Small Osteophytes Research Articles

Deep learning based detection of osteophytes in radiographs and magnetic resonance imagings of the knee using 2D and 3D morphology.

In this study, we investigated the discriminative capacity of knee morphology in automatic detection of osteophytes defined by the Osteoarthritis Research Society International atlas, using X-ray and magnetic resonance imaging (MRI) data. For the X-ray analysis, we developed a deep learning (DL) based model to segment femur and tibia. In case of MRIs, we utilized previously validated segmentations of femur, tibia, corresponding cartilage tissues, and menisci. Osteophyte detection was performed using DL models in four compartments: medial femur (FM), lateral femur (FL), medial tibia (TM), and lateral tibia (TL). To analyze the confounding effects of soft tissues, we investigated their morphology in combination with bones, including bones+cartilage, bones+menisci, and all the tissues. From X-ray-based 2D morphology, the models yielded balanced accuracy of 0.73, 0.69, 0.74, and 0.74 for FM, FL, TM, TL, respectively. Using 3D bone morphology from MRI, balanced accuracy was 0.80, 0.77, 0.71, and 0.76, respectively. The performance was higher than in 2D for all the compartments except for TM, with significant improvements observed for femoral compartments. Adding menisci or cartilage morphology consistently improved balanced accuracy in TM, with the greatest improvement seen for small osteophyte. Otherwise, the models performed similarly to bones-only. Our experiments demonstrated that MRI-based models show higher detection capability than X-ray based models for identifying knee osteophytes. This study highlighted the feasibility of automated osteophyte detection from X-ray and MRI data and suggested further need for development of osteophyte assessment criteria in addition to OARSI, particularly, for early osteophytic changes.

MRI underestimates presence and size of knee osteophytes using CT as a reference standard

To explore the diagnostic performance of routine magnetic resonance imaging (MRI) for the cross-sectional assessment of osteophytes (OPs) in all three knee compartments using computed tomography (CT) as a reference standard. The Strontium Ranelate Efficacy in Knee Osteoarthritis (SEKOIA) trial explored the effect of 3 years of treatment with strontium ranelate in patients with primary knee OA. OPs were scored for the baseline visit only using a modified MRI Osteoarthritis Knee Score (MOAKS) scoring system in the patellofemoral (PFJ), the medial tibiofemoral (TFJ) and the lateral TFJ. Size was assessed from 0 to 3 in 18 locations. Descriptive statistics were used to describe differences in ordinal grading between CT and MRI. In addition, weighted-kappa statistics were employed to assess agreement between scoring using the two methods. Sensitivity, specificity, positive predictive value and negative predictive value as well as area under the curve (AUC) measures of diagnostic performance were employed using CT as the reference standard. Included were 74 patients with available MRI and CT data. Mean age was 62.9±7.5 years. Altogether 1,332 locations were evaluated. For the PFJ, MRI detected 141 (72%) of 197 CT-defined OPs with a w-kappa of 0.58 (95% CI [0.52-0.65]). In the medial TFJ, MRI detected 178 (81%) of 219 CT-OPs with a w-kappa of 0.58 (95% CI [0.51-0.64]). For the lateral compartment these numbers were 84 (70%) of 120 CT-OPs with a w-kappa of 0.58 (95% CI [0.50-0.66]). MRI underestimates presence of osteophytes in all three knee compartments. CT may be helpful particularly regarding assessment of small osteophytes particularly in early disease.

COMPUTED TOMOGRAPHY OSTEOARTHRITIS KNEE SCORE (COAKS) CONSTRUCTION, REPRODUCIBILITY AND POTENTIAL FOR STRUCTURAL PHENOTYPING

