Medial Tibiofemoral Joint Space Width Research Articles

Association of physical activity with loss of knee joint space width over two years: a compositional data analysis in the Osteoarthritis Initiative

There is continued debate as to how engaging in physical activity (PA), including moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary time (SED), affects one's risk for knee osteoarthritis (OA). Traditional regression methods do not account for the codependence of these categories of PA, whereby when one category increases, the others must decrease. Thus, we used compositional data analysis (CoDA) to examine time spent in each category of PA, or PA composition, and its association with loss of knee joint space width (JSW), a common indicator of knee OA progression. We performed a secondary analysis of data from a subset of participants in the Osteoarthritis Initiative. These participants had minute-by-minute activity data collected over 7 days at baseline; we then categorized each minute as MVPA, LPA, or SED. Our exposure, PA composition, represented min/day spent in each category. Our outcome, medial JSW loss, was the difference in medial tibiofemoral JSW from baseline to 2years later. We employed CoDA, using an isometric log-ratio transformation, to examine the association of PA composition with medial JSW loss over 2years, adjusting for potential confounders. We included 969 participants (age: 64.5 years, 56% female, body mass index [BMI]: 28.8kg/m2). Mean PA composition was: MVPA 9.1min/day, LPA 278min/day, SED 690min/day. Per adjusted regression models, higher MVPA was not associated with greater medial JSW loss (β=-0.0005, P=0.97), nor was LPA (β=0.06, P=0.27) or SED (β=-0.06, P=0.21). Using CoDA, PA composition was not associated with medial JSW loss over 2years.

A Balanced Arthroscopic Debridement of the Inner Layer of the Knee Retinaculum Increases the Tibiofemoral Joint Space Width.

Introduction Traditional techniques can enlarge the medial tibiofemoral joint space width (JSW) for meniscal repairs, but a remnant ligament laxity may be developed. Alternatively, the debridement of the inner retinaculum layer may result in a balanced JSW without causing extra-ligament damage (retinaculum layers II and collateral ligament). Purpose The purpose of this study was to determine whether a concentric arthroscopic debridement of the inner retinaculum layer increases the tibiofemoral JSW in patients with meniscal injuries. Secondarily, we determine whether the increase in JSW is symmetrical between compartments and describe the rate of complications and patient satisfaction. Method Twenty middle-aged (15 male and five female) patients diagnosed with acute meniscal injury aged 36 ± 12 years were enrolled. The patients were submitted to an arthroscopic debridement of the inner layer of the knee retinaculum for both the medial and lateral compartments. The tibiofemoral JSW was measured intra-articularly using a custom instrument. A two-way ANOVA for repeated measures was used to compare the JSW. A Bland–Altman analysis and test-retest analysis were performed. Results The JSW increased following the debridement of the inner retinaculum layer, for both the medial and lateral compartments (p < 0.001). No complications were identified, and the patients were satisfied with the intervention. The minimal detectable change and bias of the custom instrument were 0.06 mm and 0.02 mm, respectively. Conclusion The debridement allows a clinically important (>1 mm) symmetric tibiofemoral JSW enlargement. The technique suggests favoring the diagnosis of meniscus injuries and manipulating arthroscopic instruments without secondary complications after one year.

Improving visualization of the articular cartilage of the knee with magnetic resonance imaging under axial traction: a comparative study of different traction weights.

Lesions of the articular cartilage of the knee, especially early grades, are not always accurately detected by magnetic resonance imaging (MRI) because of contact between the articular cartilage surfaces of the femur and the tibia. This study aimed to assess the effects of axial leg traction during knee MRI examination on joint space widening and articular cartilage visualization and evaluate the ideal weight for traction. MRI was performed on ten healthy volunteers using a 3-T MRI unit with a 3D dual-echo steady-state gradient-recalled echo sequence. Conventional MRI was performed first, followed by traction MRI. The traction weight increased in the order of 5kg, 10kg, and 15kg. Joint space widths were measured, and articular cartilage visualization was assessed at the medial and lateral tibiofemoral joints. Volunteers were asked to evaluate pain and discomfort using a visual analog scale during each procedure with axial traction to assess the safety of traction MRI. The medial tibiofemoral joint space width significantly increased, and the visualization of the articular cartilage significantly improved by applying traction. The joint space width and the articular cartilage visualization showed no significant differences among traction weights of 5kg, 10kg, and 15kg. Pain and discomfort during traction MRI examination were lowest with a traction weight of 5kg. Traction MRI examination may be useful in evaluating articular cartilage lesions at the medial tibiofemoral joint. A traction weight of 5kg may be sufficient with minimum pain and discomfort.

