Magnetic Resonance Imaging Of Cartilage Research Articles

DELAYED GADOLINIUM-ENHACED MAGNETIC RESONANCE IMAGING OF CARTILAGE IS A PREDICTOR OF PERIACETABULAR OSTEOTOMY FAILURE IN PATIENTS 40 YEARS AND OLDER

Pelvic osteotomies for hip dysplasia results can be variable and depend on the amount of preexisting arthritis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a technique designed to measure early arthritis, and could be used to select hips that would benefit from a joint-preserving reconstructive procedure. Our objective was to investigate the role of preoperative dGEMRIC in predicting the success of PAO in patients 40 and above. We hypothesized that patients who failed had lower preoperative dGEMRIC index compared to those who did not.Following IRB approval, patients 40 or older who underwent PAO between 1990–2013 and had preoperative dGEMRIC scan and minimum follow-up of 4 years were identified. Patients with prior hip surgeries or any pathologies were removed leading to a total of 70 patients (Age: 44.2 ± 2.9 years old, BMI: 25.7 ± 4.5 Kg/m2). We only included the first hip undergoing PAO for those with bilateral PAO. Out of 70, 19 had failure defined by the need for total hip replacement or WOMAC pain score of 10 and above within 10 years after index PAO surgery. Articular cartilage was segmented on the 3D pre-operative dGEMRIC scan. The average thickness and dGEMRIC index across the whole articular surface were analyzed.Failed hips had a lower dGEMRIC index by 115 ± 20 ms (P<0.001). All but one failed hips had a dGMERIC index of 400 or less (range: 313 – 479 ms), while all survived hips had a dGMERIC index of greater than 400 (range: 403 – 691 ms). Similar trends were observed when comparing the dGEMRIC index within the 6 subgroups (P<0.01). There were no differences in cartilage thickness (combined femoral head and acetabular cartilage) between the failed and survived hips (p>0.2).Patients with a high dGMERIC index (indicating high GAG content) may have a higher chance of successful outcomes following PAO. Current efforts are underway to develop a multi-modal predictive model to evaluate risk of failure after PAO.

The clinical application value of 3.0T magnetic resonance T2 mapping imaging in evaluating the degree of acetabular cartilage degeneration in joint replacement surgery running title: MRI and acetabular cartilage degeneration

BackgroundTo explore and compare the values of 3.0T magnetic resonance imaging (MRI) T2 mapping in evaluating the degree of acetabular cartilage degeneration in hip replacement surgery.MethodsA total of 26 elderly patients with femoral neck fractures who were scanned in 3.0T MRI T2 mapping quantification technique were included. Basing on MRI images, the degree of acetabular cartilage degeneration was classified into Grade 0, 1, 2, 3 and 4, according to the International Cartilage Repair Society (ICRS) scores. In addition, 8 healthy volunteers were included for control group.ResultsBy comparison with health population, T2 relaxation values in the anterior, superior, and posterior regions of acetabular cartilage in patients with femoral neck fracture were obviously increased (P < 0.001). Among the patients with femoral neck fractures, there were 16 hip joint with Grade 1–2 (mild degeneration subgroup) and 10 hip joints with Grade 3–4 (severe degeneration subgroup), accounting for 61.54% and 38.46%, respectively. Additionally, T2 relaxation values in the anterior and superior bands of articular cartilage were positively related to the MRI-based grading (P < 0.05); while there was no significant difference of T2 relaxation values in the posterior areas of articular cartilage between severe degeneration subgroup and mild degeneration subgroup (P > 0.05). Importantly, acetabular cartilage degeneration can be detected through signal changes of T2 mapping pseudo-color images.Conclusion3.0T MRI T2 mapping technology can be used to determine the degree of acetabular cartilage degeneration, which can effectively monitor the disease course.

Imaging Modalities in the Preoperative Assessment of Femoroacetabular Impingement and Hip Dysplasia: Determining Best Practices.

» In the last decade, significant progress has been made in understanding hip pain, especially related to femoroacetabular impingement (FAI) and hip dysplasia (HD), which collectively affect over 20% of the population.» Preoperative imaging, including plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US), plays a pivotal role in diagnosing FAI and HD. Imaging precision, standardized techniques, and accurate interpretation are crucial for effective treatment planning.» The continual advancements in imaging techniques, especially seen in MRI (arthrograms, application of leg traction, and delayed gadolinium-enhanced MRI of cartilage), represent important strides in the precise assessment of pathology associated with FAI and HD.» By incorporating these advancements into routine imaging protocols, healthcare providers can ensure a comprehensive understanding of hip joint dynamics, enabling more accurate diagnosis and effective management strategies for patients with FAI and HD, ultimately leading to improved clinical outcomes.

