Knee Structural Changes Research Articles

Familial effects on structural changes relevant to knee osteoarthritis: a prospective cohort study

Genetic factors play an important role in the pathogenesis of knee osteoarthritis (OA), but which knee structural changes mediate this is unclear. This study aimed to describe the differences in knee structural changes over 8-10 years between offspring having at least one parent with total knee replacement (TKR) for severe primary knee OA and controls with no family history of knee OA. 115 offspring (mean age 45 years) with a family history of TKR for severe knee OA were compared with 104 (mean age 46 years) controls. T1 or T2-weighted fat saturated magnetic resonance imaging (MRI) was performed respectively to evaluate knee cartilage defects, bone marrow lesions (BMLs), meniscal extrusion and tears at baseline and 10 years. Multivariate logistic regression model was used to adjust for potential confounders. Offspring had a greater increase in cartilage defect score (1.03 vs 0.52, P = 0.007) and meniscal extrusion score (0.28 vs 0.10, P = 0.027) over 10 years, and a greater increase in meniscal tear score (0.40 vs 0.10, P = 0.012) over 8 years in the medial but not the lateral tibiofemoral compartment. Changes in BMLs over 8-years were not different between the two groups. These associations were independent of potential confounders, and strengthened after further adjustment for each other. With the exception of BMLs, offspring with a family history of knee OA have a greater risk of increases in multiple knee structural abnormalities in the medial tibiofemoral compartment suggesting pleiotropic familial effects.

Association between MRI-detected knee joint regional effusion-synovitis and structural changes in older adults: a cohort study

ObjectiveTo describe the cross-sectional and longitudinal associations between knee regional effusion-synovitis and structural changes in older adults.MethodsA total of 977 subjects were randomly selected from the local community (mean 62...

OP0064 Cross Sectional and Longitudinal Associations between Knee Joint Effusion and Osteoarthritic Structural Changes in Older Adults

BackgroundMultiple joint pathological changes such as synovial effusion, cartilage and subchondral bone lesions are involved in osteoarthritis (OA). The causal relationship between joint effusion and other knee structural changes was...

THU0220 Impact of Meniscal Extrusion on the Progression of Knee Osteoarthritis Structural Changes and the Effects of Treatment: Data from the Osteoarthritis Initiative Progression Cohort

BackgroundThe Osteoarthritis Initiative (OAI) is the largest knee osteoarthritis (OA) observational cohort. It provides the possibility to study the evolution of OA structural changes over time and the associated risk...

Association between infrapatellar fat pat maximum area and changes in knee symptoms and structures in older adults: a longitudinal study

Association between infrapatellar fat pat maximum area and changes in knee symptoms and structures in older adults: a longitudinal study

First-line analysis of the effects of treatment on progression of structural changes in knee osteoarthritis over 24 months: data from the osteoarthritis initiative progression cohort

To determine, using data from participants enrolled in the progression cohort of the OAI, the effects of conventional osteoarthritis (OA) pharmacological treatment and those of the combination of glucosamine and chondroitin sulfate (Glu/CS) on knee structural changes. Six hundred patients with knee OA were stratified based on whether or not they received for 24 consecutive months the OA conventional pharmacological treatment and/or Glu/CS. The main outcomes were knee structural changes, including the loss of joint space width (JSW) and of cartilage volume measured by quantitative MRI. Participants reported taking (+) (n=300) or not taking (-) (n=300) OA treatment (analgesic/NSAIDs). The +analgesic/NSAIDs participants had higher Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p<0.001) and smaller JSW (p=0.01), reflecting more severe disease at baseline. In the -analgesic/NSAIDs group, participants taking Glu/CS had significantly reduced loss of cartilage volume at 24 months in the medial central plateau (p=0.007). Further subdivision revealed that this effect of Glu/CS occurred in participants with a higher severity of the disease (JSW≤median). In the +analgesic/NSAIDs group, those taking Glu/CS had significantly reduced loss of cartilage volume in the global plateau at 12 months (p=0.05), and in the central plateau at 24 months (p=0.05). These effects occurred in participants with less disease severity (JSW>median). By contrast, no significant reduction in JSW was found between all groups. In +analgesic/NSAIDs groups and -analgesic/NSAIDs groups, participants who took Glu/CS had reduced loss of cartilage volume over 24 months in subregions when assessed with qMRI, arguing for a disease-modifying effect of Glu/CS which could not be identified by X-rays.

