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Cartilage loss in a patient with baseline meniscal tears in the right knee. ( A ) Coronal DESS MRI at baseline shows normal cartilage at the medial tibiofemoral joint. ( B ) Sagittal intermediate- weighted fat-suppressed MRI at baseline shows a horizontal tear of the posterior horn of the medial meniscus ( small arrows ) with small subchondral femoral bone marrow lesion ( large arrow ). ( C ) Coronal DESS MRI at two-year follow-up shows dramatic cartilage loss at both the weight- bearing medial femur ( small arrows ) and the tibia ( large arrow ), which is confirmed on ( D ), the sagittal intermediate- weighted fat-suppressed MRI. In addition, there are extensive tibial and femoral subchondral bone marrow lesions ( large arrows ) and new joint effusion ( asterisk ). Also, a slight increase in the size of the anterior femoral and tibial osteophytes is observed ( small arrows )
Source publication
Arthroscopy-based semiquantitative scoring systems such as Outerbridge and Noyes’ scores were the first to be developed for the purpose of grading cartilage defects. As magnetic resonance imaging (MRI) became available faor evaluation of the osteoarthritic knee joint, these systems were adapted for use with MRI. Later on, grading methods such as th...
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IntroductionPatients with knee osteoarthritis (KOA) often complain about clinical symptoms affected by weather-related factors. The purpose of the present study was to use cross-sectional analysis to determine whether weather sensitivity was associated with clinical symptoms, as well as structure abnormalities, in KOA patients.Methods
Data from 80...
Background
Previously, fragments from Sirtuin 1 (SIRT1) were identified in preclinical and clinical samples to display an increase in serum levels for N-terminal (NT) SIRT1 vs. C-terminal (CT) SIRT1, indicative of early signs of OA. Here we tested NT/CT SIRT1 levels as well as a novel formulated sandwich assay to simultaneously detect both domains...
Objective
Anterior cruciate ligament (ACL) injury is one of the causes for post-traumatic knee osteoarthritis (OA), and ACL reconstruction surgery is reportedly unable to prevent OA development. In early-stage knee OA, medial meniscus extrusion (MME) is closely correlated with tibial medial osteophyte width, which consists of bone and cartilage -pa...
Background:
To evaluate the longitudinal changes of bone marrow edema-like lesions (BMELs) in patients after anterior cruciate ligament (ACL) reconstruction and to investigate the effect of BMELs on cartilage matrix composition changes measured using MR T1ρ and T2 mapping.
Methods:
Patients with acute ACL tear were enrolled in a prospective stud...
Citations
... MRI has proven its useful role as an imaging tool for research in OA as it is capable of assessing the pathology at the molecular level in structures not visualized by radiography [17,18]. The biochemical changes in the cartilage can be assessed before morphologic changes become evident [19]. ...
Osteoarthritis (OA) is a common degenerative disorder of the articular cartilage, which is associated with hypertrophic changes in the bone, synovial inflammation, subchondral sclerosis, and joint space narrowing (JSN). Radiography remains the first line of imaging till now. Due to the lack of soft-tissue depiction in radiography, researchers are exploring various imaging techniques to detect OA at an early stage and understand its pathophysiology to restrict its progression and discover disease-modifying agents in OA. As the OA relates to the degradation of articular cartilage and remodeling of the underlying bone, an optimal imaging tool must be sensitive to the bone and soft tissue health. In that line, many non-invasive imaging and minimally invasive techniques have been explored. Out of these, the non-invasive compositional magnetic resonance imaging (MRI) for evaluation of the integrity of articular cartilage and positron emission tomography (PET) scan with fluorodeoxyglucose (FDG) and more specific bone-seeking tracer like sodium fluoride (18F-NaF) for bone cartilage interface are some of the leading areas of ongoing work. Integrated PET-MRI system, a new hybrid modality that combines the virtues of the above two individual modalities, allows detailed imaging of the entire joint, including soft tissue cartilage and bone, and holds great potential to research complex disease processes of OA. This narrative review attempts to signify individual characteristics of MRI, PET, the fusion of these characteristics in PET-MRI, and the ongoing research on PET-MRI as a potential tool to understand the pathophysiology of OA.
