Radiographic Grading Research Articles

Risk factors predicting a higher grade of subarachnoid haemorrhage in small ruptured intracranial aneurysm (< 5 mm).

To identify the risk factors for clinical and radiographic grades of subarachnoid haemorrhage (SAH) in small (< 5 mm) intracranial aneurysms (SIAs). We retrospectively analysed patients with SIAs treated in our centre between February 2009 and June 2018. The clinical status was graded using the Hunt and Hess (H&H) score and the radiological severity of SAH was graded by Fisher grades (FG). The risk factors were determined using multivariate logistic regression analysis. A total of 160 patients with ruptured SIAs (< 5 mm) were included. In univariate analysis, smoking (P = 0.007), alcohol use (P = 0.048), aspirin use (P = 0.001), and higher size ratio (SR) (P = 0.001) were significantly associated with a higher H&H grade (3-5) in SIAs; and smoking (P = 0.019), aspirin use (P = 0.031), inflow angle < 90 degrees (P = 0.011), and aneurysm size (P = 0.039) were significantly associated with a higher FG score (3-4). In the adjusted multivariate analysis, previous SAH (OR, 12.245, 95% CI, 2.261-66.334, P = 0.004), aspirin use (OR, 4.677, 95% CI, 1.392-15.718, P = 0.013), alcohol use (OR, 3.392, 95% CI, 1.146-10.045, P = 0.027), inflow angle < 90 (OR, 3.881, 95% CI, 1.273-11.831, P = 0.017), and higher SR (OR, 6.611, 95% CI, 2.235-19.560, P = 0.001) were independent risk factors for a higher H&H grade in ruptured SIAs; smoking (OR, 2.157, 95% CI, 1.061-4.384, P = 0.034), and inflow angle < 90 degrees (OR, 2.603, 95% CI, 1.324-5.115, P = 0.006) were independent risk factors for a higher FG (3-4). This study revealed that inflow angle < 90 degrees and size ratio, but not absolute size, may highly predict poorer grade of SAH in SRA. Aspirin use, previous SAH, and alcohol use were significantly associated with a higher H&H grade in ruptured SIAs, and smoking was a significant predictor of poorer FG.

Association of leg muscle symmetry with knee osteoarthritis.

This study aimed to evaluate the relationship of leg muscle symmetry to the prevalence, radiographic grade, and symptoms of knee osteoarthritis (OA). We conducted a cross-sectional study using data from the Korean National Health and Nutrition Examination Survey (KNHANES), collected in 2010 and 2011. Men and women aged 60years or older were included. Leg muscle mass was measured using dual-energy X-ray absorptiometry, and the muscle asymmetry index was defined as ∣(left leg muscle mass)/(left and right leg muscle mass) × 100 - 50∣. Statistical analyses were performed to examine the relationships between the muscle asymmetry index and the radiographic grade and knee symptoms. A total of 2548 subjects were included in the analysis. The muscle asymmetry index was positively associated with radiographic knee OA grade and knee pain, especially in men. Men with knee OA and the highest quartile of muscle asymmetry index were 3.3 times more likely to have knee pain compared with those in the lowest quartile. When subjects were divided into four groups by body mass index (BMI) and muscle asymmetry index, subjects with asymmetric obese and men with asymmetric normal BMI had worse grade of radiographic knee OA. Leg muscle asymmetry in men, irrespective of obesity, was associated with significantly higher grade of radiographic knee OA and prevalent knee pain. Longitudinal studies will be needed to determine the cause-and-effect relationship and to determine whether the higher or lower mass, beyond the asymmetry, is associated with radiographic severity or symptomatic knee OA.Key Points•Leg muscle asymmetry was related to prevalence and radiographic severity of knee OA, especially in men.•Leg muscle asymmetry was associated with knee pain.•Those with both leg muscle asymmetry and obesity showed higher prevalence of knee pain and worse radiographic knee OA.

Effect of age on radiographic outcomes of patients aged 6-24 months with developmental dysplasia of the hip treated by closed reduction.