The association between vitamin K and medial tibial-femoral knee osteoarthritis progression: Data from the osteoarthritis initiative

ObjectiveWe sought to examine the prospective association of vitamin K with radiographic progression of knee osteoarthritis. MethodsIn OAI, 1977 participants with radiographic knee OA and having dietary data at baseline were followed up to 12, 24, 36 and 48 months. Vitamin K was assessed with a Block Brief Food Frequency Questionnaire completed at baseline. To evaluate knee OA progression, we used quantitative medial tibiofemoral joint space width (JSW) based on plain radiographs. Progression was defined by measured Joints Space Width (JSW). The generalized linear mixed model was used to test the association of vitamin K and change in JSW over time, while adjusting for baseline KL grade and other potential confounding factors. ResultsWe found a relationship between dietary Vitamin K with structural progression of knee osteoarthritis measured by quantitative JSW in a dose response manner. When stratified among KL groups, a significant trend was seen in the KL2 (p ​< ​0.025) ConclusionOur results suggest that decreased vitamin K intake from food may be associated with increased progression of knee OA. Replication of these findings in other studies validating decreased vitamin K intake leading to increased knee OA progression are needed. SignificanceThis study provides insight into a potential novel risk factor for the progression of knee OA. These findings have may have clinical implications given the potential for Vitamin K to be a simple therapy for knee OA.

Radiographic hand osteoarthritis and worsening of mri-based tibiofemoral osteoarthritis-related structural damage, data from the OAI study

Purpose: To determine whether the presence of hand osteoarthritis (OA) is associated with radiographic knee OA progression (over 48-months) and MRI-based knee OA structural damage worsening (over 24-months). Methods: 600 subjects from the Foundation for the National Institute of Health (FNIH) project which is an IRB approved HIPAA compliant study were included (one index knee and hand in each subject). Baseline hand radiography of all subjects was measured for the presence of hand OA. PA radiographs of the dominant hand or the left hand (in case of ambidexterity) of included subjects were assessed by a musculoskeletal radiologist in a blinded fashion. Distal interphalangeal (DIP), proximal interphalangeal (PIP), interphalangeal (IP), metacarpophalangeal (MCP), and the first carpometacarpal (CMC) joints were assessed for the presence of OA (modified Kellgren and Lawrence (mKL) grade >=2) in each hand joint. Baseline and follow-up knee radiographic measurements and MRI OA Knee Score (MOAKS) variables for cartilage damage, bone marrow lesions, osteophytes, effusion, and Hoffa-synovitis as well as MRI-based knee periarticular bone area measurements were extracted. The association between the presence of hand OA (presence vs. absence of hand OA in each hand joint) and 48-months radiographic knee OA progression (defined as >0.7mm reduction in medial tibiofemoral joint space width) as well as 24-months change in knee MOAKS and periarticular bone measurements were analyzed using regression model (adjusted for age and sex). Results: Presence of any carpometacarpal (CMC) OA (OR 95%CI: 1.58(0.96-2.62)) and overall hand OA (prsence of any mKL>=2 in all hand joints) (OR 95%CI: 1.44(0.97-2.07)) was associated increased odds for being a radiographic or composite progressor (approached but not reached significance). In comparison with controls, subjects with hand OA showed higher odds of worsening tibial/femoral cartilage damage (OR 95%CI: 1.38(0.95-2.01) and 1.79(1.24-2.58)) and femoral periarticular bone area expansion (Beta 95%CI: 10.54(1.40-19.69)) over 24-months. CMC OA and 24-months worsening of MRI-based tibiofemoral cartilage damage and periarticular bone area expansion were also showed approached significant associations. Conclusions: Presence of hand OA, especially in CMC joint, is associated with longitudinal MRI-based knee OA-related structural damage worsening including tibial/femoral cartilage damage and periarticular bone area expansion.

