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Central sagittal MR image through the lateral tibiofemoral joint. The three anatomical cartilage ROIs which were drawn and analyzed on three consecutive images in each compartment of the tibiofemoral joint are shown. wbFC (green): weight-bearing cartilage of the femoral condyle. pFC (yellow): posterior non weight-bearing cartilage of the femoral condyle. wbTP (red): weight-bearing cartilage of the tibial plateau.
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Introduction:
Viscosupplementation with hyaluronic acid (HA) of osteoarthritic (OA) knee joints has a well-established positive effect on clinical symptoms. This effect, however, is only temporary and the working mechanism of HA injections is not clear. It was suggested that HA might have disease modifying properties because of its beneficial effe...
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Background
One potential mechanism for early superficial cartilage wear in normal joints is alteration of the lubricant content and quality of synovial fluid. The purpose of this study was to determine if the concentration and quality of the lubricant, hyaluronan, in synovial fluid: (1) was similar in left and right knees; (2) exhibited similar age...
Abstract The goal for this study was to evaluate the effects of daily oral intake of a consumable liquid fermentate containing high-molecular-weight hyaluronan, as well as to perform a basic evaluation of safety and tolerability. A randomized, double-blind placebo-controlled study design was used to examine the effects of oral intake of hyaluronan...
ABSTRACT
Background and Objectives: Intra-articular hyaluronic acid is widely used in the treatment of knee osteoarthritis. This study aimed to assess the efficacy of hyaluronic acid in moderate severity knee osteoarthritis.
Material and Methods: Patients of knee osteoarthritis were administered single intra-articular injection of Hyaluronic Acid 2...
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Highlight:
• Computer vision syndrome (CVS) that causes dry eyes becomes a health problem for college students.
• Sodium hyaluronate eyedrops can be used as one of the CVS therapy strategies for students suffering from CVS.
Abstract:
The use of computers and mobile devices is increasing. Computers and mobile devices help our daily work or study...
Citations
... Our study showed statistically significant [17] where significant improvement from baseline WOMAC score (assessing pain, stiffness, and physical function) was observed. A similar effect was noted by van Tial et al. [18] in their study, where KOOS values showed significant improvement from baseline to 14 weeks after visco-supplementation. ...
Context
While visco-supplementation is being used for the treatment of knee osteoarthritis (OA), the published reports vary widely in benefits afforded by this treatment. It was therefore proposed to assess the objective parameters along with subjective outcomes.
Aims
Our study assessed the radiological and clinical efficacy of single-dose high-molecular-weight intra-articular hyaluronic acid (HMW-IAHA) injection in knee OA.
Settings and Design
This interventional cohort study was conducted in a calculated sample size of 44 patients with knee OA.
Materials and Methods
Visual analog scale (VAS) and knee OA and outcome score (KOOS) were used for clinical assessment, and whole organ magnetic resonance imaging score (WORMS) for radiological assessment. The subjects were given a single dose of HMW-IAHA injection, 90 mg/3 ml, and were assessed on day 0 and day 90.
Statistical Analysis
Statistical Package for Social Sciences (SPSS) software was used.
Results
At the day 90 follow-up, there was an improvement in mean ± standard deviation values of VAS score (day 0: 8.53 ± 0.81, day 90: 5.97 ± 0.87), KOOS score (day 0: 27.33 ± 15.18, day 90: 57.26 ± 14.26), and the cartilage signal and morphology in the medial femorotibial joint (day 0: 11.02 ± 6.26 and day 90: 10.91 ± 6.22) and patellofemoral joint (day 0: 10.35 ± 4.36 and day 90: 10.28 ± 4.39) compartments. There was a decrease in synovitis score from 2.3 ± 1.61 to 1.3 ± 1.3 in the medial femorotibial joint compartment and total WORMS score (day 0: 66.57 ± 36.06, day 90: 65.14 ± 35.62).
Conclusions
A single dose of intra-articular injection with high-molecular-weight hyaluronic acid produces improvement in the clinical symptoms and quality of life as well as is effective in maintaining the articular cartilage integrity and reducing synovial inflammation.
