Changes In Cartilage Thickness Research Articles

Automated measurement and grading of knee cartilage thickness: a deep learning-based approach.

Knee cartilage is the most crucial structure in the knee, and the reduction of cartilage thickness is a significant factor in the occurrence and development of osteoarthritis. Measuring cartilage thickness allows for a more accurate assessment of cartilage wear, but this process is relatively time-consuming. Our objectives encompass using various DL methods to segment knee cartilage from MRIs taken with different equipment and parameters, building a DL-based model for measuring and grading knee cartilage, and establishing a standardized database of knee cartilage thickness. In this retrospective study, we selected a mixed knee MRI dataset consisting of 700 cases from four datasets with varying cartilage thickness. We employed four convolutional neural networks-UNet, UNet++, ResUNet, and TransUNet-to train and segment the mixed dataset, leveraging an extensive array of labeled data for effective supervised learning. Subsequently, we measured and graded the thickness of knee cartilage in 12 regions. Finally, a standard knee cartilage thickness dataset was established using 291 cases with ages ranging from 20 to 45 years and a Kellgren-Lawrence grading of 0. The validation results of network segmentation showed that TransUNet performed the best in the mixed dataset, with an overall dice similarity coefficient of 0.813 and an Intersection over Union of 0.692. The model's mean absolute percentage error for automatic measurement and grading after segmentation was 0.831. The experiment also yielded standard knee cartilage thickness, with an average thickness of 1.98 mm for the femoral cartilage and 2.14 mm for the tibial cartilage. By selecting the best knee cartilage segmentation network, we built a model with a stronger generalization ability to automatically segment, measure, and grade cartilage thickness. This model can assist surgeons in more accurately and efficiently diagnosing changes in patients' cartilage thickness.

The effect of attending rehabilitation after traumatic knee joint injury on femoral articular cartilage morphology in collegiate rugby players with a history of intracapsular knee joint injury during two-year consecutive rugby seasons.

This present study aimed to compare ultrasonographic measures of femoral articular cartilage during two-year seasons between collegiate rugby players who have attended supervised rehabilitation following intracapsular knee joint injury and those without a history of knee injury. Using a prospective observational study design, 12 male collegiate rugby players with a previous history of intracapsular knee joint injury who have received and completed supervised rehabilitation following their injury and 44 players without knee joint injury participated in this study. Ultrasonographic images were used to verify changes in femoral articular cartilage thickness and cross-sectional area (CSA) with or without a previous history of knee joint injury over two consecutive rugby seasons. Significant time main effects were observed for the lateral condylar thickness (p < 0.001), the intercondylar thickness (p = 0.001), the medial condylar thickness (p < 0.001), and CSA (p < 0.001). No significant interactions nor group main effects were identified for all femoral articular cartilage (p < 0.05). Collegiate rugby players demonstrated a decrease in femoral articular cartilage thickness and CSA over two-year consecutive rugby seasons. These findings indicate that engaging in collegiate rugby induces alterations in femoral articular cartilage structure. Furthermore, there were no differences in all femoral cartilage outcome measures between rugby players with and without a previous history of traumatic knee joint injury. Therefore, attending supervised rehabilitation at the time of their knee joint injury appeared to reduce the impact of a previous history of intracapsular knee joint injury on the change in femoral articular cartilage thickness and CSA among active rugby players.

Association of Knee Osteoarthritis and Flexion Contracture With Localized Tibial Articular Cartilage Loss: Data From the Osteoarthritis Initiative.

To evaluate whether a knee flexion contracture (FC) was associated with localized tibial articular cartilage loss over a 1-year period using Osteoarthritis Initiative quantitative data. Five hundred seventy-eight participants from a previously established nested case-control study of people with radiographic knee OA with or without progression, based on radiographs and symptoms, had their knee range of extension measured at baseline and received magnetic resonance imaging (MRI) at baseline and 1 year. The tibial articular cartilage of the medial and lateral condyles was segmented into anterior, center, and posterior regions. We tested for associations between knee FC (defined as lack of extension to 0°), and localized changes in tibial articular cartilage thickness or percent of denuded bone (0 mm thickness) after 1 year relative to baseline using ANOVA, controlling for baseline MRI outcomes and clinical factors. Knee FC was associated with denuded bone in the medial condyle center (β 0.44, 95% CI 0.02-0.86) and preserved cartilage thickness in the medial condyle posterior (β 0.01, 95% CI 0.002-0.03) regions. Knee FC unloading the tibial center region and loading the posterior region was associated with localized articular cartilage loss centrally and preserved articular cartilage posteriorly. These findings are consistent with knee FC negatively affecting unloaded tibial articular cartilage.

