Cartilage Lesions Research Articles

Factors associated with meniscus volume in knees free of degenerative features

To explore factors that were associated with meniscus volume in knees free of radiographic osteoarthritis (OA) features and symptoms of OA. In the third Rotterdam Study cohort, clinical, radiographic, and magnetic resonance data were obtained at baseline (BL) and after 5 years of follow-up. Meniscus volumes and their change over time were calculated after semi-automatic segmentation on Magnetic Resonance Imaging. Knees with radiographic OA features (Kellgren and Lawrence>0) or clinical diagnosis of OA (American College of Rheumatology) at BL were excluded. Ten OA risk factors were adjusted in the multivariable analysis (generalized estimating equations), treating two knees within subjects as repeated measurements. From 1065 knees (570 subjects), the average (standard deviation) age and Body mass index (BMI) of included subjects were 54.3 (3.7) years and 26.5 (4.4) kg/m2. At BL, nine factors (varus alignment, higher BMI, meniscus pathologies, meniscus extrusion, cartilage lesions, injury, greater physical activity level, quadriceps muscle strength, and higher age) were significantly associated with greater meniscus volume. Five factors (injury, meniscus pathologies, meniscus extrusion, higher age, and change of BMI) were significantly associated with meniscus volume loss. Modifiable factors (varus alignment, BMI, physical activity level, and quadriceps muscle strength) and non-modifiable factors (higher age, injury, meniscus pathologies, meniscus extrusion, and cartilage lesions) were all associated with meniscus volume or meniscus volume loss over time.

Nuclear protein-1 is the common link for pathways activated by aging and obesity in chondrocytes: A potential therapeutic target for osteoarthritis.

Pathways leading to osteoarthritis (OA) are diverse depending on the risk factors involved; thus, developing OA therapeutics has been challenging. Here we report that nuclear protein-1 (Nupr1), a stress-inducible protein/transcription factor, is activated by pathways associated with obesity and aging in chondrocytes. Treatment of human chondrocytes with free fatty acids (palmitate and oleate; a model for high-fat diet/obesity) induced PERK signaling and increased expression of caspase-3, TRB3, and Nupr1. On the other hand, treatment of chondrocytes with menadione (oxidative stress inducer) induced oxidation of IRE1, activated antioxidant response (higher Nrf2 expression), and increased expression of Nupr1 and matrix metalloproteinases. Experimental OA was induced by destabilization of the medial meniscus (DMM) in the knee joints of Nupr1+/+ and Nupr1-/- mice. Loss of Nupr1 expression reduced the severity of cartilage lesions in this model. Together, our findings suggest that Nupr1 is a common factor activated by signaling pathways activated by obesity (ER stress) and age (oxidative stress) and a potential drug target for OA resulting from various risk factors.

FACTORS AFFECTING RETURN TO SPORT IN ELITE ATHLETES AFTER MICROFRACTURE FOR CHONDRAL LESIONS IN THE KNEE

AbstractIntroductionThe aim of this study was to determine the factors affecting return to sport (RTS) and career longevity of elite athletes after microfracture of the knee.MethodsA retrospective review of a consecutive series of elite athletes with chondral injuries in the knee treated with microfracture was undertaken. RTS was defined as competing in at least one event at professional level or national/ international level in amateur sport. Demographic, pre, intra and post operative factors affecting RTS were analysed.ResultsFifty six athletes, including 35 (62.5%) footballers and 14 (25.0 %) rugby players, with a mean age 24.8 (+/− 3.9) years, were included. 18 (32.1 %) of chondral injuries were secondary to trauma, 20 (35.7 %) post meniscectomy, 9 (16.1%) post anterior cruciate ligament (ACL) reconstruction and 9 (16.1%) idiopathic.Fifty (89.3%) of athletes RTS at a mean time of 10.0 (+/−5.8) months. 43 (86.0%) athletes were still playing at 2 years. At 5 years 25 (59.5%) of the players who had RTS and had surgery more than 5 years ago were still playing professional sport.Factors associated with not playing at 5 years were cartilage lesions >1.5cm2(52.4% vs 66.7%), more than 1 lesion (35.7% vs74.1%), lateral meniscal surgery (42.1% vs 73.7%) and effusion on RTS (47.7% vs 72.2%).ConclusionOver 89 % of elite athletes returned to professional sport after microfracture in the knee. However, the ability to continue playing is affected by several factors such as the extent of the chondral damage and recurrent effusions.