... [25] In the development of osteoarthritis of the knee joint, damaged MFLs may constitute an additional risk factor mostly due to the increased femorotibial contact pressure. [26] According to Forkel et al., [24] one MFL at least was found in 94.4% of cases. Contrary to other studies where the aMFL was present in approximately 24 to 36%, [25][26][27] the present study showed that the incidence of aMFL of Humphrey was 72.3%. ...
... [26] According to Forkel et al., [24] one MFL at least was found in 94.4% of cases. Contrary to other studies where the aMFL was present in approximately 24 to 36%, [25][26][27] the present study showed that the incidence of aMFL of Humphrey was 72.3%. This finding is consistent with a previous study of Röhrich et al. [28] Of 199 knee MRI examinations, aMFL was seen in 144 patients in Groups 2 and 4. Despite the presence or absence of ACL tear, the presence of aMFL was closely correlated with a buckled PCL morphology on sagittal MRI images and demonstrated a close association with low mean PCL buckling angle values of 104.8±7.3 and 116.8±8.4 degrees, respectively. ...
... Although PCL buckling has been described in several patients with an absent aMFL, non-visualization of aMFL on MRI does not exclude its total absence, since MRI is only 85% sensitive and 75% specific in detecting MFLs. [26,27] In this study, the increased PCL buckling was associated with the presence of Humphrey ligament. Since PCL buckling sign has been described in many cases without associated ACL rupture, it cannot be considered a specific secondary sign of ACL injury. ...
Objectives:
This study aims to investigate the correlation between posterior cruciate ligament (PCL) buckling phenomena and the presence or absence of the anterior meniscofemoral ligament (aMFL).
Patients and methods:
Between January 2012 and January 2019, magnetic resonance imaging of a total of knee joints of 199 patients (163 males, 16 females; mean age: 31.5±5.3 years; range, 18 to 40 years) were reviewed retrospectively. The patients were divided into four groups. The first group included 32 patients with a ruptured anterior cruciate ligament (ACL) and absent aMFL. The second group included 67 patients with a ruptured ACL and apparent aMFL. The third group included 23 patients with an intact ACL and absent aMFL, and the fourth group included 77 patients with an intact ACL and apparent aMFL. The PCL angle was used to measure the buckling degree of the ligament, as calculated as the angle between two lines drawn through the tibial and femoral central portions of the PCL insertions. We assessed the buckling phenomena of the PCL in ACL-ruptured and ACL-intact knees and examined a possible correlation between the PCL buckling angle and the presence or absence of the aMFL of Humphrey.
Results:
In the ruptured ACL groups (Groups 1 and 2), the mean PCL buckling angle values were 133.88±6.32 and 104.83±7.34 degrees, respectively. A significant difference was detected between both groups (p=0.026). In the intact ACL groups (Groups 3 and 4), the mean PCL buckling angle values were 143.47±5.96 and 116.77±8.38 degrees, respectively. A significant difference was detected between both groups (p=0.039). No statistically significant difference was observed between Groups 1 and 3 (p=0.13) and between Groups 2 and 4 (p=0.088).
Conclusion:
The PCL buckling sign is not specific for ACL ruptures, and can be seen frequently in normal knee joints which it is strongly associated with the presence of aMFL of Humphrey.
... Knee malalignment affects the distribution of loads across the joint in an unfavorable manner leading to increased contact pressure in the more heavily loaded regions [1]. Consequently, knee malalignment can be considered a risk factor for osteoarthritis and cartilage loss as well as a biomarker for assessing severity and progression [2,3,4]. As shown in Fig. 1, knee alignment is defined as the angle between the mechanical axes of the femoral and tibial bones. ...
Background and Objective: We present a fully automated method for the quantification of knee alignment from full-leg radiographs.
Methods: A state-of-the-art object detector, YOLOv4, was trained to locate regions of interests in full-leg radiographs for the hip joint, knee, and ankle. Residual neural networks were trained to regress landmark coordinates for each region of interest. Based on the detected landmarks the knee alignment, i.e., the hip-knee-ankle (HKA) angle was computed. The accuracy of landmark detection was evaluated by a comparison to manually placed ones for 180 radiographs. The accuracy of HKA angle computations was assessed on the basis of 2,943 radiographs by a comparison to results of two independent image reading studies (Cooke; Duryea) both publicly accessible via the Osteoarthritis Initiative. The agreement was evaluated using Spearman’s Rho, weighted kappa, and regarding the correspondence of the class assignment.