Computed tomography (CT) has been shown to be more sensitive identifying certain structural features of OA than radiography and MRI. The ability to acquire weight bearing CT (WBCT) at the knee is also an important current advantage over MRI that has created an opportunity to assess the entire weight bearing joint in 3-D. This could have implications for longitudinal monitoring of disease progression and the selection of participants in clinical trials according to structural phenotype. 1) To introduce the semi-quantitative CT OA Knee Score (COAKS); 2) to report initial interobserver reproducibility; and 3) to demonstrate its potential for structural disease phenotyping. 106 WBCT examinations were sourced from existing research projects at the Department of Rehabilitation Medicine, University of Kansas Medical Center, USA. A 4-point scoring system (0-3) was created for each cardinal radiographic feature of osteoarthritis (J = joint space width; O = osteophytes; C = subchondral cysts; S = subchondral sclerosis) to be assessed at each joint compartment (MTF = medial tibiofemoral; LTF = lateral tibiofemoral; PF = patellofemoral; PTF = proximal tibiofibular). Brief verbal definitions are given for each feature score in table 1. After initial training and grading of all knees by a musculoskeletal radiology clinical fellow (J.J.H.), a reference atlas was created that included a standardised review guide (including display settings and multiplanar reformat orientations), examples of each score for each feature at each compartment, and common pitfalls. Blinded to the imaging data, 10 test knees and 35 study knees were super-selected by their initial scoring to stratify disease features as evenly as possible. No restrictions were placed on the quality of imaging, the presence of ACL reconstruction (an inclusion criteria for one source study), or imaging review platform. T.D.T. trained another consultant musculoskeletal radiologist (Z.A.), who both assessed the 10 test knees, reviewed performance, then repeated the test assessment. Both then scored the 35 study knees without communication during the assessment period. A cloud score sheet was used in Google Sheets (table 2) with the reference atlas in Google Docs, both accessible online or via the respective smart phone / tablet app. The weighted kappa score for interobserver reproducibility was calculated for each structural feature across all compartments. Compartment feature scores were also plotted as heat maps for each knee to provide a visualisation of structural OA phenotype. The weighted kappa scores (+95% CI) for each feature were: J = 0.87 (0.86-0.89); O = 0.79 (0.76-0.82); C = 0.66 (0.63-0.70); S = 0.84 (0.82-0.86). On average, it took less than 5 minutes to score a single knee. Selected heat maps (figure 1) show how different phenotypes can be ascertained using the COAKS system: RUNA053L is an early MTF phenotype with PF involvement; RUNA045R is a late MTF phenotype with multicompartment disease; RUNA023L is a late LTF phenotype with severe multicompartmental osteophytosis but no other features; RUNA088L is a PF phenotype with small tibiofemoral osteophytes only. A whole joint COAKS score is also possible (out of 48), as is a score by compartment (out of 12) or by feature (out of 12) as desired. COAKS is a feasible semi-quantitative WBCT-based scoring system of knee OA that demonstrates initial substantial to almost perfect inter-observer agreement across radiographic features. The ability of COAKS to score and phenotype the weight bearing knee in 3-D may exceed individual capabilities of MRI and radiography in certain aspects, offering flexibility in phenotyping for patient selection as well as potential sensitivity for longitudinal monitoring of disease severity in clinical trials or cohort studies. It is also possible to use the COAKS in non-weight bearing CT if flagged as such and not used to compare with weight bearing studies.

Humeral osteophyte size and clinical outcomes after anatomic total shoulder arthroplasty

BackgroundThe severity of primary glenohumeral osteoarthritis (PGOA) has been associated with advanced radiographic findings including inferior humeral head osteophytes. The primary objective of this study is to analyze for any correlation between the size of the inferior humeral head osteophyte and functional outcomes in patients undergoing anatomic total shoulder arthroplasty (TSA) for PGOA. MethodsA retrospective review of a multi-surgeon database was performed to identify all patients with PGOA from 2015 to 2019 with a minimum of two-year clinical follow-up. Preoperative anteroposterior and Grashey views were used for all included patients to obtain measurements of the inferior humeral osteophyte. Two groups at the extremes of osteophyte width were identified: 1) patients with absent or minimal osteophytes (lowest quartile of width, < 4.9 mm) and those with large osteophytes (highest quartile of width, > 10.1 mm). Change in active range of motion (ROM) from baseline, patient-reported outcomes (PROs), strength and complications were assessed at a minimum of 2 years postoperatively and compared between the two groups. ResultsDemographics were similar for the large osteophyte group (n = 57) and small osteophyte group (n = 56). There was a higher percentage of patients with more significant glenoid deformity in the large osteophyte group compared to the small osteophyte group (P = .009 for A1 deltoid). The large osteophyte group had significantly more restricted preoperative ROM for all measures (P < .05 for all). There were no significant differences in final ROM achieved between the two groups. Patients in the large osteophyte group had greater improvement from baseline for external rotation at the side (31° vs 21°, P = .015), external rotation at 90° abduction (38° vs 20°, P = .004), and internal rotation at 90° abduction (30° vs 12°, P < .001) compared to the small osteophyte group. Overall, there were very few differences between the small and large osteophyte groups in final PROs, with the exception of a higher American Shoulder and Elbow Surgeons score in the large osteophyte group (90.8 vs 85.9, P = .048). ConclusionPatients with large humeral osteophytes have significantly greater restrictions in preoperative ROM compared to patients with small osteophytes. Patients with large osteophytes experience greater improvements in rotational motion after anatomic TSA compared to patients with small osteophytes, although the final ROM achieved was similar between groups. Overall, PROs after anatomic TSA were similar between patients with small and large osteophytes preoperatively.

Total Talar Replacement With Custom-Made Vitallium Prosthesis for Talar Avascular Necrosis.