This study aimed to investigate the effect of age on the rates of redislocation, avascular necrosis (AVN) of the femoral head, and final radiographic outcomes in patients with developmental dysplasia of the hip (DDH) treated with closed reduction. A total of 308 hips (276 patients) with DDH treated with closed reduction were included and divided into three groups according to age (<12, 12-18, 18-24 months). Tönnis grade, rate of redislocation and AVN, Severin radiographic grade, and risk of surgery were evaluated on radiographs. Tönnis grade significantly increased with age (P < 0.001). Redislocation occurred in 17 (5.5%) and AVN occurred in 36 (11.7%) hips. The rate of redislocation and AVN was similar among the three age groups in all Tönnis grades. However, redislocation rate significantly increased with Tönnis grade (P = 0.027). Overall, 246 hips (79.9%) had satisfactory final outcomes, and 62 hips (20.1%) had unsatisfactory outcome; no difference was observed among three age groups. A total of 103 hips (33.4%) were found to be at risk for secondary surgery. The surgical risk (25%) in patients younger than 12 months was lower than that of older patients (12-18 months: 34.4%; 18-24 months: 37.9%). Logistic regression analysis also confirmed that age was not a risk factor for redislocation, AVN, or poor radiographic outcome. In conclusion, age has no significant impact on redislocation and AVN in patients aged 6-24 months with DDH treated by closed reduction. Although older patients have a higher risk developing residual acetabular dysplasia, secondary pelvic surgery provides favorable outcomes in most patients.

Technique de réduction des fractures de l’acétabulum à déplacement antéro-médial utilisant un clamp colinéaire par voie ilio-inguinale modifiée

The authors present a surgical technique using a collinear reduction clamp through the modified ilioinguinal approach (MIA) for anteromedially displaced acetabular fractures along with the surgical outcomes. Between October 2010 and June 2015, 15 patients underwent surgical treatment for anteromedially displaced acetabular fractures; 10 both-column fractures and 5 anterior column and posterior hemitransverse fractures. Anteriorly displaced anterior column fragment and medially displaced quadrilateral plate fragment were simultaneously reduced using a collinear clamp and fixed with a 3.5 mm-reconstruction plate through MIA. Postoperatively, anatomical reduction was achieved in 12 patients, while imperfect reduction was achieved in 3. At a mean follow-up of 49.0 months (range, 24–93 months), the mean Postel Merle d’Aubigné score were 16.3 and the mean VAS score was 0.9. Final radiographic grades according to Matta system were excellent in 13 patients and good in 2. Surgical technique using a collinear reduction clamp through the MIA can provide satisfactory outcomes in anteromedially displaced acetabular fractures.

Association of UCMA levels in serum and synovial fluid with severity of knee osteoarthritis.

Osteoarthritis (OA) is one of the most common joint diseases causing physical disability in the aged population. OA pathogenesis is not fully known and yet there are no effective therapeutic options against OA. Upper Zone of Growth Plate and Cartilage Matrix Associated (UCMA) is a member of vitamin K-dependent protein family, and is involved in inflammation, cardiovascular diseases, cancer, and OA. In the present study, our aim was to detect serum and synovial fluid (SF) levels of UCMA and to analyze their correlation with radiographic findings and symptomatic severity in OA patients as well as the correlation between oxidative stress levels and SF UCMA levels. Forty OA patients with cartilage degeneration and 20 patients with other knee joint disorders (non-OA control) were included in the present study. We used the Kellgren-Lawrence (KL) classification and Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores to assess radiographic grading and symptomatic severity of OA, respectively. UCMA levels were measured in SF and serum. And also oxidative stress markers were analyzed in SF. SF UCMA levels of OA patients were higher compared to those of the non-OA control group and were positively correlated with radiographic finding and symptomatic severity of OA. However, there was no significant correlation between oxidative markers of SF and the KL grade, WOMAC scores, and SF UCMA levels in OA patients. There is a close connection between UCMA SF levels and symptomatic and radiographic severities of knee OA. Therefore, UCMA can be a promising biomarker in the diagnosis and/or prognosis of OA disease.

