Changes In Bone Shape Research Articles

Sistem Pakar Diagnosa Paget's Disease dengan Menerapkan Algoritma Teorema Bayes

Paget's Disease, also known as Paget's Disease of the bone, is a bone disorder that typically arises in the elderly, particularly after the age of 40. The risk of this disease increases with advancing age. Aging and genetic factors are believed to play a role in the development of this condition. Symptoms include bone pain, bone fragility, abnormal bone growth, changes in bone shape, decreased hearing, as well as symptoms such as headaches, dizziness, and joint complaints. Expert systems or artificial intelligence draw inspiration from the knowledge of experts to analyze situations. With algorithms like the Bayes theorem, this system provides solutions to emerging issues. In this context, expert systems aid doctors in identifying diseases without face-to-face consultations. The Bayes theorem serves as the foundation for this mechanism, emulating expert abilities. This research applies the Bayes theorem for an efficient and objective diagnosis of Paget's Disease. The results indicate a strong likelihood of patients having Paget's Disease at 73.87%. Consequently, the use of expert systems has the potential to enhance efficiency and objectivity in handling cases, assisting doctors in formulating diagnoses based on presenting symptoms.

The role of bone remodeling in measuring migration of custom implants for large acetabular defects.

In revision total hip arthroplasty, achieving robust fixation is difficult and implant movement may occur over time. Bone may also rearrange around the implant as a result of mechanical loading, making the measurement of migration challenging. The study aimed to quantify changes in bone shape and implant position 1 year following acetabular reconstruction using custom three-dimensional-printed cups. This observational retrospective cohort study involved 23 patients with Paprosky type IIIB defects. Postop computed tomography scans taken within 1 week of surgery and at 1-year postsurgery were co-registered and analyzed. Three co-registration strategies were implemented including bone-to-bone and implant-to-implant. (1) Co-registration of the ipsilateral innominate bone (diseased anatomy) was used to measure changes in implant position. (2) Co-registration of the implant was carried out to quantify changes in the ipsilateral innominate bone shape. (3) Co-registration of the contralateral innominate bone (nondiseased anatomy) was performed to measure changes in the ipsilateral innominate bone shape and implant position. The median centroid distances (interquartile range [IQR]) were 2.3 mm (IQR: 3.7-1.7 mm) for changes in implant position, 2.4 mm (IQR: 3.6-1.6 mm) for changes in ipsilateral innominate bone shape, and 3.7 mm (IQR: 4.6-3.5 mm) for changes in ipsilateral innominate bone shape and implant position. Following acetabular reconstruction, implant movements and periprosthetic bone remodeling are physiological and of a similar extent. Surgeons and engineers should consider this when performing implant monitoring in these patients.

Using 3D MRI Bone Shape to Predict Pre-Osteoarthritis of the Knee 2 Years After Anterior Cruciate Ligament Reconstruction

Background: Anterior cruciate ligament (ACL) injury increases risks for osteoarthritis (OA), a poorly modifiable and disabling condition. Joint changes of potentially reversible pre-OA have been described just 2 years after ACL reconstruction (ACLR) when early bone shape changes have also been reported. Purpose: This study evaluates relationships between interlimb differences in tibiofemoral bone shape derived from statistical shape modeling (SSM) of magnetic resonance imaging (MRI) and participant factors on patient-reported outcomes 2 years after unilateral ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: SSM-derived tibiofemoral bone shape and subchondral bone area were assessed from bilateral knee MRI scans of 72 participants with unilateral ACLR (mean age, 34 ± 11 years; 32 women) and compared with a reference cohort of 398 older individuals without OA (mean age, 50 ± 3 years; 213 women). Multivariable logistic regression models examined relationships between participant and surgical factors with interlimb differences in bone shapes or subchondral bone areas. Relationships between patient-reported outcomes and the interlimb differences in bone shape and subchondral area were examined using similar models. Results: Bone shape scores and subchondral bone areas were greater (more OA-like) in ACLR knees than uninjured contralateral knees in every bone metric tested (P≤ .001). Interlimb differences in femur shape scores of participants with ACLR were 65% greater (P < .001) than those of the significantly older reference cohort. Taller height, medial meniscal tears, and decreasing age were associated with larger interlimb differences in shape scores and subchondral areas (P < .05). Bone–patellar tendon–bone (BPTB) autograft recipients demonstrated greater interlimb subchondral area differences compared with allograft recipients (P < .05). Interlimb differences for hamstring autograft recipients did not differ from those with BPTB or allograft. Greater interlimb differences in medial femur subchondral areas were associated with worse patient-reported Knee injury and Osteoarthritis Outcome Score Symptoms (R = 0.27; P = .040). Conclusion: Even in the absence of radiographic OA, just 2 years after unilateral ACLR patients showed greater bone shape scores and subchondral areas consistent with pre-OA in their ACLR knees. Furthermore, greater medial femur bone areas were weakly associated with worse symptoms. Patients who are younger, are taller, have meniscal tears, or have BPTB grafts may be at increased risk for bony asymmetries 2 years after ACLR.