Promoting Regeneration in Degenerative Disc Disease.

The degenerative disc disease has a multifactorial etiology and mechanical stress is one of the most important etiological factor. The purpose of this study was to evaluate the intervertebral disc (IVD) after axial stress diminution from the point of view of its proteoglycan (PG) content, with preoteoglicans (PGs) being very important in the normal function but also in the degenerative or regenerative processes. This is a single-center, prospective, non-randomized study of 38 degenerated intervertebral discs treated with monosegmental or polisegmental posterior lumbar spinal fixation in 27 patients. During surgery, a posterior intervertebral distraction at operated levels was applied. Patients' mean age was 50.77 years and the mean follow-up 28.74 months. Both clinical (visual analog pain scale, Oswestry disability index) and radiological (lumbar spine lordosis, disc thickness) analyses were made before and after surgery. A new method of cartilage analysis, which was also validated for the IVD, delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) was used to determine the PG content before and after surgery for both the intervertebral degenerative disc and control level L1-L2 disc. The clinical features improved significantly. The thickness of the operated discs increased by an average of 1.71 mm postoperatively and remained unchanged in the control group. The lumbar lordosis did not change significantly. In dGEMRIC studies, the discs accumulated in average 410.08 units /cm2 of gadolinium before surgery and 272.45 units/cm2 after surgery, without significant changes in the control group. Our study shows an improvement of PG quantity in degenerated IVD due to a decrease in gadolinium binding seen in dGEMRIC study. Thus, we can ameliorate IVD homeostasis by eliminating mechanical stress, which could be a step towards the process of disc regeneration.

The value of adding T2 mapping sequence to the routine MRI protocol in the evaluation of cartilage lesions of the ankle joint

BackgroundAnkle joint cartilage injury is frequently associated with degenerative changes, even in the absence of symptoms. Earlier treatment of cartilage damage with joint preservation is clearly more successful. The main limitation of morphologic cartilage magnetic resonance imaging sequences is that they are not very sensitivity in the detection of early cartilage degeneration. Recent advances in biochemical magnetic resonance imaging have yielded sequences that are sensitive to molecular changes in the composition of cartilage matrix. This includes water- and collagen-sensitive T2\\T2* mapping. The aim of this study was to determine the extent of improvement of the diagnostic performance of routine magnetic resonance imaging protocol in the evaluation of ankle joint articular cartilage lesions following the addition of a T2 mapping sequence.ResultsA total of 45 cases, 30 patients (12 male and 18 female) and 15 controls (10 male and 5 female) who underwent routine ankle magnetic resonance imaging with additional T2 mapping sequence, were included in the study. Out of 30 patients, four patients were misdiagnosed as being normal, while having changes of cartilage composition of early degenerative changes, discovered by T2 mapping sequence. The patients group as well as the-control groups had significantly higher T2-values in the superficial cartilage layer (P < 0.001) compared to the deep layer. When comparing between the medial and the lateral compartments at patients group, the T2-relaxation times were more pronounced in the medial talar cartilage compartment compared to the lateral talar cartilage compartment.ConclusionsMagnetic resonance imaging can observe not only the destruction of the structural integrity but also the change of the components in articular cartilage. In this study, the addition of a T2 mapping of the ankle cartilage sequence to a routine MR ankle protocol improved sensitivity and accuracy in the detection of early cartilage lesions within the ankle joint.

Intra-Articular Mineralization on Computerized Tomography of the Knee and Risk of Cartilage Damage: The Multicenter Osteoarthritis Study.

Intra-articular (IA) mineralization may contribute to osteoarthritis (OA) structural progression. We studied the association of IA mineralization on knee computed tomography (CT) with cartilage damage worsening on knee magnetic resonance imaging (MRI), with a focus on location- and tissue-specific effects. Participants from the Multicenter Osteoarthritis Study with knee CT and MRI scans were included. Presence of IA mineralization on CT was defined as a Boston University Calcium Knee Score >0 anywhere in the knee. Cartilage worsening on MRI was defined as any increase in the MRI OA Knee Score, including incident damage. We evaluated the association of whole-knee, compartment-specific (ie, medial or lateral), and subregion-specific (ie, location-matched) IA mineralization at baseline with cartilage worsening at two years' follow-up in the corresponding locations using binomial regression with generalized estimating equations, adjusting for age, sex, and body mass index (BMI). We included 1,673 participants (mean age 60 years, 56% female, mean BMI 29). Nine percent had any IA mineralization in the knee, and 47.4% had any cartilage worsening on follow-up. Mineralization of any tissue in the knee, regardless of location, was not associated with MRI cartilage worsening. However, cartilage mineralization was associated with 1.39 (95% confidence interval 1.04-1.88) times higher risk of cartilage worsening in the same compartment, with similar results in subregion-specific analysis. CT-detected IA mineralization in the cartilage was associated with higher risk of MRI cartilage worsening in the same compartment and subregion over two years. These findings suggest potential localized, tissue-specific effects of IA mineralization on cartilage pathology in knee OA.