Selenomethionine Antagonized microRNAs Involved in Apoptosis of Rat Articular Cartilage Induced by T-2 Toxin.

T-2 toxin and selenium deficiency are considered important etiologies of Kashin-Beck disease (KBD), although the exact mechanism is still unclear. To identify differentially expressed microRNAs (DE-miRNAs) in the articular cartilage of rats exposed to T-2 toxin and selenomethionine (SeMet) supplementation, thirty-six 4-week-old Sprague Dawley rats were divided into a control group (gavaged with 4% anhydrous ethanol), a T-2 group (gavaged with 100 ng/g·bw/day T-2 toxin), and a T-2 + SeMet group (gavaged with 100 ng/g·bw/day T-2 toxin and 0.5 mg/kg·bw/day SeMet), respectively. Toluidine blue staining was performed to detect the pathological changes of articular cartilage. Three rats per group were randomly selected for high-throughput sequencing of articular cartilage. Target genes of DE-miRNAs were predicted using miRanda and RNAhybrid databases, and the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway were enriched. The network map of miRNA-target genes was constructed using Cytoscape software. The expression profiles of miRNAs associated with KBD were obtained from the Gene Expression Omnibus database. Additionally, the DE-miRNAs were selected for real-time quantitative PCR (RT-qPCR) verification. Toluidine blue staining demonstrated that T-2 toxin damaged articular cartilage and SeMet effectively alleviated articular cartilage lesions. A total of 50 DE-miRNAs (28 upregulated and 22 downregulated) in the T-2 group vs. the control group, 18 DE-miRNAs (6 upregulated and 12 downregulated) in the T-2 + SeMet group vs. the control group, and 25 DE-miRNAs (5 upregulated and 20 downregulated) in the T-2 + SeMet group vs. the T-2 group were identified. Enrichment analysis showed the target genes of DE-miRNAs were associated with apoptosis, and in the MAPK and TGF-β signaling pathways in the T-2 group vs. the control group. However, the pathway of apoptosis was not significant in the T-2 + SeMet group vs. the control group. These results indicated that T-2 toxin induced apoptosis, whereas SeMet supplementation antagonized apoptosis. Apoptosis and autophagy occurred simultaneously in the T-2 + SeMet group vs. T-2 group, and autophagy may inhibit apoptosis to protect cartilage. Compared with the GSE186593 dataset, the evidence of miR-133a-3p involved in apoptosis was more abundant. The results of RT-qPCR validation were consistent with RNA sequencing results. Our findings suggested that apoptosis was involved in articular cartilage lesions induced by T-2 toxin, whereas SeMet supplementation antagonized apoptosis, and that miR-133a-3p most probably played a central role in the apoptosis process.

Arthroscopic posterior capsulolabral repair grants adequate outcomes in shoulders with posterior instability without glenoid cartilage lesions.

Posterior capsulolabral repair (posterior Bankart) is effective to restore shoulder stability and relieve pain, though a recent meta-analysis reported recurrent instability in 9.5% of patients, and that only 62.7% were able to resume sports. The purpose of this study was to assess the outcomes of arthroscopic posterior capsulolabral repair in a population of unselected patients, in terms of recurrence of instability, clinical scores, and return to sports. The authors retrospectively studied a consecutive series of 22 patients that underwent posterior capsulolabral repair between 2009 and 2019. Patients were assessed before posterior capsulolabral repair and at a minimum follow-up of 24months, in terms of subjective shoulder value (SSV), Western Ontario Shoulder Instability Index (WOSI), as well as level of sport. Following surgery, all complications, reoperations or episodes of instability were noted. The cohort comprised 21 men (95%) and 1 woman (5%), aged 38.8 ± 12.5years (range 17-61) at index surgery. Of the 20 patients that performed sports, only 2 (10%) stopped sports after surgery, while 18 resumed their main sport (90%). At a follow-up of 65.4 ± 34.8months (range 25-146), the SSV was 85.1 ± 14.7, pain on VAS was 1.9 ± 2.1, and the Constant-Murley score was 71.6 ± 17.9. Five patients had subjective instability without dislocation (23%). Nine patients (41%) had no pain (0 points), 6 patients (27%) had mild pain (1-2 points), 4 patients (18%) had moderate pain (3 points), while 3 patients (14%) had severe pain (5-8 points). Arthroscopic posterior capsulolabral repair prevented recurrent dislocation in patients with posterior shoulder instability at a minimum follow-up of 2years, despite persistent pain in 32%, and subjective instability in 23%. These complications were mainly observed in patients with work-related accidents and glenoid cartilage lesions. III, case series.