Background: The current study investigated the application of three-dimensional (3D) printing technology in the treatment of talar avascular necrosis (TAN). Custom-made Vitallium talar prostheses were designed and generated via 3D printing. We hypothesized that these talar prostheses would facilitate more stable positioning, better ergonomically fit the ankle joint surfaces, and promote favorable long-term prognoses. Material and Methods: Computed tomography scans of both ankle joints were acquired from three patients diagnosed with TAN. The talar on the unaffected side was used as the design blueprint. Hence, with the aid of 3D printing technology a customized talar prosthesis made from a novel Vitallium alloy could be manufactured for each individual patient. Results: In all three cases there were no signs of prosthesis loosening or substantial degenerative change in the surrounding area of the joint, but small osteophytes were observed on the tibial side and navicular side. No chronic infection or other prosthesis-related complications were observed in any of the patients. All three were able to walk without pain at the most recent follow-up. Conclusion: With the aid of 3D printing and a novel Vitallium alloy, total talar replacement achieved encouraging results in 3/3 patients. All patients were satisfied with their joint function, and were able to return to their daily activities without limitations. Although more cases and longer-term follow-up periods are required, the success rate reported herein is encouraging.

Computed Tomographic Features of Non-Lame French Bulldog Elbows.

French Bulldogs are predisposed to humeral condylar fractures. Computed tomography (CT) in English Springer Spaniel elbows has allowed identification of humeral intracondylar fissures (HIF), which can cause lameness and predispose to condylar fractures. This study aimed to evaluate CT characteristics of non-lame French Bulldog elbows, to determine the presence of underlying elbow disease. Retrospective evaluation of CT images from elbows of non-lame French Bulldogs from scans obtained for soft tissue or neurological evaluation was performed. Images were evaluated for the presence of HIF and other elbow abnormalities: condylar and supracondylar remodelling, humeral condylar sclerosis, elbow incongruency, medial coronoid process disease and elbow osteoarthritis. Descriptive statistics were performed. Computed tomographic scans from 37 dogs (74 elbows) were reviewed. No HIF were identified, although 28/74 elbows had an intracondylar sclerotic band. Medial coronoid process disease was noted in 16/74 elbows, and small osteophytes were present in 21/74 elbows, suggesting a degree of subclinical elbow disease. Widening of the caudolateral aspect of the radial incisure was identified (37/74) as a breed normal. Elbow incongruency was otherwise rare. Non-lame French Bulldogs showed a low prevalence of occult elbow disease but a proportion had radial incisure widening. Although humeral intracondylar sclerosis was present in over a third of dogs, no HIF were identified and therefore no clear cause for their increased risk of humeral condylar fracture was identified.

Thirty-eight-year outcome of osteochondral autograft transplantation in the knee joint: A case report

In 1985, we reported two cases of osteochondral autograft transplantation with the goal of repairing osteochondral defects in the knee joints of patients with osteochondritis dissecans using hyaline cartilage. Since then, osteochondral autograft transplantation, mosaicplasty, autologous chondrocyte transplantation, and allogeneic osteochondral transplantation have been developed and implemented as treatments for osteochondral defects. However, the long-term outcomes of these treatment modalities have not been hitherto reported. The patient was a 21-year-old man. He had medial extended type left knee joint osteochondritis dissecans osteochondral autograft transplantation was performed in 1980. A piece of osteochondral autograft was collected from the medial side of the trochlea and transplanted to the crater. Cancellous bone with cortical bone was transplanted from the ilium to the osteochondral collection site.There were neither subjective symptoms nor abnormal objective findings in the knee 38 years after. Radiographs showed small osteophytes in the medial tibiofemoral joint, and the patella skyline view showed narrowing of the medial patellofemoral joint space. On computed tomography, the bony part of the transplanted osteochondral autograft was fused with the surrounding bone tissue, and the trabecular pattern was similar to that of the original bone. A coronal section of a magnetic resonance imaging scan showed that the signal intensity of the transplanted cartilage was similar to that of the adjacent native cartilage. In the patellofemoral joint, the cartilage of the medial facet of the patella and trochlea was uneven. We reported 38-year outcomes in a patient who underwent osteochondral autograft transplantation in the knee joint. There were neither subjective symptoms nor abnormal objective findings in the knee. Imaging findings showed that a piece of osteochondral autograft filled the crater in the femoral condyle, and the superficial cartilage was considered to be alive.