Clinical Assessments of Hand Function in First Carpometacarpal Osteoarthritis Do Not Appear to Correlate with Radiographic Findings

Thumb carpometacarpal (first CMC) osteoarthritis (OA), a degenerative process affecting hand use, is typically assessed by clinical examination and radiographs. This assessment determines treatment, but it may not reflect functional limitations. We aimed to explore the relationship between measures of hand function and radiographs in individuals with and without first CMC OA. We designed a cross-sectional, observational pilot study, enrolling five patients with first CMC OA (nine thumbs with modified Eaton-Littler grades ranging from 1 to 4, using retrospective radiographic data) and nine healthy controls. They underwent evaluation of hand function using four patient-reported outcome measures (PROMs)-the Patient-Specific Functional Scale (PSFS); the Patient-Rated Wrist/Hand Evaluation (PRWHE); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH)-and one performance measure, the Arthritis Hand Function Test (AHFT). Spearman's ρ with 95% subject clustered bootstrapped confidence intervals was calculated to assess for correlations between radiographic findings and measures of hand function. Only the DASH work score showed strong positive correlation with radiographic OA grade, with PSFS, PRWHE, M-SACRAH, and AHFT scores demonstrating low to moderate correlations. Notable differences were found between patients and control subjects in median scores of the DASH, PSFS, PRWHE, andM-SACRAH, as well as in the grip, pinch, and button scores of the AHFT. While only the DASH work score strongly correlated with radiographic grade of first CMC OA, several measures detected considerable differences in functional hand use between patients and control subjects. The findings of this pilot study suggest that hand function scores be considered in addition to radiographs when determining severity of first CMC OA. The findings can also inform the design of a larger, powered study.

Younger age is associated with greater pain expression among patients with knee or hip osteoarthritis scheduled for a joint arthroplasty

BackgroundThis study describes how patients with knee or hip osteoarthritis (OA), scheduled for arthroplasty, characterize their pain qualitatively and quantitatively and investigates whether differences exist in pain expression between younger and older patients, and between men and women.MethodsOne hundred eight patients scheduled for a joint arthroplasty completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) or Hip Disability and Osteoarthritis Outcome Score (HOOS) and a health-related quality of life question. Pain was assessed using the visual analogue scale (VAS), KOOS/HOOS and the Pain-o-Meter (POM) consisting of 12 sensory and 11 affective words (POM-Words). Frequency of analgesics use was assessed and preoperative radiographs were graded. ANOVA was used to test differences in pain expression with age (< 65 vs. ≥65 years), sex, and affected joint as independent factors.ResultsPatients < 65 years of age used more affective words (POM) and words with higher affective intensity (median scores 8 (3–39), 5.5 (2–27) respectively), than older patients, despite having less radiographically advanced OA. They also reported more symptoms (KOOS/HOOS) than older patients. However, pain ratings, as measured by VAS and KOOS/HOOS pain, did not differ between younger and older adults. Women reported more frequent analgesics use (45.7 and 26.5% respectively) and rated their pain higher than men (mean POM-VAS = 42 (SD 24) and 31 (SD 19); respectively). No differences existed between sexes for sensory or affective POM-Words, or radiographic grade of OA. With age and sex as independent factors, a significant difference between knee and hip OA remained for sensory POM-words intensity scores.ConclusionsYounger adults scheduled for arthroplasty expressed pain using more affective words and words with higher intensity and had less radiographically advanced OA than older adults. However, VAS and KOOS/HOOS pain subscales could not distinguish the difference in pain expression. Thus, the POM may be a valuable tool for assessment of pain.

Relationship between the stage of osteoarthritis before and six months after tibial tuberosity advancement procedure in dogs.