Evaluation of Open Versus Arthroscopic Anterior Talofibular Ligament Reconstruction for Chronic Lateral Ankle Instability With Talar and Subtalar Cartilage MRI T2 Mapping: A 3-Year Prospective Study.

Previous studies have examined patients with chronic lateral ankle instability (CLAI) undergoing open and arthroscopic anterior talofibular ligament (ATFL) reconstruction, reporting equivalent clinical results between the 2 procedures. However, data on the magnetic resonance imaging (MRI) outcomes on cartilage health after the 2 procedures are limited. To compare the cartilage MRI T2 values of the talar and subtalar joints between patients with CLAI undergoing open and arthroscopic ATFL reconstruction. Cohort study; Level of evidence, 3. A prospective study was conducted on patients who underwent open or arthroscopic ATFL reconstruction between January 2018 and December 2019, with a mean follow-up duration of 3 years. MRI scans and American Orthopaedic Foot & Ankle Society (AOFAS) and Tegner score estimations were completed by patients ≤1 week before surgery, as a baseline measurement, and at a 3-year follow-up. A total of 21 healthy volunteers were included who underwent MRI at baseline. Cartilage health was evaluated using MRI T2 mapping. The talar and subtalar cartilage regions were segmented into 14 subregions. At baseline, patients with CLAI had substantially higher T2 values in the medial anterior, medial center, medial posterior, and lateral center regions on the talus compared with the healthy controls (P = .009, .003, .001, and .025, respectively). Remarkable increases in T2 values in the lateral posterior region on the talus were observed from baseline to follow-up in the open group (P = .007). Furthermore, T2 values were considerably higher in the medial center, medial posterior, lateral posterior, and lateral posterior calcaneal facets of the posterior subtalar joint at follow-up in the arthroscopic group compared with the baseline values (P = .025, .002, .006, and .044, respectively). No obvious differences in ΔT2 values were noted between the 2 groups at follow-up. The AOFAS and Tegner scores remarkably improved from baseline to follow-up for the 2 groups (open: 3.25 ± 0.58 vs 5.13 ± 0.81, P < .001; arthroscopic: 3.11 ± 0.90 vs 5.11 ± 1.08, P < .001), with no considerable difference between them. The elevated T2 values of cartilage could not be fully recovered after open or arthroscopic ATFL reconstruction. Both arthroscopic and open ATFL reconstruction displayed similar effects on cartilage health concerning ΔT2, but the arthroscopic group demonstrated more degenerative cartilage subregions than the open group.

Current MR imaging of cartilage in the context of knee osteoarthritis (part2) : Cartilage pathologies and their assessment

High-quality magnetic resonance (MR) imaging is essential for the precise assessment of the knee joint and plays a key role in the diagnostics, treatment and prognosis. Intact cartilage tissue is characterized by asmooth surface, uniform tissue thickness and an organized zonal structure, which are manifested as depth-dependent signal intensity variations. Cartilage pathologies are identifiable through alterations in signal intensity and morphology and should be communicated based on a precise terminology. Cartilage pathologies can show hyperintense and hypointense signal alterations. Cartilage defects are assessed based on their depth and should be described in terms of their location and extent. The following symptom constellations are of overarching clinical relevance in image reading and interpretation: symptom constellations associated with rapidly progressive forms of joint degeneration and unfavorable prognosis, accompanying symptom constellations mostly in connection with destabilizing meniscal lesions and subchondral insufficiency fractures (accelerated osteoarthritis) as well as symptoms beyond the "typical" degeneration, especially when adiscrepancy is observed between (minor) structural changes and (major) synovitis and effusion (inflammatory arthropathy).

Femoral cartilage ultrasound echo-intensity is a valid measure of cartilage composition.