Minced Cartilage Implantation in Acetabular Cartilage Defects: Case Series with 2-Year Results.

The objective was to evaluate clinical outcome and safety of arthroscopic, autologous minced cartilage implantation for acetabular cartilage lesions observed during hip arthroscopy to treat femoroacetabular impingement syndrome (FAIS). Eleven male patients, average age: 29.4 ± 5.4 years, average body mass index (BMI): 24.2 ± 2.2 kg/m2, scheduled for hip arthroscopy due to FAIS accompanied by an acetabular cartilage lesion were included in the case series. Cartilage tissue was harvested and minced from the loose cartilage flap at the chondrolabral lesion by arthroscopic shaver, augmented with autologous conditioned plasma, implanted into the defect, and fixated by autologous thrombin. Concomitant interventions were performed as indicated. The patients were evaluated preoperatively and at 24-month follow-up, using the International Hip Outcome Tool-12 (iHOT-12) and Visual Analog Scale (VAS) pain score and by magnetic resonance imaging (MRI) using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) grading scale at the 2-year follow-up. The defect size was on average 3.5 cm2 (1.5-4.5 cm2). From preoperatively to 2 years postoperatively, the iHOT-12 significantly improved from 50.2 ± 18 to 86.5 ± 19 (P < 0.0001), and pain score decreased from 5.6 ± 1.8 to 1.0 ± 1.5 (P < 0.0001) on the Visual Analog Scale pain score. Regarding functional outcome and pain, 10 of the 11 patients and all patients reached the minimal clinically important difference (MCID), respectively. The postoperative average MOCART score was 87.2 (± 9.2). No adverse events or reoperations were observed. Arthroscopic, autologous minced cartilage implantation for treating full-thickness acetabular cartilage lesions in FAIS shows statistically and clinically significant improvement at short-term follow-up.

Concomitant Injuries Associated With ACL Rupture in Elite Professional Alpine Ski Racers and Soccer Players: A Comparative Study With Propensity Score Matching Analysis.

For elite professional soccer players and alpine skiers, injuries associated with anterior cruciate ligament (ACL) rupture, such as meniscal, cartilage, or collateral ligament lesions, could result in a delayed return to sport compared with isolated ACL injury. The purpose of the study was to provide a detailed description of associated injuries at the time of primary ACL reconstruction in elite soccer players and alpine skiers. It was hypothesized that soccer players and skiers would present different typical injury patterns due to different injury mechanisms. Cohort study; Level of evidence, 3. Surgical reports and arthroscopic images of elite professional soccer players and alpine skiers who underwent primary ACL reconstruction at a single institution between January 2010 and June 2022 were analyzed retrospectively. The presence and location of multiligamentous injury, meniscal tears, and chondral lesions were compared between the athlete groups. A propensity score matching analysis with 1:1 ratio was performed between skiers and soccer players to limit the effect of selection bias. Included were ACL reconstruction data representative of 37 soccer players and 44 alpine skiers. Meniscal pathology was found in 32 (86%) soccer players and 30 (68%) skiers. Chondral injuries were reported in 11 (30%) soccer players and 15 (34%) skiers. Results of the propensity score matching analysis in 15 pairs of soccer players and skiers indicated that soccer players had a significantly higher rate of medial meniscal injuries (73% vs 27%; P = .03) and lateral posterior root tears (33% vs 0%; P = .04) compared with skiers. A higher prevalence of combined chondral and meniscal injuries versus isolated ACL injuries was observed in both groups of athletes. Professional soccer players were characterized by higher prevalence of medial meniscal tears and lateral posterior root lesions compared with professional alpine skiers.

