Degree Of Articular Cartilage Damage Research Articles

Cartilage Collagen Neoepitope C2C Expression in the Articular Cartilage and Its Relation to Joint Tissue Damage in Patients with Knee Osteoarthritis.

Pathological cleavage of type II collagen (Col2) and generation of Col2 neoepitopes can serve as useful molecular markers of the progression of osteoarthritis (OA). One of such potential biomarkers is type II collagen neoepitope C2C. The aim of this study was to correlate the degree of articular cartilage damage in OA patients with C2C expression in histological samples of tissues removed during total knee replacement. Cartilage samples were obtained from 27 patients ranging in age from 55 to 66 years. In each patient, medial and lateral tibia plateau samples were analyzed according to the OARSI histopathology grading system. The C2C expression was evaluated on histological slides by semi-quantitative analysis using ImageJ Fiji 2.14.0 software. Spearman's rank correlation analysis revealed a positive weak correlation (rho = 0.289, p = 0.0356) between the histological grade of tissue damage and the percentage of C2C staining. In addition, a highly significant positive correlation (rho = 0.388, p = 0.0041) was discovered between the osteoarthritis score (combining the histological grade of damage with the OA macroscopic stage) and the percentage of C2C staining in the samples. The C2C expression was detected in all the regions of the articular cartilage (i.e., the superficial zone, mid zone, deep zone and tidemark area, and the zone of calcified cartilage). Our findings imply that local expression of C2C correlates with the articular cartilage damage in OA-affected knees. This confirms that C2C can be used as a prospective marker for assessing pathological changes in the OA course and OA clinical trials.

Expression of CILP-2 and DDR2 and ultrastructural changes in the articular cartilage of patients with knee osteoarthritis undergoing total knee arthroplasty: a pilot morphological study.

The aim of the study was to correlate the immunohistochemical expression of cartilage intermediate layer protein 2 (CILP-2) and discoidin domain receptor 2 (DDR2), and the ultrastructural changes in the cartilage with the degree of articular cartilage damage in osteoarthritis (OA) patients. Cartilage samples were obtained from twenty patients aged from 46 to 68years undergoing total knee arthroplasty. In each patient, medial and lateral tibial plateau samples were analysed applying OARSI histopathology grading. Positive correlation was noted between the extent of CILP-2 staining intensity and OARSI grades. Abundant staining for CILP-2 was found in the superficial and middle layers and in the pericellular matrix (PCM) of the deep zone. Transmission electron microscopy studies demonstrated strong damage of chondrocytes, the organelles were often diminished or focally aggregated. As a characteristic finding, PCM was frequently expanded, which may reflect a pathogenic step in OA progression. In conclusion, CILP-2 may potentially be a relevant marker of OA progression as its expression correlated better with cartilage damage than the known marker of articular cartilage damage, DDR2.

Features of Arthrosis of the Shoulder Joint in the Conditions of Initially Realized Shoulder Instability and in Case of its Combination with Damage to the Rotator Cuff According to Magnetic Resonance Imaging and Arthroscopy

