Medial Osteophytes Research Articles

Effect of Medial Osteophyte Removal on Correction of Varus Deformity in Total Knee Arthroplasty.

To restore neutral limb alignment in total knee arthroplasty (TKA), the procedure usually starts with removing osteophytes in varus osteoarthritic knees. However, the exact effect on alignment correction is unknown. The purpose of this study was to determine the effect of osteophyte removal alone during TKA for varus knees on correction of limb alignment on the coronal plane. Fifteen knees with medial osteoarthritis and varus malalignment scheduled for TKA were studied. After registration in a navigation system, each knee was tested at maximum extension, and at 30, 40, and 60 degrees of flexion, before and after osteophyte removal. External loads of 10 N·m valgus torque at each angle and in both states were applied. Later, the widths of the resected osteophytes were measured. The average preoperative hip-knee-ankle angle was -14.2 degrees. The average width of osteophytes was 7.6 mm in the femur and 5.3 mm in the tibia. Angle corrections after osteophyte removal were 3.4 degrees at maximum extension, 3.4 degrees at 30 degrees flexion, and 3.6 degrees at 60 degrees flexion; the difference was significant for all angles. There was a positive correlation between osteophyte width and the degree of angle correction at 30 degrees. At 30 degrees of knee flexion, osteophyte width was correlated with the degree of angle correction on the coronal plane in TKA. The degree of angle correction per 1 mm of width of removed osteophytes was 0.4 degrees.

Statistical shape modelling provides a responsive measure of morphological change in knee osteoarthritis over 12 months.

Responsive biomarkers are needed to assess the progression of OA and their lack has hampered previous clinical trials. Statistical shape modelling (SSM) from radiographic images identifies those at greatest risk of fast-progression or joint replacement, but its sensitivity to change has not previously been measured. This study evaluates the responsiveness of SSM in knee OA in a 12-month observational study. A total of 109 people were recruited who had undergone knee radiographs in the previous 12 months, and were grouped based on severity of radiographic OA (Kellgren-Lawrence grading). An SSM was built from three dual-energy X-ray absorptiometry scans at 6-month intervals. Change-over-time and OA were assessed using generalized estimating equations, standardized response means (SRM) and reliable change indices. Mode 1 showed typical features of radiographic OA and had a strong link with Kellgren-Lawrence grading but did not change significantly during the study. Mode 3 showed asymmetrical changes consistent with medial cartilage loss, osteophytes and joint malalignment, and was responsive to change, with a 12-month SRM of 0.63. The greatest change was observed in the moderate radiographic OA group (SRM 0.92) compared with the controls (SRM 0.21), and the reliable change index identified 14% of this group whose progression was clinically significant. Shape changes linked the progression of osteophytosis with increasing malalignment within the joint. Modelling of the whole joint enabled quantification of change beyond the point where bone-to-bone contact has been made. The knee SSM is, therefore, a responsive biomarker for radiographic change in knees over 12 months.

The Role of High Resolution Ultrasound in the Assessment of Knee Osteoarthritis

AbstractBackground: Osteoarthritis (OA) is a common musculoskeletaldisease with high prevalence worldwide. Knee OAis primary diagnosed using conventional radiography, however,changes of articular cartilage or menisci cannot be directlyassessed using conventional radiology. Ultrasound (US) canbe used to assess soft tissue degeneration directly.Aim of Study: The aim of this study is to evaluate theefficacy of High Resolution Ultrasound (HRUS) in the assessmentof structural abnormalities found in knee osteoarthritis.Patients and Methods: The study was conducted upon 20patients with knee OA (12F, 8M; mean age 53 years), eachsubject was evaluated for the presence of medial and lateralfemoral cartilage thinning, medial and lateral femoral andtibial osteophytes, medial and lateral meniscal degeneration,joint effusion and Baker's cyst using ultrasound and MRI,considering MRI as a reference standard.Results: The overall sensitivity of the ultrasound in thedetection of knee OA parameters was good (89.3%), theoverall accuracy was excellent (90%), the overall specificitywas excellent (93.1%). The Positive Predictive Value (PPV)and the Negative Predictive Value (NPV) were 98.3 and 65.9respectively. The p-value was highly significant (<0.01) whencomparing assessment of knee osteoarthritis parameters betweenultrasound and MRI.Conclusion: Ultrasound assessment of the knee joint isan accurate imaging method for detection of knee osteoarthritisparameters including medial and lateral femoral articularcartilage thinning, medial and lateral osteophytes, medial andlateral meniscal degeneration, joint effusion and Baker's cyst.Thus, Knee ultrasound can be used as a complementaryimaging technique to radiography, especially when MRI isnot available, to assess tissue-specific structural OA degenerationnot detected by conventional radiographs.

Size of Medial Knee Osteophytes Correlates With Knee Alignment But Not With Coronal Laxity in Patients With Medial Knee Osteoarthritis.

