. Arthroplast Today 2020; 6:694-698. [PMID: 32923552 PMCID: PMC7475047 DOI: 10.1016/j.artd.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/29/2020] [Accepted: 07/11/2020] [Indexed: 01/01/2023] Open
Abstract
Background The ability to utilize magnetic resonance imaging (MRI) to assess bony fixation in 3 dimensions may allow a better understanding of the implant design and bony integration. We hypothesized that a new 3-dimensionally printed cementless highly porous acetabular component (Stryker Trident II TritaniumTM) would show better fixation than an earlier cup from the same manufacturer as assessed by the noninvasive technique of multispectral MRI. Methods Multiacquisition variable-resonance image combination selective metal suppression MRI was performed in 19 patients implanted with a new 3-dimensionally printed cup and 20 patients who had received a previous-generation cup from the same manufacturer at 1-year follow-up. Each cup was graded globally as well as by 9 specific zones. Integration grades were performed for each zone: 0, full bone integration; 1, fibrous membrane present; 2, osteolysis; and 3, fluid present. A mixed-effects logistic regression model was used to compare fixation between the 2 groups. Results All cups in both cohorts showed greater than 90% estimated global bony integration (3-dimensionally printed cups, 99.4%; regular cups 91.6%) with no osteolysis or fluid observed in any cup. The 3-dimensionally printed cup had 1 of 171 zones (0.6%) graded as fibrous membrane present, while the 2-dimensional group had 15 of 180 zones (8.3%) graded as fibrous. Of note, screw hole regions were omitted but may be read as fibrous membrane areas. Conclusion Using multiacquisition variable-resonance image combination selective MRI, our analysis showed greater osteointegration and less fibrous membrane formation in the 3-dimensionally printed cups than the control group at 1-year follow-up.
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Affiliation(s)
- Vignesh K Alamanda
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Ivan Demartino
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Bin Lin
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Ahava Muskat
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Koff MF, Burge AJ, Potter HG. Clinical magnetic resonance imaging of arthroplasty at 1.5 T. J Orthop Res 2020; 38:1455-1464. [PMID: 31975444 PMCID: PMC7293946 DOI: 10.1002/jor.24606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/10/2019] [Accepted: 01/22/2020] [Indexed: 02/04/2023]
Abstract
Magnetic resonance imaging (MRI) has historically been avoided for the routine clinical evaluation of metal implants at many clinical centers due to the presence of artifact that creates in-plane and through-plane distortions and signal intensity voids in generated images. However, when the image acquisition parameters are appropriately modified and advanced multi-spectral pulse sequences are used, high-quality diagnostic images can be generated and may be used for diagnosing patients with suspected periprosthetic pathology. MRI provides superior soft-tissue contrast and excellent sensitivity for mobile water and is, therefore, a valuable tool in the evaluation of these patients, given the increasing prevalence of arthroplasty within the general population. Knowledge of expected normal postoperative appearance in patients with total hip arthroplasty, total knee arthroplasty, and total shoulder arthroplasty facilitates the detection of abnormal findings in this population, as does familiarity with common pathologic conditions encountered in the periprosthetic region. This review article will provide background information regarding the presence of image artifacts, methods to reduce the artifacts, and application of MRI at 1.5 T for evaluating common complications in subjects with total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty.