Correlations of Medial Joint Space Width on Fixed‐Flexed Standing Computed Tomography and Radiographs With Cartilage and Meniscal Morphology on Magnetic Resonance Imaging

To assess whether medial tibiofemoral joint space width (JSW) on 3-dimensional (3-D) standing computed tomography (SCT) correlates more closely with magnetic resonance imaging cartilage morphology (CM) and meniscal scores than does radiographic 2-D JSW. Participants in the Multicenter Osteoarthritis Study, who had standing fixed-flexion posteroanterior knee radiographs, were recruited. Medial tibiofemoral 3-D JSW on SCT and 2-D JSW on fixed-flexion radiographs were compared with medial tibiofemoral cartilage and meniscal morphology using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations between the area of the articular surface with 3-D JSW <2.5 mm on SCT, radiographic minimal 2-D JSW, and the WORMS-CM and meniscal scores were assessed using Spearman's rho. For the 19 participants included (33 knees), mean ± SD age was 66.9 ± 5.4 years, body mass index was 29.5 ± 4.4 kg/m(2) , 42.1% of participants were female, and the Kellgren/Lawrence grades were 0 (21.2%), 1 (36.4%), 2 (18.2%), and 3 (24.2%). The articular surface area with 3-D JSW <2.5 mm on SCT correlated with WORMS-CM scores for the central medial tibia (rs = 0.84, P < 0.001), central medial femur (rs = 0.60, P < 0.007), and posterior medial meniscal tear (rs = 0.39, P < 0.026), as did other cut points for 3-D JSW. Correlations with radiographic minimal 2-D JSW were -0.66, -0.52, and -0.40, respectively, differing from SCT only for tibial cartilage (P = 0.001). Greater surface area with a low JSW, measured by SCT, correlates more strongly with the severity of tibial cartilage lesions, while correlating with medial femoral cartilage and meniscal damage to a similar extent as radiographic minimal JSW. SCT may enable valid stratification of participants in clinical trials, through quickly and inexpensively characterizing osteoarthritis features.

Exploratory analysis of osteoarthritis progression among medication users: data from the Osteoarthritis Initiative.

We conducted an exploratory analysis of osteoarthritis progression among medication users in the Osteoarthritis Initiative to identify interventions or pathways that may be associated with disease modification and therefore of interest for future clinical trials. We used participants from the Osteoarthritis Initiative with annual medication inventory data between the baseline and 36-month follow-up visit (n = 2938). Consistent medication users were defined for each medication classification as a participant reporting at all four annual visits that they were regularly using an oral prescription medication at the time of the visit. The exploratory analysis focused on medication classes with 40 or more users. The primary outcome measures were medial tibiofemoral joint space width change and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) knee pain score change (12-36-month visits). Within each knee, we explored eight comparisons between users and matched or unmatched nonusers (defined two ways). An effect size of each comparison was calculated. Medication classes had potential signals if (a) both knees had less progression among users compared with nonusers, or (b) there was less progression based on structure and symptoms in one knee. We screened 28 medication classes. Six medication classes had signals for fewer structural changes and better knee pain changes: alpha-adrenergic blockers, antilipemic (excluding statins and fibric acid), anticoagulants, selective serotonin reuptake inhibitors, antihistamines, and antineoplastic agents. Four medication classes had signals for structural changes alone: anti-estrogen (median effect size = 0.28; range = -0.41-0.64), angiotensin-converting enzyme inhibitors (median effect size = 0.13; range = -0.08-0.28), beta-adrenergic blockers (median effect size = 0.09; range = 0.01-0.30), and thyroid agents (median effect size = 0.04; range = -0.05-0.14). Thiazide diuretics had evidence for symptom modification (median effect size = -0.12; range = -0.24-0.04). Users of neurovascular, antilipemic, or hormonal interventions may have less disease progression compared with nonusers.