Results: The average deviation of landmarks manually placed by experts and automatically detected ones by our proposed “YOLOv4 And Resnet Landmark regression Algorithm” (YARLA) was less than 2.0 ± 1.5 mm for all structures. The average mismatch between HKA angle determinations of Cooke and Duryea was 0.09 ± 0.63∘; YARLA resulted in a mismatch of 0.09 ± 0.73∘ compared to Cooke and of 0.18 ± 0.67∘ compared to Duryea. Cooke and Duryea agreed almost perfectly with respect to a weighted kappa value of 0.86, and showed an excellent reliability as measured by a Spearman’s Rho value of 0.98. Similar values were achieved by YARLA, i.e., a weighted kappa value of 0.83 and 0.87 and a Spearman’s Rho value of 0.98 and 0.98 compared to Cooke and Duryea, respectively. Cooke and Duryea agreed in 91% of all class assignments and YARLA did so in 90% against Cooke and 92% against Duryea.
Conclusions: YARLA yields HKA angles similar to those of human experts and provides a basis for an automated assessment of knee alignment in full-leg radiographs.
... К основным этиологическим факторам развития остеоартроза коленного сустава относят микро-и макротравмы сустава, возникающие в результате ин-тенсивных физических нагрузок различного происхождения (в том числе, спорт, избыточная масса тела и т.д.) [17,22]. В таком случае неравномерно распределённая нагрузка по поверхности суставного хряща и максимальное давление сосредоточиваются на небольшой площади, в месте наибольшего сближения суставных поверхностей, приводя к дистрофии и дегенерации хряща [12,32]. Эти негативные процессы связывают с нарушением метаболизма хряща, который сопровождается уменьшением содержания протеогликанов и разрывом коллагеновых волокон. ...
Introduction Osteoarthritis (OA) is a heterogenic group of disorders of different etiology with similar biological, morphological and clinical manifestations
and outcomes. OA is now considered a disease of the whole joint, including alterations in the articular cartilage, subchondral bone, synovial membrane,
ligaments, capsule and periarticular muscles. OA of the knee as the most commonly affected joint accounts for the great medical, medical, social and
economic impact. Material and methods A literature review assessing Russian and foreign studies on molecular mechanisms of etiology and pathogenesis
of knee OA identified a set of factors for which there was consistent evidence for their association with onset of knee OA. A search of studies published in
Russian and in English for the last ten years was conducted using bibliographic databases, including PubMed, PubMedCentral, GoogleScholar, eLIBRARY.
Search terms included 'knee osteoarthritis', 'etiology', 'pathogenesis', 'risk factors'. Results Review of the literature showed that patients with knee OA
are characterized by changes in cartilage, subchondral bone, synovium, suggesting common mechanisms of joint degeneration during OA development.
Osteoarthritis (OA) is multifactorial in origin and closely associated with a wide spectrum of local (previous injury, muscle weakness, knee malalignment,
knee surgeries, abnormal mechanical loading, excessive high impact sports, occupational physical activities) and systemic risk factors (advanced age,
female sex, height, greater body mass index and obesity, hormone status, family history, mineral bone density, vitamin D deficiency, ethnicity). The
prevalence of the knee OA and patterns of joint involvement vary among different racial and ethnic groups. Conclusion The literature review allowed us to
identify the molecular mechanisms of etiopathogenesis of knee OA and the major risk factors for the pathology.
... Compared to the arthroscopy, MRI was suggested for the diagnosis and therapy of meniscal lesions in the economic and damage consideration [23,24]. Alizai et al. [25,26] suggested to use MRI-based semiquantitative grading methods to describe cartilage assessment and provide an update on the risk factors for cartilage loss in knee osteoarthritis. So the modified WORMS evaluation using MRI with the SPGR sequence is suitable for the evaluation of early knee arthritis and will have a bright future with the development of MRI technology. ...