Sequential Change in T2* Values of Cartilage, Meniscus, and Subchondral Bone Marrow in a Rat Model of Knee Osteoarthritis

BackgroundThere is an emerging interest in using magnetic resonance imaging (MRI) T2* measurement for the evaluation of degenerative cartilage in osteoarthritis (OA). However, relatively few studies have addressed OA-related changes in adjacent knee structures. This study used MRI T2* measurement to investigate sequential changes in knee cartilage, meniscus, and subchondral bone marrow in a rat OA model induced by anterior cruciate ligament transection (ACLX).Materials and MethodsEighteen male Sprague Dawley rats were randomly separated into three groups (n = 6 each group). Group 1 was the normal control group. Groups 2 and 3 received ACLX and sham-ACLX, respectively, of the right knee. T2* values were measured in the knee cartilage, the meniscus, and femoral subchondral bone marrow of all rats at 0, 4, 13, and 18 weeks after surgery.ResultsCartilage T2* values were significantly higher at 4, 13, and 18 weeks postoperatively in rats of the ACLX group than in rats of the control and sham groups (p<0.001). In the ACLX group (compared to the sham and control groups), T2* values increased significantly first in the posterior horn of the medial meniscus at 4 weeks (p = 0.001), then in the anterior horn of the medial meniscus at 13 weeks (p<0.001), and began to increase significantly in the femoral subchondral bone marrow at 13 weeks (p = 0.043).ConclusionQuantitative MR T2* measurements of OA-related tissues are feasible. Sequential change in T2* over time in cartilage, meniscus, and subchondral bone marrow were documented. This information could be potentially useful for in vivo monitoring of disease progression.

History of knee injury is only weakly associated with knee structural change in middle or older aged adults

History of knee injury is only weakly associated with knee structural change in middle or older aged adults

The relationship between retinal vessel calibre and knee cartilage and BMLs

BackgroundWhether the increase in vascular disease prevalence and mortality in OA populations is a result of co-occurrence of cardiovascular disease and OA, which are both common in the older population, is due to OA treatments or to the common association with reduced physical activity and/or obesity is unclear. One way to explore this non-invasively is to examine the cross-sectional relationship between changes in retinal microvasculature, which have been shown to be markers of generalized vascular pathology, and knee structural changes in an asymptomatic community-based population.MethodsA community sample of 289 (61% women) aged 50–79 years with no knee symptoms underwent magnetic resonance imaging (MRI) of their dominant knee in 2003. Cartilage volume and bone marrow lesions (BMLs) were determined. All subjects also had retinal photographs taken from which retinal arteriolar and venular diameters were determined and summarized as the central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE).ResultsRetinal venular diameter was significantly wider in subjects with a BML compared with subjects without a BML (mean (SD) 214.2 (2.8) μm versus 207.5 (1.1) μm respectively independent of age, gender and BMI. A trend for decreased medial tibial cartilage with increasing CRAE was also observed (regression coefficient −2.70 μl, 95%CI-5.74, 0.5, p=0.08).ConclusionThese findings suggest that vascular pathology, indicative of inflammatory processes, is associated with early structural knee changes. The role of micro-vascular changes in the pathogenesis of OA warrants further investigation.

The association between objectively measured physical activity and knee structural change using magnetic resonance imaging (MRI)

The association between objectively measured physical activity and knee structural change using magnetic resonance imaging (MRI)

The association between objectively measured physical activity and knee structural change using MRI

ObjectivesThis study describes the longitudinal association between objectively assessed physical activity (PA) and knee structural change measured using MRI.Methods405 community-dwelling adults aged 51–81 years were measured at baseline and approximately...

