Lateral Tibial Cartilage Research Articles

High systemic LDL cholesterol levels during experimental osteoarthritis lead to increased synovial activation and ectopic bone formation at end-stage osteoarthritis, while excessive levels accelerate development of joint pathology already at early-stage of osteoarthritis

High systemic LDL cholesterol levels during experimental osteoarthritis lead to increased synovial activation and ectopic bone formation at end-stage osteoarthritis, while excessive levels accelerate development of joint pathology already at early-stage of osteoarthritis

Combined Anatomic Factors Predicting Risk of Anterior Cruciate Ligament Injury for Males and Females

Background: Knee joint geometry has been associated with risk of suffering an anterior cruciate ligament (ACL) injury; however, few studies have utilized multivariate analysis to investigate how different aspects of knee joint geometry combine to influence ACL injury risk. Hypotheses: Combinations of knee geometry measurements are more highly associated with the risk of suffering a noncontact ACL injury than individual measurements, and the most predictive combinations of measurements are different for males and females. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 88 first-time, noncontact, grade III ACL-injured subjects and 88 uninjured matched-control subjects were recruited, and magnetic resonance imaging data were acquired. The geometry of the tibial plateau subchondral bone, articular cartilage, and meniscus; geometry of the tibial spines; and size of the femoral intercondylar notch and ACL were measured. Multivariate conditional logistic regression was used to develop risk models for ACL injury in females and males separately. Results: For females, the best fitting model included width of the femoral notch at its anterior outlet and the posterior-inferior–directed slope of the lateral compartment articular cartilage surface, where a millimeter decrease in notch width and a degree increase in slope were independently associated with a 50% and 32% increase in risk of ACL injury, respectively. For males, a model that included ACL volume and the lateral compartment posterior meniscus to subchondral bone wedge angle was most highly associated with risk of ACL injury, where a 0.1 cm3 decrease in ACL volume (approximately 8% of the mean value) and a degree decrease in meniscus wedge angle were independently associated with a 43% and 23% increase in risk, correspondingly. Conclusion: Combinations of knee joint geometry measurements provided more information about the risk of noncontact ACL injury than individual measures, and the aspects of geometry that best explained the relationship between knee geometry and the risk of injury were different between males and females. Consequently, a female with both a decreased femoral notch width and an increased posterior-inferior–directed lateral compartment tibial articular cartilage slope combined or a male with a decreased ACL volume and decreased lateral compartment posterior meniscus angle were most at risk for sustaining an ACL injury.

In Vivo Measurement of Localized Tibiofemoral Cartilage Strains in Response to Dynamic Activity

Background: Altered local mechanical loading may disrupt normal cartilage homeostasis and play a role in the progression of osteoarthritis. Currently, there are limited data quantifying local cartilage strains in response to dynamic activity in normal or injured knees. Purpose/Hypothesis: To directly measure local tibiofemoral cartilage strains in response to a dynamic hopping activity in normal healthy knees. We hypothesized that local regions of cartilage will exhibit significant compressive strains in response to hopping, while overall compartmental averages may not. Study Design: Controlled laboratory study. Methods: Both knees of 8 healthy subjects underwent magnetic resonance imaging before and immediately after a dynamic hopping activity. Images were segmented and then used to create 3-dimensional surface models of bone and cartilage. These pre- and postactivity models were then registered using an iterative closest point technique to enable site-specific measurements of cartilage strain (defined as the normalized change in cartilage thickness before and after activity) on the femur and tibia. Results: Significant strains were observed in both the medial and lateral tibial cartilage, with each compartment averaging a decrease of 5%. However, these strains varied with location within each compartment, reaching a maximum compressive strain of 8% on the medial plateau and 7% on the lateral plateau. No significant averaged compartmental strains were observed in the medial or lateral femoral cartilage. However, local regions of the medial and lateral femoral cartilage experienced significant compressive strains, reaching maximums of 6% and 3%, respectively. Conclusion: Local regions of both the femur and tibia experienced significant cartilage strains as a result of dynamic activity. An understanding of changes in cartilage strain distributions may help to elucidate the biomechanical factors contributing to cartilage degeneration after joint injury. Clinical Relevance: Site-specific measurements of in vivo cartilage strains are important because altered loading is believed to be a factor contributing to the development and progression of osteoarthritis. Specifically, this methodology and data could be used to evaluate the effects of soft tissue injuries (such as ligament or meniscus tears) on cartilage strains in response to dynamic activities of daily living.