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Affiliation(s)
- Matthew F. Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Alissa J. Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
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Sherafati M, Bauer TW, Potter HG, Koff MF, Koch KM. Multivariate use of MRI biomarkers to classify histologically confirmed necrosis in symptomatic total hip arthroplasty. J Orthop Res 2020; 38:1506-1514. [PMID: 32162716 PMCID: PMC8100875 DOI: 10.1002/jor.24654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/24/2020] [Accepted: 02/29/2020] [Indexed: 02/04/2023]
Abstract
The failure of total hip arthroplasty (THA) is commonly associated with the necrosis of the periprosthetic tissue. To date, there is no established method to noninvasively quantify the progression of such necrosis. Magnetic resonance imaging (MRI) of soft tissues near implants has undergone a recent renaissance due to the development of multispectral metal-artifact reduction techniques. Advanced analysis of multispectral MRI has been shown capable of detecting small magnetism effects of metallic debris in periprosthetic tissue. The purpose of this study is to demonstrate the diagnostic utility of these MRI-based tissue-magnetism signatures. Together with morphological MRI metrics, such as synovial volume and thickness, these measurements are utilized as biomarkers to noninvasively detect soft-tissue necrosis in symptomatic THA patients ( N = 78 ). All subjects underwent an advanced MRI scan before revision surgery and tissue biopsies utilized for necrosis grading. Statistical analyses demonstrated a weak, but significant positive correlation (P = .04) between MRI magnetism signatures and necrosis scores, while indicating no meaningful association between the latter and serum cobalt and chromium ion levels. Receiver-operating characteristic (ROC) analyses were then performed based on uni- and multivariate logistic regression models utilizing the measured MRI biomarkers as predictors of severe necrosis. The area under the curve of the ROC plots for MRI biomarkers as combined predictors were found to be 0.70 and 0.84 for cross-validation and precision-recall tests, respectively.
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Affiliation(s)
| | - Thomas W. Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Matthew F. Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Kevin M. Koch
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
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Burge AJ, Potter HG. Imaging of Failed Cartilage Repair. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2019.150710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Femoroacetabular impingement syndrome (FAIS) is a common disorder of the hip resulting in groin pain and ultimately osteoarthritis. Radiologic assessment of FAI morphologies, which may present with overlapping radiologic features of hip dysplasia, often requires the use of computed tomography (CT) for evaluation of osseous abnormality, owing to the difficulty of direct visualization of cortical and subchondral bone with conventional magnetic resonance imaging (MRI). The use of a zero echo time (ZTE) MRI pulse sequence may obviate the need for CT by rendering bone directly from MRI. PURPOSE/HYPOTHESIS The purpose was to explore the application of ZTE MRI to the assessment of osseous FAI and dysplasia morphologies of the hip. It was hypothesized that angular measurements from ZTE images would show significant agreement with measurements obtained from CT images. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Thirty-eight hips from 23 patients were imaged with ZTE MRI and CT. Clinically relevant angular measurements of hip morphology were made in both modalities and compared to assess agreement. Measurements included coronal and sagittal center-edge angles, femoral neck-shaft angle, acetabular version (at 1-, 2-, and 3-o'clock positions), Tönnis angle, alpha angle, and modified-beta angle. Interrater agreement was assessed for a subset of 10 hips by 2 raters. Intermodal agreement was assessed on the complete cohort and a single rater. RESULTS Interrater agreement was demonstrated in both CT and ZTE, with intraclass correlation coefficient values ranging from 0.636 to 0.990 for ZTE and 0.747 to 0.983 for CT, indicating "good" to "excellent" agreement. Intermodal agreement was also shown to be significant, with intraclass correlation coefficients ranging from 0.618 to 0.904. CONCLUSION Significant agreement of angular measurements for hip morphology exists between ZTE MRI and CT imaging. ZTE MRI may be an effective method to quantitatively evaluate osseous hip morphology.