Vitamin D supplementation in the management of knee osteoarthritis: study protocol for a randomized controlled trial

BackgroundOsteoarthritis (OA) is a common health issue worldwide in the aging population who are also commonly deficient in vitamin D. Our previous study suggested that higher serum 25-(OH)D levels were associated with reduced knee cartilage loss, implying that vitamin D supplementation may prevent the progression of knee OA. The aim of the VItamin D Effects on OA (VIDEO) study is to compare, over a 2- year period, the effects of vitamin D supplementation versus placebo on knee structural changes, knee pain, and lower limb muscle strength in patients with symptomatic knee OA.Methods/designRandomised, placebo-controlled, and double-blind clinical trial aiming to recruit 400 subjects (200 from Tasmania and 200 from Victoria) with both symptomatic knee OA and vitamin D deficiency (serum [25-(OH)D] level of >12.5 nmol/liter and <60 nmol/liter). Participants will be randomly allocated to vitamin D supplementation (50,000 IU compounded vitamin D3 capsule monthly) or identical inert placebo group for 2 years. The primary endpoint is loss of knee cartilage volume measured by magnetic resonance imaging (MRI) and Western Ontario and McMaster Universities Index of OA (WOMAC) knee pain score. The secondary endpoints will be other knee structural changes, and lower limb muscle strength. Several other outcome measures including core muscle images and central blood pressure will be recorded. Linear and logistic regression will be used to compare changes between groups using univariable and multivariable modeling analyses. Both intention to treat and per protocol analyses will be utilized.DiscussionThe trial is designed to test if vitamin D supplementation will reduce loss of knee cartilage volume, prevent the progression of other knee structural abnormalities, reduce knee pain and strengthen lower limb muscle strength, thus modify disease progression in knee OA.Trial registrationClinicalTrials.gov identifier: NCT01176344; Australian New Zealand Clinical Trials Registry: ACTRN12610000495022

Increased fasting serum glucose concentration is associated with adverse knee structural changes in adults with no knee symptoms and diabetes

ObjectiveThere is evidence to suggest that elevated glucose concentration and clinical diabetes are associated with osteoarthritis (OA). However, the association may be confounded by knee symptoms, concomitant treatment for OA or diabetes. We performed a longitudinal cohort study to examine the relationship between serum glucose concentration and knee structure in adults with no knee symptoms or diabetes. Methods179 participants who had fasting serum glucose measurements at 1990–4, with no knee symptoms or diabetes (physician-diagnosed or fasting serum glucose ≥7mmol/L), underwent knee MRI in 2003–4 and 2 years later. Body mass index was measured at 1990–4 and 2003–4. Cartilage volume and bone marrow lesions were determined from MRI at 2003–4 and 2006–7. ResultsFasting serum glucose concentration was positively associated with the rate of tibial cartilage volume loss over 2 years in women (B=44.2mm3, 95% CI 4.6, 83.8) but not in men (B=6.0mm3, 95% CI −68.5, 80.6). Fasting serum glucose concentration was positively associated with incident bone marrow lesions in women (OR=5.76, 95% CI 1.06, 31.21) but not in men (OR=0.11, 95% CI 0.01, 1.79) with significant gender difference (p=0.001 for interaction). ConclusionIncreased fasting serum glucose concentration in a non-diabetic population was associated with adverse structural changes at the knee in women but not in men, suggesting that there may be susceptibility to knee structural change even below the arbitrary “diabetic range” of serum glucose levels. The sex differences warrant further investigation as this may be one mechanism underlying the sex difference in knee OA.

294 DIETARY ANTIOXIDANTS AND HIP CARTILAGE VOLUME IN ADULTS WITHOUT CLINICAL HIP OSTEOARTHRITIS

Purpose: Whether the increase in vascular disease prevalence and mortality in OA populations is a result of co-occurrence of cardiovascular disease and OA, which are both common in the older population, is due to OA treatments or to the common association with reduced physical activity and/or obesity is unclear. One way to explore this noninvasively is to examine the relationship between changes in retinal microvasculature, which have been shown to be markers of generalized vascular pathology, and knee structural changes in an asymptomatic community-based population. Methods: A community sample of 289 (61% women) aged 50–79 years with no knee symptoms underwent magnetic resonance imaging (MRI) of their dominant knee in 2003. Cartilage volume and bone marrow lesions (BMLs) were determined. All subjects also had retinal photographs taken from which retinal arteriolar and venular diameters were determined and summarized as the central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE). Results: Retinal venular diameter was significantly wider in subjects with a BML compared with subjects without a BML [mean (SD)] 214.2 (2.8) mm versus 207.5 (1.1) mm respectively independent of age, gender and BMI. A trend for decreased medial tibial cartilage with increasing CRAE was also observed (regression coefficient −2.70ml, 95%CI −5.74, 0.5, p = 0.08). Conclusions: These findings suggest that vascular pathology, indicative of inflammatory processes, is associated with early structural knee changes. The role of micro-vascular changes in the pathogenesis of OA warrants further investigation.