Importance of material properties and porosity of bone on mechanical response of articular cartilage in human knee joint--a two-dimensional finite element study.

Mechanical behavior of bone is determined by the structure and intrinsic, local material properties of the tissue. However, previously presented knee joint models for evaluation of stresses and strains in joints generally consider bones as rigid bodies or linearly elastic solid materials. The aim of this study was to estimate how different structural and mechanical properties of bone affect the mechanical response of articular cartilage within a knee joint. Based on a cadaver knee joint, a two-dimensional (2D) finite element (FE) model of a knee joint including bone, cartilage, and meniscus geometries was constructed. Six different computational models with varying properties for cortical, trabecular, and subchondral bone were created, while the biphasic fibril-reinforced properties of cartilage and menisci were kept unaltered. The simplest model included rigid bones, while the most complex model included specific mechanical properties for different bone structures and anatomically accurate trabecular structure. Models with different porosities of trabecular bone were also constructed. All models were exposed to axial loading of 1.9 times body weight within 0.2 s (mimicking typical maximum knee joint forces during gait) while free varus-valgus rotation was allowed and all other rotations and translations were fixed. As compared to results obtained with the rigid bone model, stresses, strains, and pore pressures observed in cartilage decreased depending on the implemented properties of trabecular bone. Greatest changes in these parameters (up to -51% in maximum principal stresses) were observed when the lowest modulus for trabecular bone (measured at the structural level) was used. By increasing the trabecular bone porosity, stresses and strains were reduced substantially in the lateral tibial cartilage, while they remained relatively constant in the medial tibial plateau. The present results highlight the importance of long bones, in particular, their mechanical properties and porosity, in altering and redistributing forces transmitted through the knee joint.

Changes to the articular cartilage thickness profile of the tibia following anterior cruciate ligament injury

We sought to determine if anterior cruciate ligament (ACL)-injured subjects demonstrated side-to-side differences in tibial cartilage thickness soon after injury, and if uninjured-control subjects displayed side-to-side symmetry in cartilage thickness. Second, we aimed to investigate associations between body mass index (BMI), cross-sectional area (CSA) of the proximal tibia, and articular cartilage thickness differences. Bilateral Magnetic Resonance Images (MRIs) were obtained on 88 ACL-injured subjects (27 male; 61 female) a mean 27 days post-injury, and 88 matched uninjured control subjects. Within ACL-injured and uninjured control subjects, side-to-side differences in medial and lateral tibial articular cartilage thickness were analyzed with adjustment for tibial position relative to the femur during MRI acquisition. Associations between tibial CSA and cartilage thickness differences were tested within high and low BMI groups. Within the medial tibial compartment, ACL-injured females displayed significant increases: mean (confidence interval (CI)) = +0.18 mm (0.17, 0.19) and decreases: mean (CI) = -0.14 mm (-0.13, -0.15) in tibial cartilage thickness within the central and posterior cartilage regions respectively. Adjustment for tibial position revealed a decreased area of significant cartilage thickness differences, though 46% of points maintained significance. In the lateral compartment anterior region, there was a significantly different relationship between cartilage thickness differences and CSA, within high and low BMI groups (BMI group*CSA interaction, P = 0.007). Within the low BMI group, a significant negative correlation between cartilage thickness and CSA was identified (P = 0.03). ACL-injured females displayed cartilage thickness differences in the central, and posterior medial tibial cartilage regions. Tibial position effected thickness differences, but did not account for all significant differences.

Quantitative proteomics at different depths in human articular cartilage reveals unique patterns of protein distribution

The articular cartilage of synovial joints ensures friction-free mobility and attenuates mechanical impact on the joint during movement. These functions are mediated by the complex network of extracellular molecules characteristic for articular cartilage. Zonal differences in the extracellular matrix (ECM) are well recognized. However, knowledge about the precise molecular composition in the different zones remains limited. In the present study, we investigated the distribution of ECM molecules along the surface-to-bone axis, using quantitative non-targeted as well as targeted proteomics.\\In a discovery approach, iTRAQ mass spectrometry was used to identify all extractable ECM proteins in the different layers of a human lateral tibial plateau full thickness cartilage sample. A targeted MRM mass spectrometry approach was then applied to verify these findings and to extend the analysis to four medial tibial plateau samples.In the lateral tibial plateau sample, the unique distribution patterns of 70 ECM proteins were identified, revealing groups of proteins with a preferential distribution to the superficial, intermediate or deep regions of articular cartilage. The detailed analysis of selected 29 proteins confirmed these findings and revealed similar distribution patterns in the four medial tibial plateau samples.The results of this study allow, for the first time, an overview of the zonal distribution of a broad range of cartilage ECM proteins and open up further investigations of the functional roles of matrix proteins in the different zones of articular cartilage in health and disease.