Growth factor-loaded sulfated microislands in granular hydrogels promote hMSCs migration and chondrogenic differentiation.

Cell-based therapies for articular cartilage lesions are expensive and time-consuming; clearly, a one-step procedure to induce endogenous repair would have significant clinical benefits. Acellular heterogeneous granular hydrogels were explored for their injectability, cell-friendly cross-linking, and ability to promote migration, as well as to serve as a scaffold for depositing cartilage extracellular matrix. The hydrogels were prepared by mechanical sizing of bulk methacrylated hyaluronic acid (HAMA) and bulk HAMA incorporating sulfated HAMA (SHAMA). SHAMA's negative charges allowed for the retention of positively charged growth factors (GFs) (e.g., TGFB3 and PDGF-BB). Mixtures of HAMA and GF-loaded SHAMA microgels were annealed by enzymatic cross-linking, forming heterogeneous granular hydrogels with GF deposits. The addition of GF loaded sulfated microislands guided cell migration and enhanced chondrogenesis. Granular heterogeneous hydrogels showed increased matrix deposition and cartilage tissue maturation compared to bulk or homogeneous granular hydrogels. This advanced material provides an ideal 3D environment for guiding cell migration and differentiation into cartilage. STATEMENT OF SIGNIFICANCE: Acellular materials which promote regeneration are of great interest for repair of cartilage defects, and they are more cost- and time-effective compared to current cell-based therapies. Here we develop an injectable, granular hydrogel system which facilities cell migration from the surrounding tissue, facilitating endogenous repair. The hydrogel architecture and chemistry were optimized to increase cell migration and extracellular matrix deposition. The present study provides quantitative data on the effect of microgel size and chemical modification on cell migration, growth factor retention and tissue maturation.

Single-step ultra-purified alginate gel implantation in patients with knee chondral defects.

Implantation of ultra-purified alginate (UPAL) gel is safe and effective in animal osteochondral defect models. This study aimed to examine the applicability of UPAL gel implantation to acellular therapy in humans with cartilage injury. A total of 12 patients (12 knees) with symptomatic, post-traumatic, full-thickness cartilage lesions (1.0 to 4.0 cm2) were included in this study. UPAL gel was implanted into chondral defects after performing bone marrow stimulation technique, and assessed for up to three years postoperatively. The primary outcomes were the feasibility and safety of the procedure. The secondary outcomes were self-assessed clinical scores, arthroscopic scores, tissue biopsies, and MRI-based estimations. No obvious adverse events related to UPAL gel implantation were observed. Self-assessed clinical scores, including pain, symptoms, activities of daily living, sports activity, and quality of life, were improved significantly at three years after surgery. Defect filling was confirmed using second-look arthroscopy at 72 weeks. Significantly improved MRI scores were observed from 12 to 144 weeks postoperatively. Histological examination of biopsy specimens obtained at 72 weeks after implantation revealed an extracellular matrix rich in glycosaminoglycan and type II collagen in the reparative tissue. Histological assessment yielded a mean overall International Cartilage Regeneration & Joint Preservation Society II score of 69.1 points (SD 10.4; 50 to 80). This study provides evidence supporting the safety of acellular UPAL gel implantation in facilitating cartilage repair. Despite being a single-arm study, it demonstrated the efficacy of UPAL gel implantation, suggesting it is an easy-to-use, one-step method of cartilage tissue repair circumventing the need to harvest donor cells.

The use of radiofrequency in equine orthopedic surgery.

The use of radiofrequency energy (RFE) has become increasingly popular in equine orthopedic surgery in recent years, particularly for the debridement of cartilage lesions and soft tissue resection. However, despite considerable advancements in the technology, the safety and efficacy of RFE have continued to be questioned. While studies investigating the use of RFE for chondroplasty in the equine population are lacking, there is an abundance of research studies in the human literature assessing its effect on healthy chondrocytes, and researchers are seeking to develop guidelines to minimize collateral damage. This review article provides a concise and thorough summary of the current use of RFE in equine orthopedics, in addition to discussing the recent evidence surrounding its use for chondroplasty in both the human and equine populations.