Rationale and objectives
The aim of this study was to investigate the efficacy of magnetic resonance imaging (MRI) with a spoiled gradient-recalled (SPGR) sequence to evaluate early knee cartilage degeneration and the relationship between cartilage and other tissues using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS).
Materials and methods
Eighty-four patients with knee joint pain were evaluated by X-ray and MRI with an SPGR sequence from June 2015 to December 2016. Joint degeneration was graded by two experienced radiologists using the Kellgren-Lawrence (K-L) grading scale. The modified WORMS was used to evaluate cartilage lesions, bone marrow abnormalities, bone cysts, osteophytes, joint effusion and synovitis. The difference between the WORMS of the SPGR and the T2 sequences evaluated by the Wilcoxon signed-rank test was determined, and the relationships between the WORMS features were evaluated by a Spearman correlation.
Results
The modified WORMS for the cartilage lesion evaluation was significantly higher with the SPGR sequence than with the T2 sequence (P < 0.05). The cartilage lesions showed a moderate correlation with osteophytes, synovitis and joint effusion (Rs > 0.40, P < 0.05) and weak correlations with bone marrow abnormalities and bone cysts (Rs < 0.4, P < 0.05).
Conclusion
The modified WORMS evaluation using MRI with the SPGR sequence was much better than the normal sequence for early knee osteoarthritis (OA). The cartilage lesions are associated with bone marrow abnormalities and the other features of OA.
... This is a powerful non-invasive tool for detecting this pathology and monitoring the results of pharmacological therapy and surgical intervention [3,4]. MRI is a more sensitive method than X-ray imaging or computed tomography to visualize most changes of bone structures due to multi-dimensional tomographic capabilities [5,6], can better visualize osteophytes, especially central ones, which are inherent in deforming arthrosis (DA) [7]. The method is used to monitor trabecular changes in the subchondral bone if osteoarthritis develops [8,9]. ...
The paper analyzes the effectiveness of magnetic resonance imaging with cartilage diagram in diagnosing signs of professional deforming arthrosis of knee joints in miners working in conditions of significant physical loading. Aim of the research – to determine of diagnostic efficiency of indicators of magnetic resonance imaging of the knee joint and cartilage diagram in miners of the main occupations suffering from deforming arthrosis. Methods. The research is conducted in 30 miners of basic occupations: 20 mining workers of breakage face (MWBF) and 10 machinists of shearer mining machines (МSMM) have been treated in the inpatient department of occupational pathology of the Lviv Regional Clinical Hospital in 2015-2017 due to deforming arthrosis. Damages of the main anatomical elements of the knee joint with arthrosis were analyzed, visualized initially with the help of MRI, and then - cartilage diagram. Results. According to the MRI data, in miners of the main occupations with arthrosis of the knee joint the posterior cross-shaped ligament are most commonly affected (in 75.0±9.7 % MWBF and 70.0±14.5 % МSMM), damage to the medial collateral ligament are diagnosed less frequently (in 5.0±4.9 % in the MWBF and in 10.0±9.5 % in the МSMM). On average 3.8±0.4 modified elements of the knee joint are visualized in patients, whereas 4.8±0.1 affected areas are visualized on the cartilage diagram (р<0.05). In 86.7±6.2 % patients, in the analysis of cartilage diagram, changes in all five analyzed areas are diagnosed, indicating a higher efficiency of the diagnosis of changes in the structures of the joint with DA of the professional etiology of the method of cartilage diagram compared with MRI. According to the cartilage diagram the most significant changes are noted in the hypertrophy of the femur: among all miners 62.5±0.3 ms (medial) and 62.6±0.4 ms (lateral), in the MWBF group the average time of Т2-delay is the largest in the area of the medial hypertrophy of the femur is 60.9±2.3 ms, in the МSMM group – in the area of the lateral hypertrophy of the femur: 66.7±3.3 ms, which can be linked to the peculiarities of the forced working position of miners of these professions and the kinetics of joint structures. These results can be used to diagnose the initial lesions of joint structures with DA of professional genesis, as well as the creation of prognostic models for determining the the degree of risk of development of knee joint damage, which will allow to improve the system of personified approach to diagnostic and preventive measures in working persons in conditions of considerable physical activity and forced working position.