Large-Scale Analysis of Meniscus Morphology as Risk Factor for Knee Osteoarthritis.

While it is established that structural damage of the meniscus is linked to knee osteoarthritis (OA) progression, the predisposition to future development of OA due to geometric meniscal shapes is plausible and unexplored. This study aims to identify common variations in meniscal shape and determine their relationships to tissue morphology, OA onset, and longitudinal changes in cartilage thickness. 4,790 participants from the Osteoarthritis Initiative dataset were studied. A statistical shape model was developed for the meniscus and shape scores were evaluated between a control group and an OA incidence group. Shape features were then associated with cartilage thickness changes over 8 years to localize the relationship between meniscus shape and cartilage degeneration. Seven shape features between the medial and lateral menisci were identified to be different between knees that remain normal and those that develop OA. These include length-width ratios, horn lengths, root attachment angles, and concavity. These "at-risk" shapes were linked to unique cartilage thickness changes that suggest a relationship between meniscus geometry and decreased tibial coverage and rotational imbalances. Additionally, strong associations were found between meniscal shape and demographic subpopulations, future tibial extrusion, and meniscal and ligamentous tears. This automatic method expanded upon known meniscus characteristics that are associated with the onset of OA and also discovered novel shape features that have yet to be investigated in the context of OA risk.

Associations between weight change, knee subcutaneous fat and cartilage thickness in overweight and obese individuals: 4-Year data from the osteoarthritis initiative

To assess (i) the impact of changes in body weight on changes in joint-adjacent subcutaneous fat (SCF) and cartilage thickness over 4 years and (ii) the relation between changes in joint-adjacent SCF and knee cartilage thickness. Individuals from the Osteoarthritis Initiative (total=399) with >10% weight gain (n=100) and >10% weight loss (n=100) over 4 years were compared to a matched control cohort with less than 3% change in weight (n=199). 3.0T Magnetic Resonance Imaging (MRI) of the right knee was performed at baseline and after 4 years to quantify joint-adjacent SCF and cartilage thickness. Linear regression models were used to evaluate the associations between the (i) weight change group and 4-year changes in both knee SCF and cartilage thickness, and (ii) 4-year changes in knee SCF and in cartilage thickness. Analyses were adjusted for age, sex, baseline body mass index (BMI), tibial diameter (and weight change group in analysis (ii)). Individuals who lost weight over 4-years had significantly less joint-adjacent SCF (beta range, medial/lateral joint sides: 2.2-4.2mm, p<0.001) than controls; individuals who gained weight had significantly greater joint-adjacent SCF than controls (beta range: -1.4 to -3.9mm, p<0.001). No statistically significant associations were found between weight change and cartilage thickness change. However, increases in joint-adjacent SCF over 4 years were significantly associated with decreases in cartilage thickness (p=0.04). Weight change was associated with joint-adjacent SCF, but not with change in cartilage thickness. However, 4-year increases in joint-adjacent SCF were associated with decreases in cartilage thickness independent of baseline BMI and weight change group.

The knee connectome: A novel tool for studying spatiotemporal change in cartilage thickness.

Cartilage thickness change is a well-documented biomarker of osteoarthritis pathogenesis. However, there is still much to learn about the spatial and temporal patterns of cartilage thickness change in health and disease. In this study, we develop a novel analysis method for elucidating such patterns using a functional connectivity approach. Descriptive statistics are reported for 1186 knees that did not develop osteoarthritis during the 8 years of observation, which we present as a model of cartilage thickness change related to healthy aging. Within the control population, patterns vary greatly between male and female subjects, while body mass index (BMI) has a more moderate impact. Finally, several differences are shown between knees that did and did not develop osteoarthritis. Some but not all significance appears to be accounted for by differences in sex, BMI, and knee alignment. With this work, we present the connectome as a novel tool for studying spatiotemporal dynamics of tissue change.