The present retrospective study evaluated the progression of osteoarthritis in stifle joints based on the radiographic grade of osteoarthritis (OA) scored in dogs with cranial cruciate ligament rupture. The aim of the study was to search for a correlation between the stage of radiographic osteoarthritis prior to surgery and the osteoarthritis progression occurring after the tibial tuberosity advancement (TTA) procedure. It was hypothesized that the procedure carried out in dogs in the early stages of OA could reduce the OA changes. A total of 190 X-ray images obtained from the medical records of 38 dogs were evaluated. The radiographic signs of osteoarthritis of 38 stifle joints were scored from 0 to 3 in 10 specific anatomic locations. The radiographs were divided into 4 groups based on the global scores: A) no-OA, B) mild-OA, C) moderate-OA, D) severe-OA; they were assessed prior to surgery, and 1, 2, 3 and 6 months post-operatively (T0, T1, T2, T3 and T6). There were no differences in osteoarthritis progression in Groups A and C at any time. Osteoarthritis changes from T0 to T6 were statistically significant in Group B. The OA changes in the anatomic locations were investigated. The most common anatomic sites for OA changes were the patella apex, the proximal and distal trochlear ridges, and the caudal aspect of the tibial plateau assessed before surgery. After surgery, the score increased in the first three locations in 10, 9 and 11 joints, respectively; instead, the progression of osteoarthritis in the caudal aspect of the tibial plateau occurred in 23 out of 38 stifle joints. The results indicated that the TTA procedure could be effective in slowing down the OA progression when carried out in the absence of or in the early stages of disease. Therefore, an early intervention may be suggested in clinical practice to obtain minimal or no progression 6 months postoperatively.

Predictors of Radiographic Osteoarthritis 2 to 3 Years After Anterior Cruciate Ligament Reconstruction: Data From the MOON On-site Nested Cohort.

Background:Multiple studies have shown that patients are susceptible to posttraumatic osteoarthritis (PTOA) after an anterior cruciate ligament (ACL) injury, even with ACL reconstruction (ACLR). Prospective studies using multivariable analysis to identify risk factors for PTOA are lacking.Purpose/Hypothesis:This study aimed to identify baseline predictors of radiographic PTOA after ACLR at an early time point. We hypothesized that meniscal injuries and cartilage lesions would be associated with worse radiographic PTOA using the Osteoarthritis Research Society International (OARSI) atlas criteria.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 421 patients who underwent ACLR returned on-site for standardized posteroanterior semiflexed knee radiography at a minimum of 2 years after surgery. The mean age was 19.8 years, with 51.3% female patients. At baseline, data on demographics, graft type, meniscal status/treatment, and cartilage status were collected. OARSI atlas criteria were used to grade all knee radiographs. Multivariable ordinal regression models identified baseline predictors of radiographic OARSI grades at follow-up.Results:Older age (odds ratio [OR], 1.06) and higher body mass index (OR, 1.05) were statistically significantly associated with a higher OARSI grade in the medial compartment. Patients who underwent meniscal repair and partial meniscectomy had statistically significantly higher OARSI grades in the medial compartment (meniscal repair OR, 1.92; meniscectomy OR, 2.11) and in the lateral compartment (meniscal repair OR, 1.96; meniscectomy OR, 2.97). Graft type, cartilage lesions, sex, and Marx activity rating scale score had no significant association with the OARSI grade.Conclusion:Older patients with a higher body mass index who have an ACL tear with a concurrent meniscal tear requiring partial meniscectomy or meniscal repair should be advised of their increased risk of developing radiographic PTOA. Alternatively, patients with an ACL tear with an articular cartilage lesion can be reassured that they are not at an increased risk of developing early radiographic knee PTOA at 2 to 3 years after ACLR.

Variation in the Thickness of Knee Cartilage. The Use of a Novel Machine Learning Algorithm for Cartilage Segmentation of Magnetic Resonance Images

BackgroundThe variation in articular cartilage thickness (ACT) in healthy knees is difficult to quantify and therefore poorly documented. Our aims are to (1) define how machine learning (ML) algorithms can automate the segmentation and measurement of ACT on magnetic resonance imaging (MRI) (2) use ML to provide reference data on ACT in healthy knees, and (3) identify whether demographic variables impact these results. MethodsPatients recruited into the Osteoarthritis Initiative with a radiographic Kellgren-Lawrence grade of 0 or 1 with 3D double-echo steady-state MRIs were included and their gender, age, and body mass index were collected. Using a validated ML algorithm, 2 orthogonal points on each femoral condyle were identified (distal and posterior) and ACT was measured on each MRI. Site-specific ACT was compared using paired t-tests, and multivariate regression was used to investigate the risk-adjusted effect of each demographic variable on ACT. ResultsA total of 3910 MRI were included. The average femoral ACT was 2.34 mm (standard deviation, 0.71; 95% confidence interval, 0.95-3.73). In multivariate analysis, distal-medial (−0.17 mm) and distal-lateral cartilage (−0.32 mm) were found to be thinner than posterior-lateral cartilage, while posterior-medial cartilage was found to be thicker (0.21 mm). In addition, female sex was found to negatively impact cartilage thickness (OR, −0.36; all values: P < .001). ConclusionML was effectively used to automate the segmentation and measurement of cartilage thickness on a large number of MRIs of healthy knees to provide normative data on the variation in ACT in this population. We further report patient variables that can influence ACT. Further validation will determine whether this technique represents a powerful new tool for tracking the impact of medical intervention on the progression of articular cartilage degeneration.