... A challenge for murine models of OA is the lack of non-invasive approaches that allow researchers to assess the severity and progression of OA diseases longitudinally. X-ray and magnetic resonance imaging (MRI) are widely used in OA patients with established quantitative and semi-quantitative assessment standards [5][6][7][8]. However, use of these imaging modalities in small animals, especially mice, is limited due to expensive and low resolution equipment, and operator dependence. ...
... Understanding meniscal pathology is a major part of ongoing OA research. Studies show a substantial correlation be- tween meniscal abnormalities and incident OA, progression of OA, and cartilage 5 loss [1,2,3,4,5,6,7,8]. In contrast to conventional semi-quantitative (SQ) MRI reading, employing the Whole-Organ Magnetic Resonance Imaging Score (WORMS), the Boston-Leeds Osteoarthritis Knee Score (BLOKS), or the MRI Osteoarthritis Knee Score (MOAKS) [9,10,11], quantitative meniscal measures are needed to better classify the grade of OA and to identify patients, which have 10 a high risk of developing OA. ...
... The authors declare that they have no conflict of interest. , and meniscal extrusion ME [mm] estimated from our medial menisci (MM) and lateral menisci (LM) masks for Dataset B. Differences between groups of radiographic OA rOA (no: 0,1; mild: 2; advanced: 3,4), joint space narrowing JSN (0, 1, 2) and WOMAC pain scores (0, [1][2][3][4][5][6][7][8][9][10], [11][12][13][14][15][16][17][18][19][20]) were evaluated using two-sample t-tests (significance level: 0.05). [%], and meniscal extrusion ME [mm] estimated from our medial menisci (MM) and lateral menisci (LM) masks for Dataset B. Differences between groups of radiographic OA rOA (no: 0,1; mild: 2; advanced: 3,4), joint space narrowing JSN (0, 1, 2) and WOMAC pain scores (0, [1][2][3][4][5][6][7][8][9][10], [11][12][13][14][15][16][17][18][19][20]) were evaluated using two-sample t-tests (significance level: 0.05). ...
... , and meniscal extrusion ME [mm] estimated from our medial menisci (MM) and lateral menisci (LM) masks for Dataset B. Differences between groups of radiographic OA rOA (no: 0,1; mild: 2; advanced: 3,4), joint space narrowing JSN (0, 1, 2) and WOMAC pain scores (0, [1][2][3][4][5][6][7][8][9][10], [11][12][13][14][15][16][17][18][19][20]) were evaluated using two-sample t-tests (significance level: 0.05). [%], and meniscal extrusion ME [mm] estimated from our medial menisci (MM) and lateral menisci (LM) masks for Dataset B. Differences between groups of radiographic OA rOA (no: 0,1; mild: 2; advanced: 3,4), joint space narrowing JSN (0, 1, 2) and WOMAC pain scores (0, [1][2][3][4][5][6][7][8][9][10], [11][12][13][14][15][16][17][18][19][20]) were evaluated using two-sample t-tests (significance level: 0.05). ...
Objective:
To present a novel method for automated segmentation of knee menisci from MRIs. To evaluate quantitative meniscal biomarkers for osteoarthritis (OA) estimated thereof.
Method:
A segmentation method employing convolutional neural networks in combination with statistical shape models was developed. Accuracy was evaluated on 88 manual segmentations. Meniscal volume, tibial coverage, and meniscal extrusion were computed and tested for differences between groups of OA, joint space narrowing (JSN), and WOMAC pain. Correlation between computed meniscal extrusion and MOAKS experts' readings was evaluated for 600 subjects. Suitability of biomarkers for predicting incident radiographic OA from baseline to 24 months was tested on a group of 552 patients (184 incident OA, 386 controls) by performing conditional logistic regression.
Results:
Segmentation accuracy measured as Dice Similarity Coefficient was 83.8% for medial menisci (MM) and 88.9% for lateral menisci (LM) at baseline, and 83.1% and 88.3% at 12-month follow-up. Medial tibial coverage was significantly lower for arthritic cases compared to non-arthritic ones. Medial meniscal extrusion was significantly higher for arthritic knees. A moderate correlation between automatically computed medial meniscal extrusion and experts' readings was found (ρ=0.44). Mean medial meniscal extrusion was significantly greater for incident OA cases compared to controls (1.16±0.93 mm vs. 0.83±0.92 mm; p<0.05).