This study aimed to create a conversion equation that accurately predicts cartilage magnetic resonance imaging (MRI) T2 relaxation times using ultrasound echo-intensity and common participant demographics. We recruited 15 participants with a primary anterior cruciate ligament reconstruction between the ages of 18 and 35 years at 1-5 years after surgery. A single investigator completed a transverse suprapatellar scan with the ACLR limb in max knee flexion to image the femoral trochlea cartilage. A single reader manually segmented the femoral cartilage cross-sectional area to assess the echo-intensity (i.e., mean gray-scale pixel value). At a separate visit, a T2 mapping sequence with the MRI beam set to an oblique angle was used to image the femoral trochlea cartilage. A single reader manually segmented the cartilage cross-sectional area on a single MRI slice to assess the T2 relaxation time. A stepwise, multiple linear regression was used to predict T2 relaxation time from cartilage echo-intensity and common demographic variables. We created a conversion equation using the regression betas and then used an ICC and Bland-Altman plot to assess agreement between the estimated and true T2 relaxation time. Cartilage ultrasound echo-intensity and age significantly predicted T2 relaxation time (F = 7.33, p = 0.008, R2 = 0.55). When using the new conversion equation to estimate T2 relaxation time from cartilage echo-intensity and age, there was strong agreement between the estimated and true T2 relaxation time (ICC2,k = 0.84). This study provides promising preliminary data that cartilage echo-intensity combined with age can be used as a clinically accessible tool for evaluating cartilage composition.

Comparison of compositional MRI techniques to quantify the regenerative potential of articular cartilage: a preclinical minipig model after osteochondral defect treatments with autologous mesenchymal stromal cells and unseeded scaffolds.

The field of orthopedics seeks effective, safer methods for evaluating articular cartilage regeneration. Despite various treatment innovations, non-invasive, contrast-free full quantitative assessments of hyaline articular cartilage's regenerative potential using compositional magnetic resonance (MR) sequences remain challenging. In this context, our aim was to investigate the effectiveness of different MR sequences for quantitative assessment of cartilage and to compare them with the current gold standard delayed gadolinium-enhanced MR imaging of cartilage (dGEMRIC) measurements. We employed ex vivo imaging in a preclinical minipig model to assess knee cartilage regeneration. Standardized osteochondral defects were drilled in the proximal femur of the specimens (n=14), which were divided into four groups. Porcine collagen scaffolds seeded with autologous adipose-derived stromal cells (ASC), autologous bone marrow stromal cells (BMSC), and unseeded scaffolds (US) were implanted in femoral defects. Furthermore, there was a defect group which received no treatment. After 6 months, the specimens were examined using different compositional MR methods, including the gold standard dGEMRIC as well as T1, T2, T2*, and T1ρ techniques. The statistical evaluation involved comparing the defect region with the uninjured tibia and femur cartilage layers and all measurements were performed on a clinical 3T MR Scanner. In the untreated defect group, we observed significant differences in the defect region, with dGEMRIC values significantly lower (404.86±64.2 ms, P=0.018) and T2 times significantly higher (44.24±2.75 ms, P<0.001). Contrastingly, in all three treatment groups (ASC, BMSC, US), there were no significant differences among the three regions in the dGEMRIC sequence, suggesting successful cartilage regeneration. However, T1, T2*, and T1ρ sequences failed to detect such differences, highlighting their lower sensitivity for cartilage regeneration. As expected, dGEMRIC is well suited for monitoring cartilage regeneration. Interestingly, T2 imaging also proved to be a reliable cartilage imaging technique and thus offers a contrast agent-free alternative to the former gold standard for subsequent in vivo studies investigating the cartilage regeneration potential of different treatment modalities.

Imaging of knee osteoarthritis: a review of multimodal diagnostic approach.

Knee osteoarthritis (KOA) is a common chronic condition among the elderly population that significantly affects the quality of life. Imaging is crucial in the diagnosis, evaluation, and management of KOA. This manuscript reviews the various imaging modalities available until now, with a little focus on the recent developments with Artificial Intelligence. Currently, radiography is the first-line imaging modality recommended for the diagnosis of KOA, owing to its wide availability, affordability, and ability to provide a clear view of bony components of the knee. Although radiography is useful in assessing joint space narrowing (JSN), osteophytes and subchondral sclerosis, it has limited effectiveness in detecting early cartilage damage, soft tissue abnormalities and synovial inflammation. Ultrasound is a safe and affordable imaging technique that can provide information on cartilage thickness, synovial fluid, JSN and osteophytes, though its ability to evaluate deep structures such as subchondral bone is limited. Magnetic resonance imaging (MRI) represents the optimal imaging modality to assess soft tissue structures. New MRI techniques are able to detect early cartilage damage measuring the T1ρ and T2 relaxation time of knee cartilage. Delayed gadolinium-enhanced MRI of cartilage, by injecting a contrast agent to enhance the visibility of the cartilage on MRI scans, can provide information about its integrity. Despite these techniques can provide valuable information about the biochemical composition of knee cartilage and can help detect early signs of osteoarthritis (OA), they may not be widely available. Computed tomography (CT) has restricted utility in evaluating OA; nonetheless, weight-bearing CT imaging, using the joint space mapping technique, exhibits potential in quantifying knee joint space width and detecting structural joint ailments. PET-MRI is a hybrid imaging technique able to combine morphological information on bone and soft tissue alterations with the biochemical changes, but more research is needed to justify its high cost and time involved. The new tools of artificial intelligence, including machine learning models, can assist in detecting patterns and correlations in KOA that may be useful in the diagnosis, grading, predicting the need for arthroplasty, and improving surgical accuracy.