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Affiliation(s)
- Ryan E Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Eric A Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Susan C Lee
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
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Chauhan A, McQueen P, Chalmers PN, Ciccotti MG, Camp CL, D'Angelo J, Potter HG, Fealy SA, Erickson BJ, Hoenecke HR, Keefe D, McCauley J, Fronek J. Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries With and Without Platelet-Rich Plasma in Professional Baseball Players: A Comparative and Matched Cohort Analysis. Am J Sports Med 2019; 47:3107-3119. [PMID: 31589470 DOI: 10.1177/0363546519876305] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies evaluating nonoperative treatment of elbow ulnar collateral ligament (UCL) injuries augmented with platelet-rich plasma (PRP) have shown promising results. To date, no comparative studies have been performed on professional baseball players who have undergone nonoperative treatment with or without PRP injections for UCL injuries. HYPOTHESIS Players who received PRP injections would have better outcomes than those who did not receive PRP. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The Major League Baseball (MLB) Health and Injury Tracking System identified 544 professional baseball players who were treated nonoperatively for elbow UCL injuries between 2011 and 2015. Of these, 133 received PRP injections (PRP group) before starting their nonoperative treatment program, and 411 did not (no-PRP group). Player outcomes and a Kaplan-Meier survival analysis were compared between groups. In addition, to reduce selection bias, a 1:1 matched comparison of the PRP group versus the no-PRP group was performed. Players were matched by age, position, throwing side, and league status: major (MLB) and minor (Minor League Baseball [MiLB]). A single radiologist with extensive experience in magnetic resonance imaging (MRI) interpretation of elbow injuries in elite athletes analyzed 243 MRI scans for which images were accessible for tear location and grade interpretation. RESULTS Nonoperative treatment of UCL injuries resulted in an overall 54% rate of return to play (RTP). Players who received PRP had a significantly longer delay in return to throwing (P < .001) and RTP (P = .012). The matched cohort analysis showed that MLB and MiLB pitchers in the no-PRP group had a significantly faster return to throwing (P < .05) and the MiLB pitchers in the no-PRP group had a significantly faster RTP (P = .045). The survival analysis did not reveal significant differences between groups over time. The use of PRP, MRI grade, and tear location were not statistically significant predictors for RTP or progression to surgery. CONCLUSION In this retrospective matched comparison of MLB and MiLB pitchers and position players treated nonoperatively for a UCL tear, PRP did not improve RTP outcomes or ligament survivorship, although there was variability with respect to PRP preparations, injection protocols, time from injury to injection, and rehabilitation programs. MRI grade and tear location also did not significantly affect RTP outcomes or progression to surgery.
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Affiliation(s)
- Aakash Chauhan
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Peter McQueen
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Peter N Chalmers
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Michael G Ciccotti
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Christopher L Camp
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - John D'Angelo
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Hollis G Potter
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Stephen A Fealy
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Brandon J Erickson
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Heinz R Hoenecke
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Daniel Keefe
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Julie McCauley
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Jan Fronek
- Investigation performed at Division of Sports Medicine, Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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Kowash HM, Potter HG, Edye ME, Prinssen EP, Bandinelli S, Neill JC, Hager R, Glazier JD. Poly(I:C) source, molecular weight and endotoxin contamination affect dam and prenatal outcomes, implications for models of maternal immune activation. Brain Behav Immun 2019; 82:160-166. [PMID: 31415868 DOI: 10.1016/j.bbi.2019.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/10/2019] [Accepted: 08/10/2019] [Indexed: 01/08/2023] Open
Abstract
The viral mimetic polyinosinic:polycytidylic acid (poly(I:C)) is increasingly used to induce maternal immune activation (mIA) to model neurodevelopmental disorders (NDDs). Robust and reproducible phenotypes across studies are essential for the generation of models that will enhance our understanding of NDDs and enable the development of improved therapeutic strategies. However, differences in mIA-induced phenotypes using poly(I:C) have been widely observed, and this has prompted the reporting of useful and much needed methodological guidelines. Here, we perform a detailed investigation of molecular weight and endotoxin variations in poly(I:C) procured from two of the most commonly used suppliers, Sigma and InvivoGen. We demonstrate that endotoxin contamination and molecular weight differences in poly(I:C) composition lead to considerable variability in maternal IL-6 response in rats treated on gestational day (GD)15 and impact on fetal outcomes. Specifically, both endotoxin contamination and molecular weight predicted reductions in litter size on GD21. Further, molecular weight predicted a reduction in placental weight at GD21. While fetal body weight at GD21 was not affected by poly(I:C) treatment, male fetal brain weight was significantly reduced by poly(I:C), dependent on supplier. Our data are in agreement with recent reports of the importance of poly(I:C) molecular weight, and extend this work to demonstrate a key role of endotoxin on relevant phenotypic outcomes. We recommend that the source and batch numbers of poly(I:C) used should always be stated and that molecular weight variability and endotoxin contamination should be minimised for more robust mIA modelling.