Longitudinal MRI-defined cartilage loss and radiographic joint space narrowing following intra-articular corticosteroid injection for knee osteoarthritis: A systematic review and meta-analysis

BackgroundIntra-articular corticosteroid injections (IACS) are interventions which provide pain relief in knee osteoarthritis (OA). It remains unclear whether IACS have a deleterious effect on knee cartilage structure. PurposeTo estimate the effect of IACS on cartilage structure in patients with knee OA, using joint space width (JSW) (in radiographic studies), and cartilage thickness (in magnetic resonance imaging). Materials and methodsA literature search was performed to identify randomized control trials and observational studies published from inception to June 15, 2022. Studies were included if patients received IACS for knee OA, with a control arm. Given the different metrics used in reporting continuous variable outcomes among studies, pooled estimates for cartilage thickness change were assessed using standardized mean differences (defined as the difference between the means of the groups divided by a within-group standard deviation) to odds ratio transformation. Sensitivity analyses were conducted based on outcome metric, imaging modality, and number of injections. ResultsSix studies (1437 participants) were identified. The estimated effect of IACS on cartilage structure revealed greater odds of cartilage structure worsening (Odds Ratio (OR): 2.01, 95% Confidence Interval (CI): 1.18,3.44). Sensitivity analyses revealed similar trends, with significant results for singular injections with preference to JSW (OR: 2.44, 95%CI: 1.23,4.82), radiographic outcomes with preference to KL grade (OR: 2.03, 95%CI: 1.01,4.10), binary outcomes with preference to KL grade (OR: 2.93, 95%CI: 1.18,7.25) and quantitative measures (Standardized Mean Differences (SMD): -0.34, 95%CI: -0.66, -0.02) ConclusionsIACS use may contribute to imaging features of knee cartilage loss. Further studies are warranted to investigate the underlying pathogenesis.

Which risk factors determine cartilage thickness and composition change in radiographically normal knees? – Data from the Osteoarthritis Initiative

ObjectiveTherapy for osteoarthritis ideally aims at preserving structure before radiographic change occurs. This study tests: a) whether longitudinal deterioration in cartilage thickness and composition (transverse relaxation-time T2) are greater in radiographically normal knees “at risk” of incident osteoarthritis than in those without risk factors; and b) which risk factors may be associated with these deteriorations. Design755 knees from the Osteoarthritis Initiative were studied; all were bilaterally Kellgren Lawrence grade [KLG] 0 initially, and had magnetic resonance images available at 12- and 48-month follow-up. 678 knees were “at risk”, whereas 77 were not (i.e., non-exposed reference). Cartilage thickness and composition change was determined in 16 femorotibial subregions, with deep and superficial T2 being analyzed in a subset (n ​= ​59/52). Subregion values were used to compute location-independent change scores. ResultsIn KLG0 knees “at risk”, the femorotibial cartilage thinning score (−634 ​± ​516 ​μm) over 3 years exceeded the thickening score by approximately 20%, and was 27% greater (p ​< ​0.01; Cohen D −0.27) than the thinning score in “non-exposed” knees (−501 ​± ​319 ​μm). Superficial and deep cartilage T2 change, however, did not differ significantly between both groups (p ​≥ ​0.38). Age, sex, body mass index, knee trauma/surgery history, family history of joint replacement, presence of Heberden's nodes, repetitive knee bending were not significantly associated with cartilage thinning (r2<1%), with only knee pain reaching statistical significance. ConclusionsKnees “at risk” of incident knee OA displayed greater cartilage thinning scores than those “non-exposed”. Except for knee pain, the greater cartilage loss was not significantly associated with demographic or clinical risk factors.

Adeno-Associated Virus-Delivered Fibroblast Growth Factor 18 Gene Therapy Promotes Cartilage Anabolism.