Radiographic Landmarks for Locating the Femoral Origin and Tibial Insertion of the Knee Anterolateral Ligament

Background: Recent anatomic studies have confirmed the presence of a true ligament structure, the anterolateral ligament (ALL), in the anterolateral region of the knee. This structure is involved in the rotatory instability of the knee and might explain why some isolated reconstructions of the anterior cruciate ligament result in a residual pivot shift. Therefore, when considering the least invasive method for reconstruction of this structure, it is important to identify the corresponding bony landmarks on radiographic images. Purpose: To establish radiographic femoral and tibial landmarks for the ALL in frontal and lateral views. Study Design: Descriptive laboratory study. Methods: Ten unpaired cadaver knees were dissected. The attachments of the ALL were isolated and its anatomic parameters were quantified. Its origin and insertion were marked with a 2-mm-diameter metallic sphere, and radiographs were taken from frontal and lateral views. The obtained images were analyzed and the ALL parameters established. Results: The origin of the ALL in the lateral view was found at a point an average ± SD of 47.5% ± 4.3% from the anterior edge of the femoral condyle and about 3.7 ± 1.1 mm below the Blumensaat line. In the frontal view, the origin was about 15.8 ± 1.9 mm from the distal condyle line. The ALL insertion was an average of 53.2% ± 5.8% from the anterior edge of the lateral tibial plateau in the lateral view and 7.0 ± 0.5 mm below the lateral tibial plateau in the frontal view. In anatomic dissections, the origin of the ALL was 1.9 ± 1.4 mm anterior and 4.1 ± 1.1 mm distal to the lateral collateral ligament, and the insertion was 4.4 ± 0.8 mm below the lateral tibial plateau cartilage. Conclusion: The ALL origin on an absolute lateral radiograph of the knee is approximately 47% of the anterior-posterior size of the condyle and 3.7 mm caudal to the Blumensaat line. In a frontal radiograph, the ALL is 15.8 mm from the posterior bicondyle line. The ALL insertion is approximately 53.2% of the anterior-posterior size of the plateau in the lateral view and 7.0 mm below the articular line in the frontal view. Clinical Relevance: Knowledge of the anatomic landmarks of the ALL on radiography will permit minimally invasive surgical reconstruction with lower morbidity.

OP0063 Associations between Abnormal Infrapatellar FAT PAD Quality and Knee Osteoarthritic Changes in Older Adults: A Cohort Study

BackgroundInfrapatellar fat pad (IPFP), an intracapsular but extrasynovial structure, is situated in the knee under the patella, between the patellar tendon, femoral condyle and tibial plateau, and is structurally similar...

Weight change and change in tibial cartilage volume and symptoms in obese adults

Introduction There is a paucity of data examining the effects of weight change on knee joint structures and symptoms. This study examined the effect of weight change on change in knee cartilage volume and symptoms in an obese cohort. Methods 112 obese subjects (Body Mass Index ≥30 kg/m 2 ) were recruited from various community sources to examine the effect of obesity on musculoskeletal health. Tibial cartilage volume, determined by MRI, and knee symptoms, determined by the Western Ontario and McMaster Osteoarthritis Index (WOMAC) were collected at baseline and an average of 2.3 years later. Results Percentage weight change was associated with change in medial tibial cartilage volume (β −1.2 mm 3 , 95% CI −2.3 to −0.1 mm 3 , p=0.03) that was consistent throughout the spectrum of weight loss through to mild weight gain. Percentage weight change was not associated with change in the lateral tibial (p=0.93) or patella (p=0.32) cartilage volumes. Percentage weight change was associated with change in all WOMAC subscales (all p≤0.01): pain (β −1.8 mm, 95% CI −3.2 to −0.4 mm), stiffness (β −1.6 mm, 95% CI −2.5 to −0.7 mm) and function (β −6.9 mm, 95% CI −11.6 to −2.1 mm). Conclusions The linearity of effect implies that weight loss is associated with reduced medial cartilage volume loss and improved knee symptoms, while weight gain is associated with increased medial cartilage volume loss and worse knee symptoms. These results suggest that in obese people, small amounts of weight change may have the potential for a disease modifying effect on both knee joint structure and symptoms. While weight loss is an important primary management strategy in obese individuals, avoidance of further weight gain should also be a clinical goal.