Facteurs de risque de persistance d’un kyste poplité résiduel après décompression arthroscopique et kystectomie : association avec des lésions cartilagineuses dégénératives

BackgroundIn previous studies, good results have been reported after arthroscopic treatment of popliteal cysts and concomitant intra-articular pathology. However, only a few studies have reported the associated factors with residual popliteal cysts. The aim of this study was to examine the clinical and radiographic outcomes and investigate the factors associated with the recurrence of popliteal cyst after arthroscopic cyst decompression and cyst wall resection. HypothesisThe authors hypothesized that residual popliteal cyst after arthroscopic decompression and cystectomy would be associated with degenerative cartilage lesions. Patients and methodsFrom December 2010 to December 2018, 54 patients with popliteal cysts were treated with arthroscopic decompression and cyst wall resection through an additional posteromedial cystic portal. Magnetic resonance imaging (MRI) or ultrasonography was used to observe whether the popliteal cyst had disappeared or decreased. The maximum diameter of the popliteal cyst was measured after surgery. The patients were classified into the disappeared and reduced groups according to the treatment outcome. Age, sex, symptom duration, preoperative degenerative changes based on the Kellgren–Lawrence (K-L) grade, cartilage lesions according to the International Cartilage Repair Society (ICRS) grades, synovitis, functional outcomes, and associated intra-articular lesions were compared between the two groups. The functional outcome was evaluated on the basis of the Rauschning and Lindgren knee score. The study included 22 men and 32 women, with mean age of 49.6years (range: 5–82years). According to the ICRS grade system, 28 (51.8%) patients had grade 0 to II, 26 (48.2%) patients had grade III to IV. ResultsFollow-up radiographic evaluation revealed that the cyst had completely disappeared in 20 patients (37%) and reduced in size in 34 (63%). The mean cyst size was decreased significantly from 5.7cm (range: 1.7–15cm) to 1.7cm (range: 0–6.4cm), and the Rauschning and Lindgren knee score showed improved clinical features in all the patients. Between the disappeared and reduced groups, the presence of degenerative cartilage lesions (p=0.022, odds ratio 8.702, 95% confidence interval: 1.368–55.362) showed a statistically significant differences. DiscussionThrough the posteromedial cystic portal, cysts were completely removed in approximately 40% of patients, and the size was reduced in 60% of patients. Presence of degenerative cartilage lesion represents an associated risk factor for residual popliteal cyst. These findings could be helpful in ensuring explaining poor prognostic factors. Level of evidenceIIIb; retrospective cohort study.

Tongbi Huoluo Decoction alleviates cartilage degeneration in knee osteoarthritis by inhibiting degradation of extracellular matrix

BackgroundKnee osteoarthritis (KOA) is an age-related degenerative disease characterized by abrasion of articular cartilage. Tongbi Huoluo Decoction (TBHLD) has been transformed from the famous traditional Chinese medicine Duhuo Jisheng Decoction, which can effectively alleviate pain symptoms in KOA. However, the active components and mechanisms of TBHLD in treating KOA have not yet been elucidated. The purpose of the study was to demonstrate the molecular mechanism of TBHLD in treating KOA.MethodsThe components and targets of TBHLD and KOA were collected from multiple databases, and the protein to protein interaction (PPI) network was constructed. Next, we performed topological calculation and enrichment analysis. Besides, we performed virtual screening for molecular docking and molecular dynamics simulation (MDS). Furthermore, the vitro and vivo experiments were performed to evaluate the validity and mechanism of TBHLD.Results206 active components and 187 potential targets were screened from Tongbi Huoluo Decoction. A total of 50 intersecting genes were identified between TBHLD and KOA, 20 core targets were calculated by network topology analysis. The core targets were enriched in the ECM interaction pathways. The results of virtual screening for molecular docking and MDS showed that the active components of TBHLD had steady binding conformations with core genes. Moreover, we identified 32 differential serum components in TBHLD-containing serum using LC–MS, including 22 upregulated and 10 downregulated serum components. TBHLD improved the proliferation activity of OA chondrocytes, decreased the expression of Col1a1, Col1a2, Mmp2, Mmp13 in OA chondrocytes, ameliorated the cartilage lesions and restored the cartilage abrasion.ConclusionTBHLD inhibited degradation of cartilage ECM by regulating the expression of type I collagens and Mmps to ameliorate cartilage degeneration in KOA.