SIZE OF KNEE OSTEOPHYTES is under‐estimated as Assessed by MRI USING CT AS A REFERENCE STANDARD

The radiographic diagnosis of knee osteoarthritis (OA) is based on the presence of a definite osteophyte (OP). Epidemiologic studies and clinical trials commonly employ MRI using standard clinical sequences and OP assessment is one of the features included. Commonly used sequence protocols in such studies are based on triplanar fat suppressed T2- or proton density-weighted sequences with bony features as well as fibrous and lipomatous tissues appearing hypointense. This may potentially result in underestimation of such features including osteophyte assessment. Computed tomography (CT) is considered as the modality of choice for the analysis of OPs and may therefore be considered a reference standard. To explore the diagnostic performance of routine MRI as used in observational studies and clinical trials of knee OA for the assessment of OPs in all three knee compartments and the femoral notch using CT as a reference standard. The Strontium Ranelate Efficacy in Knee Osteoarthritis Trial (SEKOIA) clinical trial explored the effect of 3 years of treatment with strontium ranelate in patients with primary knee OA. All patients included in the current study participated in the CT sub-study of SEKOIA. In the current investigation, baseline data from three different centers were used. OPs were scored using a modified MOAKS scoring system in the patellofemoral (PFJ), the medial tibio-femoral (TFJ) and the lateral TFJ. Size was assessed from 0 to 3 in 18 locations. Descriptive statistics were used to describe differences in ordinal grading between CT and MRI. In addition, weighted-kappa statistics were employed to assess agreement between scoring using the two methods. Finally, sensitivity, specificity, positive predictive value and negative predictive value as well as AUC measures of diagnostic performance were employed using CT as the reference standard. Mean age of the randomized patients was 62.9 ±7.5 years with a majority of women (70%). Body mass index was 29.9±5.0 kg/m 2 . The target knee JSW was 3.50±0.84 mm at baseline, patients were Kellgren and Lawrence grade 2 (62%) or 3 (38%). Included were 74 patients with available MRI and CT data. Altogether 1332 locations were evaluated. For the PFJ MRI detected 141 (72%) of 197 CT-defined OPs with a w-kappa of 0.58 (95% CI [0.52-0.65]). In the medial TFJ, MRI detected 178 (81%) of 219 CT-OPs with a w-kappa of 0.58 (95% CI [0.51-0.64]). For the lateral compartment these numbers were 84 (70%) of 120 CT-OPs with a w-kappa of 0.58 (95% CI [0.50-0.66]). Regarding disagreement, for the PFJ MRI underestimated OP size in 94 cases (21%) and over-estimated in 27 cases (6%). For the medial TFJ these numbers were 90 (20%) and 29 (7%), and for the lateral TFJ 67 (15%) and 15 (3%). Details of the diagnostic performance analysis are presented in Table 1 . MRI underestimates presence and size of osteophytes in all 3 knee compartments. However, the sensitivity of >0.9 for OP detection in the medial compartment, which is commonly the compartment of relevance in clinical DMOAD trials, reflects that MRI is adequately able to detect osteophytes that commonly define structural disease. CT may be helpful particularly reading assessment of small osteophytes particularly in early disease. No funding was received for this sub-analysis of the SEKOIA Study AG has received consultancies, speaking fees, and/or honoraria from Pfizer, Novartis, AstraZeneca, Merck Serono, and TissueGene and is President and shareholder of Boston Imaging Core Lab (BICL), LLC a company providing image assessment services. FWR is Chief Medical Officer and shareholder of BICL, LLC. and has received consultancies, speaking fees, and/or honoraria from Calibr –California Institute of Biomedical Research and Grünenthal, GmbH CORRESPONDENCE ADDRESS: frank.roemer@uk-erlangen.de .

Experimental evidence that physical activity inhibits osteoarthritis: Implications for inferring activity patterns from osteoarthritis in archeological human skeletons

AbstractObjectivesOsteoarthritis (OA) is a common joint disease whose causes are not fully understood, but a longstanding hypothesis is that OA stems primarily from the cumulative effects of joint mechanical loading throughout life. Based on this wear and tear hypothesis, anthropologists have assumed that the presence of OA in archeological human skeletons can be interpreted as evidence of a highly physically active lifestyle. Here, we use guinea pigs to experimentally test the hypothesis that higher levels of routine physical activity result in greater OA degeneration.Materials and methodsGuinea pigs are a useful model for OA research because they spontaneously develop the disease in a manner similar to humans. One group of growing animals was housed for 22 weeks in a large room that promoted voluntary physical activity (4.8 km of movement per day, on average), while animals in another group were housed in small cages that restricted their mobility (n = 15/group). After the experiment, histological and microcomputed tomographic analyses were conducted focusing on the knees.ResultsRather than causing greater OA degeneration, elevated levels of routine physical activity resulted in significantly less knee cartilage deterioration, less synovial inflammation, smaller osteophytes, and maintenance of greater epiphyseal trabecular bone quantity.DiscussionThese results are inconsistent with the hypothesis that high levels of routine physical activity drive the pathogenesis of OA and call into question typical interpretations of OA in studies of archeological human skeletons.