Data-driven Normative Reference of Pediatric Cranial Bone Development.

Background:Available normative references of cranial bone development and suture fusion are incomplete or based on simplified assumptions due to the lack of large datasets. We present a fully data-driven normative model that represents the age- and sex-specific variability of bone shape, thickness, and density between birth and 10 years of age at every location of the calvaria.Methods:The model was built using a cross-sectional and multi-institutional pediatric computed tomography image dataset with 2068 subjects without cranial pathology (age 0–10 years). We combined principal component analysis and temporal regression to build a statistical model of cranial bone development at every location of the calvaria. We studied the influences of sex on cranial bone growth, and our bone density model allowed quantifying for the first time suture fusion as a continuous temporal process. We evaluated the predictive accuracy of our model using an independent longitudinal image dataset of 51 subjects.Results:Our model achieved temporal predictive errors of 2.98 ± 0.69 mm, 0.27 ± 0.29 mm, and 76.72 ± 91.50 HU in cranial bone shape, thickness, and mineral density changes, respectively. Significant sex differences were found in intracranial volume and bone surface areas (P < 0.01). No significant differences were found in cephalic index, bone thickness, mineral density, or suture fusion.Conclusions:We presented the first pediatric age- and sex-specific statistical reference for local cranial bone shape, thickness, and mineral density changes. We showed its predictive accuracy using an independent longitudinal dataset, we studied developmental differences associated with sex, and we quantified suture fusion as a continuous process.

Surface spherical encoding and contrastive learning for virtual bone shape aging.

Bone shape changes are considered a relevant biomarker in understanding the onset and progression of knee osteoarthritis (OA). This study used a novel deep learning pipeline to predict longitudinal bone shape changes in the femur four years in advance, using bone surfaces that were extracted in knee MRIs from the OA initiative study, via a segmentation procedure and encoded as shape maps using spherical coordinates. Given a sequence of three consecutive shape maps (collected in a time window of 24 months), a fully convolutional network was trained to predict the whole bone surface 48 months after the last observed time point, and a classifier to diagnose OA in the predicted maps. For this, a novel multi-term loss function, based on contrastive learning was designed. Experimental results show that the model predicted shape changes with an L1 error comparable to the MRI slice thickness (0.7mm). Next, an ablation study demonstrated that the introduction of a contrastive term in the loss improved sensitivity of the OA classifier, increasing sensitivity from 0.537 to 0.709, just shy of the upper bound of 0.740 computed on the ground truth bone shape maps. Our approach provides a promising tool, suitable for patient specific OA trajectory analysis.

INTRA-ARTICULAR TPX-100 SIGNIFICANTLY IMPROVES PAIN MEASURES AND SLOWS PATHOLOGICAL BONE SHAPE CHANGE IN KNEE OA

Purpose: TPX-100 is a 23-amino acid peptide derived from Matrix Extracellular Phosphoglycoprotein (MEPE); a small integrin-binding ligand N-linked glycoprotein (SIBLING) family member highly expressed by osteocytes that may play a role in osteoarthritic bone remodeling. Non-clinical data in experimental knee joint injury in large and small animal species and in OA clinical trials support the safety and efficacy of TPX-100 as a potential disease-modifying OA drug. Study TPX-100-5 was designed to examine MRI-based 3-dimensional bone shape changes after IA TPX-100 or placebo in subjects with moderate to severe knee OA; and to investigate associations between bone shape changes and knee pain measures over 12 months.