Relevance. Osteoarthritis (OA) leads to functional limitation and reduced quality of life; it is a major cause of pain and disability. Currently, there is a relatively small number of radiological studies concerning the features of OA of the shoulder joint (SJ) provoked by the realized instability and its combination with damage to the tendons of the rotator cuff (RC) of the shoulder.
 Objective: to study the features of the manifestations and course of SJ OA in the conditions of initially realized isolated instability in combination with damage to the tendons of the RC according to magnetic resonance imaging (MRI) and arthroscopy.
 Materials and Methods. The MRI and arthroscopy data of 75 patients with isolated Bankart lesion and combination with RC tendon damage were retrospectively analyzed. The results of the MRI examination were independently assessed by 2 radiologists with 8 and 10 years of experience. Arthroscopic diagnosis was performed at the beginning of the reconstructive stage by a standard examination from 21 points. The degree of articular cartilage damage on MRI was determined according to the adapted classification of R. Outerbridge.
 Results. In Bankart lesion, sites of chondromalacia of the glenoid cavity cartilage can be detected in the form of a linear or curvilinear hyperintensive MR signal on PDfs in the cartilage thickness or as its marginal defect. The thickness of the cartilage in primary dislocations is generally preserved. When instability is combined with RC tendon damage, the degree of cartilage damage is much greater with a decrease in its thickness. The largest area of cartilage damage is observed when 2 or more RC tendons are damaged.
 Conclusions. Primary SJ dislocation is not always accompanied by damage to the articular cartilage. The MR-semiotics of SJ OA in primary dislocation and in a combination with damage to the tendons of RC has the corresponding features. Delaying the restoration of stability in the shoulder joint with the help of surgical treatment is an unfavorable prognostic factor in the development of rheumatoid arthritis and OA SJ. Realized instability in combination with damage to the rotator cuff is an extremely aggravating prognostic factor for OA, as it adds an additional pathophysiological factor in the form of rotational arthropathy.

Microstructural analysis of subchondral bone in knee osteoarthritis

SummaryThe results of this study show increased formation of bone in the subchondral areas in advanced stages of osteoarthritis of the knee. These changes seem to be influenced by mechanical factors.IntroductionSubchondral bone changes seem to contribute to the progression of knee osteoarthritis (OA). This study aimed to analyze subchondral bone microstructure in specimens of late-stage knee OA in respect to articular cartilage damage, meniscus integrity, and knee joint alignment.MethodsThirty proximal tibiae of 30 patients (20 female and 10 male) with late-stage OA retrieved during total knee arthroplasty were scanned using a high-resolution micro-computed tomography. The scans were semi-automatically segmented into five volumes of interest. The volumes of interest were then further analyzed using commercially available software. The degree of articular cartilage damage was assessed semi-quantitatively by magnetic resonance imaging before surgery.ResultsThe mean bone fraction volume (bone volume/total volume (BV/TV)) in all weight-bearing locations was significantly higher compared to the non-weight-bearing reference point below the anterior cruciate ligament (p = 0.000). The mean BV/TV in the medial compartment was significantly higher compared to the lateral compartment (p = 0.007). As for the BV/TV in intact menisci, there was a significantly lower subchondral bone fraction volume compared to subluxated or luxated menisci in the medial (p = 0.020) and lateral compartment (p = 0.005). Varus alignment had a significantly higher subchondral BV/TV in the medial compartment, whereas valgus alignment had a significantly higher subchondral BV/TV in the lateral compartment (p = 0.011).ConclusionsThe results show significant differences of subchondral bone microstructural parameters in respect to cartilage damage, meniscus’ structural integrity, and knee joint alignment. Therefore, subchondral bone changes seem to be a secondary process in the late-stage OA of the knee caused by mechanical changes.

Assessment of Articular Cartilage Disorders After Distal Radius Fracture Using Biochemical and Morphological Nonenhanced Magnetic Resonance Imaging

To assess radiocarpal articular cartilage after distal radius fracture, with and without intra-articular extension, compared with healthy controls using multiparametric, nonenhanced magnetic resonance imaging (MRI). In this prospective study, multiparametric MRI of the radiocarpal articular cartilage was performed in 26 participants (16 males and 10 females; mean age, 39.5 ± 14.7 years; range, 20-70 years) using 3T MRI. The cohort consisted of 14 patients with a distal radius fracture and 12 healthy volunteers. The radiocarpal articular cartilage was assessed using morphological (Double Echo Steady-State [DESS] and True Fast Imaging With Steady-State Precession [TrueFISP]) and biochemical (T2∗) MRI sequences without an intravenous contrast agent. The modified Outerbridge classification system for morphological analyses and region-of-interest biochemical analysis were applied to assess the degree of articular cartilage damage in each patient. Morphological articular cartilage assessment showed no difference between the DESS sequence and the reference standard, TrueFISP. In the morphological (DESS and TrueFISP) and biochemical (T2∗) assessments, patients with intra-articular fractures did not show articular cartilage damage different from those with extra-articular fractures. Greater articular cartilage degradation was observed after distal radius fracture compared with controls. Posttraumatic radiocarpal articular cartilage damage did not differ between fractures with intra-articular and extra-articular extension, but patients with fractures had notably higher articular cartilage degradation compared with healthy controls. Magnetic resonance imaging using advanced multiparametric sequences may facilitate accurate, noninvasive assessment of articular cartilage changes after distal radius fracture without the need for a contrast agent. Diagnostic IV.