Weight change and change in tibial cartilage volume and symptoms in obese adults

IntroductionThere is a paucity of data examining the effects of weight change on knee joint structures and symptoms. This study examined the effect of weight change on change in knee...

Quantitative Magnetic Resonance Imaging Assessment of Cartilage Status: A Comparison Between Young Men With and Without Anterior Cruciate Ligament Reconstruction

To assess the cartilage status of the knee joints using magnetic resonance imaging at least 2 years after anterior cruciate ligament reconstruction (ACLR) in young adult men. Thirty young male patients with unilateral ACLR and 15 age-matched and body mass index--matched healthy men (controls) participated in this study. All participants underwent quantitative magnetic resonance imaging scans. Three-dimensional dual-echo steady-state sagittal images were segmented using solid model software to calculate the mean cartilage thickness, and multi-echo sagittal images were segmented with Siemens software (Siemens, Erlangen, Germany) to determine the T2 relaxation time of each cartilage plate. There was no statistically significant difference in the mean thickness of each cartilage plate between the ACLR and control groups (P = .9616 for lateral femoral cartilage, P = .5962 for lateral tibial cartilage, P = .9328 for patellar cartilage, P = .9712 for trochlear cartilage, P = .4408 for medial femoral cartilage, and P = .1933 for medial tibial cartilage). The ACLR group had significantly higher T2 values than the control group in the lateral femoral cartilage (P < .001), lateral tibia (P = .0011), trochlea (P = .0028), medial femur (P < .001), and medial tibia (P < .001). In addition, the patella showed no difference in T2 values between the 2 groups (P = .2152). The medial compartment cartilage showed a much higher percentage change in cartilage T2 values in the ACLR group. Although no difference in cartilage thickness was detected between the ACLR group and the control group, the mean T2 relaxation time in the ACLR patients was significantly longer than that in control subjects. Level III, retrospective comparative study.

Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy

PurposeHigh tibial osteotomy (HTO) is a surgical procedure used to correct abnormal mechanical loading of the knee joint; additionally, intra-articular hyaluronic acid injections have been shown to restore the viscoelastic properties of synovial fluid and balance abnormal biochemical processes. It was hypothesized that combining HTO with intra-articular hyaluronic acid injections would have benefit to improve the cartilage volume of knee joints.MethodsForty patients with medial compartment knee osteoarthritis (OA) were randomly placed into 1 of 2 groups. The study group (n = 20) received 2 cycles (at 6-month intervals) of 5 weekly intra-articular hyaluronic acid injections after HTO operation. The control group (n = 20) did not receive any intra-articular injections after HTO surgery. Cartilage volume (primary outcome) was assessed by magnetic resonance imaging (MRI) pre-operatively and 1 year post-operatively. Treatment efficacy (secondary outcomes) was evaluated with the Western Ontario and McMaster Universities OA Index (WOMAC) and by the comparison of the total rescue medication (paracetamol/diclofenac) used (weeks 6, 12, 24, 48).ResultsMRI studies showed a significant increase in total cartilage volume (p = 0.033), lateral femoral cartilage volume (p = 0.044) and lateral tibial cartilage volume (p = 0.027) in the study group. Cartilage volume loss was detected at the lateral tibial plateau in the control group. There were significant improvements after surgery in both groups for all subscales of WOMAC scores (p < 0.001) compared to the baseline. However, no difference was found between the two groups. The study group had significantly lower amounts of diclofenac consumption (p = 0.017).ConclusionBased on the findings of the present study, intra-articular hyaluronic acid injections may be beneficial for increasing total cartilage volume and preventing the loss of lateral tibiofemoral joint cartilage after HTO.Level of evidenceTherapeutic study, Level I.

Cross-sectional and longitudinal associations between circulating leptin and knee cartilage thickness in older adults