Study TPX-100-5: intra-articular TPX-100 significantly delays pathological bone shape change and stabilizes cartilage in moderate to severe bilateral knee OA

BackgroundTPX-100, a promotor of osteoblast and chondroblast differentiation, is a potential osteoarthritis (OA) therapy. This retrospective study compared MRI 3D femoral bone shape changes (B-scores) after intra-articular TPX-100 or placebo and analyzed the relationship between cartilage thickness and bone shape change over 12 months.MethodsOne hundred and four participants with bilateral moderate to severe knee cartilage defects were randomized to receive TPX-100 (200 mg) or placebo. Each subject’s contralateral placebo-treated knee served as a paired internal control. After MRI quality control, 78/93 subjects (84%; 156 knees) were analyzed for quantitative femoral B-score and cartilage thickness. All analyses were performed centrally, blind to treatment assignment and clinical data.ResultsTPX-100-treated knees (n = 78) demonstrated a statistically significant decrease in pathologic bone shape change compared with placebo-treated knees at 6 and 12 months: 0.0298 (95% C.I. − 0.037, 0.097) vs 0.1246 (95% C.I. 0.067, 0.182) (P = 0.02), and 0.0856 (95% C.I. 0.013, 0.158) vs. 0.1969 (95% C.I. 0.123, 0.271) (P = 0.01), respectively. The correlation between bone shape change and medial and total tibiofemoral cartilage thickness changes at 12 months was statistically significant in TPX-100-treated knees (P < 0.01).ConclusionsThis is the first report of a potential therapy demonstrating a significant effect on bone shape measured by B-score in knee OA. These data, in combination with previously reported statistically significant and clinically meaningful improvements in WOMAC physical function versus placebo, support TPX-100 as a candidate for disease modification in knee OA.Trial registrationNIH ClinicalTrials.gov, NCT01925261. Registered 15 August 2013

Novel nomogram for predicting the progression of osteoarthritis based on 3D-MRI bone shape: data from the FNIH OA biomarkers consortium

BackgroundOsteoarthritis(OA) is a major source of pain, disability, and socioeconomic cost in worldwide. However, there is no effective means for the early diagnosis of OA, nor can it accurately predict the progress of OA. To develop and validate a novel nomogram to predict the radiographic progression of mild to moderate OA based on three-dimensional(3D)-MRI bone shape and bone shape change during 24 months.MethodAnalysis of publicly available data from the Foundation for the National Institutes of Health (FNIH) OA Biomarkers Consortium. Radiographic progression was defined as minimum radiographic narrowing of the medial tibiofemoral joint space of ≥ 0.7 mm from baseline at 24, 36, or 48 months. There were 297 knees with radiographic progression and 303 without. The bone shapes of the tibia, femur, and patella were evaluated by 3D-MRI at the baseline and at 24 months. Two nomograms were separately established by multivariate logistic regression analysis using clinical risk factors, bone shape at baseline (nomogram 0), or bone shape change at 24 months (nomogram Δ24). The discrimination, calibration, and usefulness were selected to evaluate the nomograms.ResultsThere were significant differences between groups in baseline Kellgren-Lawrence (KL) grade, gender, age, and tibia, femur, and patella shape. The areas under the curve (AUC) of nomogram 0 and nomogram Δ24 were 0.66 and 0.75 (p < 0.05), with accuracy of 0.62 and 0.69, respectively. Both nomograms had good calibration. The decision curve analysis ( DCA) showed that nomogram Δ24 had greater clinical usefulness than nomogram 0 when the risk threshold ranged from 0.04 to 0.86.ConclusionsNomograms based on 3D-MRI bone shape change were useful for predicting the radiographic progression of mild to moderate OA.

Diaphyseal and Metaphyseal Modeling Defects-Clinical Findings and Identification of WRAP53 Deficiency in Craniometadiaphyseal Dysplasia.

Background: Diaphyseal and metaphyseal modeling defects lead to severe changes in bone mass and shape, which are common features in osteoporosis that linked to non-vertebral fractures. Original mechanism of diaphyseal and metaphyseal modeling defects has proved elusive. Studying rare syndromes can elucidate mechanisms of common disorders and identify potential therapeutic targets.Methods: We evaluated a family pedigree with craniometadiaphyseal dysplasia (CRMDD, OMIM 269300), a genetic disorder that is characterized by cortical-bone thinning, limb deformity, and absent of normal metaphyseal flaring and diaphyseal constriction. Systemic radiographic examination and serum hormone test were made for this rare disease. One patient and her two normal parents were examined by means of whole-exome sequencing (WES) to identify the candidate pathogenic gene and rule out mucopolysaccharidosis and Prader–Willi Syndrome by means of Sanger sequencing.Results: There are several conspicuous radiographic characteristics: (1) bullet-shaped phalanges, (2) long and narrow pelvic inlet, absent of supra-acetabular constriction, (3) round rod-shaped long tubular bones, (4) prominent aiploic mastoid, (5) bending-shaped limb, genua varus and genu varum, and (6) congenital dislocation of elbow. Here, we did not find any wormian bones, and there are several typical clinical characteristics: (1) macrocephaly and wide jaw, (2) Avatar elf-shaped ears, pointed and protruding ears, (3) hypertrophy of limbs, (4) flat feet and giant hand phenomenon, (5) nail dystrophy, (6) limb deformity, (7) high-arched palate, (8) superficial hemangiomas, (9) tall stature, and intellectual disability. In this patient, we found biallelic frameshift deletion mutations in WRAP53, and those two mutations were transmitted from her parents respectively.Conclusions: We describe her clinical and radiological findings and presented a new subtype without wormian bones and with a tall stature. Our study showed that craniometadiaphyseal dysplasia was caused by a deficiency of WRAP53 with autosomal recessive inheritance.

Medication Correction of the Bone Tissue’s Structural Condition in Patients with Different Forms of Braitsev-Lichtenstein Disease

The article presents a modern view on anti-osteoporotic medication therapy in patients with various forms of Braitsev-Lichtenstein disease. Against the background of fundamental studies of the bone tissue’s structural condition in this pathology improved and tested medication correction of its disorders depending on changes in bone metabolism, shape, clinical and orthopedic manifestations of the disease, the patient’s age. The article presents the rationale, general principles and features of anti-osteoporotic therapy; indications and contraindications to it; dose calculations and regimens for the use of certain medications, including from the group of bisphosphonates in various forms of Braitsev-Lichtenstein disease. The presented medication therapy has been successfully tested in 16 patients with Braitsev-Lichtenstein disease. The effectiveness of the treatment is confirmed by the reduction or elimination of pain, stopping the progression of pathological diseases on average in the bones of the lower extremities, improving the structural condition of bone tissue and its metabolism.

Bone Geometry Is Altered by Follistatin‐Induced Muscle Growth in Young Adult Male Mice

ABSTRACTThe development of the musculoskeletal system and its maintenance depends on the reciprocal relationship between muscle and bone. The size of skeletal muscles and the forces generated during muscle contraction are potent sources of mechanical stress on the developing skeleton, and they shape bone structure during growth. This is particularly evident in hypermuscular global myostatin (Mstn)‐null mice, where larger muscles during development increase bone mass and alter bone shape. However, whether muscle hypertrophy can similarly influence the shape of bones after the embryonic and prepubertal period is unknown. To address this issue, bone structure was assessed after inducing muscle hypertrophy in the lower hindlimbs of young‐adult C57BL/6J male mice by administering intramuscular injections of recombinant adeno‐associated viral vectors expressing follistatin (FST), a potent antagonist of Mstn. Two FST isoforms were used: the full‐length 315 amino acid isoform (FST‐315) and a truncated 288 amino acid isoform (FST‐288). In both FST‐treated cohorts, muscle hypertrophy was observed, and the anterior crest of the tibia, adjacent to the tibialis anterior muscle, was lengthened. Hypertrophy of the muscles surrounding the tibia caused the adjacent cortical shell to recede inward toward the central axis: an event driven by bone resorption adjacent to the hypertrophic muscle. The findings reveal that inducing muscle hypertrophy in mice can confer changes in bone shape in early adulthood. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Is meniscal status in the anterior cruciate ligament injured knee associated with change in bone surface area? An exploratory analysis of the KANON trial