Physical Activity Associates with T1rho MRI of Femoral Cartilage After Anterior Cruciate Ligament Reconstruction.

Less physical activity has been associated with systemic biomarkers of cartilage breakdown after anterior cruciate ligament reconstruction (ACLR). However, previous research lacks analysis of deleterious cartilage compositional changes and objective physical activity after ACLR. The purpose of this study was to determine the association between physical activity quantified via accelerometer-based measures of daily steps and time in moderate-to-vigorous physical activity (MVPA), and T1rho magnetic resonance imaging (MRI) of the femoral articular cartilage, a marker of proteoglycan density in individuals with ACLR. Daily steps and MVPA were assessed over 7 d using an accelerometer worn on the hip in 26 individuals between 6 and 12 months after primary unilateral ACLR. Resting T1rho MRI was collected bilaterally, and T1rho MRI interlimb ratios (ILR: ACLR limb/contralateral limb) were calculated for lateral and medial femoral condyle regions of interest. We conducted univariate linear regression analyses to determine associations between T1rho MRI ILRs and daily steps and MVPA with and without controlling for sex. Greater T1rho MRI ILR of the central lateral femoral condyle, indicative of less proteoglycan density in the ACLR limb, was associated with greater time in MVPA ( R2 = 0.178, P = 0.032). Sex-adjusted models showed significant interaction terms between daily steps and sex in the anterior ( P = 0.025), central ( P = 0.002), and posterior ( P = 0.002) medial femoral condyle. Lesser physical activity may be a risk factor for maintaining cartilage health after ACLR; additionally, the relationship between physical activity and cartilage health may be different between males and females.

T2 mapping magnetic resonance imaging of cartilage in hemophilia

BackgroundIn hemophilia, recurrent hemarthrosis may lead to irreversible arthropathy. T2 mapping MRI may reflect cartilage changes at an earlier reversible stage of arthropathy as opposed to structural MRI. ObjectivesTo evaluate interval changes of T2 mapping compared with the International Prophylaxis Study Group (IPSG) structural MRI scores of ankle cartilage in boys with hemophilia receiving prophylaxis. MethodsEight boys with hemophilia A (median age, 13; range, 9-17 years), 7 age- and sex-matched healthy boys (controls, median age, 15; range, 7-16 years). A multiecho spin-echo T2-weighted MRI sequence at 3.0T was used to obtain T2 maps of cartilage of boys with hemophilia and controls. Structural joint status was evaluated using the IPSG MRI score. ResultsT2 relaxation times of ankle cartilage increased significantly over time in both persons with hemophilia and controls (P = .002 and P = .00009, respectively). Changes in T2 relaxation time strongly correlated with changes in IPSG cartilage scores (rs = 0.93 to rs = 0.78 [P = .0007 to P = .023]), but not with changes in age (P = .304 to P = .840). Responsiveness of T2 relaxation times were higher than that of IPSG cartilage scores, with standardized response means >1.4 for T2 mapping in all regions-of-interest compared with 0.84 for IPSG cartilage scores. Baseline T2 relaxation time strongly correlated with timepoint 2 IPSG cartilage score (rs = 0.93 to rs = 0.82 [P = .001 to P = .012]) and T2 relaxation time (rs = 0.98 to rs = 0.88 [P = .00003 to P = .004]) changes in most regions-of-interest. ConclusionT2 mapping shows sensitivity to biochemical changes in cartilage prior to detectable damage using conventional MRI, offering potential for early detection of bleed-related cartilage damage in boys with hemophilia.