Prevalence of small osteophytes on knee MRI in several large clinical and population-based studies of various age groups and OA risk factors

ObjectiveOsteophytes, also small ones, are an important imaging feature of OA. However, due to their high prevalence on MR, the question has arisen whether these are truly pathophysiologic features of early OA, a result of physiologic aging, or rather a merely transient phenomenon. The aim of this study was to explore the prevalence of osteophytes on MR in various locations of the knee, with special emphasis on small osteophytes, across multiple large studies conducted in our institution comprising a wide range of subjects at different ages. MethodRetrospective explorative study of the prevalence of osteophytes, particularly grade 1 according to MOAKS, among four studies with a wide variety in age and OA risk factors. ResultsA large number of grade 1 osteophytes were found in all four studies. The largest number of osteophytes were present in the youngest age group of <30 years (69.6%) compared to 36.8% in the age group of ≥30 ​< ​50 years and 54,3% when aged ≥50 years, of which most were grade 1 osteophytes. ConclusionSmall osteophytes are highly prevalent among populations with varying age and OA risk factors, in particular among young subjects without other OA features. This might suggest that these “osteophytes” do not necessarily represent early OA, but rather indicate a transient physiologic phenomenon.

Effectiveness of radiographs and computed tomography in evaluating primary elbow osteoarthritis

Preoperative radiographic assessment of osteophyte and loose body locations is critical in planning an arthroscopic débridement for primary elbow osteoarthritis. The purpose of this study was to evaluate the effectiveness of radiographs and computed tomography (CT) in localizing osteophytes and loose bodies. A consecutive series of 36 patients with primary elbow osteoarthritis was investigated with radiographs and multiaxial 2-dimensional CT prior to elbow arthroscopy. The location of osteophytes and loose bodies was assessed in 9 anatomic locations by 2 fellowship-trained upper extremity surgeons. The diagnostic effectiveness of both imaging modalities was evaluated by calculating the sensitivity and specificity and compared to the gold standard of elbow arthroscopy. Inter- and intrarater percentage agreement between the observations was calculated using Kappa score. The mean sensitivity for detecting osteophytes in the 9 different anatomic locations was 46% with radiographs and 98% with CT, whereas the mean specificity was 66% and 21% for radiographs and CT, respectively. The mean sensitivity and specificity for loose body detection with radiography were 49% and 89%, respectively, whereas CT had a mean sensitivity of 98% and specificity of 47%. The overall inter-rater percentage agreement between the surgeons in detecting osteophytes and loose bodies on radiographs was 80% and 85%, respectively, whereas on CT it was 95% for detecting osteophytes and 91% for loose bodies. CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. The lower specificity of CT may be due to this imaging modality's ability to detect small osteophytes and loose bodies that may not be readily identified during elbow arthroscopy. Radiographs have an inferior inter-rater percentage agreement compared with CT. CT is a valuable preoperative investigation to assist surgeons in identifying the location of osteophytes and loose bodies in patients undergoing surgery for primary elbow osteoarthritis.

A Novel Anterior Cervical X-Shape-Corpectomy and Fusion for Cervical Spinal Stenosis at C4-C6 Level: A Technical Note

Anterior cervical corpectomy and fusion (ACCF) is employed in patients with localized cervical spinal stenosis (CSS). However, there are some disadvantages such as subsidence of the titanium mesh cage, slow fusion rates, breakage of the plate and screws, and donor-site complications. For patients with small posterior osteophytes, ossified or hypertrophy of the posterior longitudinal ligaments or ligamentum flavum, the range of decompression from the classic anterior cervical discectomy and fusion (ACDF) cannot meet the clinical requirements. However, employing ACCF is controversial. Therefore, it is necessary to seek a novel, safe and effective surgery that can combine the strengths of ACDF and ACCF. Our objective was to describe a novel anterior approach cervical surgery and investigate its clinical outcomes on segmental CSS at the C4-C6 levels 6 months postoperatively. A novel anterior cervical X-shape-corpectomy and fusion (ACXF) was performed to correct the CSS. The patient's neurologic function and myodynamia of the extremities were improved significantly 3 and 6 months after surgery with good bony fusion. Neck pain also was relieved. Immediately postoperative and after 6-month images indicated no significant spinal stenosis. The patient's cervical curvature was improved after surgery without significant implant subsidence or loss of adjacent intervertebral height. There were no postoperative complications. ACXF may be a safe and effective procedure for segmental CSS and an alternative for ACCF, as it has a wide operative field of view, sufficient decompression range, excellent transverse vertebral bony fusion, less internal fixation-related complications, and graft subsidence and no donor-site complications.

Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty

Removing osteophytes from the posterior compartment of the femur eliminates the tenting effects on the joint capsule and consequently increases the extension gap in total knee arthroplasty. However, there is no clear association with the size of osteophytes removed and the potential degree of additional extension achieved at time of surgery. AimsCorrelate the size of posterior osteophytes removed with the degree of extension gained intraoperatively in total knee arthroplasty and develop a radiological classification system to grade these osteophytes. MethodsPatients who underwent a TKA had pre and post operative sagittal radiographs assessed and classified according to 4 different categories of a proposed classification system. Knee extension was then assessed by a computer navigated system before incision and after implant insertion. Confounding factors were controlled and considered on the analysis. The study was done retrospectively. Results147 patients were included in the study. Ninety-three (63.2%) patients had osteophytes on the posterior aspect of the femur completely removed and fifty-four patients (36.8%) did not have radiological evidence of osteophytes on the posterior aspect of the femur. There was a positive and linear correlation (Pearson correlation 0.327, p .005) between osteophyte size and degree of extension corrected at time of surgery. On Multivariate Logistic Regression Analysis, we found that small osteophytes (Grade 1) did not seem to affect the extension, while removing Grade 2 or Grade 3 osteophytes lead to a gain in extension of 2.7 and 4.5° respectively. ConclusionRemoving large osteophytes (Grade 2 and Grade 3) from the posterior femoral compartment can be used as an adjuvant strategy to ensure that intraoperative extension is optimal. However removing small osteophytes (Grade 1) should not be expected to affect extension at the time of surgery in TKA and could increase intra-operative time and morbidity.

The Clinical Significance of Osteophytes in Compartments of the Knee Joint With Normal Articular Cartilage.

The purpose of this study is to determine whether marginal osteophytes in compartments with normal cartilage would be more frequently observed in knees with cartilage lesions and osteophytes in other compartments. This retrospective study reviewed 500 consecutive knee MRI examinations performed within 6 months of arthroscopic knee surgery conducted for 497 patients with symptoms (289 male patients and 208 female patients; age range, 17-74 years; median age, 43 years). The highest grade of cartilage lesion detected at MRI and arthroscopy was recorded. Marginal osteophytes were graded on MRI with use of a standardized scoring system, with grade 0 denoting no osteophyte; grade 1, small osteophyte; grade 2, medium-size osteophyte; and grade 3, large osteophyte). The frequency of false-positive osteophytes, defined as osteophytes present in compartments (the patellofemoral, medial tibiofemoral, and lateral tibiofemoral compartments) with normal cartilage observed on MRI and arthroscopy, was calculated. The Goodman and Kruskal gamma statistic was used to test the association of osteophyte size between compartments. Logistic regression was used to test the association between osteophyte size and the severity of the cartilage lesions. Marginal osteophytes were seen in compartments with normal cartilage on MRI and arthroscopy in 60.5% of knees (75 of 124) with cartilage lesions and osteophytes in other compartments and accounted for all false-positive grade 2 and grade 3 osteophytes. Marginal osteophytes were seen in 12.7% of knees (13 of 102) that had no cartilage lesions in any compartment on MRI or arthroscopy, and all of these were grade 1 osteophytes. The presence of larger sized osteophytes in the compartments with cartilage lesions was associated with the presence of larger sized osteophytes in the compartments with normal cartilage. More severe cartilage lesions were associated with larger osteophyte size. Compartments with marginal osteophytes and normal cartilage are commonly seen in knees that have other compartments with osteophytes and cartilage lesions.

Diagnóstico radiográfico e tomográfico de osteocondrose dissecante em tarso de cão