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Affiliation(s)
- H M Kowash
- Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9WL, UK
| | - H G Potter
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
| | - M E Edye
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Medicine, Biology and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
| | - E P Prinssen
- Roche Innovation Centre, Basel, 124 Grenzacherstrasse, Basel, CH 4070, Switzerland
| | - S Bandinelli
- Roche Innovation Centre, Basel, 124 Grenzacherstrasse, Basel, CH 4070, Switzerland
| | - J C Neill
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Medicine, Biology and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK. http://www.b-neuro.com
| | - R Hager
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
| | - J D Glazier
- Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9WL, UK; Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
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Pownder SL, Caserto BG, Bowker RM, Lin B, Potter HG, Koff MF. Quantitative magnetic resonance imaging and histological hoof wall assessment of 3-year-old Quarter Horses. Equine Vet J 2019; 52:435-440. [PMID: 31598997 DOI: 10.1111/evj.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few noninvasive methods are available for equine hoof wall evaluation. The highly organised wall structures and composition of proteoglycans and collagens may make this region amenable to quantitative MRI (qMRI) techniques of T1ρ and T2 mapping to identify pathology related to proteoglycan content and collagen organisation respectively. OBJECTIVE To establish normative T1ρ and T2 values of the equine hoof wall of 3-year-old Quarter Horses with histological comparison. STUDY DESIGN Cadaveric anatomical study. METHODS Six cadaveric left thoracic feet from 3-year-old racing Quarter Horses with no reported lameness were evaluated using T1ρ and T2 mapping. Mapping was performed at six regions of interest at the toe of each hoof including proximal and distal regions of the inner epidermis, stratum lamellatum and corium. Histology was evaluated for standard hoof morphology and proteoglycan staining. RESULTS T2 values of the stratum lamellatum and corium were similar (42.9 [95% CI: 41.6-44.2] ms and 44 [95% CI: 42.7-45.3] ms respectively), but both were significantly different to the inner epidermis (35.8 [95% CI: 34.5-37.1] ms, P<0.001). T1ρ values for the inner epidermis, stratum lamellatum and corium were significantly different (25.1 [95% CI: 23.1-27.1] ms, 44.4 [95% CI: 42.4-46.4] ms and 50.1 [95% CI: 48.1-52.1] ms, respectively, P<0.001). Histology demonstrated normal organised morphology. Proteoglycan staining was only visible in the stratum lamellatum and corium. MAIN LIMITATIONS Cadaveric study with frozen samples used. CONCLUSIONS Variation of qMRI metrics through the depth of the equine hoof wall was found. Although the highly ordered environment of collagen may contribute to T2 values, there was lack of evidence to support proteoglycan content as a major contributor of T1ρ values. It is possible T1ρ values had a greater dependence on total water content as the lowest values were seen in the epidermis. Additional research using qMRI is needed to determine mapping values in different disease states.
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Affiliation(s)
- S L Pownder
- MRI Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - B G Caserto
- VetPath Services, Stone Ridge, New York, USA
| | - R M Bowker
- Michigan State University, East Lansing, Michigan, USA
| | - B Lin
- MRI Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - H G Potter
- MRI Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - M F Koff
- MRI Laboratory, Hospital for Special Surgery, New York, New York, USA
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Nakagawa Y, Fortier LA, Mao JJ, Lee CH, Goodale MB, Koff MF, Uppstrom TJ, Croen B, Wada S, Carballo CB, Potter HG, Rodeo SA. Long-term Evaluation of Meniscal Tissue Formation in 3-dimensional-Printed Scaffolds With Sequential Release of Connective Tissue Growth Factor and TGF-β3 in an Ovine Model. Am J Sports Med 2019; 47:2596-2607. [PMID: 31386550 PMCID: PMC7422478 DOI: 10.1177/0363546519865513] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Artificial meniscal scaffolds are being developed to prevent development of osteoarthritis after meniscectomy. Previously, it was reported that 3-dimensional (3D) anatomic scaffolds loaded with connective tissue growth factor (CTGF) and transforming growth factor β3 (TGF-β3) achieved meniscal regeneration in an ovine model. This was a relatively short-term study (3 months postoperative), and outcome analyses did not include magnetic resonance imaging (MRI). PURPOSE To evaluate long-term outcome of meniscal replacement with growth factor-laden poly-ε-caprolactone (PCL) scaffolds. STUDY DESIGN Controlled laboratory study. METHODS Anatomically shaped ovine meniscal scaffolds were fabricated from PCL with a 3D printer based on MRI data. Skeletally mature sheep (N = 34) were randomly allocated to 3 groups: scaffold without growth factor (0-µg group), scaffold