Predilection of Patellofemoral Cartilage Lesions in Patients with Posterior Medial Meniscal Root Lesions.

The present study aims to compare the presence and severity of patellofemoral osteoarthritis between patients with root lesions and non-root lesions. A total of 102 patients were included in this study (51 root lesions and 51 non-root lesions). The root lesion cohort was matched to a non-root lesion cohort based on sex, body mass index, and age at the time of surgery. Radiographic evaluation with modified Outerbridge scoring of MRI of the knee was performed to determine the severity of degeneration of the knee joint preoperatively. Mann-Whitney and Independent t tests were used to compare the groups. The root lesion group had statistically greater Outerbridge patella scores (M = 2.45 ± 1.12) and trochlear scores (M = 2.27 ± 1.37) than the non-root lesion patients (M = 1.78 ± 1.30, P = 0.006, and M = 1.55 ± 1.40, P = 0.010, respectively). When using a new scale for grading patellofemoral arthritis, the root lesion group had statistically greater scores (M = 8.33 ± 3.38) than the non-root lesion patients (M = 5.67 ± 3.07) (P < 0.001). Patients with root lesions have a greater degree of patellofemoral cartilage lesions than patients without root lesions. The presence of cartilage lesions preoperatively in root lesion patients has presented the question of whether repair is worthwhile or if one should delay surgery until arthroplasty is indicated. Future research should be carried out on outcomes of root repair surgery in patients with patellofemoral cartilage lesions, in addition to considering the patient's age, activity level, and other risk factors.

Reliability of Conventional Hip MRI in Detecting Labral Tear and Labrocartilagenous Lesions in cases of Femoroacetabular Impingement, A Comparative Study with Hip Arthroscopy.

Imaging studies play a crucial role in diagnosing femoroacetabular impingement (FAI), including plain radiography and Magnetic Resonance Imaging (MRI). FAI is a combined pathology of bony abnormality, labral and labrocartilagenous erosions. Surgical treatment for such cases has become more established and preoperative imaging is the roadmap that includes the assessment of labrum and articular cartilage. During a period of 2 years, thirty-seven patients with a clinical diagnosis of FAI were retrospectively enrolled in this study, including 17 men and 20 women, aged 27-62 years. There were 22 right hips and 15 left hips. MRI was done for all patients to identify bony details, labral and chondral abnormalities and to exclude coexisting disorders. The imaging findings were compared with the arthroscopic data. 15 patients had Pincer FAI, 11 patients had CAM, and 11 patients had combined Cam/Pincer FAI. Labral tear was detected in 100 % of patients, 97 % had an anterosuperior labral tear. 82 % of patients had partial thickness cartilage lesions and 8 % had full thickness cartilage lesions. MRI had a sensitivity of 100 % compared to hip arthroscopy in detecting labral tear, 60 % in detecting cartilage erosion. Conventional hip MRI detects bony changes in FAI, type of impingement and associated labral tear and cartilage erosions in comparison to the hip arthroscopy.

Deep Learning Convolutional Neural Network Reconstruction and Radial k-Space Acquisition MR Technique for Enhanced Detection of Retropatellar Cartilage Lesions of the Knee Joint.