Does the dGEMRIC Index Recover 3 Years After Surgical FAI Correction and an Initial dGEMRIC Decrease at 1-Year Follow-up? A Controlled Prospective Study

Background: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) allows objective and noninvasive assessment of cartilage quality. An interim analysis 1 year after correction of femoroacetabular impingement (FAI) previously showed that the dGEMRIC index decreased despite good clinical outcome. Purpose: To evaluate dGEMRIC indices longitudinally in patients who underwent FAI correction and in a control group undergoing nonoperative treatment for FAI. Study Design: Cohort study; Level of evidence, 3. Methods: This prospective, comparative longitudinal study included 39 patients (40 hips) who received either operative (n = 20 hips) or nonoperative (n = 20 hips) treatment. Baseline demographic characteristics and presence of osseous deformities did not differ between groups. All patients received indirect magnetic resonance arthrography at 3 time points (baseline, 1 and 3 years of follow-up). The 3-dimensional cartilage models were created using a custom-developed deep learning–based software. The dGEMRIC indices were determined separately for acetabular and femoral cartilage. A mixed-effects model was used for statistical analysis in repeated measures. Results: The operative group showed an initial (preoperative to 1-year follow-up) decrease of dGEMRIC indices: acetabular from 512 ± 174 to 392 ± 123 ms and femoral from 530 ± 173 to 411 ± 117 ms (both P < .001). From 1-year to 3-year follow-up, dGEMRIC indices improved again: acetabular from 392 ± 123 to 456 ± 163 ms and femoral from 411 ± 117 to 477 ± 169 ms (both P < .001). The nonoperative group showed no significant changes in dGEMRIC indices in acetabular and femoral cartilage from baseline to either follow-up point (all P > .05). Conclusion: This study showed that 3 years after FAI correction, the dGEMRIC indices improved compared with short-term 1-year follow-up. This may be due to normalized joint biomechanics or regressive postoperative activation of the inflammatory cascade after intra-articular surgery.

Machine-learning predicted and actual 2-year structural progression in the IMI-APPROACH cohort.

In the Innovative Medicine's Initiative Applied Public-Private Research enabling OsteoArthritis Clinical Headway (IMI-APPROACH) knee osteoarthritis (OA) study, machine learning models were trained to predict the probability of structural progression (s-score), predefined as >0.3 mm/year joint space width (JSW) decrease and used as inclusion criterion. The current objective was to evaluate predicted and observed structural progression over 2 years according to different radiographic and magnetic resonance imaging (MRI)-based structural parameters. Radiographs and MRI scans were acquired at baseline and 2-year follow-up. Radiographic (JSW, subchondral bone density, osteophytes), MRI quantitative (cartilage thickness), and MRI semiquantitative [SQ; cartilage damage, bone marrow lesions (BMLs), osteophytes] measurements were obtained. The number of progressors was calculated based on a change exceeding the smallest detectable change (SDC) for quantitative measures or a full SQ-score increase in any feature. Prediction of structural progression based on baseline s-scores and Kellgren-Lawrence (KL) grades was analyzed using logistic regression. Among 237 participants, around 1 in 6 participants was a structural progressor based on the predefined JSW-threshold. The highest progression rate was seen for radiographic bone density (39%), MRI cartilage thickness (38%), and radiographic osteophyte size (35%). Baseline s-scores could only predict JSW progression parameters (most P>0.05), while KL grades could predict progression of most MRI-based and radiographic parameters (P<0.05). In conclusion, between 1/6 and 1/3 of participants showed structural progression during 2-year follow-up. KL scores were observed to outperform the machine-learning-based s-scores as progression predictor. The large amount of data collected, and the wide range of disease stage, can be used for further development of more sensitive and successful (whole joint) prediction models. Trial Registration: Clinicaltrials.gov number NCT03883568.

Combined femoral and acetabular version and synovitis are associated with dGEMRIC scores in people with femoroacetabular impingement (FAI) syndrome.

This study sought to explore, in people with symptoms, signs and imaging findings of femoroacetabular impingement (FAI syndrome): (1) whether more severe labral damage, synovitis, bone marrow lesions, or subchondral cysts assessed on magnetic resonance imaging(MRI) were associated with poorer cartilage health, and (2) whether abnormal femoral, acetabular, and/or combined femoral and acetabular versions were associated with poorer cartilage health. This cross-sectional study used baseline data from the 50 participants with FAI syndrome in the Australian FASHIoN trial (ACTRN12615001177549) with available dGEMRIC scans. Cartilage health was measured using delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score sampled at the chondrolabral junction on three midsagittal slices, at one acetabular and one femoral head region of interest on each slice, and MRI features were assessed using the Hip Osteoarthritis MRI Score. Analyses were adjusted for alpha angle and body mass index, which are known to affect dGEMRIC score. Linear regression assessed the relationship with thedGEMRIC score of (i) selected MRI features, and (ii) femoral, acetabular, and combined femoral and acetabular versions. Hips with more severe synovitis had worse dGEMRIC scores (partial η2 = 0.167, p = 0.020), whereas other MRI features were not associated. A lower combined femoral and acetabular version was associated with a better dGEMRIC score (partial η2 = 0.164, p = 0.021), whereas isolated measures of femoral and acetabular version were not associated. In conclusion, worse synovitis was associated with poorer cartilage health, suggesting synovium and cartilage may be linked to the pathogenesis of FAI syndrome. A lower combined femoral and acetabular version appears to be protective of cartilage health at the chondrolabral junction.