Long-term prognosis for return to athletic function after interspinous ligament desmotomy for treatment of impinging and overriding dorsal spinous processes in horses: 71 cases (2012-2017).

To determine the long-term return to performance of horses with impinging and/or overriding dorsal spinous processes (ORDSP) treated with interspinous ligament desmotomy (ISLD) and to determine the prognostic value of radiographic and scintigraphic grades. Retrospective study. Seventy-one horses with ORDSP treated with ISLD. Medical records were reviewed for signalment, physical examination, gait evaluation, and number of interspinous spaces treated. Preoperative radiographic and scintigraphic images were evaluated with grading scales. Follow-up was obtained with a telephone questionnaire. Prognostic value of the number of affected interspinous spaces, radiographic grading, and scintigraphic grading was tested by using a χ2 test. A median follow-up of 35 months (range, 8-64) was available for 56 horses. Fifty-one of 56 (91.1%) horses returned to some level of performance, with 27 of 51 (52.9%) horses achieving equivalent or higher level of performance. Achieving a lower level of performance was attributed to recurrent back pain in nine of 24 (37.5%) horses and to unassociated lameness in nine of 24 (37.5%) horses. Owners of 44 of 56 (78.6%) horses were satisfied with the postoperative performance level, and owners of 46 of 56 (82.1%) horses would recommend the procedure. None of the variables tested influenced the return to performance. Interspinous ligament desmotomy allowed horses with ORDSP to return to some level of performance, although fewer returned to an equivalent or higher level of performance than had previously been reported. Interspinous ligament desmotomy allows affected horses to return to some level of performance, regardless of the severity of radiographic and scintigraphic findings.

Quantifying the Impact of Patient-Specific Factors and Disease Severity on Clinical Decision Making in Cuff Tear Arthropathy: A Case-Based Survey

BackgroundRotator cuff tears are a common cause of disability. Some patients with massive and irreparable tears can develop cuff tear arthropathy (CTA), which makes management more challenging.Questions/PurposesWe sought to examine how orthopedists determine treatment for patients with CTA. Specifically, we investigated (1) the effect of patient age, symptoms, activity level, range of motion, and radiographic findings on the decision making of shoulder specialists and (2) the observer reliability of the Seebauer and Hamada grading systems.MethodsFive shoulder surgeons were each sent 108 simulated patient cases. Each simulated patient had a different combination of factors, including patient age, symptoms, activity level, range of motion, and radiographs. Responders graded the radiographs and chose a treatment (non-operative, arthroscopic, hemiarthroplasty, or reverse total shoulder arthroplasty). Spearman’s correlations and χ2 tests were used to assess the relationship between factors and treatments. Sub-analysis was performed on surgical cases. An intra-class correlation (ICC) was used to assess observer agreement.ResultsThe significant Spearman’s correlations were symptoms (0.45), Hamada grade (0.38), patient age (0.34), and Seebauer type (0.29). In sub-analysis of operative cases, the significant correlations were Hamada grade (0.56), patient age (0.51), Seebauer type (0.46), activity level (−0.13). The χ2 analysis was significant for all factors except activity level. The inter- and intraobserver reliabilities were, respectively, Seebauer type (0.59 and 0.63) and Hamada grade (0.58 and 0.65). Interobserver reliability for patient management was 0.44.ConclusionWhen evaluating CTA, patient symptoms, radiographic grade, and patient age are the factors most strongly associated with the decision making of shoulder specialists. Additionally, the Seebauer and Hamada classifications had similar reliability and clinical utility. However, there was only fair agreement regarding treatment, which indicates that CTA management remains controversial.