The severity of osteoarthritis (OA) has been related to osteophyte size. However, the effects on osteophyte size of repeated and increased loading associated with joint laxity and varus misalignment remain unclear. We investigated these relationships in patients with medial knee OA and compared the performances of computed tomography (CT) and radiography for assessing osteophyte parameters. We examined knee joint alignment on radiographs and knee laxity using arthrometry in 191 patients with medial knee OA who were undergoing total knee arthroplasty. We also measured femur and tibia osteophyte distance (largest perpendicular distance from the cortical line to outer margin of the osteophyte) using radiography and CT, osteophyte areas (largest area surrounded by the outer margin of an osteophyte) by CT and determined the locations of the osteophytes in the femur and tibia by CT. We then analyzed the correlations between the variables using Spearman's rank correlation tests. Osteophyte sizes in the femur and tibia as determined by radiography (distance) or CT (distance and area) were positively correlated with the degree of varus alignment but not with medial or lateral laxity. There was also a significant correlation between maximum osteophyte distances measured by radiography and CT. The greatest number and the largest osteophytes were located in the posterior third of the femur and middle third of the tibia, respectively. Osteophyte size was correlated with preoperative knee alignment but not with knee laxity in patients with medial knee OA. Osteophyte size can be evaluated using conventional radiography, without the need for CT. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:639-644, 2020.

Imaging features in incident radiographic patellofemoral osteoarthritis: the Beijing Shunyi osteoarthritis (BJS) study

BackgroundThe present study aims to describe the imaging features in incident radiographic patellofemoral osteoarthritis (RPFOA) population in a Chinese suburban area.MethodsThe Beijing Shunyi osteoarthritis (BJS) study was a population-based, longitudinal and prospective study. Residents were recruited by randomized cluster sampling in 2014 and were followed 3 years later. Home interviews and clinical examinations were performed; weight-bearing posterior-anterior semi-flexed (45-degree) views of the tibiofemoral (TF) joints and skyline (45-degree) views of the patellofemoral (PF) joints were included. For each batch of study films (n = 100), 20 films from the year 2014 and 20 previously read PF radiographs were fed back to test inter−/intra-reader repeatability. The imaging features of incident RPFOA were analyzed. Narrative statistics, independent-sample t-tests, and nonparametric tests were performed.ResultsA total of 1295 participants (2590 knees) were recruited at baseline in 2014, and 967 (74.7%) residents were followed in 2017. Of all the knees (n = 1537) without RPFOA at baseline, 139 knees (13.3%) across 119 people developed incident RPFOA. Compared with the whole population, age (p = 0.031), body mass index (BMI, p = 0.042), and incidence of knee pain symptoms (p < 0.01) were significantly different in the incident RPFOA population, while range of motion (ROM, p = 0.052) and gender (0/1, p = 0.203) showed no significance. In the incident population, the changes of each imaging indicator grade were evaluated—lateral patellofemoral osteophyte (LPOST, increased by 1.02), medial patellofemoral osteophyte (MPOST, increased by 0.49), lateral joint space narrowing (LJSN, increased by 0.30), medial joint space narrowing (MJSN, increased by 0.06); indicator grade progress decreases, respectively. The progress of LPOST was the fastest among the four indicators (p < 0.01).ConclusionsIn this population-based longitudinal study, among the incident RPFOA population, the imaging indicators show that marginal patellofemoral osteophyte is more pronounced than patellofemoral joint space narrowing. LPOST is the fastest-progressing indicator among all the radiographic features, which is also the most common imaging manifestation of RPFOA. In the incident RPFOA population, the proportion of elders, women, higher-BMI individuals, and people suffering knee pain is more than the normal population.

Classifications in Brief: The Hartofilakidis Classification of Developmental Dysplasia of the Hip

Classifications in Brief: The Hartofilakidis Classification of Developmental Dysplasia of the Hip

Osteophytes formation processes in early stage knee osteoarthritis in human

Purpose: Reduction of ADL by osteoarthritis of the knee (knee OA) is a major factor threatening healthy life expectancy. Thus, clarification of the pathology of knee OA is desired. We reported that cartilage part of osteophyte could be detected using T2 mapping MRI and medial meniscal extrusion (MME) was associated with medial tibial osteophyte evaluated by T2 mapping MRI in early-stage knee OA (Arthritis Res Ther, 19:201, 2017). However, there is no report showing cartilage part of osteophytes in early stage knee OA in human, histologically. The aim of this study was to investigate the morphological feature of osteophytes in human knee OA using cadavers. Methods: All cadavers were from persons who had donated their bodies for medical education and research to our university. Prior to donation, written consent was obtained from the individuals and families. The protocol for the present research project was approved by the Ethics Committee of our university. Fourteen left legs were collected from embalmed Japanese cadavers (3 males, 11 females; average age, 83.3±8.2 years of age), which were dissected by medical students in the gross anatomy course at Juntendo University School of Medicine. Knee joint was dissected out proximal and distal 10cm from the knee articular surface after skin removal. Anteroposterior view radiographs were taken and then evaluated according to the Kellgren-Lawrence (K/L) classification. Then, the patella and muscle were removed and the 2 cm width of medial parts of the knee joint remaining the medial collateral ligament were collected. They were fixed in 10% neutral buffered formalin, decalcified, and embedded in paraffin. The samples were cut into sections and stained with safranin-O and fast green. The histological features of medial tibial plateau (MTP) was quantified by histological grading scores. The cartilage degradation score used in the present study was the modified Mankin score (0-18) (Mankin, JBJS, 1971). The osteophyte formation score used in the present study was a score for its maturity with 5 degrees (0-4; grade 0: no osteophyte like lesion, grade 1: pre-cartilagious lesion, grade 2: predominantly cartilaginous, grade 3: mixed cartilage and bone, grade 4: predominantly bone), which was modified by the score for the evaluation of osteophyte in mouse model, as previously reported (Kamekura et al., Osteoarthritis Cartilage, 2005). Results: The severities of radiographic knee OA of the subjects in the present study were 7 (50.0%) for K/L grade 1, 5 (37.7%) for K/L grade 2, 2 (14.3%) for K/L grade 4, respectively. The cartilage degradation scores of the subjects were 4.1 [standard deviation (SD): 1.5] for K/L grade 1, 5.2 (1.3) for K/L grade 2, 15.0 (3.0) for K/L grade 4, respectively. Osteophytes were observed in all the samples of the subjects, regardless of the radiographic severity of knee OA. The osteophyte scores of the subjects were 7 (50.0%) for grade 1, 3 (21.4%) for grade 2, 2 (14.3%) for grade 3, and 2 (14.3%) for grade 4, respectively (Fig. 1). The histological sections with grade 4 of osteophytes were consisted of proliferative, pre-hypertrophic, hypertrophic, and ossification zones, while those with grade 1 were consisted of reduplication of synovial tissues. Conclusions: The histological examinations showed that osteophytes were existed in all the samples of the subjects, which showed the radiographic knee OA changes not only with K/L grade 2 to 4 but also with K/L grade 1. The developmental processes of the osteophyte in knee OA in human were similar to those observed in the growth plate in the murine model, which is the process similar to the endochondral ossification.

The association of frontal plane alignment to MRI-defined worsening of patellofemoral osteoarthritis: the MOST study

To determine the sex-specific relation of frontal plane alignment (FPA) to magnetic resonance imaging (MRI)-defined features of patellofemoral osteoarthritis, and also to tibiofemoral osteoarthritis and knee pain. The Multicenter Osteoarthritis Study is cohort study comprised of individuals with or at risk of knee osteoarthritis. We determined the sex-specific dose-response relation of baseline FPA to MRI-defined patellofemoral and tibiofemoral structural worsening, and incident knee pain, over 7years. In women only, greater varus alignment was associated with medial patellofemoral osteophytes (risk ratio [RR] 1.7 [95% CI 1.2, 2.6]) and valgus with lateral patellofemoral osteophytes (RR 1.9 [1.0, 3.6]). In men, greater varus increased risk for medial tibiofemoral cartilage worsening (RR 1.7 [1.1, 2.6]), and valgus for lateral tibiofemoral cartilage worsening (RR 1.8 [1.6, 2.2]). In women, findings were similar for tibiofemoral cartilage, but varus also increased risk for medial bone marrow lesions [BMLs] (RR 2.2 [1.6, 3.1]) and medial osteophytes (RR 1.8 [1.3, 2.5]), and valgus for lateral BMLs (RR 3.3 [2.2, 4.5]) and osteophytes (RR 2.0 [1.2, 3.2]). Varus increased risk of incident pain in men (RR 1.7 [1.4, 2.2]) and women (RR 1.3 [1.0, 1.6]), valgus did so in men only (RR 1.5 [1.1, 1.9]). FPA was associated with patellofemoral osteophyte worsening in women, though overall was more strongly associated with tibiofemoral than patellofemoral osteoarthritis feature worsening. FPA in women was more consistently associated with structural worsening, yet men had higher associations with incident pain.

Regional gene expression analysis of multiple tissues in an experimental animal model of post-traumatic osteoarthritis

To characterize local disease progression of the medial meniscus transection (MMT) model of post-traumatic osteoarthritis (OA) at the molecular level, in order to establish a baseline for therapeutic testing at the preclinical stage. Weight-matched male Lewis rats underwent MMT or sham surgery on the left limb with the right leg as contralateral control. At 1 and 3 weeks post-surgery, tissues were harvested from different areas of the articular cartilage (medial and lateral tibial plateaus, and medial osteophyte region) and synovium (medial and lateral), and analyzed separately. RNA was extracted and used for microarray (RT-PCR) analysis. Gene expression changes due to surgery were isolated to the medial side of the joint. Gene changes in chondrocyte phenotype of the medial tibial plateau cartilage preceded changes in tissue composition genes. Differences in inflammatory markers were only observed at the osteophyte region at 3 weeks post-surgery. There was surgical noise in the synovium at week 1, which dissipated at week 3. At this later timepoint, meniscal instability resulted in elevated expression of matrix degradation proteins and osteogenic markers in the synovium and cartilage. These results suggest feedback interactions between joint tissues during disease progression. Regional tissue expression differences found in MMT joints indicated similar pathophysiology to human OA, and provided novel insights about this degeneration model. The examination of gene expression at a localized level in multiple tissues provides a well-characterized baseline to evaluate mechanistic effects of potential therapeutic agents on OA disease progression in the MMT model.

Clinical outcomes of patients with residual medial osteophytes following mobile bearing unicompartmental knee arthroplasty.

IntroductionThe surgical technique used in unicompartmental knee arthroplasty (UKA) is crucial for achieving good short and long term clinical outcomes. The medial mobile bearing UKA has shown excellent clinical outcomes and survivorship. But release of the medial collateral ligament during entering joint is cause of mobile bearing dislocation in short term outcomes and lateral compartment osteoarthritis may occur in the mid to long term outcomes. Removing all osteophytes at the time of UKA is sometime impossible due to their large size and extend to the inferior part of medial tibial plateau and removing them completely my result in release of the MCL. But no data exist on clinical outcomes in such patients.MethodsWe conducted a prospective study from 2010 to 2015 of patients undergoing mobile bearing UKA and classified them in to two groups: those with (Gp1) and without (Gp2) residual osteophytes. Osteophyte size was measured using Hernborg’s technique. The primary outcomes were pain score, functional score, and knee scores and the presence of reported medial knee pain.Results176 patients who underwent 199 mobile bearing UKAs were recruited: Gp1 = 42 patients (46 knees) and Gp2 = 134 patients (153 knees). Residual osteophyte sizes ranged from 2.13–9.42 mm (mean 4.12). The mean Gp1 Gp2 pain score (49.04, 48.92, p = 0.84), functional score (83.75, 84.04, p = 0.83) and knee score (89.86, 98.7, p = 0.0.78) scores were almost identical and no one complained of medial joint pain. Followed up ranged from 2 − 7 years (mean 4.23). No patients were lost to follow up.ConclusionThe patients with residual osteophytes of length less than 9 mm had good and similar clinical outcomes as patients without residual osteophytes following mobile bearing UKA.Level of evidenceLevel II-2, evidence obtained from well-designed cohort studies or case-control studies, preferably from more than one center or research group.

A novel method for assessing proximal tibiofibular joint on magnetic resonance images in patients with knee osteoarthritis

Purpose: Knee osteoarthritis (OA) is well accepted as a whole organ disease that involves abnormalities of various structures. Proximal tibiofibular joint (ProxTibFibJ) is a synovial sliding joint that has been estimated to transmit one-sixth of the leg’s static load. Despite extensive studies on tibiofemoral and patellofemoral compartments, little attention has been paid to the ProxTibFibJ in OA research. One study has reported that proximal fibular osteotomy could significantly improve the clinical outcomes in patients with medial compartment OA. However, no study has delineated the measurement of ProxTibFibJ morphological parameters (ProxTibFibJ contacting area, load-bearing area, lateral stress-bolstering area and posterior stress-bolstering area) on magnetic resonance imaging (MRI) and investigated their correlations with knee OA structural abnormalities. This study, therefore, is to describe and validate a pragmatic method of measuring the ProxTibFibJ morphological parameters, and to investigate the longitudinal associations with joint abnormal structural changes in patients with knee OA. Methods: A total of 408 participants with knee OA were selected from the Vitamin D Effects on Osteoarthritis (VIDEO) Study, which was a multi-center, randomized and double-blind clinical trial. ProxTibFibJ morphological parameters were measured on coronal and sagittal MRI. The contacting area of ProxTibFibJ (S), its projection areas onto the horizontal (load-bearing area, Sτ), sagittal (lateral stress-bolstering area, Sφ) and coronal plane (posterior stress-bolstering area, Sυ) were assessed, respectively. MRI knee structural abnormalities, including cartilage defects, bone marrow lesions (BMLs) and cartilage volume, were evaluated at baseline and 2 years later. Ordinal logistic regression analyses were used to assess the cross-sectional associations between ProxTibFibJ morphological parameters and cartilage defects, BMLs, osteophytes, and JSN. Log binominal regression and linear regression models were used to assess the longitudinal associations between ProxTibFibJ morphological parameters and osteoarthritic structural changes. The reliabilities were examined by calculating the intra- and inter-observer correlation coefficients. Results: The average ProxTibFibJ fibular contacting area was 2.4 ± 0.7 cm2. The intra- and inter-observer correlation coefficients for all measures were excellent (all ≥0.90). In cross-sectional analyses, the ProxTibFibJ morphological parameters (S, Sτ, Sυ and Sφ) were significantly associated with radiographic medial JSN (OR 1.72 for S; 2.20 for Sτ; 1.65 for Sυ), radiographic medial osteophyte (OR 0.51 for Sφ) and MRI-assessed knee joint structural abnormalities including cartilage volume (β −0.07 for S; −0.09 for Sτ), cartilage defects (OR 1.63 for S; 1.95 for Sτ) and BMLs (OR 1.54 for S; 1.74 for Sτ) at medial tibiofemoral compartment. In longitudinal analyses, S (RR, 1.45) and Sτ (RR, 1.55) of ProxTibFibJ were significantly and positively associated with an increase in medial tibial cartilage defects over 2 years, after adjustment for age, gender, height, weight, ROA, tibial plateau bone area and intervention. Sτ (β, −0.07), Sυ (β, −0.07) and S (β, −0.06) of ProxTibFibJ were significantly and negatively associated with change in medial tibial cartilage volume, after adjusted for above covariates. Sτ (RR, 1.55) of ProxTibFibJ was positively associated with an increase in medial tibial BML, and Sφ (RR, 0.35) was negatively associated with an increase in medial femoral BMLs. No significant associations were found between ProxTibFibJ morphological parameters and osteoarthritic changes in lateral tibiofemoral compartment. Conclusions: This novel method to assess the morphological parameters of ProxTibFibJ using MRI is reproducible, and has clinical construct validity. The longitudinal associations with osteoarthritic changes suggest that higher load-bearing area of ProxTibFibJ is a potential risk factor for medial compartment OA. This may contribute to a theoretical basis of proximal fibular osteotomy in the treatment of medial tibiofemoral OA.

Influence of Remained Medial Osteophyte on the Outcome after Ulnohumeral Arthroplasty

Objective: The authors reported the long-term results of ulnohumeral arthroplasty (UHA) for symptomatic elbow osteoarthritis. UHA does not allow access to the medial ulnohumeral osteophyte and to the radiohumeral joint, and the influence of remained medial ulnohumeral osteophyte on the outcome is still unclear. The purpose of the present study was to determine the influence of remained medial osteophyte on the outcome in a much larger sample size. Methods: Fifty-eight elbows in 51 patients with elbow osteoarthritis underwent UHA and were evaluated. Before surgery, all patients complained of motion pain and loss of flexion-extension arc of the elbow. Preoperative evaluation and the outcome at follow-up were assessed using Mayo Elbow Performance Score (MEPS), and medial ulnohumeral osteophyte was assessed in anteroposterior radiograph. Results: Forty-one elbows had no pain and 17 decreased pain. The average flexion-extension arc improved from 93° preoperatively to 107°postoperatively. Total MEPS improved from 69 to 91. The result was excellent for 40 elbows (69%), good for 14 (24%), fair for four (7%) and no poor case. Patients’ satisfaction showed that fifty (86%) were satisfactory subjective result and eight (14%) were unsatisfactory result. The preoperative flexion-extension arc was factors for predicting postoperative results. Remained medial ulnohumeral osteophyte was related to decreased arc of the flexion-extension but not patients’ satisfaction and pain scale. Conclusions: Remained medial ulnohumeral osteophyte was related to decreased arc of the flexion-extension but not patients’ satisfaction and pain scale after UHA.

Meniscal extrusion seen on ultrasonography affects the development of radiographic knee osteoarthritis: a 3-year prospective cohort study.

The objective of this study is to determine whether meniscal extrusion (ME) of the medial meniscus on ultrasonography affects knee osteoarthritis (KOA) progression during 3-year follow-up. Two hundred seventy volunteers (70 men, 200 women; mean age 60.5years) participated. Weight-bearing radiographs were evaluated. All subjects had medial radiographic KOA (Kellgren-Lawrence grade [KLG], ≥2) in at least one knee at baseline (BL). KLG 2 was defined as moderate KOA (MKOA); KLG 3 and 4 were defined as severe KOA (SKOA). Medial and lateral joint space width (MJSW and LJSW) were measured at the minimum width of femoro-tibial compartment. The medial and lateral osteophyte area (MOPA and LOPA) were measured. Rapid joint space narrowing progression (RP) was defined as ≥25% loss of JSW from BL. ME was measured at the medial knee joint space on the medial collateral ligament with ultrasonography. The optimal ME cut-off for RP was determined by ROC curve. The relationship between ME and the longitudinal change of radiographic parameters was elucidated by linear and logistic regression analysis. In the 460 OA knees at BL, both MOPA and LOPA increased, while only MJSW narrowed after 3years. RP occurred in 25 knees among 281 MKOA knees and 42 among 179 SKOA knees. ME was associated with medial joint space narrowing only in the SKOA group, while the ME was associated with MOPA in the MKOA and SKOA groups. The cut-off value to detect RP was 5.5mm only in the SKOA group. Ultrasonographic evaluation of medial ME was useful to detect radiographic KOA progression.

Association of medial meniscal extrusion with medial tibial osteophyte distance detected by T2 mapping MRI in patients with early-stage knee osteoarthritis

BackgroundMedial meniscal extrusion (MME) is associated with progression of medial knee osteoarthritis (OA), but no or little information is available for relationships between MME and osteophytes, which are found in cartilage and bone parts. Because of the limitation in detectability of the cartilage part of osteophytes by radiography or conventional magnetic resonance imaging (MRI), the rate of development and size of osteophytes appear to have been underestimated. Because T2 mapping MRI may enable us to evaluate the cartilage part of osteophytes, we aimed to examine the association between MME and OA-related changes, including osteophytes, by using conventional and T2 mapping MRI.MethodsPatients with early-stage knee OA (n = 50) were examined. MRI-detected OA-related changes, in addition to MME, were evaluated according to the Whole-Organ Magnetic Resonance Imaging Score. T2 values of the medial meniscus and osteophytes were measured on T2 mapping images. Osteophytes surgically removed from patients with end-stage knee OA were histologically analyzed and compared with findings derived by radiography and MRI.ResultsMedial side osteophytes were detected by T2 mapping MRI in 98% of patients with early-stage knee OA, although the detection rate was 48% by conventional MRI and 40% by radiography. Among the OA-related changes, medial tibial osteophyte distance was most closely associated with MME, as determined by multiple logistic regression analysis, in the patients with early-stage knee OA (β = 0.711, p < 0.001). T2 values of the medial meniscus were directly correlated with MME in patients with early-stage knee OA, who showed ≥ 3 mm of MME (r = 0.58, p = 0.003). The accuracy of osteophyte evaluation by T2 mapping MRI was confirmed by histological analysis of the osteophytes removed from patients with end-stage knee OA.ConclusionsOur study demonstrates that medial tibial osteophyte evaluated by T2 mapping MRI is frequently observed in the patients with early-stage knee OA, showing close association with MME, and that MME is positively correlated with the meniscal degeneration.

Radiological and clinical outcome of lateral ankle instability with medial compartment osteoarthritis

Category: Ankle, Ankle Arthritis, osteoarthritis, ankle instability Introduction/Purpose: When lateral ankle instability (LAI) is not treated for long period, unbalanced loading on medial ankle may proceed to osteoarthritis (OA). Outcome studies about osteoarthritis with lateral ankle instability after stabilization, however, have rarely been reported. The authors have investigated the radiological and clinical outcome of ligament stabilization for LAI with medial compartment OA. Methods: The study is based on 25 ankles of LAI with medial compartment ankle OA that underwent lateral ankle ligament reconstruction from 2007 to 2014 with at least 1 year follow-up. The medial ankle OA was diagnosed with degenerative change of medial ankle on plain X-ray or MRI or arthroscopic findings. The OA was classified using Takakura stage, and arthroscopic degenerative change was classified by modified Outerbridge grading. Ligament stabilization surgery was done using either modified Broström procedure or lateral ligament reconstruction using semitendinosus tendon allograft. Arthroscopic synovectomy, debridement, and microfracture for osteochondral lesion were performed when needed. Clinical outcomes were evaluated using visual analogue scale (VAS) pain score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson- Peterson score, and subjective patient satisfaction. Statistical analysis were done using Wilcoxon signed rank test. Results: The average instability duration was 98 (range, 12-480) months and the average follow up period was 46 (range, 13-108) months. Preoperative Takakura stage was mostly I (n=19, 76%) and II (n=4, 17%), and was same postoperatively. MRI OA findings of 18 ankles were medial cartilage denudation (17%), cartilage thinning/erosion (44%), medial osteophyte (50%), and loose bodies (30%). Modified Outerbridge grade 2 and 4 were most common (both 41%). The VAS pain score decreased from 6.1 ± 1.6 preoperatively to 1.8 ± 1.6 postoperatively (P&lt;0.05). The AOFAS score improved from 61.8 ± 14.7 preoperatively to 90.0 ± 6.3 postoperatively, and the Karlsson-Peterson score improved from 54.5 ±14.4 to 89.4 ± 8.4 (P&lt;0.05). There were no significant complications. All patients were satisfied. Conclusion: Ligament stabilization accompanied with arthroscopic procedure could draw good outcome, even without structural bony deformity correction. Even with no improvement in plain radiograph, functional score could be improved.

Equine meniscal degeneration is associated with medial femorotibial osteoarthritis.

There is limited information available concerning normal equine meniscal morphology, its degeneration and role in osteoarthritis (OA). To characterise normal equine meniscal morphology and lesions and to explore the relationship between equine meniscal degeneration and femorotibial OA. Ex vivo cadaveric study. Menisci were harvested from 7 normal joints (n = 14 menisci) and 15 joints with OA (n = 30 menisci). A macroscopic femorotibial OA score (cartilage degeneration and osteophytosis) was employed to measure disease severity in each compartment. The femoral and tibial meniscal surfaces were scored for macroscopic fibrillation and tears (1-4). Histological sections (regions: cranial and caudal horn; body) were also scored for microscopic fibrillation and tears (0-3) and inner border degeneration (0-3). Partial meniscal tears were present on both femoral and tibial surfaces in all 3 regions and most frequently identified on the femoral surface of the cranial horn of the medial meniscus and body of the lateral meniscus. There was a significantly positive correlation between the global medial meniscal macroscopic scores and osteophyte (r = 0.7, P = 0.002) or cartilage degeneration (r = 0.5, P = 0.03) scores within the medial femorotibial joint. The global medial meniscal macroscopic score was greater (P = 0.004) in the advanced OA joints compared with control joints. The menisci were principally from abattoir specimens without a known clinical history because of the challenge in obtaining a large number of specimens with a clinical diagnosis of femorotibial OA. This study is the first to describe normal equine meniscal morphology and lesions. Meniscal lesions were identified in all segments and on both articular surfaces. Meniscal degeneration significantly correlated with OA severity in the equine medial femorotibial joint. The relationship between OA and meniscal pathology remains to be elucidated.

Osteophyte formation on medial wall of the intercondylar notch of femur is an early sign of osteoarthritic knee development using osteoarthritis initiative data

Purpose: Reduction of incidence of osteoarthritic knee (KOA) is a big medical problem to be solved in this aged society. Development of disease-modifying OA drugs (DMOADs) has been pursued and knowledge about mechanisms leading to develop OA has been accumulating. But still there is no good solution for this. Thus, one practical alternative to achieve reducing incidence of OA would be earlier detection of pre-disease status, which will lead to find a new set of population that will respond early intervention. In our previous study using MRI data of osteoarthritis initiative (OAI), we identified osteophytes on the notch of femoral condyle was highly identified in population that were grade 0 or I on Kellgren and Lawrence scale (KL) at baseline and developed to more than grade II after 48 months. Characteristic of this osteophyte was that it could not be identified by conventional antero-posterior or lateral view of plain X-ray. In the study we did not refer to the laterality of the osteophyte formation; i.e., whether medial or lateral wall of the femoral notch the osteophytes were formed. To utilize the findings as early KOA biomarker, more detailed information should be sought. The purpose of this paper is to examine dominance of laterality in terms of osteophyte formation on notch of the femoral condyle as an early biomarker of KOA. Methods: MRI data: MRI data was earned from OAI version E.1. In all subjects, right knee was assessed. On version E.1., 2110 right knees were registered on baseline time (version 0.E.1.), and 1658 right knees were followed until 48 months after baseline time (version 5.E.1.). We extracted 66 knees meeting following criteria. 1) Kellgren and Lawrence grade 0 or 1 at base line, and 2) more than KL grade 2 at 48 months later. They were the same population used for our previous study. Assessment of osteophytes: MRI at baseline was assessed in terms of size and laterality (medial or lateral). For assessing osteophyte size, 8 point marginal osteophyte item of Whole-Organ Magnetic Resonance Imaging Score (WORMS) was employed. With this system, osteophytes were graded from 0 to 7 using the following scale: 0: none; 1: equivocal; 2: small; 3: small-moderate; 4: moderate; 5: moderate-large; 6: large; 7: very large. The laterality of location; i.e., medial or lateral wall of itercondylar notch was also recorded. Results: On the medial wall, 3, 6, 57 knees had grade 1, 2, and 3 osteophyte respectively. That meant 100 percent of the knee had medial side osteophyte. On the lateral wall, 5 and 6 knees had grade 1 and 2 respectively. There was no isolated lateral case so the all the lateral cases had osteophyte on medial wall as well. Conclusions: In this paper we elucidated that osteophyte formation on wall of the femoral condyle was much dominant on medial side than lateral side. Although we dealt with cross-sectional data, we speculated that osteophytes on the medial wall might precede lateral side. Biomarkers to detect early cartilage degeneration have been sought. Among them usefulness of MRI has been reported. But time and cost would be big problem to use it for screening purposes in actual clinical settings. Although additional work is necessary, we believe our finding might be a clue to develop screening system for early KOA. Because our data suggest that point of focus is detect single site osteophyte formation. This will be achieved by modifying x-ray technique or ultrasound.

Automated assessment of bone changes in cross-sectional micro-CT studies of murine experimental osteoarthritis.

ObjectiveThe degradation of articular cartilage, which characterises osteoarthritis (OA), is usually paired with excessive bone remodelling, including subchondral bone sclerosis, cysts, and osteophyte formation. Experimental models of OA are widely used to investigate pathogenesis, yet few validated methodologies for assessing periarticular bone morphology exist and quantitative measurements are limited by manual segmentation of micro-CT scans. The aim of this work was to chart the temporal changes in periarticular bone in murine OA by novel, automated micro-CT methods.MethodsOA was induced by destabilisation of the medial meniscus (DMM) in 10-week old male mice and disease assessed cross-sectionally from 1- to 20-weeks post-surgery. A novel approach was developed to automatically segment subchondral bone compartments into plate and trabecular bone in micro-CT scans of tibial epiphyses. Osteophyte volume, as assessed by shape differences using 3D image registration, and by measuring total epiphyseal volume was performed.ResultsSignificant linear and volumetric structural modifications in subchondral bone compartments and osteophytes were measured from 4-weeks post-surgery and showed progressive changes at all time points; by 20 weeks, medial subchondral bone plate thickness increased by 160±19.5 μm and the medial osteophyte grew by 0.124±0.028 μm3. Excellent agreement was found when automated measurements were compared with manual assessments.ConclusionOur automated methods for assessing bone changes in murine periarticular bone are rapid, quantitative, and highly accurate, and promise to be a useful tool in future preclinical studies of OA progression and treatment. The current approaches were developed specifically for cross-sectional micro-CT studies but could be applied to longitudinal studies.

ASSOCIATION OF ANTERIOR CRUCIATE LIGAMENT DEGENERATION WITH MEDIAL MENISCUS TEAR AND INTERCONDYLAR NOTCH IMPINGEMENT

To explore the association of anterior cruciate ligament (ACL) degeneration with intercondylar notch impingement and the medial meniscus tear in knee osteoarthritis (KOA). Between July 2014 and February 2016, 55 KOA patients (55 knees) with ACL degeneration (degeneration group) and 55 KOA patients (55 knees) without ACL degeneration (control group) were included in the study. No significant difference was found in gender, age, body mass index, and side between 2 groups (P>0.05). The notch width index was measured on preoperative MRI to evaluate whether the intercondylar notch was narrow. The location of the medial and lateral meniscus tear and osteophyte of the ACL tibial insertion were observed under arthroscopy, and the incidences of the meniscus tear and osteophyte were calculated. There was no significant difference in anterior horn and body tear of the medial meniscus and in anterior horn, body, posterior horn, and root tear of the lateral meniscus (P>0.05). Significant difference was found in the posterior horn and root tear of the medial meniscus, osteophyte of the ACL tibial insertion, narrow intercondylar notch, and the notch width index between 2 groups (P<0.05). The incidence of root tear of the medial meniscus was 53.8% (7/13) in 13 knees with osteophyte of the ACL tibial insertion and was 16.5% (16/97) in 97 knees without osteophyte, showing significant difference (χ2=9.671, P=0.002). There is a strong association of ACL degeneration with posterior horn and root tear of the medial meniscus and intercondylar notch impingement in KOA. And the high incidence of root tear of the medial meniscus in knee is correlated with osteophyte of the ACL tibial insertion.

Absence of a relationship between joint space narrowing and osteophyte formation in early knee osteoarthritis among Japanese community-dwelling elderly individuals: A cross-sectional study

Objectives: Joint space narrowing and osteophyte formation, radiographic features of knee osteoarthritis (OA), are not necessarily synchronous processes. We evaluated the relationship between medial minimum joint space width (mJSW) and osteophyte formation.Methods: We conducted a retrospective study of 1050 individuals (424 males; 626 females; mean age 64.9 years) who underwent knee radiography as part of a health screening program, between 2011 and 2013. mJSW and tibial osteophyte area (OF) were quantified using automated software. The mJSW range was subdivided into tertiles, and OF, mJSW, and quality of life (QOL) were compared among them. Correlation between OF and mJSW was evaluated.Results: In females, OF was largest and correlated with mJSW only in the lowest tertile group. Patients in the lowest mJSW tertile group had a lower QOL and higher pain than those in the other two groups. Based on our generalized additive models and a receiver operating characteristic curve analysis, an mJSW cutoff point of 3.5 mm was apparent in females, with no significant cutoff identified in males.Conclusions: OF correlates with mJSW below a cutoff value of about 3.5 mm in females. OA symptoms, namely physical function impairment and pain, increases significantly as mJSW decreases below the cutoff.