Proof-of-Concept Double-Blind Placebo-Controlled Trial Measuring Cartilage Composition in Early Rheumatoid Arthritis under TNF-α-Inhibitor Therapy

Low levels of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) values are indicative of cartilage degeneration. Patients with early rheumatoid arthritis are known to have low dGEMRIC values due to inflammatory activity. The additional effect of biological disease-modifying antirheumatic drug (bDMARD) and conventional synthetic disease-modifying antirheumatic drug (csDMARD) treatment on cartilage status is still unclear. In this prospective, double-blinded, randomized proof-of-concept clinical trial, patients with early rheumatoid arthritis (disease duration less than 12 months from symptoms onset) were treated with methotrexate + adalimumab (10 patients: 6/4 (f/m)). A control group with methotrexate alone (four patients: 2/2 (f/m)) was used. Cartilage integrity in the metacarpophalangeal joints was compared using dGEMRIC at baseline, 12, and 24 weeks after treatment initiation. A statistically significant increase in dGEMRIC levels was found in the adalimumab group considering the results after 12 and 24 weeks of therapy (p < 0.05) but not in the control group (p: non-significant). After 24 weeks, a tendency towards increased dGEMRIC values under combination therapy was observed, whereas methotrexate alone showed a slight decrease without meeting the criteria of significance (dGEMRIC mean change: +85.8 ms [-156.2-+346.5 ms] vs. 30.75 ms [-273.0-+131.0 ms]; p: non-significant). After 24 weeks of treatment with a combination of methotrexate and adalimumab, a trend indicating improvement in cartilage composition is seen in patients with early rheumatoid arthritis. However, treatment with methotrexate alone showed no change in cartilage composition, as observed in dGEMRIC sequences of metacarpophalangeal joints.

Moderators, Mediators, and Prognostic Indicators of Treatment With Hip Arthroscopy or Physical Therapy for Femoroacetabular Impingement Syndrome: Secondary Analyses From the Australian FASHIoN Trial

Background: Although randomized controlled trials comparing hip arthroscopy with physical therapy for the treatment of femoroacetabular impingement (FAI) syndrome have emerged, no studies have investigated potential moderators or mediators of change in hip-related quality of life. Purpose: To explore potential moderators, mediators, and prognostic indicators of the effect of hip arthroscopy and physical therapy on change in 33-item international Hip Outcome Tool (iHOT-33) score for FAI syndrome. Study Design: Cohort study; Level of evidence, 2. Methods: Overall, 99 participants were recruited from the clinics of orthopaedic surgeons and randomly allocated to treatment with hip arthroscopy or physical therapy. Change in iHOT-33 score from baseline to 12 months was the dependent outcome for analyses of moderators, mediators, and prognostic indicators. Variables investigated as potential moderators/prognostic indicators were demographic variables, symptom duration, alpha angle, lateral center-edge angle (LCEA), Hip Osteoarthritis MRI Scoring System (HOAMS) for selected magnetic resonance imaging (MRI) features, and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score. Potential mediators investigated were change in chosen bony morphology measures, HOAMS, and dGEMRIC score from baseline to 12 months. For hip arthroscopy, intraoperative procedures performed (femoral ostectomy ± acetabular ostectomy ± labral repair ± ligamentum teres debridement) and quality of surgery graded by a blinded surgical review panel were investigated for potential association with iHOT-33 change. For physical therapy, fidelity to the physical therapy program was investigated for potential association with iHOT-33 change. Results: A total of 81 participants were included in the final moderator/prognostic indicator analysis and 85 participants in the final mediator analysis after exclusion of those with missing data. No significant moderators or mediators of change in iHOT-33 score from baseline to 12 months were identified. Patients with smaller baseline LCEA (β = −0.82; P = .034), access to private health care (β = 12.91; P = .013), and worse baseline iHOT-33 score (β = −0.48; P < .001) had greater iHOT-33 improvement from baseline to 12 months, irrespective of treatment allocation, and thus were prognostic indicators of treatment response. Unsatisfactory treatment fidelity was associated with worse treatment response (β = −24.27; P = .013) for physical therapy. The quality of surgery and procedures performed were not associated with iHOT-33 change for hip arthroscopy (P = .460-.665 and P = .096-.824, respectively). Conclusion: No moderators or mediators of change in hip-related quality of life were identified for treatment of FAI syndrome with hip arthroscopy or physical therapy in these exploratory analyses. Patients who accessed the Australian private health care system, had smaller LCEAs, and had worse baseline iHOT-33 scores, experienced greater iHOT-33 improvement, irrespective of treatment allocation.