To investigate cross-sectional and longitudinal associations between serum leptin levels and knee cartilage thickness in older adults. A prospective cohort of 163 randomly selected subjects (mean 63 years, range 52-78, 46% women) was studied. Knee cartilage thickness at medial tibial, lateral tibial, femoral and patellar sites was determined using T1-weighted fat-suppressed MRI. Serum leptin levels were measured by radioimmunoassay. Radiographic osteoarthritis, body fat (%), trunk fat (%), weight and height were measured, and body mass index (BMI) was calculated. Cross-sectionally, serum levels of leptin were negatively associated with femoral (β: -0.013, 95% CI -0.022 to -0.003), medial tibial (β: -0.009, 95% CI -0.018 to -0.001), lateral tibial (β: -0.012, 95% CI -0.021 to -0.003) and patellar (β: -0.014, 95% CI -0.026 to -0.002) cartilage thickness after adjustment for covariates. Moreover, BMI, trunk fat and total body fat were negatively associated with cartilage thickness, and the significant associations disappeared after further adjustment for leptin. Longitudinally, both baseline leptin and change in leptin were associated with greater changes in medial tibial cartilage thickness (β: -0.004, 95% CI -0.007 to -0.001 and β: -0.009, 95% CI -0.018 to -0.001, respectively) in multivariable analyses. Serum levels of leptin are independently and consistently associated with reduced cartilage thickness cross-sectionally and longitudinally. In addition, the associations between adiposity measures and cartilage thickness are mediated by leptin, suggesting leptin may play a key role in cartilage thinning.

Cross-sectional and longitudinal associations between systemic, subchondral bone mineral density and knee cartilage thickness in older adults with or without radiographic osteoarthritis

ObjectivesTo investigate cross-sectional and longitudinal associations between systemic bone mineral density (BMD), subchondral BMD (sBMD) and knee cartilage thickness in older adults with or without radiographic osteoarthritis (ROA).MethodsA prospective cohort...

Relationship between knee alignment and T1ρ values of articular cartilage and menisci in patients with knee osteoarthritis

ObjectiveTo assess the relationship between knee alignment and subregional T1ρ values of the femorotibial cartilage and menisci in patients with mild (Kellgren–Lawrence grade 1) to moderate (KL3) osteoarthritis (OA) at 3T. Materials and methods26 subjects with a clinical diagnosis of KL1-3 OA were included and subdivided into three subgroups: varus, valgus, and neutral. All subjects were evaluated on a 3T MR scanner. Mann–Whitney and Wilcoxon signed rank tests were performed to determine any statistically significant differences in subregional T1ρ values of femorotibial cartilage and menisci among the three subgroups of KL1-3 OA patients. ResultsMedial femoral anterior cartilage subregion in varus group had significantly higher (p<0.05) T1ρ values than all cartilage subregions in valgus group. Medial tibial central cartilage subregion had significantly higher T1ρ values (p<0.05) than lateral tibial central cartilage subregion in varus group. The posterior horn of the medial meniscus in neutral group had significantly higher T1ρ values (p<0.0029) than all meniscus subregions in valgus group. ConclusionThere exists some degree of association between knee alignment and subregional T1ρ values of femorotibial cartilage and menisci in patients with clinical OA

SAT0310 Use of Low Dose Aspirin is Associated with Reduced Medial Tibial Cartilage Loss in Symptomatic Osteoarthritis: Data from a Cohort Study

BackgroundInflammation and vascular disease have recently been shown to play a role in the pathogenesis of osteoarthritis (OA). Low dose aspirin is commonly used in the prevention of cardiovascular disease....

Effects of radial tears and partial meniscectomy of lateral meniscus on the knee joint mechanics during the stance phase of the gait cycle-A 3D finite element study

The purpose of the current study was to evaluate influences of radial tears and partial meniscectomy of lateral meniscus on the knee joint mechanics during normal walking by using computational modeling. A 3D geometry of a knee joint of a healthy patient was obtained from our previous study, whereas the data of normal walking were taken from the literature. Cartilage tissue was modeled as a fibril reinforced poroviscoelastic material, whereas meniscal tissue was modeled as a transverse isotropic elastic material. The realistic gait cycle data were implemented into the computational model and the effects of radial tears and partial meniscectemy of lateral meniscus on the knee joint mechanics were simulated. Middle, posterior, and anterior radial tears in lateral meniscus increased stresses by 300%, 430%, and 1530%, respectively, at the ends of tears compared to corresponding areas in the model with intact lateral meniscus. Meniscus tears did not alter stresses and strains at the tibial cartilage surface, whereas partial meniscectomy increased contact pressures, stresses, strains and pore pressures in the tibial cartilage by 50%, 44%, 21%, and 43%, respectively. Increased stresses and strains were observed primarily during the first ∼50% of the stance phase of the gait cycle. The present study suggests that anterior radial tear causes the highest risk for the development of total meniscal rupture, whereas partial meniscectomy increases the risk for the development of OA in lateral tibial cartilage. Highest risks for meniscus and cartilage failures are suggested to occur during the loading response and mid-stance of the gait cycle. In the future, the present modeling may be further developed to offer a clinical tool for aid in decision making of clinical interventions for patients with knee joint injuries.