... Although PRP and HA have both been shown to improve pain and functional outcomes, and, when used in combination, these outcomes can be enhanced, there is some uncertainty regarding the impact of PRP and HA on cartilage regeneration, based on data from clinical trials. In fact, to visualize small changes to cartilage necessitates the use of MRI and this has often been beyond the scope of clinical trials [60]. Thus, there are only a few trials that have investigated changes in cartilage following PRP injection. ...
Regenerative medicine, based on the use of autologous tissues and embryonic, stem or differentiated cells, is gaining growing interest. However, their preparation, in a manner compliant with good practices and health regulations, is a technical challenge. The aim of this manuscript is to present the design of reliable CE marked medical devices for the preparation of standardized platelet-rich plasma (PRP) and other autologous biologics intended for therapeutic uses. There are numerous PRP isolation processes. Depending on the methodology used, PRP composition varies greatly in terms of platelet concentration, platelet quality, and level of contamination with red and white blood cells. This variability in PRP composition might affect the clinical outcomes. The devices presented here are based on a specific technology, patented all over the world, that allows the precise separation of blood components as a function of their density using thixotropic separator gels in closed systems. This allows the preparation, in an automated manner, of leukocyte poor PRP with a standardized composition. Production of different forms of PRP is a clinical asset to suit various therapeutic needs. Therefore, we are offering solutions to prepare PRP either in liquid or gel form, and PRP combined with hyaluronic acid. These biologics have been successfully used in many different therapeutic domains, resulting in more than 150 published clinical studies. We also developed the CuteCell technology platform for cell culture expansion for further autologous cell therapies. This technology enables the safe and rapid in vitro expansion of cells intended for therapeutic use in good manufacturing practices (GMP) and autologous conditions, using blood-derived products as culture media supplementation. We summarize in this article our 20 years’ experience of research and development for the design of PRP devices and, more recently, for PRP combined with hyaluronic acid.
... Regions of interest (ROIs) were drawn manually at both medial and lateral FCC (Fig. 1). According to the nomenclature suggested by Eckstein et al., 20 the central portion of medial and lateral FCC was considered the weight-bearing portion 21 and we additionally analyzed the anterior third portion of the medial and lateral FCC as the non-weight-bearing portion. The posterior third FCC was not analyzed because this cartilage can be both weight-bearing and non-weight-bearing depending on knee flexion. ...
Objective
To investigate compositional changes in the distal femoral condylar cartilage (FCC) of children and young adults with and without discoid meniscus by T2 relaxation time mapping.
Design
We retrospectively reviewed knee magnetic resonance images including sagittal T2 maps of distal FCC performed in patients with or without discoid meniscus. Combined meniscal pathology such as degeneration or tears was also reviewed. Regions of interest were selected, and T2 relaxation time profiles were generated according to medial and lateral and FCC and according to weight-bearing and non-weight-bearing FCC. Nonparametric comparison tests using median values were performed.
Results
Seventy-nine knees from 73 patients (2-20 years) including 45 knees with lateral discoid meniscus (discoid group) were studied. T2 values of FCC showed negative correlation with age in both the discoid and nondiscoid groups ( P < 0.01), except for medial weight-bearing FCC. In the discoid group, T2 relaxation times of lateral weight-bearing FCC (median, 46.5 ms) were lower than those of lateral non-weight-bearing (median, 53.2 ms; P < 0.001) and medial weight-bearing (median, 50.5 ms; P = 0.012) FCC. Lateral weight-bearing FCC also showed lower T2 values than other areas in patients with meniscal pathology in the discoid group. However, T2 relaxation times did not differ between the discoid and nondiscoid groups in patients without meniscal pathology.
Conclusions
Children and young adults with discoid meniscus have lower T2 relaxation times in lateral weight-bearing FCC compared with non-weight-bearing or medial FCC, suggesting compositional changes have occurred in these patients.
... dGEMRIC is a non-invasive technique that generates cartilage images that can be used as an indirect measurement of glycosaminoglycan (GAG) concentration in the extracellular cartilage matrix. [20] Representative dGEM-RIC MRI images and post-surgical T1 quantification results are shown in Figure 2. ...