To study bone shape changes as a potential early feature of post-traumatic structural knee OA development, we estimated the association between meniscal status in the anterior cruciate ligament (ACL) injured knee and longitudinal condyle changes in bone surface area. We used data from the KANON trial, including 121 young ACL-injured adults. We obtained baseline and 2-year follow-up knee MRIs. Our outcome was change in the bone surface areas (mean mm2, log-transformed) in 4 locations (femur, tibia, patella, and trochlea femur) in the medial and lateral compartment from baseline to 2 years. Meniscal pathology was defined as both present at baseline and newly developed (i.e., incident or progressed) using ACLOAS. We used multilevel linear regression adjusted for baseline bone area, age, sex, body mass index, treatment arm (i.e., early or optional delayed ACL reconstruction), and location. We analyzed medial and lateral compartment separately. We present results as percentage (%) bone area change difference with 95% confidence intervals (CI). We analyzed 109 subjects (median 27 (18-36) years, 83% men) due to missing MRI information. The bone surface area increased on average by ∼2% over 2 years. The differences between knees with and without baseline meniscal pathology were 1.1% (95%CI 0.0-2.3%) and 1.4% (95%CI 0.6-2.2%) in the medial and lateral compartment, respectively, and 1.2% (95%CI 0.3-2.0%) and 1.3% (95%CI 0.6-2.0%) for medial and lateral newly developed pathology, respectively. Our finding of ∼1% increase bone area in compartment with meniscal pathology suggests a potentially important association between meniscal integrity and early bone surface area changes after ACL injury. Trial registration number ISRCTN 84752559.

Učestalost anomalija skeleta u fetalnim i neonatalnim obdukcijama

Introduction: Skeletal anomalies are a heterogeneous group of disorders including changes in bone shape, size, and density that cause abnormalities of the extremities, trunk, and head. They rank second in Europe in the frequency of all congenital anomalies. The most common skeletal anomalies include head, face and limb anomalies. Aim: The aim of this study was to determine the frequency of skeletal anomalies and their association with anomalies of internal organs, as well as to show the age of the mother and the gestational week of the fetus with established skeletal anomalies. Material and methods: All fetal and neonatal autopsies in the period from January 1, 2018 to December 31, 2020 at the Institute of Pathology "Djordje Joannovic" of the Faculty of Medicine University of Belgrade were analyzed. In the mentioned period, 580 fetal and neonatal autopsies were performed. Clinical data were obtained from the Gynecology and Obstetrics Clinic "Narodni Front" on the basis of completed requests for clinical autopsy. Descriptive statistics methods were used (data are presented as absolute numbers and percentage frequencies). Results: The most common skeletal anomalies are divided into seven groups: spina bifida (20; 33.34%), limb anomalies (16; 26.67%), head and face bone anomalies (15; 25%), joint anomalies (2; 3.33%), achondroplasia (3; 5%), osteogenesis imperfecta (2; 3.33%) and other anomalies (2; 3.33%). The most common associated anomalies were central nervous system (CNS) abnormalities, followed by heart and kidney abnormalities. The youngest mother was 15 years old, and the oldest was 47 years old. The mean age of the mothers was 30 years. Conclusion: In our study, the most common anomaly was spina bifida, while limb anomalies and craniofacial anomalies are next in frequency. Skeletal anomalies were often associated with anomalies of the heart, kidneys, and CNS. They were mostly diagnosed between the 22nd and 27th gestational week. Our results showed that skeletal anomalies are more common in fetuses or neonates of mothers older than 30 years.