Predictors of Radiographic Osteoarthritis 2-3 Years after ACL Reconstruction: Data from MOON Onsite Nested Cohort

Objectives: Multiple studies have shown patients are susceptible to post-traumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) injury even with ACL reconstruction (ACLR). Prospective studies using multivariate analysis to identify risk factors for PTOA are lacking. This study aims to identify baseline predictors of radiographic PT OA after ACLR at an early time point and hypothesizes that meniscal injury and cartilage lesions will be associated with worse radiographic OA using the Osteoarthritis Research Society International (OARSI) atlas criteria. Methods: 421 patients who underwent ACLR returned onsite for standardized posteroanterior metatarsophalangeal radiographs a minimum of 2 years after surgery. At baseline, demographics, graft type, meniscal status/treatment, and cartilage status were collected. OARSI atlas criteria were used to grade all knee radiographs. Multivariable ordinal regression models identified baseline predictors of radiographic OARSI grades at follow-up. Results: The mean age was 19.8 years with 51.3% females. Higher age (odds ratio (OR) 1.06) and BMI (OR 1.05) were statistically significantly associated with higher OARSI grade in the medial compartment. Patients with a meniscal repair and a partial meniscectomy had statistically significantly higher OARSI grades in the medial compartment (meniscal repair OR 1.92 and meniscectomy OR 2.11) and in the lateral compartment (meniscal repair OR 1.96 and meniscectomy OR 2.97). Graft type, cartilage lesion, sex, and Marx activity scales had no significant association with OARSI grade. Conclusion: Older patients with a higher BMI who have an ACL tear with concurrent meniscal tear requiring partial meniscectomy or meniscal repair should be advised of their increased risk of developing radiographic OA. Alternatively, patients with an ACL tear with an articular cartilage lesion can be reassured that they are not at increased risk of developing radiographic knee OA at 2-3 years following ACLR.

Standard and Advanced Imaging of Hip Osteoarthritis. What the Radiologist Should Know.

Osteoarthritis (OA) of the hip is caused by degeneration of articular cartilage and the underlying bone and can be divided into two types: primary (associated with advancing age) and secondary (subsequent to fractures, avascular necrosis, infection, developmental dysplasia, and femoroacetabular impingement). Radiography remains the first-line imaging modality for diagnosing and monitoring OA, due to its accessibility, low cost, and ease of interpretation. Kellgren-Lawrence and Tönnis classification systems are radiographic OA grading systems used primarily in research, and they reflect the degree of joint space narrowing, sclerosis, cysts, deformity of the femoral head and acetabulum, and osteophytes. Unenhanced computed tomography (CT) provides detailed visualization of the hip joint segments that may be difficult to appreciate on radiographs, such as the inferoposterior and posterolateral hip joint. CT arthrography, magnetic resonance imaging (MRI), and magnetic resonance arthrography with two-dimensional reconstructions can delineate labral abnormalities, cartilage lesions, and other intra-articular hip pathology. T2 and T2* mapping, delayed gadolinium-enhanced MRI of cartilage, T1rho, ultra-short echo time, and zero echo time are investigative MR techniques with promising evaluation of hip OA.

Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden.