Focal chondral lesions of the knee are the most frequent type of trauma in younger patients and are associated with a high risk of developing early posttraumatic osteoarthritis. The only current clinical solutions include microfracture, osteochondral grafting, and autologous chondrocyte implantation. Cartilage tissue engineering based on biomimetic scaffolds has become an appealing strategy to repair cartilage defects. Here, a chondrogenic collagen‐chondroitin sulfate scaffold is tested in an orthotopic Lapine in vivo model to understand the beneficial effects of the immunomodulatory biomaterial on the full chondral defect. Using a combination of noninvasive imaging techniques, histological and whole transcriptome analysis, the scaffolds are shown to enhance the formation of cartilaginous tissue and suppression of host cartilage degeneration, while also supporting tissue integration and increased tissue regeneration over a 12 weeks recovery period. The results presented suggest that biomimetic materials could be a clinical solution for cartilage tissue repair, due to their ability to modulate the immune environment in favor of regenerative processes and suppression of cartilage degeneration.
... Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) has been developed to evaluate cartilage degeneration. [4][5][6][7] dGEMRIC is regarded as a molecular imaging technique to examine the relative distribution of glycosaminoglycan (GAG) content in cartilage and can provide useful information beyond that available from radiography in the assessment of hip cartilage. 8,9 Furthermore, dGEMRIC has been shown to be reliable at identifying early cartilage metabolic changes and predicting outcomes with joint preserving surgery in hip dysplasia 10 . ...
Objective
Hip cartilage quality is essential for the success of joint-preserving surgery for osteonecrosis. This study aimed to characterize cartilage changes in osteonecrosis of femoral head (ONFH) using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC).
Design
Fifteen asymptomatic (control) and 60 ONFH subjects were included in this study. The ONFH subjects were stratified in accordance with the Association Research Circulation Osseous (ARCO) classification ( n = 15 hips per ARCO stage). All participant hips were investigated using dGEMRIC and theT1Gd data were collected and analyzed.
Results
T1Gd value was significantly lower in the ONFH group (365.1 ± 90.5 ms; range 200-498 ms) compared with the control group (546.1 ± 26.0 ms; range 504-580 ms) ( P < 0.001). The T1Gd values of ARCO stage I-IV ONFH were 460.2 ± 17.3 ms (439-498 ms), 408.9 ± 43.4 ms (337-472 ms), 359.9 ± 34.5 ms (303-412 ms), 231.5 ± 15.1 ms (200-253 ms), respectively. Decreased T1Gd value was found to correlate significantly with increased ONFH severity ( P < 0.001). T1Gd value in collapse stage was significantly lower than that of noncollapse stage (295.7 ± 70.3 ms [range 200-412 ms] vs. 434.6 ± 41.7 ms [range 337-498 ms]; P < 0.001).
Conclusions
dGEMRIC identified hip cartilage as abnormal in ONFH, even at early-stage, as represented by decreased T1Gd, and this was further aggravated by ONFH collapse.
... Regarding radiographic progression, previous studies [26][27][28] showed that treatments such as PRP or HA have no significant influence on cartilage condition evaluated by MRI. In our study, no statistically significant difference was found in the Kellgren-Lawrence progression or in the responsiveness of quantitative cartilage measures in MRI. ...
Background:
Knee osteoarthritis (OA) is a disease with a high prevalence in the adult population. Nonsteroidal anti-inflammatory drugs (NSAID) or intra-articular injections [hyaluronic acid (HA) or platelet-rich plasma (PRP)] can provide clinical benefit. Magnetic resonance imaging (MRI) has proven to be useful for the evaluation of cartilage volume and thickness in knee osteoarthritis. The purpose of this study was to evaluate the benefit provided by PRP injection in comparison with hyaluronic acid and NSAID in knee OA patients and to compare the radiographic evolution at the 52-week follow-up.
Methods:
One hundred and six patients were enrolled and randomized according to the Spanish Rheumatology Society knee osteoarthritis diagnosis criteria. Ninety-eight patients completed the study (33 received NSAID treatment, 32 a single hyaluronic acid injection and 33 a single PRP injection). Patients were prospectively evaluated at baseline, 26 and 52 weeks using the Western Ontario McMaster Universities osteoarthritis index (WOMAC) and the visual analogue scale (VAS), and at baseline and 52 weeks with X-ray and MRI.