Body fat is associated with increased and lean mass with decreased knee cartilage loss in older adults: a prospective cohort study

To determine the associations between body composition at baseline and knee cartilage loss over 2.9 years in older adults. A total of 395 randomly selected subjects (mean 62 years, range 51-81, 50% female) were studied at baseline and 2.9 years later. T1-weighted fat-suppressed magnetic resonance imaging of the right knee was performed to determine knee cartilage volume and tibial bone area at baseline and follow-up. Height, weight and radiographic osteoarthritis were measured by standard protocols at baseline. Fat mass and lean mass were measured by dual-energy X-ray absorptiometry at baseline. Tibial cartilage volume decreased by 2.0-2.7% per annum. In multivariable analysis, annual change in medial cartilage volume was negatively and significantly associated with body mass index (β: -0.14% per kg m(-2), 95% confidence interval (CI): -0.25%, -0.02%), percentage total body fat (β: -0.19% per %, 95% CI: -0.30%, -0.07%) and percentage trunk fat (β: -0.10% per %, 95% CI: -0.19%, -0.02%), and positively associated with percentage lean mass (β: 0.20% per %, 95% CI: 0.08%, 0.32%). Change in lateral tibial cartilage volume was also significantly associated with percentage total body fat (β: -0.11% per %, 95% CI: -0.21%, -0.001%) and total lean mass (β: 0.13% per kg, 95% CI: 0.04%, 0.22%). These were independent of sex and age even though both were also significant predictors. Body fat adversely affects tibial cartilage loss over time, whereas lean mass is protective. Strategies aimed at reducing body fat but increasing lean mass may reduce knee cartilage loss in older people.

The association between parity and knee cartilage in young women

There have been no reported studies of the association between parity and cartilage in young individuals. The aim of this study was to describe the association between parity, cartilage volume and cartilage defects in women aged 31-41 years. Cross-sectional study of 144 women, mean age 36 years and BMI 25 kg/m(2), who were participants in an established prospective study. Parity was assessed using a questionnaire. Knee (medial tibial, lateral tibial and patellar) cartilage volume, cartilage defects (grade 0-4 depending on the severity of cartilage thickness loss at tibial and patellar sites) and tibial bone area were assessed using T1-weighted fat-suppressed MRI. The prevalence of cartilage defects (grade ≥2) in this population was 13%. Parity was associated with a higher risk of cartilage defects at the patellar [prevalence ratio (PR) per birth 1.52, 95% CI 1.05, 2.21; PR parous vs nulliparous 1.93, 95% CI 0.66, 5.65], but not tibial sites, after adjustment for confounders including age, BMI, smoking, physical activity, knee injury and tibial bone area. This association between parity and patellar cartilage defects was stronger for those women who had three or more births (vs nulliparous, PR 5.27, 95% CI 1.39, 20.01). There were no significant associations between parity and cartilage volume. Parity was associated with knee cartilage defects primarily at the patellar site in this sample of young women. This association was more apparent with increasing number of live births, suggesting a possible adverse effect of parity on knee cartilage.

Examining the cytokine profiles of whole blood and autologous protein solution of patients with osteoarthritis: preliminary results

surgery) and total used of rescue medication (acetaminophen/diclofenac). Cartilage volume measurements were assessed by Magnetic Resonance Imaging (MRI) at preoperative period and 1 year after operation. Results: All patients completed 1 year of study period. After the surgery, all subscales of WOMAC scores in both groups were significantly improved (p<0.001) when compare to baseline levels. However, there were no differences between the two groups. Patients who received intra-articular hyaluronic acid injections had significantly reduce the amount of diclofenac consumption (p¼0.017). MRI studies showed significantly increase of the total cartilage volume (p¼0.033), lateral femoral volume (p¼0.044) and lateral tibial volume (p¼0.027) in the study group compared to the control group. In addition, loss of lateral tibial plateau cartilage volume was showed only in the control group. There were no severe adverse events in both groups. Conclusion: This study demonstrated positive synergistic effect for using continuous intra-articular hyaluronic acid injection in patients with osteoarthritis of the knee who underwent high tibial osteotomy. Base on our finding, intra-articular hyaluronic acid may beneficial to increased total cartilage volume and prevented the loss of cartilage at lateral tibiofemoral joint after high tibial osteotomy. Further long term studies with larger number of patients are warranted.