SUBCHONDRAL BONE IN OSTEOARTHRITIS OF THE KNEE

Subchondral bone changes seem to contribute to the progression of knee osteoarthritis (OA). The study aimed to analyze subchondral bone microstructure in specimens of late-stage knee OA in respect to articular cartilage damage, meniscus integrity and knee joint alignment. Methods and Materials: 30 proximal tibiae of 30 patients (20 female and 10 male) with late-stage OA retrieved during total knee arthroplasty (TKA) were scanned using a high-resolution MicroComputed Tomography (μCT). The scans were semi-automatically segmented into five volumes of interest (VOIs). The VOIs were than further analyzed using commercially available software. The degree of articular cartilage damage was assessed semi-quantitatively by magnetic resonance imaging (MRI) before surgery. Results: The mean bone fraction volume (BV/TV) in all weight bearing locations was significantly higher compared to the non weight-bearing reference point below the anterior cruciate ligament (p=0,000). The mean BV/TV in the medial compartment was significantly higher compared to the lateral compartment (p=0,007). The BV/TV in intact menisci, there was a significantly lower subchondral BV/TV compared to subluxated or luxated menisci in the medial (p=0,020) and lateral compartment (p=0,005). Varus alignment had a significantly higher subchondral BV/TV in the medial compartment, whereas valgus alignment had a significantly higher subchondral BV/TV in the lateral compartment (p=0,011). Conclusion: The results show significant differences of subchondral bone microstructural parameters in respect to cartilage damage, meniscus’ structural integrity and knee joint alignment. Therefore, subchondral bone changes seem to be a secondary process in the late-stage OA of knee caused by mechanical changes.

Microstructural analysis of subchondral bone in knee osteoarthritis

Purpose: Subcondral bone changes seem to contribute to the progression of knee osteoarthritis (OA). This study aimed to analyse subchondral bone microstructure in specimens of late-stage knee OA in respect to articular cartilage damage, meniscus integrity and knee joint alignment. Methods: 30 proximal tibiae of 30 patients (20 female and 10 male) with late-stage OA that were retrieved during total knee arthroplasty (TKA) were scanned using a high-resolution Micro-Computed Tomography (μCT). The scans were semi-automatically segmented into five regions of interest (ROIs). The ROIs were than further analysed using a commercially available software. The degree of articular cartilage damage was assessed semiquantitatively by magnetic resonance imaging (MRI) before surgery. Results: The mean bone fraction volume in the medial compartment was significantly higher compared to the mean bone fraction volume in the lateral compartment (62,07 ± 12,53 vs. 52,57 ± 13,33). The differences were statistically significant (p=0,007). The submeniscal mean bone fraction volume in the medial compartment was statistically significantly higher compared to submeniscal mean bone fraction volume in the lateral compartment (56,76 ± 12,8 vs. 47,36 ± 14,97; p=0,015). There was a significantly lower bone fraction volume in the medial submeniscal subchondral bone compared to the subchondral bone fraction volume from the medial tibial plateau compartment (p=0,041). There was a significant difference in the lateral submeniscal subchondral bone fraction volume compared to the subchondral bone fraction volume from the lateral tibial plateau compartment (p=0,024). The bone fraction volume in all weight bearing locations (medial meniscus, medial tibial plateau, lateral meniscus, lateral tibial plateau) was significantly higher compared to the non weight-bearing reference point below the ACL (p=0,000). In intact menisci, there was a significantly lower subchondral bone fraction volume compared to subluxated or luxated meniscus in the medial (p=0,020) and lateral compartment (p=0,005). Varus alignment had a significantly higher subchondral bone fraction volume in the medial compartment than valgus, whereas valgus alignment had a significantly higher subchondral bone fraction volume in the lateral compartment (p=0,011). Conclusions: The results of this study show significant differences of subchondral bone microstructural parameters in respect to cartilage damage, meniscus’ structural integrity and knee joint alignment. Therefore, subchondral microstructural bone changes seem to be a secondary process in the late-stage OA of knee caused by mechanical changes.

