Abstract
BackgroundIn this cross-sectional study, we conducted a comprehensive assessment of all articular elements that could be measured using knee MRI. We assessed the association of pathological change in multiple articular structures involved in the pathoanatomy of osteoarthritis.MethodsKnee MRI scans from patients over 45 years old were assessed using a semi-quantitative knee MRI assessment form. The form included six distinct elements: cartilage, bone marrow lesions, osteophytes, subchondral sclerosis, joint effusion and synovitis. Each type of pathology was graded using an ordinal scale with a value of zero indicating no pathology and higher values indicating increasingly severe levels of pathology. The principal dependent variable for comparison was the mean cartilage disease score (CDS), which captured the aggregate extent of involvement of articular cartilage. The distribution of CDS was compared to the individual and cumulative distributions of each articular element using the Chi-squared test. The correlations between pathological change in the various articular structures were assessed in a Spearman correlation table.ResultsData from 140 patients were available for review. The cohort had a median age of 61 years (range 45-89) and was 61% female. The cohort included a wide spectrum of OA severity. Our analysis showed a statistically significant trend towards pathological change involving more articular elements as CDS worsened (p-value for trend < 0.0001). Comparison of CDS to change in the severity of pathology of individual articular elements showed statistically significant trends towards more severe pathology as CDS worsened for osteophytes (p-value for trend < 0.0001), bone marrow lesions (p = 0.0003), and subchondral sclerosis (p = 0.009), but not joint effusion or synovitis. There was a moderate correlation between cartilage damage, osteophytes and BMLs as well as a moderate correlation between joint effusion and synovitis. However, cartilage damage and osteophytes were only weakly associated with synovitis or joint effusion.ConclusionOur results support an inter-relationship of multiple articular elements in the pathoanatomy of knee OA. Prospective studies of OA pathogenesis in humans are needed to correlate these findings to clinically relevant outcomes such as pain and function.
Highlights
In this cross-sectional study, we conducted a comprehensive assessment of all articular elements that could be measured using knee magnetic resonance imaging (MRI)
Cartilage damage vs. severity of pathological changes for individual articular elements We investigated the association of the severity of disease of individual articular elements with the severity of the cartilage disease score
We investigated the inter-relationship of multiple articular elements involved the pathoanatomy of OA in a cohort of 140 patients who had arthroscopic partial meniscectomy and knee MRI at our institution in 2002
Summary
In this cross-sectional study, we conducted a comprehensive assessment of all articular elements that could be measured using knee MRI. Recent research findings from both in vivo and in vitro human experiments as well as animal models suggest that OA results from the interplay of multiple factors including local inflammation, joint stability, joint loading, alignment and genetic predisposition [2,3,4,5]. Together these studies suggest a more contemporary and encompassing view of OA pathogenesis that incorporates all of the articular structures into an integrated process involving the entire joint [6,7]. The use of magnetic resonance imaging (MRI) to visualize structures such as the synovium, meniscus and bone marrow that cannot be visualized with plain radiographs has demonstrated that these structures are affected in the context of OA [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]
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