To assess diagnostic performance of standard radial k-space (PROPELLER) MRI sequences and compare with accelerated acquisitions combined with a deep learning-based convolutional neural network (DL-CNN) reconstruction for evaluation of the knee joint. Thirty-five patients undergoing MR imaging of the knee at 1.5 T were prospectively included. Two readers evaluated image quality and diagnostic confidence of standard and DL-CNN accelerated PROPELLER MR sequences using a four-point Likert scale. Pathological findings of bone, cartilage, cruciate and collateral ligaments, menisci, and joint space were analyzed. Inter-reader agreement (IRA) for image quality and diagnostic confidence was assessed using intraclass coefficients (ICC). Cohen's Kappa method was used for evaluation of IRA and consensus between sequences in assessing different structures. In addition, image quality was quantitatively evaluated by signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements. Mean acquisition time of standard vs. DL-CNN sequences was 10 min 3 s vs. 4 min 45 s. DL-CNN sequences showed significantly superior image quality and diagnostic confidence compared to standard MR sequences. There was moderate and good IRA for assessment of image quality in standard and DL-CNN sequences with ICC of 0.524 and 0.830, respectively. Pathological findings of the knee joint could be equally well detected in both sequences (κ-value of 0.8). Retropatellar cartilage could be significantly better assessed on DL-CNN sequences. SNR and CNR was significantly higher for DL-CNN sequences (both p < 0.05). In MR imaging of the knee, DL-CNN sequences showed significantly higher image quality and diagnostic confidence compared to standard PROPELLER sequences, while reducing acquisition time substantially. Both sequences perform comparably in the detection of knee-joint pathologies, while DL-CNN sequences are superior for evaluation of retropatellar cartilage lesions.

Diagnostic Performance of Multi-Detector Computed Tomography Arthrography and 3-Tesla Magnetic Resonance Imaging to Diagnose Experimentally Created Articular Cartilage Lesions in Equine Cadaver Stifles.

The purpose of the study was to determine the diagnostic performance of computed tomographic arthrography (CTA) and 3-Tesla magnetic resonance imaging (MRI) for detecting artificial cartilage lesions in equine femorotibial and femoropatellar joints. A total of 79 cartilage defects were created arthroscopically in 15 cadaver stifles from adult horses in eight different locations. In addition, 68 sites served as negative controls. MRI and CTA (80-160 mL iodinated contrast media at 87.5 mg/mL per joint) studies were obtained and evaluated by a radiologist unaware of the lesion distribution. The stifles were macroscopically evaluated, and lesion surface area, depth, and volume were determined. The sensitivity and specificity of MRI and CTA were calculated and compared between modalities. The sensitivity values of CTA (53%) and MRI (66%) were not significantly different (p = 0.09). However, the specificity of CTA (66%) was significantly greater compared to MRI (52%) (p = 0.04). The mean lesion surface area was 11 mm2 (range: 2-54 mm2). Greater lesion surface area resulted in greater odds of lesion detection with CTA but not with MRI. CTA achieved a similar diagnostic performance compared to high-field MRI in detecting small experimental cartilage lesions. Despite this, CTA showed a higher specificity than MRI, thus making CTA more accurate in diagnosing normal cartilage. Small lesion size was a discriminating factor for lesion detection. In a clinical setting, CTA may be preferred over MRI due to higher availability and easier image acquisition.

Surgical Treatment ofFocal Chondral Lesions ofthe Knee inthe Military Population: Current andFuture Therapies.

Chondral and osteochondral defects of the knee are common injuries in the military population that have a significant impact on readiness. Definitive treatment of these injuries is challenging since cartilage has a limited capacity for self-repair and regeneration. Management is particularly challenging in military patients who maintain a higher level of activity similar to athletes. Existing surgical techniques have variable results and often long recovery times, sparking the development of several new innovative technologies to return service members back to duty more quickly and effectively after cartilage injury. The purpose of this article is to review the current and future surgical treatments for chondral and osteochondral knee lesions and their relevance in managing these injuries in the military. In this review article, we describe the current treatments for chondral and osteochondral defects of the knee, reporting on outcomes in military populations. We explore emerging treatment modalities for cartilage defects, reporting innovations, stage of research, and current data. Published results of each treatment option in military populations are reviewed throughout the article. This review includes 12 treatments for chondral lesions. Of these therapies, four are considered synthetic and the remaining are considered regenerative solutions. Regenerative therapies tend to perform better in younger, healthier populations with robust healing capacity. Success of treatment depends on lesions and patient characteristics. Nearly all modalities currently available in the USA were successful in improving patients from presurgical function in the short (<6 months) term, but the long-term efficacy is still challenged. Upcoming technologies show promising results in clinical and animal studies that may provide alternative options desirable for the military population. The current treatment options for cartilage lesions are not entirely satisfactory, usually with long recovery times and mixed results. An ideal therapy would be a single procedure that possesses the ability to enable a quick return to activity and duty, alleviate pain, provide long-term durability, and disrupt the progression of osteoarthritis. Evolving technologies for cartilage lesions are expanding beyond currently available techniques that may revolutionize the future of cartilage repair.