Is meniscal damage in the anterior cruciate ligament injured knee associated with early bone shape changes? An exploratory analysis of the kanon trial

Purpose: Bone shape changes, which may be an important feature of osteoarthritis (OA) development, have been observed to occur early in the knee after anterior cruciate ligament (ACL) injury. However, the association between co-existing meniscal damage and bone shape changes is unclear. Therefore, to gain new knowledge about the pathophysiology of early post-traumatic OA, we determined the association between meniscal damage and changes in ipsilateral condyle bone shapes.

Study TPX-100-5: Significant reduction in femoral bone shape change 12 months after IA TPX-100 correlates with tibiofemoral cartilage stabilization

Purpose: Bone shape changes occur as part of normal aging in the knee. However, the rate of change and degree of pathologic deformation of bone is strikingly increased in knee OA. Based on data from the Osteoarthritis Initiative, pathologic three-dimensional (3D) changes in the femur have been shown to precede measurable thinning of tibiofemoral cartilage and to predict progression of OA, including total knee arthroplasty. Study TPX-100-5 was designed to compare 3D femoral shape changes in knees 6 and 12 months after IA TPX-100 or placebo in subjects with bilateral moderate to severe knee OA, and to analyze relationships between cartilage thickness and bone shape change from baseline to 12-month follow up.

Role of Mechanical Force on the Growth Plate

The shape and size of the limb is determined by genetic, biochemical, and mechanical factors resulting from weight bearing activity or muscle contraction. Changes in bone shape in response to mechanical forces was first reported by Wolf, 1892. Observations by Hueter‐Volkman indicated that supraphysiological forces lead to reduced skeletal growth. More recently, Frost (1990) proposed the concept of chondral modeling to describe physiological loading. In this case, both tension and compression lead to increased skeletal growth up to a peak then compression beyond that peak leads to inhibition of growth. Recent experiments using zebra fish, chick, and muscle‐less Spd mice indicated a specific connection between mechanical load and endochondral bone formation in embryonic skeleton. A role for mechanical forces on postnatal skeletal development is apparent in clinical manifestations of children with hemiplegia resulting in unequal loading of developing limbs. A large proportion of children with hemiplegia demonstrated significant limb length discrepancy with the paralyzed limb being shorter than the other limb. An age dependent effect of force on limb development in mice during spaceflight and tail suspended rats indicated a critical developmental window where loading regulates growth plate function. Longitudinal growth of limbs occurs through cartilaginous structures called the growth plate in a process called endochondral bone formation. One important feature of the growth plate is that the cells align into columns that represent a continuum of differentiation. It was suggested that the magnitude of bone growth is dependent on chondrocyte proliferation, matrix deposition, and hypertrophy; however, without the columnar structure, growth would not be longitudinal and the proper length and shape of skeletal elements would be disrupted. Recent experimental data indicate that mechanical load is required to regulate growth plate function including proliferation of chondrocytes and column formation. The molecular mechanism governing proliferation and column formation in response to load are not known but may involve chondrocytes sensing mechanical changes in the environment thought their actin cytoskeleton. Unloading mouse hind limb results in disorganization of the actin structure in chondrocytes, loss of columnar structure in the growth plate, and reduced limb length. Mice with conditional deletion of genes associated with regulation of the actin cytoskeleton demonstrate similar alterations in their growth plates. These observations highlight the importance of mechanical loading on growth plate function but there is still limited understanding of the molecular mechanisms of how limb length is regulated in response to mechanical loads.Support or Funding InformationNIH/NIAMS R21 AR070097 and the US‐Israel Bi‐national Science Foundation

Changes in bone shape are both a risk factor for and a result of hip osteoarthritis, a follow-up study in the check cohort

Changes in bone shape are both a risk factor for and a result of hip osteoarthritis, a follow-up study in the check cohort

3D bone-shape changes and their correlations with cartilage T1ρ and T2 relaxation times and patient-reported outcomes over 3-years after ACL reconstruction