Conclusion:
Especially for medial menisci an excellent segmentation accuracy was achieved. Our meniscal biomarkers were validated by comparison to experts' readings as well as analysis of differences w.r.t groups of OA, JSN, and WOMAC pain. It was confirmed that medial meniscal extrusion is a predictor for incident OA.
... Accordingly, synergisms between the MFLs and the PCL have been described on many levels [2,[10][11][12][13][14][15][16]. In addition, in the development of knee osteoarthritis (OA) [17], damaged MFLs may constitute a contributory risk factor due to the increase in femorotibial contact pressure [11,[18][19][20][21]. ...
Objectives:
To quantify the morphological correlation between the posterior cruciate ligament (PCL) and the meniscofemoral ligaments (MFLs), to propose normal ranges for different age populations, and to define guidelines for correct identification and differentiation of MFLs in routine MRI.
Methods:
Three hundred forty-two subjects were included retrospectively and subdivided into five age groups. Morphometrics of the PCL and the MFLs were measured on standard MRI in the sagittal, coronal, and axial planes. Student's t test, Mann-Whitney U test, and ANOVA and Kruskal-Wallis tests with Bonferroni correction were used for comparison.
Results:
The MFLs did not vary significantly between sexes (p > 0.05) or in those older than 10 years (p > 0.05). Longitudinal MFL growth is completed before age 11 years, with cross-sectional area (CSA) increasing until age 20. The CSA of the PCL was significantly (p = 0.028) larger in knees without a pMFL (Mdn = 39.7 mm2) than with a pMFL (Mdn = 35.4 mm2). MFLs were more often detected on sagittal than coronal images.
Conclusions:
This study describes the morphometric relation between the PCL and the MFLs on routine MRI. When reporting imaging findings in preparation for arthroscopic knee surgery, evaluation of MFLs, first in the sagittal and then the coronal plane, will achieve the best results.
Key points:
• The MFLs and the PCL have distinct morphological patterns throughout life. • These patterns show intimate anatomical relationships and a potential biomechanical impact. • Those patterns and relationships can be quantified with MRI. • A correlation exists between age and morphometrics of the MFLs. • Recommendations for correct identification of the MFLs are provided.
... Osteoarthritis (OA) is a major health concern worldwide causing pain and limited range of motion in load-bearing joints, particularly for the elderly. 1 There exist several systemic and nonsystemic risk factors that contribute toward the development and progression of the OA. 2,3 Gender is one of the systemic risk factors during the onset of OA. 4,5 The various factors that contribute to the predisposition of OA in men and/or women could be cartilage structure, hormonal imbalance, biomechanics, malalignment, age, and exercise. Biomechanical factors in general play a significant role in the onset of OA 6 and previous research showed that there existed gender differences in the biomechanics of the OA knees. ...
Objective: Gender is a risk factor in the onset of Osteoarthritis (OA). The aim of the study was to investigate gender differences in Contact Area (CA) and Congruity Index (CI) in the medial tibio-femoral (MTF) joint in two different cohorts, quantified automatically from magnetic resonance imaging (MRI).
Design: The CA and CI markers were validated on two different data sets from Center for Clinical and Basic Research (CCBR) & Osteoarthritis Initiative (OAI). The CCBR cohort consisted of 159 subjects and the OAI sub-cohort consisted of 1436 subjects. From the MTF joint, the contact area was located and quantified using Euclidean distance transform. Further, the CI was quantified over the contact area by assessing agreement of the first and second order general surface features. Then, the gender differences between CA and CI values were evaluated at different stages of radiographic OA.
Results: Female CAs were significantly higher than male CAs after normalization, male CIs were significantly higher than female CIs after correcting with age and body-mass-index (p < 0.05), consistent across the two data sets. For the OAI data set, the gender differences were present at all stages of radiographic OA.
Conclusions: This study demonstrated the gender differences in CA and CI in MTF joints. The higher normalized CA and lower CI values in female knees may be linked with the increased risk of incidence of radiographic OA in females. These differences may help to further understand the gender differences and/or to establish gender specific treatment strategies.