What can we learn about osteoarthritis by studying a healthy person against a person with early onset of disease?

The structural changes of osteoarthritis are usually age-related and have long been regarded as irreversible. Using sensitive tools such as MRI in populations with relatively good knee health, including participants with a spectrum of knee structural changes from the healthy to those with the early changes of osteoarthritis, may help us to understand the trajectory of this disease from the earliest stages. Understanding pathogenic relationships at different stages of disease will help development of strategies for the prevention and treatment of osteoarthritis. This review aims to examine the recent epidemiological and clinical evidences of early knee structural changes in the younger populations with relatively healthy knees. Knee structural changes assessed by MRI are far more common than radiographic changes. A cascade of changes in joint structure start from subchondral bone expansion, bone marrow lesions (BMLs), meniscal tears and extrusion, to cartilage defects, and ultimately, but not inevitably, lead to cartilage loss and radiographic osteoarthritis at late stage. BMLs and cartilage defects both have significant potential to reverse especially at a younger age. Furthermore, novel risk factors such as smoking, lipids, leptin, vitamin D deficiency, and inflammation have been associated with early knee structural changes. Studying people from the healthy to those with early disease with new MRI techniques has enabled us understand the natural history of osteoarthritis and the effects of early risk factors. The changes in joint structure and risk factors identified in this population are potential targets for future interventions.

Magnetic resonance imaging can accurately assess the long-term progression of knee structural changes in experimental dog osteoarthritis

Objectives:Osteoarthritis (OA) structural changes take place over decades in humans. MRI can provide precise and reliable information on the joint structure and changes over time. In this study, we investigated...

Physical Activity and Knee Structural Change

Exercise therapy is effective in improving symptoms of knee osteoarthritis, but its effect on structural change remains unclear. To describe the associations between physical activity and structural changes of the knee joint as assessed by magnetic resonance imaging (MRI) in adult male and female subjects. A convenience sample of 325 subjects (mean age 45 yr, range 26-61) was measured at baseline and approximately 2 yr later. Measures of physical activity included questionnaire items, physical work capacity (PWC(170)), and lower-limb muscle strength. Knee cartilage volume, tibial plateau area, and cartilage defect score (0-4) were determined using T1-weighted fat saturation MRI. Lower-limb muscle strength at baseline was positively associated with both percent-per-year changes in total cartilage volume (r = 0.13) and lateral and total tibial plateau area (r = 0.15 and 0.17) but not other sites. Change in muscle strength was negatively associated with annual changes in lateral and total tibial plateau area (r = -0.13 and -0.17). In females only, PWC170 at baseline was negatively associated with percent-per-year changes in lateral and total cartilage volume (r = -0.16 and -0.17) and positively for lateral and total tibial plateau area (r = 0.18 and 0.16). Conversely, change in PWC(170) was positively associated with changes in cartilage volume at all sites (r = 0.24-0.26). For all associations, P < 0.05. Overall, these associations were modest in magnitude, but they suggest that knee cartilage volume and tibial plateau area are dynamic structures that can respond to physical stimuli. Greater muscle strength and endurance fitness, especially in women, may be protective against cartilage loss, but it also may result in a maladaptive enlargement of subchondral bone in both sexes, suggesting that physical activity may have both good and bad effects on the knee.

The genetic contribution to longitudinal changes in knee structure and muscle strength: A sibpair study