To determine the characterization of chondrogenic properties of adeno-associated virus type 2 (AAV2)-delivered hFGF18, via analysis of effects on primary human chondrocyte proliferation, gene expression, and in vivo cartilage thickness changes in the tibia and meniscus. Chondrogenic properties of AAV2-FGF18 were compared with recombinant human FGF18 (rhFGF18) in vitro relative to phosphate-buffered saline (PBS) and AAV2-GFP negative controls. Transcriptome analysis was performed using RNA-seq on primary human chondrocytes treated with rhFGF18 and AAV2-FGF18, relative to PBS. Durability of gene expression was assessed using AAV2-nLuc and in vivo imaging. Chondrogenesis was evaluated by measuring weight-normalized thickness in the tibial plateau and the white zone of the anterior horn of the medial meniscus in Sprague-Dawley rats. AAV2-FGF18 elicits chondrogenesis by promoting proliferation and upregulation of hyaline cartilage-associated genes, including COL2A1 and HAS2, while downregulating fibrocartilage-associated COL1A1. This activity translates to statistically significant, dose-dependent increases in cartilage thickness in vivo within the area of the tibial plateau, following a single intra-articular injection of the AAV2-FGF18 or a regimen of 6 twice-weekly injections of rhFGF18 protein relative to AAV2-GFP. In addition, we observed AAV2-FGF18-induced and rhFGF18-induced increases in cartilage thickness of the anterior horn of the medial meniscus. Finally, the single-injection AAV2-delivered hFGF18 offers a potential safety advantage over the multi-injection protein treatment as evidenced by reduced joint swelling over the study period. AAV2-delivered hFGF18 represents a promising strategy for the restoration of hyaline cartilage by promoting extracellular matrix production, chondrocyte proliferation, and increasing articular and meniscal cartilage thickness in vivo after a single intra-articular injection.

Selection of Knees With Subsequent Cartilage Thickness Loss Based on Magnetic Resonance Imaging Semiquantitative Grading: Data From the Osteoarthritis Initiative Foundation for the National Institutes of Health Biomarker Cohort.

To investigate which magnetic resonance imaging (MRI)-based articular pathologies are predictive of subsequent medial femorotibial compartment quantitative cartilage thickness loss and therefore suitable for enrichment of clinical trials with participants showing a high likelihood for structural progression. Semiquantitative MRI Osteoarthritis Knee Score (MOAKS) assessments at baseline and quantitative cartilage thickness measurements at baseline and year-2 follow-up were performed in 599 participants (age 62 years; body mass index 31 kg/m2 ; 59% female) from the Osteoarthritis Initiative-based Foundation for the National Institutes of Health Osteoarthritis Biomarkers Consortium. Knees were classified as medial femorotibial compartment (MFTC) progressors or nonprogressors based on MFTC cartilage thickness change (smallest detectable change threshold -111 μm). Logistic regression was used to investigate the association between baseline presence and severity of MFTC MOAKS pathologies with subsequent MFTC progression. The standardized response mean (SRM) was computed to estimate the sensitivity to change that can be achieved when selecting knees based on MOAKS pathologies. Presence of MFTC MOAKS cartilage damage (odds ratio [OR] 2.77 [95% confidence interval (95% CI) 1.76, 4.36]), MFTC bone marrow lesions (OR 2.69 [95% CI 1.89, 3.83]), medial meniscus extrusion or damage (OR 2.21 [95% CI 1.37, 3.55]), as well as MOAKS severity subscales for cartilage and meniscus damage were associated with subsequent progression. The SRM was greater in knees with than in knees without the presence of these pathologies and was associated with the severity of those pathologies. MRI-based grading of articular pathologies makes it possible to specifically select progressor knees suitable for inclusion in clinical trials but also to identify knees in which treatment is not indicated (e.g., knees without cartilage damage despite presence of radiographic osteoarthritis).

Outcome of Intra-articular Injection of Total Stromal Cells and Platelet-Rich Plasma in Primary Knee Osteoarthritis: A Randomized Clinical Trial.

Mesenchymal stem cell (MSC) therapy appeared promising in knee osteoarthritis (OA). We examined if a single intra-articular (IA) autologous total stromal cells (TSC) and platelet-rich plasma (PRP) injection improved knee pain, physical function, and articular cartilage thickness in knee OA. The study was performed in the physical medicine and rehabilitation department of Bangabandhu Shaikh Mujib Medical University, Dhaka, Bangladesh. Knee OAwasdiagnosed according to the American College of Rheumatology criteria and randomly assigned to treatment (received TSC and PRP) and control groups. Kallgreen-Lawrance (KL) scoring system was used to grade primary knee OA. The Visual Analogue Scale (VAS, 0-10 cm) for pain, WOMAC (Western Ontario and McMaster Universities Arthritis Index) for physical function, and medial femoral condylar cartilage (MFC) thickness (millimeters) under ultrasonogram (US) were documented and compared between groups before and after treatment. Statistical Package analyzed data for Social Scientists (SPSS 22.0; IBM Corp, Armonk, NY) was used for data analysis. Pre- and post-intervention outcomes were measured using the Wilcoxon-sign test, whereasMann-Whitney U-test calculated the difference between groups; a p-value <0.05 was considered statistically significant. Result:In the treatment group, 15 received IA-TSC and PRP preparation, and in the control group, 15 patientsreceived no injection, but quadricep muscle-strengtheningexercise. There was no significant difference betweengroups regarding VAS for pain, WOMAC physical function, and cartilage thickness before starting the treatment andtwo weeks after intervention. VAS for pain and WOMAC physical function scores improved profoundly in the treatment group after 12 and 24 weeks of intervention; the pain and physical function scores difference between groups was also significant. However, significant mean femoral cartilage thickness was not changed until the end of 24 weeks(U=175.00, p=0.009 two-tailed and U= 130.00, p=0.016 two-tailed, respectively, for right and left knee). Single TSC and PRP injection reduces knee pain and improves physical function and cartilage thickness in knee OA. While pain and physical function improvement happen earlier, cartilage thickness changetakes more time.