Soft drink intake and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative

ObjectivesWe examine the prospective association of soft drink consumption with radiographic progression of knee osteoarthritis (OA).DesignProspective cohort study.SettingThis study used data from the osteoarthritis initiative (OAI).ParticipantsIn OAI, 2149 participants with...

Assessment of the radioanatomic positioning of the osteoarthritic knee in serial radiographs: comparison of three acquisition techniques

Recent studies using various standardized radiographic acquisition techniques have demonstrated the necessity of reproducible radioanatomic alignment of the knee to assure precise measurements of medial tibiofemoral joint space width (JSW). The objective of the present study was to characterize the longitudinal performance of several acquisition techniques with respect to long-term reproducibility of positioning of the knee, and the impact of changes in positioning on the rate and variability of joint space narrowing (JSN). Eighty subjects were randomly selected from each of three cohorts followed in recent studies of the radiographic progression of knee osteoarthritis (OA): the Health ABC study (paired fixed-flexion [FF] radiographs taken at a 36-month interval); the Glucosamine Arthritis Intervention Trial (GAIT) (paired metatarsophalangeal [MTP] radiographs obtained at a 12-month interval), and a randomized clinical trial of doxycycline (fluoroscopically assisted semiflexed anteroposterior (AP) radiographs taken at a 16-month interval). Manual measurements were obtained from each radiograph to represent markers of radioanatomic positioning of the knee (alignment of the medial tibial plateau and X-ray beam, knee rotation, femorotibial angle) and to evaluate minimum JSW (mJSW) in the medial tibiofemoral compartment. The effects on the mean annualized rate of JSN and on the variability of that rate of highly reproduced vs variable positioning of the knee in serial radiographs were evaluated. Parallel or near-parallel alignment was achieved significantly more frequently with the fluoroscopically guided positioning used in the semiflexed AP protocol than with either the non-fluoroscopic FF or MTP protocol (68% vs 14% for both FF and MTP protocols when measured at the midpoint of the medial compartment; 75% vs 26% and 34% for the FF and MTP protocols, respectively, when measured at the site of mJSW; P<0.001 for each). Knee rotation was reproduced more frequently in semiflexed AP radiographs than in FF radiographs (66% vs 45%, P<0.01). In contrast, the FF technique yielded a greater proportion of paired radiographs in which the femorotibial angle was accurately reproduced than the semiflexed AP or MTP protocol (78% vs 59% and 56%, respectively, P<0.01 for each). Notably, only paired radiographs with parallel or near-parallel alignment exhibited a mean rate of JSN (+/-SD) in the OA knee that was more rapid and less variable than that measured in all knees (0.186+/-0.274 mm/year, standardized response to mean [SRM]=0.68 vs 0.128+/-0.291 mm/year, SRM=0.44). This study confirms the importance of parallel radioanatomic alignment of the anterior and posterior margins of the medial tibial plateau in detecting JSN in subjects with knee OA. The use of radiographic methods that assure parallel alignment during serial X-ray examinations will permit the design of more efficient studies of biomarkers of OA progression and of structure modification in knee OA.

Comparison of conventional standing knee radiographs and magnetic resonance imaging in assessing progression of tibiofemoral joint osteoarthritis

Although the current recommendation is to measure radiographic joint space width (JSW) to assess structural change in osteoarthritis (OA), there is increasing interest in direct measurement of cartilage volume from magnetic resonance imaging (MRI). We performed a longitudinal study to compare change in both JSW and articular cartilage volume in subjects with symptomatic knee OA. JSW was measured in 28 subjects with knee OA (57% females, mean age 62.8+/-9.8 years) who had standing radiographs in full extension, where both radiographs had satisfactory alignment. Each subject had femoral, tibial and combined femoral and tibial cartilage volumes determined from T1-weighted fat saturated sagittal knee MRI. All subjects had a repeat of the knee radiograph and MRI 1.96+/-0.4 years later. At baseline there was a moderate, but statistically significant, correlation between JSW and femoral and tibial cartilage volumes in the medial tibiofemoral joint, which was strengthened by adjusting for medial tibial bone size (R=0.58-0.66, P=0.001). Although we observed a reduction in JSW and femoral and tibial cartilage volumes over the study period, there was no significant association between reduction in JSW and cartilage volume (R<0.13). There was a trend towards a significant association between change in medial tibiofemoral cartilage volume and joint replacement at 4 years (OR=9.0, P=0.07) but not change in medial tibiofemoral JSW (OR=1.1, P=0.92). Although there was a modest correlation between cartilage volume and JSW in the medial tibiofemoral compartment, there was no correlation between longitudinal change in these measures. Change in cartilage volume appears to be a better predictor of joint replacement. Further work in larger samples over a longer period of time will be needed to confirm these findings.