Hip rotation muscle strength is implicated in the progression of early post-traumatic osteoarthritis: A longitudinal evaluation up to 5 years following ACL reconstruction

IntroductionFollowing ACL reconstruction (ACLR), deficits in hip muscle strength and relationships to future outcomes are unknown. Methods111 participants one year after ACLR, completed hip external rotation (ER) and internal rotation (IR) strength assessment. At 1 (n = 111) and 5 (n = 74) years post-ACLR, participants completed a battery of functional, symptomatic (Knee Osteoarthritis Outcome Score (KOOS)) and structural assessments (radiography, magnetic resonance imaging (MRI)). Cartilage health of the patellofemoral and tibiofemoral compartments was assessed with the semiquantitative MRI Osteoarthritis Knee Score. Hip rotation strength was compared between-limbs, and relationships between hip strength at 1 year and functional, symptomatic and cartilage outcomes at 1 and 5 years were investigated with regression models. ResultsThe index (ACLR) limb had weaker hip ER (but not IR) strength compared to the contralateral side (standardised mean difference ER = −0.33 (95%CI -0.60, −0.07; IR = −0.11 (95%CI -0.37, 0.15). Greater hip ER and IR strength was associated with superior function at 1 and 5 years, and better KOOS-Patellofemoral symptoms at 5 years. Greater hip ER strength was associated with lower odds of worsening tibiofemoral cartilage lesions at 5 years (odds ratio 0.01, 95%CI 0.00, 0.41). ConclusionHip rotation strength may play a role in worsening function, symptoms and cartilage health after ACLR.

Additional Anterolateral Ligament Reconstruction Helps Patients Improve Dynamic Postural Stability in Revision Anterior Cruciate Ligament Reconstruction.

Background and Objectives: The goal in treating anterior cruciate ligament (ACL) injury especially in revision cases is return to sports activity by regaining dynamic postural stability. Among various methods to achieve this goal, additional anterolateral ligament reconstruction (ALLR) is gaining attention. The purpose of this study was to evaluate the effects of additional ALLR in revision ACL reconstruction (RACLR). Materials and Methods: Patients who underwent RACLR between July 2015 and June 2018 were enrolled. The exclusion criteria were less than 1-year follow-up, age older than 45 years, concomitant multiple ligament injuries, contralateral knee injury, subtotal or total meniscectomized state, and articular cartilage lesions worse than Outerbridge grade 3. Thirty-nine patients (20 patients; RACLR only (Group A), 19 patients; RACLR with additional ALLR (Group B)) were included. Clinical scores (Lysholm score, subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale), isokinetic strength test, single-leg-hop for distance test (SLHDT), Y-balance test (YBT) were checked preoperatively and 1-year postoperatively. Results: Limb symmetry index values in YBT showed significantly better result in Group B 1-year postoperatively (Group A: 97.2 ± 4.0, Group B: 100.3 ± 2.9, p = 0.010), although there were no differences preoperatively between groups (Group A: 90.4 ± 6.7, Group B: 89.3 ± 5.5, p = 0.594). Regarding clinical scores, isokinetic strength tests, and SLHDT, there were no differences between groups preoperatively nor 1-year postoperatively. Conclusions: Additional ALLR in RACLR helped patients gain better dynamic postural stability at 1-year postoperative follow-up.

Poster 290: Effect of Platelet-rich Plasma Injections on Cartilage T1rho in Knee Osteoarthritis

Poster 290: Effect of Platelet-rich Plasma Injections on Cartilage T1rho in Knee Osteoarthritis