(1) To identify bone-shape changes from baseline to 3-years after anterior cruciate ligament reconstruction (ACLR). (2) to assess association between changes in bone-shape from baseline to 6-months and changes in cartilage matrix and patient functions and symptoms from baseline to 3-years after ACLR. Bilateral knees of 30 patients with unilateral ACL injuries were scanned at baseline, 6-months, 1-, 2-, and 3-years after ACLR. Bilateral knees of 13 controls were scanned at baseline, 1- and 3-years. Mean T1ρ and T2 values of each cartilage compartment were computed. Bone shape was quantified using statistical shape modeling (SSM) and 3D-MRI. Patient functions and symptoms were evaluated using Knee Injury and Osteoarthritis Outcome Score (KOOS). Statistically significant changes were observed in Femur 2 (medial femoral condyle [MF] shape), Femur 6 (intercondylar notch width), Tibia 1 (tibia plateau area), and Tibia 7 (medial tibia slope) over 3-years after ACLR. Statistically significant differences were observed between injured and control knees in several modes. Statistically significant correlations were found between changes in bone shape (ΔFemur 6, ΔFemur 8 [trochlea inclination and MF height], ΔTibia 1) from baseline to 6-months and that of cartilage T1ρ and T2 and KOOS from baseline to 3-years after ACLR. Bone shape remodeling occurs after ACLR, and early bone shape changes (within 6 months) correlated with cartilage matrix and patient outcomes at 3-years after ACLR. Bone shape can be a promising imaging biomarker that stratifies patients at high risk for post-traumatic osteoarthritis (PTOA).

Marked and rapid change of bone shape in acutely ACL injured knees – an exploratory analysis of the Kanon trial

To investigate changes in knee 3D bone shape over the first 5 years after acute anterior cruciate ligament (ACL) injury in participants of the randomized controlled KANON-trial. Serial MR images over 5 years from 121 young (32 women, mean age 26.1 years) adults with an acute ACL tear in a previously un-injured knee were analyzed using statistical shape models for bone. A matched reference cohort of 176 individuals was selected from the Osteoarthritis Initiative (OAI). Primary endpoint was change in bone area of the medial femoral condyle; exploratory analyses compared results by treatment and examined other knee regions. Comparisons were made using repeated measures mixed model ANOVA with adjustment for age, sex and body mass index (BMI). Mean medial femur bone area increased 3.2% (78.0 [95% CI 70.2 to 86.4] mm2) over 5 years after ACL injury and most prominently in knees treated with ACL reconstruction (ACLR). A higher rate of increase occurred over the first 2years compared to the latter 3-years (66.2 [59.3 to 73.2] vs 17.6 [12.2 to 23.0] mm2) and was 6.7 times faster than in the reference cohort. The pattern and location of shape change in the extrapolated KANON data was very similar to that observed in another knee-osteoarthritis cohort. 3D shape modelling after acute ACL injury revealed rapid bone shape changes, already evident at 3 months. The bone-change pattern after ACL injury demonstrated flattening and bone growth on the outer margins of the condyles similar to that reported in established knee osteoarthritis.

Update on bone fragility in spina bifida.

Patients with spina bifida (SB) are at risk for pathological fractures and low bone mineral density (BMD). This article reviews the literature and provides a comprehensive overview of how the characteristics of SB and its associated comorbidities intersect with bone fragility to identify possible pathophysiological mechanisms of fractures and low BMD. Bone fragility occurs early in the life of patients with SB as a result of a disturbance that determines changes in bone shape, quantity, and quality, as poor mineralization reduces bone stiffness. Bone fragility in SB occurs due to local and systemic factors and may be considered a state of impaired bone quality of multifactorial aetiology, with complex interacting influences of neurological, metabolic, and endocrinological origins and the presence of smaller bones. Bone fragility should be evaluated globally according to skeletal age and Tanner staging. The phases of the evolution of Charcot joints seem to intercept the evolution of epiphyseal fractures. Charcot arthropathy in SB may be initiated by the occurrence of repetitive trauma and fractures in epiphyseal and subepiphyseal regions, where there is a deficit of bone mineralization and greater bone mass deficits. Bone fragility in MMC potentially has a multifactorial neuro-endocrinological-metabolic-renal dimension, with smaller bones, lower bone mass, and mineralization deficits affecting bone strength.