Autologous Costal Cartilage Grafting for a Large Osteochondral Lesion of the Femoral Head: A 1-Year Single-Arm Study with 2 Additional Years of Follow-up.

There is currently no ideal treatment for osteochondral lesions of the femoral head (OLFH) in young patients. We performed a 1-year single-arm study and 2 additional years of follow-up of patients with a large (defined as >3 cm 2 ) OLFH treated with insertion of autologous costal cartilage graft (ACCG) to restore femoral head congruity after lesion debridement. Twenty patients ≤40 years old who had substantial hip pain and/or dysfunction after nonoperative treatment were enrolled at a single center. The primary outcome was the change in Harris hip score (HHS) from baseline to 12 months postoperatively. Secondary outcomes included the EuroQol visual analogue scale (EQ VAS), hip joint space width, subchondral integrity on computed tomography scanning, repair tissue status evaluated with the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and evaluation of cartilage biochemistry by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping. All 20 enrolled patients (31.02 ± 7.19 years old, 8 female and 12 male) completed the initial study and the 2 years of additional follow-up. The HHS improved from 61.89 ± 6.47 at baseline to 89.23 ± 2.62 at 12 months and 94.79 ± 2.72 at 36 months. The EQ VAS increased by 17.00 ± 8.77 at 12 months and by 21.70 ± 7.99 at 36 months (p < 0.001 for both). Complete integration of the ACCG with the bone was observed by 12 months in all 20 patients. The median MOCART score was 85 (interquartile range [IQR], 75 to 95) at 12 months and 75 (IQR, 65 to 85) at the last follow-up (range, 24 to 38 months). The ACCG demonstrated magnetic resonance properties very similar to hyaline cartilage; the median ratio between the relaxation times of the ACCG and recipient cartilage was 0.95 (IQR, 0.90 to 0.99) at 12 months and 0.97 (IQR, 0.92 to 1.00) at the last follow-up. ACCG is a feasible method for improving hip function and quality of life for at least 3 years in young patients who were unsatisfied with nonoperative treatment of an OLFH. Promising long-term outcomes may be possible because of the good integration between the recipient femoral head and the implanted ACCG. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Correlation of Delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) Value With Hip Arthroscopy Intraoperative Findings and Midterm Periacetabular Osteotomy Outcomes.

Background:Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an advanced imaging technique that is purported to quantify cartilage damage in acute and chronic joint disease and predict periacetabular osteotomy (PAO) outcomes. There is a paucity of literature relating dGEMRIC values to arthroscopic findings before PAO and postoperative outcomes after PAO.Purpose:To assess the utility and validity of dGEMRIC as a preoperative and prognostic assessment tool of cartilage status and integrity as it relates to intraoperative findings and midterm postoperative outcomes after PAO.Study Design:Case series; Level of evidence, 4.Methods:We analyzed a cohort of 58 patients (70 hips) with a median age of 30.1 years (range, 15-50) with hip dysplasia who underwent hip arthroscopy, followed by a PAO with preoperative dGEMRIC. The primary outcome measures were intraoperative assessment and correlation with cartilage damage (presence of cartilage flap, Outerbridge grade of the acetabulum and femoral head). Secondary outcome measures were postoperative patient-reported outcome (PRO) scores, including the International Hip Outcome Tool and Non-arthritic Hip Score. Correlation analyses were performed to determine the relationship between dGEMRIC values and (1) PROs and (2) intraoperative assessment of cartilage damage.Results:There were significant negative linear relationships between dGEMRIC values and the primary outcome measures: presence of a cartilage flap (coronal, P = .004; sagittal, P < .001), Outerbridge grade of acetabular articular cartilage lesion (coronal, P = .002; sagittal, P = .003), and Outerbridge grade of femoral head articular cartilage lesion (coronal, P = .001; sagittal, P < .001). Despite significant overall improvement in all patients, there was no significant correlation between preoperative dGEMRIC values and improvement in PROs from presurgery to latest postoperative follow-up (median, 2.2 years; range, 1.0-5.0 years).Conclusion:Although dGEMRIC values (sagittal and coronal) were significant predictors of the intraoperative presence of cartilage flaps and overall cartilage integrity, they were not associated with midterm outcomes after PAO.