Chondrocalcinosis of Femoro-Tibial and Proximal Tibio-Fibular Joints in Cadaveric Specimens: A High-Resolution CT Imaging Study of the Calcification Distribution

Sébastien Touraine,Martine Cohen-Solal,Valérie Bousson,Liess Laouisset,Christine Chappard,Frédéric Lioté,Hang Korng Ea,Jean-Denis Laredo,Ryan K Roeder

doi:10.1371/journal.pone.0054955

Abstract

ObjectivesTo analyze calcium deposits by computed tomography (CT) in femoro-tibial compartments and proximal tibio-fibular joints; to assess the relationship with CT-assessed osteoarthritis (OA).Methods68 (34 pairs) cadaveric knees (mean age of 84) were scanned at high resolution CT. Menisci and hyaline cartilage calcifications in the femoro-tibial and proximal tibio-fibular joints were analyzed. OA was CT-assessed by the Kellgren and Lawrence score. Gross appearance of OA was evaluated on 29 left knees after dissection and India ink staining of tibial plateaus.ResultsIn femoro-tibial joints, meniscal calcifications (MC) and hyaline cartilage calcifications (HCC) were detected in 23(34%) and 14(21%) knees respectively. Calcifications mainly involved the three meniscal segments and were mainly observed in all thirds of the femoro-tibial compartments. In proximal tibio-fibular joints, HCC were detected in 19(28%) knees. The association HCC-MC in femoro-tibial joints and between calcifications in femoro-tibial and proximal tibio-fibular joints was strong (p<0.0001). Femoro-tibial and proximal tibio-fibular CT-assessed OA were respectively found in 23(34%) and 19(28%) knees. HCC were significantly associated with femoro-tibial OA (p = 0.04) while MC were not (p = 0.34). OA macroscopic evaluation showed a mean surface of cartilage lesions of 35% (range 0.13–0.55). No significant difference was demonstrated regarding the CT-detection of MC, HCC or CT-assessed OA.ConclusionsThis is the first study to report a strong association of chondrocalcinosis between femoro-tibial and tibio-fibular joints in addition to a strong association between MC and HCC in femoro-tibial compartments. No significant relationship between chondrocalcinosis and OA was demonstrated.

Highlights

Since the report by Zitnan and Sitaj in 1963 [1], chondrocalcinosis has been identified as a well-recognized but complex entity
In 2011, the EUropean League Against Rheumatism (EULAR) defined chondrocalcinosis as cartilage calcifications mainly linked to calcium pyrophosphate (CPP) crystals and detected by imaging or histological examination [2]
Since knees are a key-target for both chondrocalcinosis and OA, we studied the association between chondrocalcinosis and OA, assessing the gross appearance of the cartilage after knee dissection and ink staining

Summary

Introduction

Since the report by Zitnan and Sitaj in 1963 [1], chondrocalcinosis has been identified as a well-recognized but complex entity. In 2011, the EUropean League Against Rheumatism (EULAR) defined chondrocalcinosis as cartilage calcifications mainly linked to calcium pyrophosphate (CPP) crystals and detected by imaging or histological examination [2]. Coexistence of other calcium-containing crystals has been fully recognized [3]. The significance of articular cartilage mineralization by calcium crystals remains controversial considering the composition of calcium-containing crystals, clinical symptoms and onset of osteoarthritis (OA). There are growing evidences supporting the hypothesis of a pathogenic role of articular calcifications in OA. Several human studies have recently demonstrated the presence of basic calcium phosphate (BCP) crystals in patients with severe knee and hip OA [4,5].

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