Results:
A 20% decrease in WOMAC pain and increase in physical function was found in 30 and 24%, respectively, of those patients who received PRP treatment, at the 52-week follow-up. WOMAC pain and VAS improved in the hyaluronic acid and NSAID groups. However, better results were obtained in the PRP group compared to hyaluronic acid and NSAIDs (P < 0.05). No differences in Kellgren-Lawrence or cartilage thickness progression were found.
Conclusions:
Leukocyte-poor platelet-rich plasma (LP-PRP) injections are better in terms of clinical improvement with respect to HA injections or oral NSAID treatment in knee osteoarthritis patients at the 52-week follow-up. Moreover, a single LP-PRP injection is effective. However, LP-PRP has no influence on cartilage progression.
Level of evidence:
Level II.
... The selection of the regions of interest (ROIs) was standardized and based on the suggestions by Eckstein et al. [18] and van Tiel et al. [19] The ROIs were drawn manually on three consecutive slices through the lateral compartment (central slice and one adjacent slice on each side), and consisted of the femoral cartilage (FC), the weight-bearing FC (wbFC), the posterior non-weight-bearing FC (pFC), and the tibial cartilage (TC) [ Figure 1a]. The MATLAB 7.1 (Mathworks Inc., Natick, MA, USA) and MRIMapper software packages (2006a R2.2, Beth Israel Deaconess Medical Center, Boston, MA, USA) were used to create T1 maps of the femoral and tibial cartilage in the three consecutive slices, and the mean dGEMRIC indices (T1Gd) were calculated in each ROI [ Figure 1]. ...
... The GAG content was significantly higher in the TC than the wbFC, pFC, and FC in both healthy knees and osteoarthritic knees, which is in line with previous researches. [19,33] We have no proper explanations for this finding yet. The reason may be related to mechanical transmission, as mechanical stress in the lateral compartment is transmitted through a smaller surface area of the TC and dissipated along a broader area of the corresponding FC. [11,27] Another possible explanation could be related to the thickness maps of cartilage, which reveal that cartilage regions are thickest at the lateral facet of the tibia and are thinnest at the medial facet. ...
Background: The quality of the lateral compartment cartilage is important to preoperative evaluation and prognostic prediction of unicompartmental knee arthroplasty (UKA). Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) enables noninvasive assessment of glycosaminoglycan (GAG) content in cartilage. This study aimed to determine the GAG content of the lateral compartment cartilage in knees scheduled to undergo Oxford medial UKA.
Methods: From December 2016 to May 2017, twenty patients (20 osteoarthritic knees) conforming to the indications for Oxford medial UKA were included as the osteoarthritis (OA) group, and 20 healthy volunteers (20 knees) paired by sex, knee side, age (±3 years), and body mass index (BMI) (±3 kg/m2) were included as the control group. The GAG contents of the weight-bearing femoral cartilage (wbFC), the posterior non-weight-bearing femoral cartilage (pFC), the lateral femoral cartilage (FC), and tibial cartilage (TC) were detected using dGEMRIC. The dGEMRIC indices (T1Gd) were calculated in the middle three consecutive slices of the lateral compartment. Paired t-tests were used to compare the T1Gd in each region of interest between the OA group and control group.
Results: The average age and BMI in the two groups were similar. In the OA group, T1Gd of FC and TC was 386.7 ± 50.7 ms and 429.6 ± 59.9 ms, respectively. In the control group, T1Gd of FC and TC was 397.5 ± 52.3 ms and 448.6 ± 62.5 ms, respectively. The respective T1Gd of wbFC and pFC was 380.0 ± 47.8 ms and 391.0 ± 66.3 ms in the OA group and 400.3 ± 51.5 ms and 393.6 ± 57.9 ms in the control group. Although the T1Gd of wbFC and TC tended to be lower in the OA group than the control group, there was no significant difference between groups in the T1Gd in any of the analyzed cartilage regions (P value of wbFC, pFC, FC, and TC was 0.236, 0.857, 0.465, and 0.324, respectively).