with CTGF microspheres (µS) (5 µg) + TGF-β3 µS (5 µg) (5-µg group), and scaffold with CTGF µS (10 µg) + TGF-β3 µS (10 µg) (10-µg group). Unilateral medial meniscal replacement was performed. Animals were euthanized at 6 or 12 months. Regenerated meniscus, articular cartilage status, and synovial reaction were evaluated quantitatively with gross inspection, histology, and MRI. Kruskal-Wallis and Dunn tests were used to compare the 3 groups. RESULTS Remnants of the PCL scaffold were evident in the 6-month specimens and were decreased but still present at 12 months in most animals. There were no significant differences among groups in gross inspection, histology, or MRI for either meniscal regeneration or articular cartilage protection. All experimental groups exhibited articular cartilage degeneration as compared with control (nonoperated). In terms of synovitis, there were no clear differences among groups, suggesting that growth factors did not increase inflammation and fibrosis. MRI revealed that meniscal extrusion was observed in most animals (82.7%). CONCLUSION Previously, the combination of CTGF and TGF-β3 was shown to stimulate mesenchymal stem cells into a fibrochondrocyte lineage. CTGF and TGF-β3 did not aggravate synovitis, suggesting no adverse response to the combination of 3D-printed PCL scaffold combined with CTGF and TGF-β3. Further work will be required to improve scaffold fixation to avoid meniscal extrusion. CLINICAL RELEVANCE A significant advantage of this technique is the ability to print custom-fit scaffolds from MRI-generated templates. In addition, average-size menisci could be printed and available for off-the-shelf applications. Based on the 1-year duration of the study, the approach appears to be promising for meniscal regeneration in humans.
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Affiliation(s)
- Yusuke Nakagawa
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA., Department of Cartilage Regeneration, Graduate
School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Lisa A. Fortier
- Department of Clinical Sciences, College of
Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Jeremy J. Mao
- Tissue Engineering and Regenerative Medicine
Laboratory, Columbia University Medical Center, Columbia University, New York, New
York, USA
| | - Chang Hun Lee
- Tissue Engineering and Regenerative Medicine
Laboratory, Columbia University Medical Center, Columbia University, New York, New
York, USA
| | - Margaret B. Goodale
- Department of Clinical Sciences, College of
Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Matthew F. Koff
- Department of Radiology and Imaging, Hospital for
Special Surgery, New York, New York, USA
| | - Tyler J. Uppstrom
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
| | - Brett Croen
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
| | - Susumu Wada
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
| | - Camila B. Carballo
- Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for
Special Surgery, New York, New York, USA
| | - Scott A. Rodeo
- Address correspondence to Scott A. Rodeo, MD,
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA., Laboratory for Joint Tissue Repair and Regeneration,
Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New
York, USA
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Bhave S, Koff MF, Kaushik SS, Potter HG, Koch KM. 3D-multi-spectral T 2 mapping near metal implants. Magn Reson Med 2019; 82:614-621. [PMID: 30883910 PMCID: PMC6554714 DOI: 10.1002/mrm.27744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE Due to host-mediated adverse reaction to metallic debris, there is an increasing need for noninvasive assessment of the soft tissue surrounding large joint arthroplasties. Quantitative T 2 mapping can be beneficial for tissue characterization and early diagnosis of tissue pathology but current T 2 mapping techniques lack the capability to image near metal hardware. A novel multi-spectral T 2 mapping technique is proposed to address this unmet need. METHODS A T 2 mapping pulse sequence based on routinely implemented 3D multi-spectral imaging (3D-MSI) pulse sequences is described and demonstrated. The 3D-MSI pulse sequence is altered to acquire images at 2 echo times. Phantom and knee experiments were performed to assess the quantitative capabilities of the sequence in comparison to a commercially available T 2 mapping sequence. The technique was demonstrated for use within a clinical protocol in 2 total hip arthroplasty (THA) cases to assess T 2 variations within the periprosthetic joint space. RESULTS The proposed multi-spectral T 2 mapping technique agreed, within experimental errors, with T 2 values derived from a commercially available clinical standard of care T 2 mapping sequence. The same level of agreement was observed in quantitative phantoms and in vivo experiments. In THA cases, the method was able to assess variations of T 2 within the synovial envelope immediately adjacent to implant interfaces. CONCLUSIONS The proposed 3D-MSI T 2 mapping sequence was successfully demonstrated in assessing tissue T 2 variations near metal implants.
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Affiliation(s)
- Sampada Bhave
- Radiology Medical College of Wisconsin Milwaukee WI 53226
USA
| | - Matthew F. Koff
- MRI Laboratory Hospital for Special Surgery New York NY
10021 USA
| | | | - Hollis G. Potter
- MRI Laboratory Hospital for Special Surgery New York NY
10021 USA
| | - Kevin M Koch
- MR Applications and Workflow GE Healthcare Waukesha WI
53188 USA
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Nguyen JC, Lin B, Potter HG. Maturation-dependent findings in the shoulders of pediatric baseball players on magnetic resonance imaging. Skeletal Radiol 2019; 48:1087-1094. [PMID: 30607454 DOI: 10.1007/s00256-018-3130-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/15/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the prevalence and characteristics of shoulder osseous and soft tissue findings on magnetic resonance imaging (MRI) with respect to skeletal maturation in symptomatic pediatric baseball players without a history of acute trauma. METHODS The IRB-approved, HIPAA-compliant retrospective study analyzed 87 consecutive pediatric baseball players (86 boys and 1 girl; mean age, 15.4 ± 2.1 years) with shoulder MRI performed between March 1, 2012 and September 30, 2017. In consensus, two radiologists assessed the MRI studies for findings involving the humerus, the glenoid, the labrum, the rotator cuff, and the acromioclavicular joint. Exact Cochran-Armitage trend and Mantel-Haenszel Chi-square tests were used to investigate the association between these findings and skeletal maturation. RESULTS The mean ages between players who are skeletally immature (37 shoulders), maturing (26 shoulders), and matured (24 shoulders) were significantly different (p < 0.001). Bone marrow edema (p < 0.001) and sclerosis (p < 0.001) within the proximal humeral metaphysis decreased with skeletal maturation. Glenoid remodeling (p = 0.038) was more severe in the skeletally immature players and the prevalence of Bennett lesions (p = 0.048) increased with skeletal maturation. The prevalence of labral tears, rotator cuff tendinosis, and acromioclavicular joint separation did not significantly change with skeletal maturation. CONCLUSIONS The change in the prevalence of findings within the proximal humerus and glenoid with skeletal maturation suggest differences in the distribution of stress within the shoulders of pediatric baseball players during development.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th street, New York, NY, 10021, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th street, New York, NY, 10021, USA
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Balazs GC, Greditzer HG, Wang D, Marom N, Potter HG, Marx RG, Rodeo SA, Williams RJ. Ramp Lesions of the Medial Meniscus in Patients Undergoing Primary and Revision ACL Reconstruction: Prevalence and Risk Factors. Orthop J Sports Med 2019; 7:2325967119843509. [PMID: 31205962 PMCID: PMC6537250 DOI: 10.1177/2325967119843509] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Ramp lesions are peripheral tears of the posterior horn of the medial meniscus that involve the meniscocapsular attachments or red-red zone and typically occur in conjunction with anterior cruciate ligament (ACL) ruptures. Purpose: To identify the prevalence of, and risk factors for, ramp lesions in a large cohort of patients undergoing primary and revision ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: We queried our institutional registry of patients who underwent primary or revision surgical treatment for an ACL injury. Those who underwent preoperative magnetic resonance imaging (MRI) at our facility were included in the study. Clinical details were extracted and verified using electronic records. All preoperative MRI scans were reviewed by a musculoskeletal radiologist for the presence of a ramp lesion. Stable ramp lesions were defined as a peripheral posterior horn medial meniscal tear identified on MRI but either not identifiable with viewing and probing from the anterior portals or, if identified, not displaceable with anteriorly directed probing. Unstable ramp lesions were defined as peripheral posterior horn medial meniscal tears at the meniscocapsular junction that were identifiable at the time of surgery and displaced into the medial compartment with probing. The prevalence of stable and unstable ramp lesions was calculated. Demographic, injury, and imaging parameters were determined using univariate statistics. Results: A total of 372 patients were included. The overall prevalence of ramp lesions was 42% (155/372). Unstable ramp lesions were present in 73 (20%) patients, and stable ramp lesions were present in 82 (22%) patients. The presence of any ramp lesion (stable or unstable) was associated with bone marrow edema of the posteromedial tibia on MRI (odds ratio [OR], 3.0; P < .0001), a contact injury mechanism (OR, 1.8; P = .02), and a concurrent lateral meniscal tear (OR, 1.7; P = .02). No demographic, injury, surgical, or radiological variable was associated with a stable versus unstable ramp lesion. Conclusion: The overall prevalence of a ramp lesion in patients treated for ACL ruptures at our institution was 42%. The presence of bone marrow edema of the posteromedial tibia, a contact injury mechanism, or a lateral meniscal tear should alert surgeons to the potential presence of a medial meniscal ramp lesion.
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Affiliation(s)
- George C Balazs
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Harry G Greditzer
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California, USA
| | - Niv Marom
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Robert G Marx
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
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Affiliation(s)
- Darryl B Sneag
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Hollis G Potter
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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49
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Sacks HA, Prabhakar P, Wessel LE, Hettler J, Strickland SM, Potter HG, Fufa DT. Generalized Joint Laxity in Orthopaedic Patients: Clinical Manifestations, Radiographic Correlates, and Management. J Bone Joint Surg Am 2019; 101:558-566. [PMID: 30893238 DOI: 10.2106/jbjs.18.00458] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hayley A Sacks
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Pooja Prabhakar
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Lauren E Wessel
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Jessica Hettler
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Sabrina M Strickland
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Hollis G Potter
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
| | - Duretti T Fufa
- Departments of Orthopaedic Surgery (H.A.S., P.P., L.E.W., S.M.S., and D.T.F.), Physical Therapy and Rehabilitation (J.H.), and Radiology and Imaging (H.G.P.), Hospital for Special Surgery, New York, NY
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Abstract
Background: Recent awareness of latissimus dorsi/teres major (LD/TM) injuries has led to an increase in diagnoses. No magnetic resonance imaging (MRI) classification system specific to the LD/TM exists, nor has tear severity been correlated with ability to return to sport (RTS). Purpose/Hypothesis: The purpose of this study was to report a novel MRI classification system for LD/TM tears as well as to correlate tear grade with performance and RTS. We hypothesized that the new MRI classification system would have high intra- and interobserver reliabilities and that players with higher grade tears would require operative management. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: All patients with LD/TM tears diagnosed by MRI who were under the care of 2 orthopaedic surgeons were included. On 2 occasions 60 days apart, MRIs were reviewed and graded by 2 authors using a new classification system. Intra- and interobserver reliabilities were calculated. Timing from injury to RTS was recorded, and performance upon RTS was analyzed. Results: The proposed grading system had excellent intra- and interrater reliabilities (Cohen kappa >0.850). A total of 20 male patients (mean ± SD age, 26 ± 9.3 years) with LD/TM tears were included (80% were baseball pitchers). Of the 16 players treated operatively, 5 were initially treated nonoperatively by an outside physician but could not RTS (all professional baseball pitchers); 2 of these players had grade IIIA tears and 3 of the players had grade IVA tears. Regardless of initial treatment, ultimately 100% of the professional baseball players were able to RTS at a mean of 8.7 ± 3.3 months, although the initial nonoperative management failed for some of these players and they needed surgical intervention. No statistically significant differences were found between pre- versus postoperative performance in those professional players who were treated surgically. Conclusion: The proposed MRI-based grading system for LD/TM tears had excellent reliability. This system may allow physicians to better advise patients and all involved health care providers. Consideration should be given to acutely treat grade III and IV tears with operative repair.
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Affiliation(s)
- Brandon J Erickson
- Shoulder & Elbow/Sports Medicine Division, Rothman Orthopaedic Institute, New York, New York, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
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