Background: The tarsal joint is the third most commonly joint affected by osteochondrosis in dogs. This joint is affected in 4 to 9% of the cases, and in 50% of these cases the disease is bilateral. Radiological signs include defect in the subchondral bone, sclerotic margin, and fragment of mineralized cartilage. Dorsoplantar in flexion and oblique radiologic images are necessary to show tarsal osteochondrosis. Computed tomography avoid overlap of bone structures and allows better visualization of subchondral lesions, showing the exact location, size and number of fragments. The objective of this study is to report a case of bilateral osteochondrosis dissecans in tarsal joint in Rottweiler.Case: A female Rottweiler was examined and presented a history of pain and difficulty in raising the pelvic limbs. There was pain in the right tibiotarsal joint (RTJ) with evident joint cracking and, after three months, the left pelvic limb started to show the same signs. Radiographic examination of the RTJ showed a small osteochondral fragment in the distal medial border of the medial malleolus of the tibia, subchondral sclerosis with radiolucent area in the medial malleolus of the tibia, and a small lateral periarticular osteophyte in the intertarsal joint. The left tibiotarsal joint (LTJ) showed mild articular incongruity and minor increase in radiological interlinear space, diffuse sclerosis in the medial malleolus and in the subchondral surface of the trochlear crest. This exam also showed a small radiolucent area in the medial malleolus of the tibia, a small fragment of radiopaque adjacent bone, and minor subchondral bone irregularity in the medial margin of the medial trochlea. The radiographic examination of the RTJ was inconclusive. Computed tomography was requested and suggested the diagnosis of medial osteochondritis dissecans in the distal talus. The most important tomographic signs were irregularity of the subchondral bone in the caudal region of the distal talus associated to isolated bone fragment, irregularity of the distal and caudal portion of the medial malleolus of the tibia associated with the presence of free adjacent osteophyte.Discussion: Only 4 to 9% of the dogs that develop osteochondrosis present this lesion in the tarsus. The Rottweiler is the breed most affected by this disease, such as the subject of this case report, and is also the breed most frequently affected in the lateral region of the tarsus. It is a fast-growing large breed, a common characteristic in animals affected by osteochondrosis. Bilateral cases are most common in young dogs, such as the patient of this case report. Clinical manifestation of pain and lameness is frequent in this type of disease, and lameness can occur in only one of the affected limbs. The dog of this study presented lesion in the medial region of the trochlea of the talus, one of the regions that present high incidence of osteochondrosis. Radiographic examination was efficient to suggest lesions in the medial region of the talus. However, only 10% of the dogs with osteochondrosis of the tarsus are diagnosed by this technique. The definitive diagnosis was not provided by radiographic examinations in this patient. Computed tomography has several advantages over conventional radiography, such as eliminating overlap of structures, decreasing image complexity, and increasing the ability to identify specific structures. This examination allowed us to reach the diagnosis of osteochondrosis dissecans in the right talus of this dog. A scan was not performed on the contralateral limb (LTJ), because the lesions observed on radiographic examination were similar to the lesions observed in the right pelvic limb.

Osteophyte induced lung fibrosis prevalence and osteophyte qualities predicting disease

ObjectiveTo determine the prevalence of osteophyte induced lung fibrosis (OIF) and its relationship to osteophyte size, location, and surrounding fat. Methods94 CT scans of the chest were reviewed, size of the largest osteophyte and the presence of fibrosis were recorded. ResultsPresence of fibrosis was higher among patient with large (>10 mm) osteophytes compared to those with small (1–10mm) osteophytes. Age and presence of periosteophyte fat were significantly associated with presence of fibrosis. ConclusionsAs the size of an osteophyte increases, there is a greater likelihood of lung fibrosis. Subpleural fat protects the lung from OIF.

Relationship between facet tropism and facet joint degeneration in the sub-axial cervical spine

BackgroundFacet tropism is the angular asymmetry between the left and right facet joint orientation. Although debatable, facet tropism was suggested to be associated with disc degeneration, facet degeneration and degenerative spondylolisthesis in the lumbar spine. The purpose of this study was to explore the relationship between facet tropism and facet degeneration in the sub-axial cervical spine.MethodsA total of 200 patients with cervical spondylosis were retrospectively analyzed. Facet degeneration was categorized into 4 grade: grade I, normal; grade II, degenerative changes including joint space narrowing, cyst formation, small osteophytes (<3 mm) without joint hypertrophy; grade III, joint hypertrophy secondary to large osteophytes (>3 mm) without fusion of the joint; grade IV, bony fusion of the facet joints. Facet orientations and facet tropisms with respect to the transverse, sagittal and coronal plane were calculated from the reconstructed cervical spine, which was based on the axial CT scan images. The paired facet joints were then categorized into three types: symmetric, moderated tropism and severe tropism. Univariate and multivariate analysis were performed to evaluate the relationship between any demographic and anatomical factor and facet degeneration.ResultsThe mean age of enrolled patients was 46.23 years old (ranging from 30 to 64 years old). There were 114 males and 86 females. The degrees of facet degeneration varied according to cervical levels and ages. Degenerated facet joints were most common at C2-C3 level and more common in patients above 50 years old. The facet orientations were also different from level to level. By univariate analysis, genders, ages, cervical levels, facet orientations and facet tropisms were all significantly different between the normal facets and degenerated facets. However, results from multivariate logistic regression suggested only age and facet tropism with respect to the sagittal plane were related to facet degeneration.ConclusionFacet degeneration were more common at C2-C3 level. Older age and facet tropism with respect to the sagittal plane were associated with the facet degeneration.