To determine whether accelerated knee osteoarthritis (KOA) is preceded by, and characterized over time by, destabilizing meniscal tears or other pathologic changes. We selected 3 sex-matched groups of subjects from the first 48 months of the Osteoarthritis Initiative, comprising adults who had a knee without KOA (Kellgren/Lawrence [K/L] radiographic grade <2) at baseline. Subjects in the accelerated KOA group developed KOA of K/L grade ≥3, those with typical KOA showed increased K/L radiographic scores, and those with no KOA had the same K/L grade over time. An index visit was the visit when the radiographic criteria for accelerated KOA and typical KOA were met (the no KOA group was matched to the accelerated KOA group). The observation period was up to 2 years before and after an index visit. Radiologists reviewed magnetic resonance (MR) images of the index knee and identified destabilizing meniscal tears (root tears, radial tears, complex tears), miscellaneous pathologic features (acute ligamentous or tendinous injuries, attrition, subchondral insufficiency fractures, other incidental findings), and meniscal damage in >2 of 6 regions (3 regions per meniscus: anterior horn, body, posterior horn). In addition, bone marrow lesions (BMLs) and cartilage damage on MR images were quantified. Linear mixed regression models were performed to analyze the results. At 1 year before the index visit, >75% of adults with accelerated KOA had meniscal damage in ≥2 regions (odds ratio 3.19 [95% confidence interval 1.70-5.97] versus adults with typical KOA). By the index visit, meniscal damage in ≥2 regions was ubiquitous in adults with accelerated KOA, including 42% of subjects having evidence of a destabilizing meniscal tear (versus 14% of subjects with typical KOA). These changes corresponded to findings of larger BMLs and greater cartilage loss in the accelerated KOA group. Accelerated KOA is characterized by destabilizing meniscal tears in a knee compromised by meniscal damage in >2 regions, and also characterized by the presence of large BMLs and greater cartilage loss.

Histopathological analysis of the synovium in trapeziometacarpal osteoarthritis.

Dorsoradial and anterior oblique ligaments were harvested during surgery in 13 patients with symptomatic trapeziometacarpal osteoarthritis, which had been graded preoperatively by a modified Eaton-Littler radiographic grading. Ligaments, including the periligamentous synovium, were stained with S100 protein, neurotrophic receptor p75, protein gene product 9.5, calcitonin gene related peptide, acetylcholine, substance P, neuropeptide Y, noradrenaline, N-methyl-D-aspartate-receptor and Met/Leu-enkephalin. The synovium was classified as showing no, low-grade or high-grade synovitis. Free nerve endings had higher immunoreactivity for substance P than for N-methyl-D-aspartate-receptor, enkephalin and noradrenaline. The synovial stroma had less immunoreactivity for N-methyl-D-aspartate-receptor than for noradrenaline, substance P and calcitonin gene related peptide. There was no relation between the grade of osteoarthritis and the visual pain analogue scale, synovitis score, immunoreactivity of all antibodies and quantity of free nerve endings or blood vessels. Synovium in trapeziometacarpal joint osteoarthritis produces several neuromediators causing a polymodal neurogenic inflammation and which may serve as biomarkers for osteoarthritis or therapeutic targets.

Retrospective Audit of Various Surgical Modalities Adopted for Giant Cell Tumor in a Rural Tertiary Cancer Center.

Giant cell tumor of bone (GCTB) is a rare tumor with a spectrum of clinical behavior. Standard treatment modalities include surgical curettage to wide resection, and varying oncological and functional results have been reported. The aim of this study was to evaluate the functional outcome and recurrence rates of patients who underwent surgery for giant cell tumor in a rural tertiary cancer center from June 2009 to December 2016. A retrospective review of 12 patients (7 males and 5 females) with GCT of the extremity bones treated in the institution between the period of June 2009 and December 2016 was performed to study the oncological and functional outcomes. All patients were evaluated by clinical examination, plain X-ray of local parts, X-ray of the chest, and MRI of local parts. A biopsy was taken in all cases to confirm the diagnosis. All patients underwent surgical treatment including curettage combined with cryosurgery and bone cement or wide resection and reconstruction. Selection of the surgical technique was based on the site and size of the lesion, soft tissue involvement (intra- or extra-compartmental), and if recurrent or not. The patients were followed up to April 2018. The mean age of the patients was 31.3years. The tumor sites were distal femur in 3 cases, proximal tibia in 6, ischial bone in 1, distal radius in 1, and 1 in the metacarpal bone. Campanacci radiographic grading was grade1 in 3 cases, grade 2 in 2 cases, and grade 3 in 7 cases. Out of 12 patients, local recurrence was noted in 2 patients (16.7%). Functional evaluation was performed according to the Musculoskeletal Tumor Society Scoring (MSTS) system. Mean MSTS score was 25. To preserve the good function of the extremities and avoid local recurrence, we consider that curettage with adjunctive therapy such as polymethylmethacrylate (PMMA) and liquid nitrogen should be employed for the treatment of benign GCT of bone. Wide excision should be considered for large tumors where achieving oncological results with functional preservation would be difficult with curettage procedure.