Outcome of arthroscopy in patients with advanced osteoarthritis of the hip.

Hip arthroscopy has continued to expand its horizons in treating many conditions other than femoroacetabular impingement (FAI). However, the results of hip arthroscopy are known to be poor if the degree of articular cartilage damage is significant. We wanted to assess, whether the procedure might have a role in the management of young and active patients with advanced osteoarthritis (OA) and whether it should be offered as a treatment modality. 77 consecutive patients with Tönnis grade 2 and 3 osteoarthritis of the hip who had undergone hip arthroscopy were included in the study. Patients' medical notes, plain radiographs and outcome scores (modified Harris hip score (mHHS), non-arthritic hip score (NAHS)) preoperatively and postoperatively at six weeks, six months, one year and annually thereafter, were analysed. 77 patients consisted of 63 men and 14 women with mean follow-up of 2.8 years (2.2 to 4.2) and mean age at surgery of 43 years (19 to 64). The mean preoperative mHHS and NAHS scores were 58 (28 to 87) and 64 (27 to 93) respectively. The mean improvements in both the mHHS and NAHS scores were significant (p = 0.003 and p = 0.0001 for mHHS at one and two years, p = 0.002 and p = 0.0003 for NAHS at one and two years, respectively). There were 34 patients (44%) who required a total hip replacement at mean of 18 months (6 to 48) after hip arthroscopy. We conclude that hip arthroscopy improves outcome scores in 56% of patients with severe OA of the hip (Tönnis grade 2 and 3) for at least two years after surgery. We thus consider the procedure to be a reasonable option for patients with hip OA, although success of the procedure will be less than if undertaken for certain other conditions.

Serum TNF-alpha levels: potential use to indicate osteoarthritis progression in a mechanically induced model

To investigate plasma tumor necrosis factor-alpha (TNF-α) levels as an indicator to reflect the magnitude of the destructive inflammatory phase and articular cartilage damage after a knee trauma. Eighteen mature Wistar Albino male rats were divided into two groups equal in number. Nine animals underwent anterior cruciate ligament transection (ACLT) of the right knees, while nine animals had a sham procedure. All animals were killed at the end of 8 weeks; serum TNF-α levels were analyzed with enzyme linked-immunosorbent assay, and the osteoarthritic changes of articular cartilage were evaluated by a histopathological method using OARSI (Osteoarthritis Research Society International) osteoarthritis cartilage histopathology assessment system score. Serum TNF-α levels and OARSI scores showed significant difference between two groups. Despite 8 weeks after the initial trauma, ACLT group still demonstrated elevated levels of plasma TNF-α indicating the ongoing inflammatory phase. Serum TNF-α levels were also found to be correlated with the OARSI osteoarthritis cartilage histopathology assessment system scores. Post-traumatic local TNF-α overproduction as a proinflammatory cytokine is known to have a major role in cartilage matrix degradation. In this study, elevated plasma TNF-α levels were considered as the consequence of the early local inflammatory response to altered knee biomechanics. Degree of articular cartilage damage found to be consistent with plasma TNF-α levels suggest that monitoring plasma TNF-α levels may be a simple and reliable method to reflect the magnitude of destruction during the ongoing inflammatory phase of OA.

Evaluation of a Collagenase Generated Osteoarthritis Biomarker in the Synovial Fluid from Elbow Joints of Dogs with Medial Coronoid Disease and Unaffected Dogs

To evaluate whether synovial fluid concentrations of an osteoarthritis biomarker in dysplastic canine elbows with medial coronoid disease (MCD) are elevated compared with unaffected elbows and to determine if these concentrations correlate to the degree of articular cartilage damage. Cross sectional clinical study. Dogs (n=19; 35 elbows) with MCD and dogs (8; 16 elbows) with unaffected elbows. Concentrations of a collagenase-generated cleavage neoepitope of type II collagen (Col2-3/4C(long mono), or C2C) in joint fluid from elbows were analyzed and compared between dogs with MCD and unaffected dogs. Correlation of C2C concentration with subjective grading of articular cartilage surface damage was also evaluated. Mean (+/-SD) C2C concentration from MCD dogs was significantly higher (112.3+/-24.8 ng/mL) than in unaffected dogs (76.1+/-16.9 ng/mL; P<.05). There was a moderate correlation between cartilage damage grade and increasing C2C concentrations (P<.05, r=0.62) C2C concentrations are elevated in the synovial fluid of dogs with MCD compared with unaffected elbows, and a moderate, significant correlation was identified between these concentrations and subjective grading of articular cartilage damage. This preliminary data suggest that C2C concentrations in synovial fluid may have potential as a biomarker for diagnosis of articular cartilage damage associated with MCD and as a means of objectively determining the degree of articular cartilage damage.

Radioactive synoviorthesis for the treatment of haemophilic synovitis

Radioactive synoviorthesis, with (90)Y (knees) and (186)Rh (elbows and ankles) is a highly effective procedure that decreases both the frequency and the severity of recurrent intra-articular bleeds related to joint synovitis. The procedure should be performed as soon as possible to minimize the degree of articular cartilage damage, which based on many studies is irreversible. It can also be used in patients with inhibitors. On average, radioactive synoviorthesis has a 75-80% satisfactory outcome in the long-term. From the clinical standpoint, such efficacy can be measured by the decrease in the number of haemarthroses, with complete cessation for several years in some cases. One should bear in mind that in 20-25% of cases, radioactive synoviorthesis fails to control haemarthroses. In such cases, it can be repeated. Personal experience and the general recommendation among orthopaedic surgeons and haematologists is that when three early consecutive radioactive synoviortheses (repeated every three months) fail to halt synovitis, a surgical synovectomy (open or by arthroscopy) should be immediately considered.

Intra-articular Fibrous Tissue Formation Following Ankle Fracture: The Significance of Arthroscopic Debridement of Fibrous Tissue

The purposes of this study were to understand the clinical consequences of arthrofibrosis following surgical reduction of ankle fractures and to examine the effectiveness of arthroscopic debridement. Subjects included 33 patients (26 males, 7 females) aged 14 to 78 years (mean, 40.2 years) who had undergone open reduction and internal fixation of ankle fractures between May 2000 and May 2003. Arthroscopic examination was performed at the time of implant removal after an average of 12.4 months (range, 6 to 43 months), and abnormal fibrous tissue, when present, was removed through arthroscopy. The mean follow-up period after arthroscopy was 43.7 months (range, 22 to 68 months). Clinical outcomes before and after arthroscopy were evaluated with the American Orthopaedic Foot and Ankle Society scale and our own functional evaluation method. Arthroscopic findings, including the degree of articular cartilage damage and the quantity of fibrous tissue, were scored on a 3-point scale. Functional deterioration of the ankle joint was observed in 27% of subjects. Arthroscopy showed articular cartilage damage in 33% of patients and arthrofibrosis in 73%. In patients with functional deterioration, the rate of articular cartilage damage was 78%, and arthrofibrosis was present in all cases. Furthermore, when extensive fibrosis and impingement on the articular surface were present, 88% of patients showed impaired articular function. Arthroscopic debridement of fibrous tissue resulted in improved articular function in 89% of patients with functional deterioration of the ankle joint before arthroscopy. Arthrofibrosis following ankle fracture causes an unfavorable surgical outcome, and arthroscopic debridement of fibrous tissue is an effective means of improving articular function. Level IV, therapeutic case series.