Exploring the differences between radiographic joint space width and MRI cartilage thickness changes using data from the IMI-APPROACH cohort.

Longitudinal weight-bearing radiographic joint space width (JSW) and non-weight-bearing MRI-based cartilage thickness changes often show weak correlations. The current objective was to investigate these correlations, and to explore the influence of different factors that could contribute to longitudinal differences between the two methods. The current study included 178 participants with medial osteoarthritis (OA) out of the 297 knee OA participants enrolled in the IMI-APPROACH cohort. Changes over 2years in medial JSW (ΔJSWmed), minimum JSW (ΔJSWmin), and medial femorotibial cartilage thickness (ΔMFTC) were assessed using linear regression, using measurements from radiographs and MRI acquired at baseline, 6months, and 1 and 2years. Pearson R correlations were calculated. The influence of cartilage quality (T2 mapping), meniscal extrusion (MOAKS scoring), potential pain-induced unloading (difference in knee-specific pain scores), and increased loading (BMI) on the correlations was analyzed by dividing participants in groups based on each factor separately, and comparing correlations (slope and strength) between groups using linear regression models. Correlations between ΔMFTC and ΔJSWmed and ΔJSWmin were statistically significant (p < 0.004) but weak (R < 0.35). Correlations were significantly different between groups based on cartilage quality and on meniscal extrusion: only patients with the lowest T2 values and with meniscal extrusion showed significant moderate correlations. Pain-induced unloading or BMI-induced loading did not influence correlations. While the amount of loading does not seem to make a difference, weight-bearing radiographic JSW changes are a better reflection of non-weight-bearing MRI cartilage thickness changes in knees with higher quality cartilage and with meniscal extrusion.

Integrating MR imaging with full-surface indentation mapping of femoral cartilage in an ex vivo porcine stifle

The potential of MRI to predict cartilage mechanical properties across an entire cartilage surface in an ex vivo model would enable novel perspectives in modeling cartilage tolerance and predicting disease progression. The purpose of this study was to integrate MR imaging with full-surface indentation mapping to determine the relationship between femoral cartilage thickness and T2 relaxation change following loading, and cartilage mechanical properties in an ex vivo porcine stifle model. Matched-pairs of stifle joints from the same pig were randomized into either 1) an imaging protocol where stifles were imaged at baseline and after 35 min of static axial loading; and 2) full surface mapping of the instantaneous modulus (IM) and an electromechanical property named quantitative parameter (QP). The femur and femoral cartilage were segmented from baseline and post-intervention scans, then meshes were generated. Coordinate locations of the indentation mapping points were rigidly registered to the femur. Multiple linear regressions were performed at each voxel testing the relationship between cartilage outcomes (thickness change, T2 change) and mechanical properties (IM, QP) after accounting for covariates. Statistical Parametric Mapping was used to determine significance of clusters. No significant clusters were identified; however, this integrative method shows promise for future work in ex vivo modeling by identifying spatial relationships among variables.

IMAGING-BASED CHARACTERIZATION OF 3 DIFFERENT OA ENDOTYPES DERIVED FROM BIOCHEMICAL MARKERS - DATA FROM TWO OBSERVATIONAL COHORTS

A recent machine-learning study identified 3 different endotype clusters, based on serum and urine biomarker concentration patterns that were consistent between both the APPROACH and the OAI-based FNIH cohort. The clusters were characterized as systemic inflammation (SI), low tissue turnover (LTT), and structural damage of bone and articular cartilage (DAM, Fig. 1). To evaluate whether the prevalence of joint tissue pathologies (MRI Osteoarthritis Knee Scores (MOAKS)) and femorotibial joint (FTJ) cartilage thickness differ between these clusters, and whether 2-year changes in MOAKS scores and FTJ cartilage thickness differ between these 3 clusters. APPROACH enrolled 297 participants (age: 66.5±7.1y, BMI: 28.1±5.3 kg/m², 77.5% women, 55% KLG 2-4) and FNIH 600 OA patients (age: 61.5±8.8y, BMI: 30.7±4.8 kg/m², 58.8% women, 87.5% KLG 2-4). Of 295 APPROACH / 600 FNIH participants with biochemical marker levels available, 93/178 were assigned to the LTT cluster, 92/241 to the SI cluster, and 110/181 to the DAM cluster, respectively. Semi-quantitative MOAKS scores were assessed at months 0 and 24 by an experienced radiologist. FTJ cartilage thickness was measured at months 0 and 24 by manual, quality-controlled segmentations. Frequencies were compared using X² tests between the clusters, and cartilage thickness measures using t-tests. In APPROACH, baseline cartilage damage, osteophytes, effusion- and Hoffa-synovitis did not differ between the 3 clusters, while bone marrow lesions (BML) were more severe in the DAM cluster (Fig. 2). Medial meniscus damage was more severe in the LTT than the SI cluster (Fig. 2). In the FNIH cohort, baseline cartilage damage and BMLs were more severe in the DAM and SI clusters than in the LTT cluster (Fig. 2). Moreover, Hoffa-synovitis was more severe in the DAM than in the LTT cluster; no differences were observed for osteophytes or meniscus MOAKS scores (Fig. 2). In APPROACH, FTJ cartilage thickness was lower in the DAM than in the other clusters, while in FNIH, FTJ cartilage thickness was lower in both the DAM and SI than in the LTT cluster (data not shown). In APPROACH, the DAM cluster showed more 2-year worsening of full thickness cartilage damage, osteophytes, and medial meniscus extrusion than the LTT cluster and more worsening of osteophytes than the SI cluster (data not shown). In FNIH, the DAM cluster displayed more 2-year worsening of cartilage damage extent, lateral meniscus extrusion, and Hoffa-synovitis than the LTT cluster (data not shown). The LTT cluster showed more worsening in BMLs than the DAM cluster, and more worsening in osteophytes than the SI cluster. In both cohorts, change in FTJ cartilage thickness did not differ between clusters (data not shown). Differences in the severity of MR imaging features were more pronounced between clusters in the FNIH than in the APPROACH cohort, potentially because of the greater percentage of knees with radiographic knee OA (KLG2-4). Still, imaging features did not appear to be highly specific for the clusters derived from baseline biochemical markers, most likely because systemic biochemical markers are not only influenced by the selected target knee but also by other joints and tissue changes.

Effects of Intra-articular Platelet Rich Plasma on Cartilage Thickness, Clinical and Functional Outcomes in Knee Osteoarthritis.

Osteoarthritis of the kneeis one of the most common degenerative diseases and the fourth leading cause of years lived with disability at the global level. This study assessed the efficacy of platelet-rich plasma (PRP) in osteoarthritis of knees as to changes in cartilage thickness and clinical and functional outcomes. Thirty participants with Kellgren-Lawrence grade two and grade three osteoarthritis knee who satisfied the inclusion and exclusion criteria were enrolled in this prospective interventional study after taking written informed consent. Each participant received three doses of two ml intraarticular platelet-rich plasma at an interval of seven days. Clinical assessment was determined using the Visual Analogue Scale (VAS) and Knee Osteoarthritis Outcome Score (KOOS) on Day 0, Day 90, and Day 180. Cartilage thickness (femoral and trochlear cartilage) was measured pre (Day 0) and post-PRP (Day 180) under ultrasound guidance. The mean VAS score for pain was 7.4 before treatment which changed to 5.3 (p= <0.0001) on Day 90 and 3.37 (p= <0.0001) on Day 180 post-PRP. The mean total KOOS was 19.16 ± 10.73 before treatment which improved to 37.42 ± 9.88 (p= <0.0001) and 49.98 ± 8.82 (p= <0.0001) at 90 days, and 180 days post-injection, respectively. The mean cartilage thickness (femoral and trochlear cartilage) improved from baseline (day 0) to final follow-up on day 180, which was statistically significant and implied cartilage repair following PRP administration. This study supports the efficacy of PRP in the management of osteoarthritis knee by improvement in pain, joint stiffness, and activities of daily living, as well as aids in the repair and regeneration of articular cartilage.

Test–retest precision and longitudinal cartilage thickness loss in the IMI-APPROACH cohort

To investigate the test-retest precision and to report the longitudinal change in cartilage thickness, the percentage of knees with progression and the predictive value of the machine-learning-estimated structural progression score (s-score) for cartilage thickness loss in the IMI-APPROACH cohort - an exploratory, 5-center, 2-year prospective follow-up cohort. Quantitative cartilage morphology at baseline and at least one follow-up visit was available for 270 of the 297 IMI-APPROACH participants (78% females, age: 66.4±7.1 years, body mass index (BMI): 28.1±5.3kg/m2, 55% with radiographic knee osteoarthritis (OA)) from 1.5T or 3T MRI. Test-retest precision (root mean square coefficient of variation) was assessed from 34 participants. To define progressor knees, smallest detectable change (SDC) thresholds were computed from 11 participants with longitudinal test-retest scans. Binary logistic regression was used to evaluate the odds of progression in femorotibial cartilage thickness (threshold:-211μm) for the quartile with the highest vs the quartile with the lowest s-scores. The test-retest precision was 69μm for the entire femorotibial joint. Over 24 months, mean cartilage thickness loss in the entire femorotibial joint reached-174μm (95% CI: [-207,-141]μm, 32.7% with progression). The s-score was not associated with 24-month progression rates by MRI (OR: 1.30, 95% CI: [0.52, 3.28]). IMI-APPROACH successfully enrolled participants with substantial cartilage thickness loss, although the machine-learning-estimated s-score was not observed to be predictive of cartilage thickness loss. IMI-APPROACH data will be used in subsequent analyses to evaluate the impact of clinical, imaging, biomechanical and biochemical biomarkers on cartilage thickness loss and to refine the machine-learning-based s-score. NCT03883568.

Ultrasound assessment of distal femoral cartilage thickness measurements after walking/jogging in subjects with pes planus

BackgroundBecause there is a closed kinematic chain between the lower extremity joints during weight-bearing activities, pes planus can affect knee biomechanics. ObjectiveThis study aimed to measure distal femoral cartilage thickness with ultrasound after 3 different conditions (at rest, during walking and jogging) in subjects with pes planus and compare these conditions with each other and also with controls. MethodSixteen participants with pes planus(5-men, 11-women; aged 18–30 years) and 16 controls(3-men, 13-women; aged 18–30 years) were enrolled. Distal femoral cartilage thickness was evaluated with ultrasound before and after three separate 30-min conditions. Preferred walking speed (PWS) was determined on the ground. Subjects walked on a treadmill for 30-min at their PWS and jogged 30-min at 30% above their PWS. The Foot Function Index and the Foot-Ankle Outcome Survey were used to evaluate the clinical and functional status of the subjects. ResultsNeither PWSs nor jogging speeds were statistically different between groups (p > 0.05). There were no statistically significant differences between groups for absolute and percent change of cartilage thickness for all three conditions (p > 0.05). There were also no statistically significant differences between conditions for each intragroup (p > 0.05). The median Foot Function Index score of the subjects with pes planus was 9.78(0–44.35) for the right foot and 9.52(0–40.87) for the left foot. The median the Foot-Ankle Outcome Survey score of the subjects with pes planus was 88(65–100). ConclusionThere was no difference in knee joint cartilage deformations under different loading conditions, neither in subjects with pes planus nor in controls.

Ultrasonography of the Metacarpal/Tarsal-Phalangeal Joints in Healthy Racehorses: Normal Appearance, Breed-Related and Age-Related Features.

Simple SummaryThe ultrasound appearance of cartilage thickness and subchondral bone changes according to the age of the horse and the health status of the joints. Specific ultrasound features have been described in different joint diseases in horses. Knowledge of the normal features is thus essential during clinical investigations. The present research evaluates the ultrasound features of metacarpal/tarsal-phalangeal joints in healthy racehorses, according to the age and breed. Twenty-eight racehorses (standardbreds and thoroughbreds) were enrolled and grouped according to age (<5 and ≥5 years old). Fetlock cartilage appearance, thickness and subchondral bone appearance were ultrasonographically assessed. In younger compared to older standardbreds, the cartilage appeared thinner and with a normal ultrasound appearance, which suggests the use of specific references for the ultrasound features of the fetlock.In adult horses, specific ultrasound (US) features and reference values have been reported for the appearance of the joint cartilage and thickness according to the type of joint, such as femoropatellar and tarsocrural. The US appearance of the fetlock has been described in several diseases. The present research evaluates the US features of the metacarpal/tarsal-phalangeal joints in healthy racehorses according to age and breed, since no information is available in the literature. Seventy-one fetlocks in 28 healthy horses (15/28 thoroughbreds and 13/28 standardbreds) were assessed. The horses were grouped as follows: group A < 5 years old vs. group B ≥ 5. A portable ultrasound machine and a linear transducer (5–7.5 MHz) were used. Dorsal metacarpal/tarsal-phalangeal joints were scanned. The US images were reviewed offline in terms of articular cartilage appearance, thickness, and subchondral bone appearance by an experienced observer. Data were reported as the median, minimum, and maximum for cartilage thickness values, and differences between groups were evaluated. Cartilage thickness values were statistically lower in group A than B in the standardbreds, except for the lateral thickness in longitudinal view. No differences were detected in the thoroughbreds within age groups. All of the young standardbreds showed a normal cartilage and subchondral appearance. No statistical differences were found between breeds. Our results highlight the characteristics of the US appearance of metacarpal/tarsal-phalangeal joints specifically in racehorses, with some variations according to age. Since the cartilage can change according to joint growth, age and training activity, the present findings suggest the use of specific references for US features, which are key to correctly evaluating the health of the fetlock.

Poster 268: Allogeneic, Off The Shelf, Bone Marrow derived, Pooled, Mesenchymal Stromal Cells – A Potential Break through Therapy for Grade II &amp; III Osteoarthritis Knee Management

Poster 268: Allogeneic, Off The Shelf, Bone Marrow derived, Pooled, Mesenchymal Stromal Cells – A Potential Break through Therapy for Grade II &amp; III Osteoarthritis Knee Management

EFFECTS AND SAFETY OF PLATELET-RICH PLASMA IN COMBINATION WITH HUMAN MESENCHYMAL STEM CELLS FROM AUTOLOGOUS ADIPOSE TISSUE FOR KNEE OSTEOARTHRITIS

Objective: To evaluate the efficacy of platelet-rich plasma in combination with human mesenchymal stem cells from autologous adipose tissue for knee osteoarthritis treatment. Research object and method: In the study, there are 30 patients including 26 females and 4 males; correspondingly, 60 knee joints were diagnosed with osteoarthritis according to the American College of Rheumatology (ACR) who are at the mean age of 58,63 ± 11.11, disease duration is from 5,3± 4,6 years which is respectively of stages II - III according to Kellgren and Lawrence. All were injected with autologous platelet-rich plasma that was extracted by PRP set, APC 30 PRP PRCEDURE PRAK and autologously extracted mesenchymal stem cells from abdominal adipose tissue using the ADI-25-01 ADIPOSEPRCEDURE PRAK set with the Harvest smart stem cell separator of TERUMO BCT- USA. Results: After 12 months of treatment: the pain level according to VAS score at the right knee joint was decreased from 6.0 ± 1.28 before treatment to 1.9 ± 0.3; VAS score at the left knee joint was decreased from 6.43±1.19 to 2.25±0.43. Total Liquesce score at right knee joint was decreased from 16.04±1.57 before treatment to 4.31±1.04, at left knee joint was decreased from 17.52±1.74 before treatment to 5.15. ±1.48. Total WOMAC score at right knee joint was decreased from 55.93±5.56 to 10.37±1.56; at left knee joint was decreased from 53.97±5.57 to 10.07±1.59. There were 52/60 (86.77%) joints with cartilage thickness change and the patellar cartilage thickness was increased from 1.56 ± 0.09 mm before treatment to 1.65 ± 0.09 mm. The rate of complications at injection site, abdominal adipose removal is low, there are no complications of local infection and systemic reactions. Conclusion: The treatment of knee osteoarthritis with platelet-rich plasma in combination with mesenchymal stem cells from autologous adipose tissue is effective in reducing pain, improving patient's mobility and walking function comparing with before treatment; reforming articular cartilage thickness on magnetic resonance image which therefore improves the mobility function of the knee joint. This therapy is safe.