Conclusions: The GAG content of the lateral compartment cartilage in knees conforming to indications for Oxford medial UKA is similar with those of age- and BMI-matched participants without OA.
... Van Tiel described and used a promising reproducible methodology based on this technique to explore the potentially structural effect of HA in early stage knee OA, unsuccessfully [40]. ...
... MRI session, a double dose (0.2 mmol/kg) of gadoteric acid (Dotarem®, Guerbet, France) was injected intravenously approximately 95 min before the MRI session. Patients were then asked to exercise for 15 minutes on a cyclo-ergometer at a comfortable rate and pedaling frequency in order to promote the contrast agent distribution within the knee articular cartilage as previously described [39,40]. MRI measurements were started after an additional 80 min resting period. ...
... MR imaging was performed on a 3.0 Tesla MRI scanner (Verio, Siemens Germany) using a set of phase array surface coils positioned above and below the knee (Figure 2). After a localization procedure using scout images, quantitative sagittal T1 mapping was performed using a dualflip angle 3D GRE sequence with the following parameters as previously described [39,40,43] ...
... The methodology behind dGEMERIC is well established and has excellent correlation with in vivo imaging, histology, and detecting OA. 7,104,122 dGEMRIC can assess the effect of exercise on cartilage of both the hip and the knee (Figure 4) 121 as well as the effect of hyaluronic acid. 4,43,105 Despite the extensive experience with dGEMRIC, its application is limited because it requires a high dose of contrast (double the clinically recommended dose), raising the concern for nephrogenic systemic sclerosis, a rare complication that can lead to irreversible kidney failure. 14 The challenge of a standardized waiting period between contrast injection and scan also poses hurdles to regular clinical use. ...
Context:
Radiography is widely accepted as the gold standard for diagnosing osteoarthritis (OA), but it has limitations when assessing early stage OA and monitoring progression. While there are improvements in the treatment of OA, the challenge is early recognition.
Evidence acquisition:
MEDLINE and PubMed as well as professional orthopaedic and imaging websites were reviewed from 2006 to 2016.
Study design:
Clinical review.
Level of evidence:
Level 4.
Results:
Magnetic resonance imaging (MRI) can provide the most comprehensive assessment of joint injury and OA with the advantages of being noninvasive and multiplanar with excellent soft tissue contrast. However, MRI is expensive, time consuming, and not widely used for monitoring OA clinically. Computed tomography (CT) and CT arthrography (CTA) can also be used to evaluate OA, but these are also invasive and require radiation exposure. Ultrasound is particularly useful for evaluation of synovitis but not for progression of OA.
Conclusion:
MRI, CT, and CTA are available for the diagnosis and monitoring of OA. Improvement in techniques and decrease in cost can allow some of these modalities to be effective methods of detecting early OA.
... There is also no evidence clearly supporting that viscosupplementation influences OA's natural progression: whereas some reports show serum and urine biomarker changes, others show no changes in cartilage structural composition [6,51]. ...
Non-surgical treatments are usually the first choice for the management of knee degeneration, especially in the early osteoarthritis (OA) phase when no clear lesions or combined abnormalities need to be addressed surgically. Early OA may be addressed by a wide range of non-surgical approaches, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as physical therapies and novel biological minimally invasive procedures involving injections of various substances to obtain a clinical improvement and possibly a disease-modifying effect. Numerous pharmaceutical agents are able to provide clinical benefit, but no one has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level. Patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. Among these, exercise is an effective conservative approach, while physical therapies lack literature support. Even though a combination of these therapeutic options might be the most suitable strategy, there is a paucity of studies focusing on combining treatments, which is the most common clinical scenario. Further studies are needed to increase the limited evidence on non-surgical treatments and their combination, to optimize indications, application modalities, and results with particular focus on early OA. In fact, most of the available evidence regards established OA. Increased knowledge about degeneration mechanisms will help to better target the available treatments and develop new biological options, where preliminary results are promising, especially concerning early disease phases. Specific treatments aimed at improving joint homoeostasis, or even counteracting tissue damage by inducing regenerative processes, might be successful in early OA, where tissue loss and anatomical changes are still at very initial stages.