To estimate the heritability of longitudinal changes in knee cartilage volume, chondral defects, subchondral bone size, and lower limb muscle strength. A sibpair design was used. Longitudinal changes in lateral and medial tibial cartilage volume and bone size, as well as progression of chondral defects, were determined on serial magnetic resonance images. Radiographs were obtained and scored for individual features of radiographic osteoarthritis (OA) at baseline. Lower limb muscle strength was measured by dynamometry. Heritability was estimated using the SOLAR software package. A total of 115 subjects (55 men and 60 women, mean age 45 years) from 48 families representing 95 sibling pairs were successfully followed up for a mean of 2.4 years. The adjusted heritability estimates for changes in cartilage volume were 73% for the medial compartment (P < 0.01) and 40% for the lateral compartment (P = 0.10). The adjusted heritability estimates for changes in bone size were 62% for the lateral compartment (P = 0.03) and 20% for the medial compartment (P = 0.22). The adjusted heritability estimate for changes in muscle strength was 64% (P = 0.01). The adjusted heritability estimates for progression of chondral defects were 80% for the lateral compartment (P = 0.06) and 98% for the medial compartment (P = 0.03). These estimates changed little after adjusting for each other and for the predominantly mild radiographic OA, with the exception of progression of chondral defects in the lateral compartment. Early longitudinal changes in knee structures of relevance to later OA, such as changes in medial tibial cartilage volume, lateral tibial bone size, progression of chondral defects, and muscle strength, have high heritability, most likely reflecting a strong genetic component and suggesting their potential to be studied in quantitative trait linkage and association analysis.

Long term evaluation of disease progression through the quantitative magnetic resonance imaging of symptomatic knee osteoarthritis patients: correlation with clinical symptoms and radiographic changes

The objective of this study was to further explore the cartilage volume changes in knee osteoarthritis (OA) over time using quantitative magnetic resonance imaging (qMRI). These were correlated with demographic, clinical, and radiological data to better identify the disease risk features. We selected 107 patients from a large trial (n = 1,232) evaluating the effect of a bisphosphonate on OA knees. The MRI acquisitions of the knee were done at baseline, 12, and 24 months. Cartilage volume from the global, medial, and lateral compartments was quantified. The changes were contrasted with clinical data and other MRI anatomical features. Knee OA cartilage volume losses were statistically significant compared to baseline values: -3.7 ± 3.0% for global cartilage and -5.5 ± 4.3% for the medial compartment at 12 months, and -5.7 ± 4.4% and -8.3 ± 6.5%, respectively, at 24 months. Three different populations were identified according to cartilage volume loss: fast (n = 11; -13.2%), intermediate (n = 48; -7.2%), and slow (n = 48; -2.3%) progressors. The predictors of fast progressors were the presence of severe meniscal extrusion (p = 0.001), severe medial tear (p = 0.005), medial and/or lateral bone edema (p = 0.03), high body mass index (p < 0.05, fast versus slow), weight (p < 0.05, fast versus slow) and age (p < 0.05 fast versus slow). The loss of cartilage volume was also slightly associated with less knee pain. No association was found with other Western Ontario McMaster Osteoarthritis Index (WOMAC) scores, joint space width, or urine biomarker levels. Meniscal damage and bone edema are closely associated with more cartilage volume loss. These data confirm the significant advantage of qMRI for reliably measuring knee structural changes at as early as 12 months, and for identifying risk factors associated with OA progression.

The relationship of anxiety and depression with self-reported knee pain in the community: data from the Baltimore Longitudinal Study of Aging.

To investigate the relationship between anxiety and depression and reporting of knee pain in the community. Subjects (n = 374) were community volunteers aged 40 years and above who are participants in the Baltimore Longitudinal Study of Aging, a prospective multidisciplinary research study of normative aging. Knee pain was defined by the First National Health and Nutrition Examination Survey question "have you ever had pain in or around your knee on most days for at least one month?"; anxiety and depression were measured by the relevant subscales of the Arthritis Impact Measurement Scales questionnaire. All subjects had standing anteroposterior radiographs, read for Kellgren and Lawrence (K + L) grade. After adjustment for age, women reporting "ever" knee pain had significantly higher anxiety scores than those reporting "never" pain (3.06 +/- 0.26 versus 2.35 +/- 0.17; P = 0.025). Pain reporting was related neither to anxiety scores in men, nor to depression in either sex. Analysis stratified by radiographic severity, adjusted for age and gender, showed that differences in anxiety were confined to those reporting knee pain in the absence of radiographic change (i.e., K + L grade 0). In the community, women reporting knee pain in the absence of radiographic osteoarthritis have higher anxiety scores than those without pain. Depression was not significantly related to knee pain in this population. Psychosocial factors may explain some of the discrepancy between reported knee pain and structural change as seen on x-ray.