Age-dependent Changes in the Articular Cartilage and Subchondral Bone of C57BL/6 Mice after Surgical Destabilization of Medial Meniscus

Age is the primary risk factor for osteoarthritis (OA), yet surgical OA mouse models such as destabilization of the medial meniscus (DMM) used for evaluating disease-modifying OA targets are frequently performed on young adult mice only. This study investigates how age affects cartilage and subchondral bone changes in mouse joints following DMM. DMM was performed on male C57BL/6 mice at 4 months (4 M), 12 months (12 M) and 19+ months (19 M+) and on females at 12 M and 18 M+. Two months after surgery, operated and unoperated contralateral knees were harvested and evaluated using cartilage histology scores and μCT quantification of subchondral bone plate thickness and osteophyte formation. The 12 M and 19 M+ male mice developed more cartilage erosions and thicker subchondral bone plates after DMM than 4 M males. The size of osteophytes trended up with age, while the bone volume fraction was significantly higher in the 19 M+ group. Furthermore, 12 M females developed milder OA than males as indicated by less cartilage degradation, less subchondral bone plate sclerosis and smaller osteophytes. Our results reveal distinct age/gender-dependent structural changes in joint cartilage and subchondral bone post-DMM, facilitating more thoughtful selection of murine age/gender when using this surgical technique for translational OA research.

Intralesional Osteophyte Regrowth Following Autologous Chondrocyte Implantation after Previous Treatment with Marrow Stimulation Technique.

Objective Bone marrow stimulation surgeries are frequent in the treatment of cartilage lesions. Autologous chondrocyte implantation (ACI) may be performed after failed microfracture surgery. Alterations to subchondral bone as intralesional osteophytes are commonly seen after previous microfracture and removed during ACI. There have been no reports on potential recurrence. Our purpose was to evaluate the incidence of intralesional osteophyte development in 2 cohorts: existing intralesional osteophytes and without intralesional osteophytes at the time of ACI. Study Design We identified 87 patients (157 lesions) with intralesional osteophytes among a cohort of 497 ACI patients. Osteophyte regrowth was analyzed on magnetic resonance imaging and categorized as small or large (less or more than 50% of the cartilage thickness). Twenty patients (24 defects) without intralesional osteophytes at the time of ACI acted as control. Results Osteophyte regrowth was observed in 39.5% of lesions (34.4% of small osteophytes and 5.1% of large osteophytes). In subgroup analyses, regrowth was observed in 45.8% of periosteal-covered defects and in 18.9% of collagen membrane-covered defects. Large osteophyte regrowth occurred in less than 5% in either group. Periosteal defects showed a significantly higher incidence for regrowth of small osteophytes. In the control group, intralesional osteophytes developed in 16.7% of the lesions. Conclusions Even though intralesional osteophytes may regrow after removal during ACI, most of them are small. Small osteophyte regrowth occurs almost twice in periosteum-covered ACI. Large osteophytes occur only in 5% of patients. Intralesional osteophyte formation is not significantly different in preexisting intralesional osteophytes and control groups.

Therapeutic effects of an anti-ADAMTS-5 antibody on joint damage and mechanical allodynia in a murine model of osteoarthritis

The primary goal of this study was to test the disease-modifying effect of blocking a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-5 with a neutralizing monoclonal antibody (mAb) starting 4 weeks after destabilization of the medial meniscus (DMM) in the mouse. We also investigated whether ADAMTS-5 blockade reversed mechanical allodynia and decreased monocyte chemoattractant protein (MCP)-1 production by dorsal root ganglia (DRG) cells. Ten-week old male C57BL/6 mice underwent DMM surgery and were either left untreated or treated with anti-ADAMTS-5 mAb or IgG2c isotype control mAb starting 4 weeks after surgery. Knees were collected for histopathology 4 or 12 weeks later. Mechanical allodynia was monitored biweekly in the ipsilateral hind paw through 16 weeks. DRG were collected and cultured 8 weeks after DMM for analysis of MCP-1 production. By 4 weeks after DMM, mild cartilage degeneration was evident in the medial compartment, small osteophytes were present, and subchondral bone sclerosis was established. By 16 weeks after surgery, significant cartilage deterioration was apparent on the medial tibial plateaux and medial femoral condyles, osteophyte size had increased, and subchondral bone sclerosis was maintained. Treatment with ADAMTS-5 mAb from week 4 to 16 after surgery slowed cartilage degeneration and osteophyte growth but did not affect subchondral bone sclerosis. Moreover, ADAMTS-5 blockade resulted in temporary reversal of mechanical allodynia, which correlated with decreased MCP-1 production by cultured DRG cells. This study suggests therapeutic efficacy of an ADAMTS-5 mAb in the DMM model, when therapy starts early in disease.