The haemophilic ankle

Radiation synoviorthesis is a very effective procedure that decreases both the frequency and the intensity of recurrent ankle bleeds related to ankle synovitis. The procedure should be performed as soon as possible to minimize the degree of articular cartilage damage. It can also be used in patients with inhibitors with minimal risk of complications. On average, the efficacy of the procedure ranges from 76% to 80%, and can be performed at any age. The procedure slows the cartilaginous damage which intra-articular blood tends to produce in the long term. After 30 years of using radiation synovectomy worldwide, no damage has been reported in relation to the radioactive materials. Radiation synovectomy is currently the preferred procedure when radioactive materials are available; however, chemical synoviorthesis is an effective alternative method if radioactive materials are not available. Personal experience and the general recommendation among orthopaedic surgeons and haematologists is that when three early consecutive synoviorthesis (repeated every 3 months) fail to halt synovitis, a surgical synovectomy (open or by arthroscopy) should be immediately considered. For advanced haemophilic arthropathy of the ankle, the best solution is an ankle arthrodesis. Primary prophylaxis and radioactive synoviorthesis are the best ways that we have today of protecting against haemophilic synovitis and arthropathy of the ankle joint.

Articular cartilage lesions in the symptomatic anterior cruciate ligament-deficient knee

Purpose: The goal of the study was to report the prevalence of the lesions of the articular cartilage of the femoral condyles and tibial plateau in patients with a symptomatic anterior cruciate ligament (ACL)-deficient knee undergoing day-case arthroscopy. Type of Study: Case series study. Methods: We studied 378 skeletally mature patients (average age, 27.3 years; range, 16–50 years; 282 men and 84 women), part of a sample of 1,978 patients undergoing a primary knee arthroscopy between January 1986 and August 1993. The articular cartilage lesions were classified according to Outerbridge by a single observer. We assessed the relationship between time of injury and articular cartilage lesions and between meniscal lesions and articular cartilage lesions. Results: A complete ACL tear was found in all 378 knees. Of these, 157 showed at least one lesion of the articular cartilage. The medial femoral condyle (MFC) showed the highest frequency of articular cartilage lesions, especially in the weight-bearing portion. Patients with a bucket-handle tear of the medial meniscus had greater degeneration of the MFC than those with other meniscal tears. A meniscal tear was associated with a greater degree of articular damage. The second most common lesion was a combined lesion of the medial and lateral compartments, followed by isolated lateral compartment lesion. A time-dependent pattern of development of articular cartilage lesions was identified. Conclusions: In patients with more advanced degenerative changes, the time from injury to arthroscopy was significantly longer than in patients with lesser articular surface abnormalities, and the presence of a meniscal tear was associated with a greater degree of articular cartilage damage. Patients with a symptomatic ACL-deficient knee and an associated tear of the medial meniscus are at high risk of having a lesion of the articular surface of the weight bearing area of the knee.

The effect of partial lateral meniscectomy in patients > or = 60 years.

To determine the benefit, if any, of meniscectomy in an older population, all patients > or = 60 years who underwent partial lateral meniscectomy were evaluated. Thirty-five patients (36 knees) were available for follow-up. The average patient age was 64.9 years. Patients were divided into two groups based on the degree of articular cartilage damage. Patients in group 1 had no damage worse than grade II and underwent arthroscopic partial meniscectomy only, while patients in Group 2 had grade III or IV damage and underwent arthroscopic debridement as well as partial meniscectomy. With an average follow-up of 36.8 months, the overall failure rate was 13.9%. Eighty-six percent of the patients reported the overall assessment of their knee as improved (94% and 80% in groups 1 and 2, respectively). While patients in group 2 tended to have less favorable results than patients in group 1, these results indicate that this procedure is warranted and that both groups benefited significantly from partial meniscectomy.