Is leptin receptor gene (Gln223Arg) polymorphism associated with disease susceptibility and severity in patients of primary knee osteoarthritis?

Aim of the workA significant role of Leptin receptor (LEPR) is documented in inflammation, body weight homeostasis and maintenance of cartilage. This study was conducted to detect the existence of genetic association between Knee osteoarthritis (KOA) susceptibility and severity; and LEPR (Gln223Arg) single nucleotide polymorphism (SNP). Patients and methods73 primary KOA patients and 73 matched healthy controls were studied. Kellgren Laurence (K/L) radiographic grading system, Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and Visual Analogue Scale (VAS) were used to assess the severity of KOA. LEPR Gln223Arg SNP (rs1137101) was genotyped in KOA patients and controls using polymerase chain reaction-restriction fragment length polymorphism (PCR –RFLP) technique and verified by direct DNA sequencing. ResultsIn the current study, a significant genetic association was found between KOA patients carrying the AA genotype of LEPR and the extent of radiological severity (p < 0.044). In addition, a significant difference was detected within the patients between Body Mass Index (BMI) and the SNP. Patients carrying the wild type (GG) genotype showed lower body mass index (BMI) in comparison to patients carrying the heterozygous (AG) genotype and the mutant (AA) genotype (p < 0.032). However, no direct genetic association was detected between the SNP and KOA. ConclusionLeptin receptor gene (Gln223Arg) SNP might be associated with severity of KOA. There is a significant genetic association between the SNP and BMI hence, LEPR SNP might be indirectly associated with the incidence of KOA. Furthermore, the SNP is not directly associated with KOA susceptibility in the Egyptian population.

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis.

OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%-19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%-11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%-6.4%, p < 0.001) and 4.3% (95% CI 2.2%-6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3-10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.

Decreased synovial fluid pituitary adenylate cyclase-activating polypeptide (PACAP) levels may reflect disease severity in post-traumatic knee osteoarthritis after anterior cruciate ligament injury

BackgroundIt has been demonstrated that anterior cruciate ligament (ACL) injury-induced cartilage degeneration is the key risk factor for post-traumatic knee osteoarthritis (PTKOA).Pituitary adenylate cyclase-activating polypeptide (PACAP), a common neuropeptide exerting a wide spectrum of functions, has been proved to inhibit inflammation and prevent cartilage degeneration. ObjectiveThe current study was performed to investigate circulating and synovial fluid PACAP concentrations in ACL injury patients to determine their relationship with the disease progression of the severity of post-traumatic knee osteoarthritis (PTKOA). Methods72 ACL injury patients receiving arthroscopical examination and surgery were enrolled in the study. Meanwhile, 60 gender-and-age non-traumatic patellar dislocation patients were enrolled as controls. The VAS score, Lysholm Score and International Knee Documentation Committee (IKDC) score were all recorded to evaluate the clinical severity. Serum and synovial fluid (SF) PACAP levels were investigated by enzyme-linked immunosorbent assay (ELISA).The IL-1β and TNF-α levels were also investigated. The degree of meniscus injury was assessed by MR imaging. The modified Mankin score was recorded to examine the cartilage histopathological alternations. Receiver operating characteristic (ROC) curve was performed to discuss the diagnostic value of PACAP levels for the prediction of the radiographic grading in comparison with IL-1β and TNF-α. ResultsSerum PACAP levels between PTKOA patients and patellar dislocation did not reach significant differences. However, SF PACAP levels were significantly lower in PTKOA patients than controls. In addition, SF PACAP levels were negatively associated with MRI imaging grade for meniscus injury and VAS score, and were positively associated with Lysholm and IKDC scores. In addition, SF PACAP levels were negatively related to Mankin score as well as the expressions of IL-1β and TNF-α. ROC analysis curve showed that attenuated PACAP may serve as a favorable marker for the diagnosis of MRI for meniscus injury. ConclusionsSF PACAP concentrations showed an independent and negative association with disease severity in PTKOA following ACL injury. Local treatment with PACAP may act as a possible adjuvant therapy for delaying the process of PTKOA.