No loss of cartilage volume over three years in patients with knee osteoarthritis as assessed by magnetic resonance imaging

Objective Magnetic resonance imaging (MRI) has the potential to provide accurate quantification of structural changes in joint disease, with sensitivity to change, as it can provide direct visualization of the cartilage and bone. In this study, we investigated whether knee cartilage volume, as assessed by MRI, is sensitive to change over time in patients with osteoarthritis (OA).Design Sixteen patient volunteers (10 male, six female) with established OA of the knee were entered into the study and demographic data recorded. At baseline, 12 months and 37±2 months, patients underwent simple measures of disease severity, as well as extended weight-bearing AP knee X-rays. In addition the patient's index knee was imaged using MR at 1.0T using a 3-D spoiled gradient–echo sequence with fat-suppression, repetition time 50ms, echo time 11ms, flip-angle 40°, sagittal slice thickness 1.56mm and in-plane pixel resolution 0.55mm. Manual image segmentation was performed on all knee cartilage compartments and the respective cartilage volumes determined.Results Eleven of the original patients recruited completed the 3-year study. Radiographic features indicated that the majority had a spectrum of well-established OA at entry. The average decrease in medial tibiofemoral joint space width was 0.21±0.37mm (mean±S.D.). Comparison of MR images at baseline and 37±2 months indicated little evidence of cartilage lesion shape or size change in any of the compartments. There was no significant MRI volume change in any of the knee cartilage compartments over the course of 1 year. The change in total knee cartilage volume, as measured by MRI, was a loss of only 1.6%, or 0.36±1.3ml (mean±S.D.), over the 3 years.Conclusions The failure to identify loss of cartilage volume over 3 years in this cohort of patients with established knee OA using MRI challenges the face validity of this endpoint to assess structural changes in OA. Copyright 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved.

161Dy isomer shifts in dysprosium compounds

Objective Magnetic resonance imaging (MRI) has the potential to provide accurate quantification of structural changes in joint disease, with sensitivity to change, as it can provide direct visualization of the cartilage and bone. In this study, we investigated whether knee cartilage volume, as assessed by MRI, is sensitive to change over time in patients with osteoarthritis (OA).Design Sixteen patient volunteers (10 male, six female) with established OA of the knee were entered into the study and demographic data recorded. At baseline, 12 months and 37±2 months, patients underwent simple measures of disease severity, as well as extended weight-bearing AP knee X-rays. In addition the patient's index knee was imaged using MR at 1.0T using a 3-D spoiled gradient–echo sequence with fat-suppression, repetition time 50 ms, echo time 11 ms, flip-angle 40°, sagittal slice thickness 1.56 mm and in-plane pixel resolution 0.55 mm. Manual image segmentation was performed on all knee cartilage compartments and the respective cartilage volumes determined.Results Eleven of the original patients recruited completed the 3-year study. Radiographic features indicated that the majority had a spectrum of well-established OA at entry. The average decrease in medial tibiofemoral joint space width was 0.21±0.37mm (mean±S.D.). Comparison of MR images at baseline and 37±2 months indicated little evidence of cartilage lesion shape or size change in any of the compartments. There was no significant MRI volume change in any of the knee cartilage compartments over the course of 1 year. The change in total knee cartilage volume, as measured by MRI, was a loss of only 1.6%, or 0.36±1.3 ml (mean±S.D.), over the 3 years.Conclusions The failure to identify loss of cartilage volume over 3 years in this cohort of patients with established knee OA using MRI challenges the face validity of this endpoint to assess structural changes in OA. Copyright 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved.