Whole-Organ Magnetic Resonance Imaging Score Research Articles

Obese and overweight individuals have greater knee synovial inflammation and associated structural and cartilage compositional degeneration: data from the osteoarthritis initiative.

This work aims to study (i) the relationship between body mass index (BMI) and knee synovial inflammation using non-contrast-enhanced MRI and (ii) the association of synovial inflammation versus degenerative abnormalities and pain. Subjects with risk for and mild to moderate radiographic osteoarthritis were selected from the Osteoarthritis Initiative. Subjects were grouped into three BMI categories with 87 subjects per group: normal weight (BMI, 20-24.9kg/m2), overweight (BMI, 25-29.9kg/m2), and obese (BMI, ≥ 30kg/m2), frequency matched for age, sex, race, Kellgren-Lawrence grade, and history of knee surgery and injury. Semi-quantitative synovial inflammation imaging biomarkers were obtained including effusion-synovitis, size and intensity of infrapatellar fat pad signal abnormality, and synovial proliferation score. Cartilage composition was measured using T2 relaxation time and structural abnormalities using the whole-organ magnetic resonance imaging score (WORMS). The Western Ontario and McMasters (WOMAC) Osteoarthritis Index was used for pain assessment. Intra- and inter-reader reproducibility was assessed by kappa values. Overweight and obese groups had higher prevalence and severity of all synovial inflammatory markers (p ≤ 0.03). Positive associations were found between synovial inflammation imaging biomarkers and average T2 values, WORMS maximum scores and total WOMAC pain scores (p < 0.05). Intra- and inter-reader kappa values for imaging biomarkers were high (0.76-1.00 and 0.60-0.94, respectively). Being overweight or obese was significantly associated with a greater prevalence and severity of synovial inflammation imaging biomarkers. Substantial reproducibility and high correlation with knee structural, cartilage compositional degeneration, and WOMAC pain scores validate the synovial inflammation biomarkers used in this study.

Threshold for lateral meniscal body extrusion on MRI in middle-aged and elderly patients with symptomatic knee osteoarthritis

PurposeTo determine the MRI-based threshold of lateral meniscal body extrusion (LMBE) that are associated with meniscal damage, cartilage damage and radiological knee osteoarthritis (OA). Materials and methodsA total of 142 patients (59 men and 83 women) with a mean age of 57.2±7.9 (SD) years (range: 41–77 years) with symptomatic knee OA were included. Radiological assessment was performed using the Kellgren-Lawrence scoring system. Meniscus and cartilage damage were assessed using the whole-organ magnetic resonance imaging score. Meniscal extrusion was quantified on coronal sections of intermediate-weighted MRI sequences. Differences between medial and lateral compartments in meniscal extrusion and incidence of tibiofemoral OA-related structural changes were assessed using Wilcoxon signed rank test and Bowker test. Receiver operating characteristic curves and Youden index were used for determining thresholds for meniscal extrusion. ResultsA total of 142 knees were assessed. Meniscal body extrusion distances between medial and lateral compartments were significantly different in the entire sample, and in subjects with and without radiological knee OA (P<0.05 for all). The incidence of structural changes between medial and lateral compartments were significantly different (P=0.003 for meniscal damage; P=0.001 for femoral cartilage damage). Three mm and 2mm were determined to be the optimal thresholds for medial and lateral meniscal body extrusion, respectively. ConclusionMedial and lateral meniscal body extrusion were associated with the incidence of OA-related knee structural changes in symptomatic patients with knee OA. A threshold of 2mm for LMBE with respect to meniscal damage, cartilage damage and radiological knee OA was determined.

Patellar Malalignment Is Associated With Patellofemoral Lesions and Cartilage Relaxation Times After Hamstring Autograft Anterior Cruciate Ligament Reconstruction

Background: There is growing evidence suggesting a link between patellofemoral joint (PFJ) osteoarthritis in anterior cruciate ligament (ACL)–reconstructed knees and altered joint alignment. Purpose: To determine whether patellar alignment differs between participants with and without ACL reconstruction (ACLR) and to identify possible associations between patellar alignment and PFJ osteoarthritis features over 3 years. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 37 participants with ACLR (sex, 23 male; mean ± SD age, 28.1 ± 7.4 years) and 20 healthy controls (13 male; 30.4 ± 4.8 years) participated. Patients underwent magnetic resonance imaging: (1) sagittal T2-weighted fat-saturated fast spin echo images to calculate patellar alignment, (2) sagittal 3-dimensional intermediate-weighted fast spin echo Cube sequence for clinical morphological grading (modified Whole-Organ Magnetic Resonance Imaging Score [WORMS]), and (3) sagittal combined T1ρ/T2 mapping sequence for performing voxel-based relaxometry. Patellar alignment of the ACLR knees were assessed at 6 months (baseline). One-way analysis of variance was used to compare patellar alignment among the ACLR (at 6 months), contralateral, and control knees. Within the ACLR group, a logistic regression model was used to identify if patellar alignment measures at baseline were risk factors for worsening of PFJ structural changes over 3 years. Statistical parametric mapping was used to evaluate the longitudinal associations between patellar alignment and cartilage relaxation times at 3 years. Results: When compared with control knees, ACLR knees exhibited a laterally and anteriorly displaced patella (P = .045 and P = .041), less flexion (P = .031), and less lateral spin (P = .012). Furthermore, excessive lateral displacement was a significant predictor of worsening of WORMS (P = .050). Lateral displacement was positively correlated with increased T1ρ and T2 in the patellar and trochlear cartilage at 3 years. Patellar lateral spin revealed similar negative findings. Conclusion: Participants with ACLR exhibited a laterally and anteriorly displaced patella, less flexion, and less lateral spin when compared with healthy controls. Excessive patellar lateral displacement was the strongest predictor to the development of PFJ osteoarthritis features longitudinally.

Evaluating the structural effects of intra-articular sprifermin on cartilage and non-cartilaginous tissue alterations, based on sqMRI assessment over 2 years

Sprifermin (recombinant human fibroblast growth factor-18), a potential disease-modifying osteoarthritis (OA) drug, demonstrated dose-dependent effects on femorotibial cartilage thickness (by quantitative magnetic resonance imaging [MRI]) in the phase II FORWARD study. This post-hoc analysis evaluated the potential effects of sprifermin on several articular structures in the whole joint over 24 months using semi-quantitative MRI assessment. Patients aged 40-85 years with symptomatic radiographic knee OA, Kellgren-Lawrence grade 2 or 3, and medial minimum joint space width ≥2.5mm in the target knee were randomized (1:1:1:1:1) to receive three double-blinded, once-weekly, intra-articular injections of sprifermin 30μg or 100μg or placebo every 6 (q6mo) or 12 months. 1.5- or 3T MRIs were read using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system at baseline and 24 months. Change from baseline at 24 months on compartment and/or whole knee level was assessed for cartilage morphology, bone marrow lesions (BMLs), and osteophytes by delta-subregional and delta-sum (DSM) approaches. Menisci, Hoffa-synovitis, and effusion-synovitis were also evaluated for worsening. 549 patients were included. Dose-dependent treatment effects from baseline to 24 months were observed on cartilage morphology (sprifermin 100μg q6mo vs placebo; mean DSM (95% confidence interval [CI])-0.6 (-1.5, 0.2); less cartilage worsening) in the entire knee and BMLs sprifermin 100μg q6mo vs placebo; mean DSM (95% CI)-0.2 (-0.5, 0.1) in the patellofemoral compartment. No effects over 24 months were observed on osteophytes, menisci, Hoffa-synovitis or effusion-synovitis. Positive effects associated with sprifermin were observed for cartilage morphology changes, and BML improvement. There were no meaningful negative or positive effects associated with sprifermin in the other joint tissues examined.

Clinical effect of intramuscular calcitonin compared with oral celecoxib in the treatment of knee bone marrow lesions: a retrospective study

BackgroundBone marrow lesions (BMLs) are a common finding in patients with osteoarthritis (OA), which are predictors of progression and pain related to cartilage damage in OA. The objective of the present research was to compare the short-term clinical effect of intramuscular calcitonin and oral celecoxib in treating knee BMLs.Patients and methodsBetween January 2016 and December 2018, the medical records of patients with knee BMLs treated by intramuscular calcitonin or oral celecoxib were reviewed. Visual analog scale (VAS) and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used to assess knee pain and function, respectively. BMLs were assessed by MRI scans and were scored by the modified Whole-Organ MRI Score (WORMS). The safety of these two medications was also evaluated.ResultsA total of 123 eligible patients who received calcitonin treatment (n = 66) or celecoxib treatment (n = 57) were included. All patients were followed up clinically and radiographically for 3 months. The VAS and WOMAC scores were lower statistically in calcitonin group than celecoxib group at 4-week and 3-month follow-up. For BMLs, the WORMS scores in the calcitonin group were significantly lower than the celecoxib group. Besides, statistically higher MRI improvement rates were found in the calcitonin group compared with the celecoxib group at 4-week follow-up (21.21% vs. 7.01%; P = 0.039) and 3-month follow-up (37.88% vs. 15.79%; P = 0.006).ConclusionIntramuscular calcitonin 50 IU once daily demonstrated a better short-term effect for knee BML patients compared with oral celecoxib 200 mg twice per day.

Natural history of new horizontal meniscal tears in individuals at risk for and with mild to moderate osteoarthritis: data from osteoarthritis initiative.

To study the natural history of new horizontal meniscal tears and their association with progression of cartilage degeneration in individuals at risk for or with mild to moderate knee osteoarthritis over 4years. Individuals who developed a new meniscal tear in the right knee over 2years were selected from the Osteoarthritis Initiative 3T MRI studies. Knee structural changes were analyzed at the time of tear appearance (baseline), and after 4years using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Meniscal tears were classified as either horizontal tears or non-horizontal tears. Individuals without a meniscal tear were 1:3 frequency matched according to BMI, gender, race, and age and served as the control group. Linear regression analysis was used to compare cross-sectional and longitudinal changes in cartilage WORMS scores. Forty-one subjects developed horizontal tears, including one indiviudal who developed a tear in both menisci, and 34 developed non-horizonal tears. We found that (29/41 (70.7%)) of horizontal and (20/34 (58.8%)) of non-horizonatal tears were stable during follow-up (p = 0.281). Although knees with an incident tear had higher than controls WORMS MAX total knee scores at baseline (coef. = 0.47, p = 0.044, 95% CI = 0.01 to 0.93), there were no significant differences between the horizontal subgroup and knees without tears in overall cartilage scores at baseline and in progression over 4years of follow-up. New horizontal meniscal tears tended to be stable over 4years and presented no significant differences in progression of cartilage degeneration when compared with knees without tears. • Most of horizonal meniscal tears were stable over 4years. • There were no statistically significant differences in overall progression of cartilage degenerative changes between knees with horizonal meniscal tears and control knees without tears • Horizontal tears most often occurred at the posterior horn of the medial meniscus and at the body of the lateral meniscus.

Meniscal Root Tears and Extrusion Are Significantly Associated with the Development of Accelerated Knee Osteoarthritis: Data from the Osteoarthritis Initiative.

To identify joint structural risk factors, measured using quantitative compositional and semiquantitative magnetic resonance imaging (MRI) scoring, associated with the development of accelerated knee osteoarthritis (AKOA) compared with a more normal rate of knee osteoarthritis (OA) development. From the Osteoarthritis Initiative we selected knees with no radiographic OA (Kellgren-Lawrence grade [KL] 0/1) that developed advanced-stage OA (KL 3/4; AKOA) within a 4-year timeframe and a comparison group with a more normal rate of OA development (KL 0/1 to KL 2 in 4 years). MRIs at the beginning of the 4-year timeframe were assessed for cartilage T2 values and structural abnormalities using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations of MRI findings with AKOA versus normal OA were assessed using multivariable logistic regression models. A total of 106 AKOA and 168 subjects with normal OA development were included. Mean cartilage T2 values were not significantly associated with AKOA (odds ratio [OR] 1.06; 95% confidence interval [CI] 0.82-1.36). Risk factors for AKOA development included higher meniscus maximum scores (OR 1.37; 95% CI 1.11-1.68), presence of meniscal extrusion (OR 6.30; 95% CI 2.57-15.49), presence of root tears (OR 4.64; 95% CI 1.61-13.34), and higher medial tibia cartilage lesion scores (OR 1.96; 95% CI 1.19-3.24). We identified meniscal damage, especially meniscal extrusion and meniscal root tears as risk factors for AKOA development. These findings contribute to identifying subjects at risk of AKOA at an early stage when preventative measures targeting modifiable risk factors such as meniscal repair surgery could still be effective.

The Relationship between Synovial Inflammation in Whole-Organ Magnetic Resonance Imaging Score and Traditional Chinese Medicine Syndrome Pattern of Osteoarthritis in the Knee

Purpose: The aim of this study was to guide the quantitative analysis of Traditional Chinese Medicine (TCM) syndromes by the measurement of magnetic resonance. Methods: A total of 213 patients with knee osteoarthritis were selected for TCM dialectical classification, and their MRI images were scored on Whole-Organ Magnetic Resonance Imaging Score (WORMS) to evaluate the correlation between severity of synovitis and TCM syndrome types in the scores. Results: Among the 213 patients, 25 were Anemofrigid-damp arthralgia syndrome (accounting for 11.7%), 84 were Pyretic arthralgia syndrome (39.4%), 43 were Blood stasis syndrome (20.2%), and 61 were Liver and kidney vitality deficiency syndrome (28.6%). In the WORMS score, 12 (5.6%) had a synovitis score of 0, 60 (28.2%) had a synovitis score of 1, 50 (23.5%) had a synovitis score of 2, and 91 (42.7%) had a synovitis score of 3. There was a statistically significant difference in the correlation analysis. The group with a synovitis score of 3 in WORMS was more likely to occur in the Pyretic arthralgia syndrome (X2 = 194.424, P = 0.000). Conclusion: In this study, Pyretic arthralgia syndrome (39.4%) was found to be the main clinical manifestation in patients with knee osteoarthritis synovitis. This finding has certain guiding significance for relevant treatment.

Complex Meniscus Tears Treated with Collagen Matrix Wrapping and Bone Marrow Blood Injection: Clinical Effectiveness and Survivorship after a Minimum of 5 Years' Follow-Up.

Purpose. To determine the 5-year success rate of the “all-inside” technique of arthroscopic meniscus suture and collagen membrane wrapping along with bone marrow blood injection, to evaluate the progression of degenerative changes and the impact of simultaneous anteriro cruciate ligament (ACL) reconstruction. Methods. Fifty-four consecutive patients with complex meniscal tears were treated with the previously described technique. The subjective scores (International Knee Documentation Committee 2000, Lysholm, EQ-5D-5L) and Barret clinical criteria of meniscal healing were recorded. Magnetic resonance images (MRIs) were assessed at 2 and 5 years postoperatively, using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) criteria. Kaplan-Meier survival analyses were performed in order to assess the survivorship after the index procedure. Thirty-nine patients were divided into 2 groups: group A—isolated meniscus repair and group B—meniscus repair with concurrent ACL reconstruction. Results. Fifty-four patients were treated and 44 were available for analysis. There was a statistically significant improvement in subjective scores and clinical assessment between the preoperative, 2-year follow-up, and 5-year follow-up time points. EQ-5D-5L utility value was 0.9 ± 1 at final follow-up. The WORMS osteoarthritis severity grade had increased from 6.9 ± 5.0 points at the 2-year follow-up to 11.1 ± 9.6 points at the 5-year follow-up (P < 0.001). There was a significant difference between the groups after 60 months. The overall survival rate at final follow-up was 88%. Conclusions. The treatment option evaluated in this study has shown very good mid-term clinical and MRI-based outcomes as well as a favorable survival rate. Simultaneous ACL reconstruction is likely a factor for osteoarthritis progression.

Using Cumulative Load to Explain How Body Mass Index and Daily Walking Relate to Worsening Knee Cartilage Damage Over Two Years: The MOST Study.

Knee cartilage damage is often linked to mechanical overloading. However, cartilage requires mechanical load to remain healthy, suggesting that underloading may be detrimental. This study was undertaken to examine knee overloading and underloading by defining cumulative load as the joint effects of body mass index (BMI) and daily walking, and examine the relationship between cumulative load and worsening cartilage damage over 2 years. We used data from the Multicenter Osteoarthritis Study. Steps/day, measured by accelerometry, and BMI were calculated at the 60-month visit. Cartilage damage on magnetic resonance imaging was semiquantitatively scored using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) at the 60-month and 84-month visits; worsening damage was defined as increased WORMS between visits. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated using binomial regression, with adjustment for potential confounders. Our study included 964 participants, 62% of whom were female, with a mean ± SD age of 66.9 ± 7.5 years. Participants had a mean ± SD BMI of 29.7 ± 4.8 kg/m2 and walked a mean ± SD of 7,153 ± 2,591 steps/day. Participants who walked a moderate number of steps/day (6,000-7,900) or a high number of steps/day (>7,900) and had a high BMI (>31 kg/m2 ) had a greater risk of worsening medial tibiofemoral (TF) damage (RR 2.83 [95% CI 1.46-5.48] and RR 2.61 [95% CI 1.50-4.54], respectively) compared with those who walked similar steps/day and had a low BMI (18-27 kg/m2 ). Participants with a low number of steps/day (<6,000) and a low BMI had a greater risk of worsening medial TF and lateral patellofemoral (PF) damage (RR 2.03 [95% CI 1.06-3.92] and RR 2.28 [95% CI 1.06-4.85], respectively) compared with those who walked a high number of steps/day and had a low BMI. Effect estimates for other compartments of the knee did not reach statistical significance. This study provides preliminary evidence that both overloading and underloading may be detrimental to medial TF cartilage, and underloading may be detrimental to lateral PF cartilage.

Tendon regeneration and muscle hypotrophy after isolated Gracilis tendon harvesting - a pilot study

PurposeThe gracilis tendon (GT) is a commonly used autologous graft in Orthopaedic surgery. The majority of information on knee function and outcomes after hamstring harvest is related to both semitendinosus and GT harvest. Little is known regarding isolated harvest of a GT. It was hypothesized that isolated GT harvest would lead to altered gait patterns (e.g. augmented anterior-posterior translation or rotation in the tibiofemoral joint) and consequently a higher prevalence of cartilage lesions and meniscal tears in knees.MethodsGT harvesting was performed on patients with chronic acromioclavicular joint instability without previous knee injuries or surgeries. MRI of both knees and thighs were performed. Knee MRI were evaluated using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Inter- and intraobserver reliabilities, cross-sectional areas of different muscles, fatty infiltration of the gracilis muscle (GM) and GT regeneration were evaluated. The contralateral limb served as reference. The observers were blinded towards the identity of the patients and the operatively treated side.ResultsAfter a mean time of 44 months after surgery testing was performed on 12 patients. No significant side-to-side differences were found using WORMS, although there was a trend towards increased cartilage lesions after GT harvest (median healthy knee 4.8 and GT harvested knee 7.8 p = 0.086). Inter- and intraobserver repeatability was high with 0.899 (95% confidence interval (CI) 0.708–0.960) and 0.988 (95% CI 0.973–0.995), respectively. A significant hypotrophy of the GM with a mean decrease of 25.3%, 18.4% and 16.9% occurred at 25% (p = 0.016), 50% (p = 0.007) and 75% (p = 0.002) of the length of the femur from distal. No compensatory hypertrophy of other thigh muscles or increased fatty infiltration of the GM was found. Tendon regeneration took place in eight out of 12 patients. In case of regeneration, the regenerated tendon inserted in a more proximal place.ConclusionIsolated harvest of the GT for shoulder procedures did not affect knee MRI significantly indicating therefore in general suitable graft utilization for surgeries outside of the knee. GT regenerated in most patients with just a more proximal insertion and a hypotrophy of the muscle belly.

Bert model fine-tuning for text classification in knee OA radiology reports

Purpose: Traditional Natural Language Processing (NLP) techniques do a good job of understanding relationships between adjacent or nearby words. However, clinical text data such as patient notes or radiology reports require capturing interactions between distant words. BERT (Bidirectional Encoder Representations from Transformers), a new form of deep neural network recently introduced by Google, overcomes this challenge given its ability to comprehend long range word interactions. While BERT has dramatically improved outcomes in NLP tasks in the general domain such as optimizing search results, its performance in domain specific tasks such as analyzing biomedical data is still being explored. We report the findings of using a pre-trained BERT model further trained on knee radiology reports with the aim of testing its ability to identify cartilage lesions in osteoarthritis (OA) patients, the first such effort in musculoskeletal imaging. Methods: 1521 MR scans of patients with osteoarthritis and corresponding radiology reports were assessed by the clinician for all 6 cartilage compartments (Patella, Trochlea, Medial Femur, Medial Tibia, Lateral Femur and Lateral Tibia) according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system for knee OA (Figure 1). These gradings were further simplified into binary (Normal and Abnormal) classes (WORMS target). The clinician also assessed (blinded) 89 radiology reports and provided binary targets (NLP target). Radiology reports contains Technique, Findings and Impression sections, due to reports vary in length, with median 329 and max 731 tokens for our dataset, and BERT has 512 tokens limitation, Findings section was selected as dataset for both classification tasks, Logistic Regression and BERT fine-tuning. Both models have 80/20 train test data split, trains on all 6 compartments and use the binary WORMS target. For baseline Logistic Regression model, texts were cleaned and tokenized with Spacy then applied Term Frequency Inverse Document Frequency (TF-IDF) transforming texts into numeric vectors as input and trained with class weighted logistic regression. After the training process, 5-fold cross validation was performed to evaluate performance. To fine-tune BERT text classification task, reports were preprocessed with lower cased text, added special tokens to mark beginning and end sentences, padded if reports are shorter than 512 tokens, then generated vector representations with bert-base-uncased pre-trained model into training features along with input mask, and segment id. In evaluation step, the fine-tuned BERT models were then tested on each compartment for both WORMS target and NLP target. Results: For both training and testing datasets, the ratio of normal to abnormal cases varies. Patella has the most abnormal making it more balanced while MT has the least (Figure 2A). In the more balanced compartments such as Patella and Trochlea, LFC, BERT significantly improved the classification results compares to the baseline model. However, for the imbalanced dataset, even though BERT shows higher accuracy, it overfits and predicted Normal for all. This can be solved by hyper-parameter tuning and adjusting class weight in loss function for each model. Each fine-tuned BERT model is tested with NLP Target (labels on 89 radiology reports) and compared with the earlier WORMS target (gradings from images) (Figure 2B). Accuracy significantly improves on the NLP target with more balanced dataset (Figure 3). However, the overfit problem persists on MFC, MT, LT compartments. This implies the discrepancies between MR images and the content in the radiology reports, using NLP target which provides a more accurate annotations on reports will further improve the model’s prediction abilities. Conclusions: Our results in cartilage abnormality prediction esp. in compartments with balanced data holds promise and calls for further investigating use of BERT for domain specific tasks. The ability to develop a model which can accurately decipher text sentiment from radiology reports avoiding the need of time-consuming image annotation will accelerate and augment image based deep learning approaches for anomaly detection and improve clinical workflow.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Opioid use is associated with worse knee osteoarthritis at baseline and faster progression of degenerative changes: data from the osteoarthritis initiative (OAI)

Purpose: Despite current guidelines, opioids are frequently prescribed as pain medication for symptom control in osteoarthritis (OA). While chondrotoxicity of different subtypes of opioids is investigated and discussed in recent studies, the impact of opioid medication itself on progression of OA has not been clarified. Thus, the aim of this study was to investigate associations between opioid use with structural and clinical characteristic of OA of the knee using cross-sectional and longitudinal analyses, with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) and WOMAC and KOOS scores as outcomes.

MRI findings change after medial opening-wedge high tibial osteotomy for medial knee osteoarthritis

Purpose: Medial opening-wedge high tibial osteotomy (OWHTO) is a surgical procedure that aims to correct the weight-bearing axis of the knee, moving the loads laterally from the medial compartment. In many studies, it was reported that medial OWHTO improved pain in medial knee osteoarthritis (OA). But it isn’t unclear how MRI findings change and why knee pain improves after OWHTO. The purpose was to prospectively evaluate the compartmental changes of OWHTO for medial knee OA with MRI. Methods: 13 medial knee OA patients (mean age 61 ± 9.3 years) with 17 knees undergoing medial OWHTO were assessed pre- and postoperatively with MRI. The implant removal surgery was done 25.4 ± 9.8 months after OWHTO. Pain at rest and walking were assessed using a 0 to 100 Visual Analogue Scale (VAS). Postoperative MRI was done after the implant removal surgery. Subchondral bone marrow lesions (BMLs) area at the medial compartment was calculated through the slice which showed maximum size of BMLs area in the coronal plane using the fat-suppressed T2-weighted FSE images. The articular cartilage and synovitis were scored using Whole-Organ Magnetic Resonance Imaging Scores (WORMS). Femorotibial angle (FTA), the percentage of mechanical axis (%MA), VAS pain at rest, VAS pain at walking, BMLs area, articular cartilage score, synovitis score and relative percentage of medial meniscus extrusion were examined. Results: Preoperative and postoperative assessments of measurements are summarized in Table 1. FTA and %MA were corrected to 180 (IQR 180,183) and 65.8 (IQR 60.4, 69.4) respectively (p < 0.01). VAS pain at rest and walking were reduced after surgery (p<0.05, p<0.01 respectively). BMLs area at both femur and tibia reduced after surgery (p < 0.05). But lateral tibiofemoral joint (LTFJ) and patellofemoral joint (PFJ) articular cartilage score, synovitis score and relative percentage of medial meniscus extrusion weren’t improved after surgery. Conclusions: In this study, OWHTO improved VAS pain and reduced BMLs area. Maybe BMLs area can be associated with pain relief in knee OA after OWHTO. On the other hand, OWHTO couldn’t improve degenerative LTFJ and PFJ articular cartilage score, synovitis score and medial meniscus extrusion. But the further studies will be needed regarding synovitis and medial meniscus extrusion. Because in this study we didn’t use contrast-enhanced MRI, there were possibility that synovitis wasn’t assessed accurately. And also, regarding the meniscus extrusion, we need to assess that not only in a supine position but also in a standing position.Tabled 1Table 1. Details of assessments of measurementspreoperativepostoperativeFTA (°)180 (180, 183)170 (168, 171) **%MA (%)19.0 (13.9, 22.7)65.8 (60.4, 68.4) **VAS pain at rest (0-100)10 (2.5, 15)0 (0, 2.5) *VAS pain at walking (0-100)50 (30, 75)0 (0, 15) **BMLs area at medial femur (cm2)45.6 (0, 96.7)12.3 (6.7, 50.8) *BMLs area at tibia (cm2)52.0 (7.7, 131.6)28.9 (0, 63.6) *MTFJ articular cartilage score (0-30)13 (12, 16)12 (11, 18)LTFJ articular cartilage score (0-30)0 (0, 2)2 (1, 3) *PFJ articular cartilage score (0-24)3 (1, 4)6 (4, 6.5) **Synovitis score (0-3)1 (1, 2)1 (1, 2)Meniscus extrusion (%)52.8 (44.1, 60.7)47.1 (31.2, 62.5) Open table in a new tab

Prevalence of medial meniscus extrusion in elderly persons -the bunkyo health study

Purpose: Meniscus function is important in knee osteoarthritis (knee OA), and aging-related dysfunction of meniscus is becoming a risk factor for the development and progression of knee OA. Recently, meniscal malposition, especially medial meniscus extrusion (MME), in addition to conventional meniscal damage is also attracting attention, and it has been shown that MME plays an important role for the incidence and progression of knee OA. However, the mechanism of the developmental process of MME is still remained unclear. In our recent study using T2 mapping MRI, MME was found in all cases with early stage knee OA patients who did not have meniscal lesion or tear. We also demonstrated that osteophyte consists of cartilage- and bone-parts, as osteophyte is formed by the process similar to the endochondral ossification. When cartilage-part of osteophyte, in addition to bone-parts, was evaluated, MME was coincided with the medial tibial osteophyte width in patients with early- to primary-stage knee OA (Arthritis Res Ther, 19:201, 2017). However, there is no report of the prevalence of MME in the general elderly cohort data. The purpose of this study was to examine the prevalence of MME among the elderly using a population-based cohort data. Methods: A total of 1,630 subjects aged between from 65 to 84 years of age participated in the Bunkyo Health Study during from November 2015 to September 2018. 1,191 subjects underwent both the plain radiograph in the standing position and MRI on knee joint (Hitachi, 0.3T). As 46 among 1,191 who showed lateral type of knee OA (femoro-tibial angle <173) were excluded, the remaining 1145 subjects (55.7% females, 72.9 years of age on average) were analyzed. A radiographic severity of knee OA was classified into four grades using the Kellgren-Lawrence (K/L) classification. FTA and medial joint space width (JSW) were measured with X-ray. The MME was evaluated according to whole organ magnetic resonance imaging score (WORMS). In addition, the position of the medial meniscus was measured for anomalies (1 mm or more was regarded as a position error), and 3 mm or more was defined as MME. A p-value less than 5% was considered to be statistically significant. All analyses were undertaken using the statistical package SPSS. Results: The severity of radiographic medial knee OA of the subjects in the present study was 16 (1.4%) for K/L 1, 986 (86.1%) for K/L 2, 106 (9.3%) for K/L 3, and 37 (3.2%) for K/L 4. Abnormal position of medial meniscus was detected in almost all cases (1,139 persons, 99.5%, 4.4±2.1mm on average). The MME was detected 842 persons (73.5%). Prevalence by generation of the MME was increased with each generation (p<0.001): 70.7% for 65-70 years of age, 74.1% for 70-75 years of age, 74.7% for 75-80 years of age, 79.9% >80 years of age. Abnormal position of the medial meniscus was associated with FTA (r = 0.18 p <0.001), JSW (r = -0.20 p <0.001), and age (r = 0.13 p <0.001). Conclusions: In the present population-based study, most of the subjects among the middle aged and elderly populations who did not require the medical treatment for their knee joint showed the K/L grade 2 of radiographic knee OA change. In elderly people over the age of 65 in Japan, most of the medial meniscus had an abnormal position, and more than 70% of medial meniscus categorizes to MME. In addition, the probability of MME becomes higher with age.

Association of blood pressure with knee cartilage composition and structural knee abnormalities: data from the osteoarthritis initiative.

To investigate the associations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with changes in knee cartilage composition and joint structure over 48months, using magnetic resonance imaging (MRI) data from the Osteoarthritis Initiative (OAI). A total of 1126 participants with right knee Kellgren-Lawrence (KL) score 0-2 at baseline, no history of rheumatoid arthritis, blood pressure measurements at baseline, and cartilage T2 measurements at baseline and 48months were selected from the OAI. Cartilage composition was assessed using MRI T2 measurements, including laminar and gray-level co-occurrence matrix texture analyses. Structural knee abnormalities were graded using the whole-organ magnetic resonance imaging score (WORMS). We performed linear regression, adjusting for age, sex, body mass index, physical activity, smoking status, alcohol use, KL score, number of anti-hypertensive medications, and number of nonsteroidal anti-inflammatory drugs. Higher baseline DBP was associated with greater increases in global T2 (coefficient 0.22 (95% CI 0.09, 0.34), P = 0.004), global superficial layer T2 (coefficient 0.39 (95% CI 0.20, 0.58), P = 0.001), global contrast (coefficient 15.67 (95% CI 8.81, 22.53), P < 0.001), global entropy (coefficient 0.02 (95% CI 0.01, 0.03) P = 0.011), and global variance (coefficient 9.14 (95% CI 5.18, 13.09), P < 0.001). Compared with DBP, the associations of SBP with change in cartilage T2 parameters and WORMS subscores showed estimates of smaller magnitude. Higher baseline DBP was associated with higher and more heterogenous cartilage T2 values over 48months, indicating increased cartilage matrix degenerative changes.

CORR Synthesis: What Is the Evidence for the Clinical Use of Stem Cell-based Therapy in the Treatment of Osteoarthritis of the Knee?

CORR Synthesis: What Is the Evidence for the Clinical Use of Stem Cell-based Therapy in the Treatment of Osteoarthritis of the Knee?

Intra-articular Injection of Culture-Expanded Mesenchymal Stem Cells Without Adjuvant Surgery in Knee Osteoarthritis: A Systematic Review and Meta-analysis

Background: Although many clinical studies have assessed the efficacy of mesenchymal stem cells (MSCs) in knee osteoarthritis, evidence on their efficacy remains unclear owing to heterogeneity of cell entity and concomitant procedures. Purpose: To determine the efficacy of culture-expanded MSCs in knee osteoarthritis in terms of clinical outcome and cartilage repair via meta-analysis of randomized controlled trials (RCTs) without adjuvant surgery. Study Design: Meta-analysis. Methods: PubMed, Embase, the Cochrane Library, CINAHL, and Scopus were searched from inception to December 31, 2018. RCTs with culture-expanded MSCs for treating knee osteoarthritis were included. Studies with adjuvant surgery or cell concentrate were excluded. Quality was assessed by the Cochrane Collaboration risk-of-bias tool. For meta-analysis, data on clinical outcomes were measured using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and data on cartilage repair were measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS); categorization related to improvement was extracted. Results: Six RCTs (203 patients) were included. Two studies were deemed to have a low risk of bias. In pooled analysis, the only significant difference was in the VAS score (mean difference, –13.55; 95% CI, –22.19 to −4.9). In cumulative pain analysis with VAS and WOMAC pain scores, there was significant improvement after treatment (standardized mean difference, –0.54; 95% CI, –0.85 to −0.23). There was no significant difference in cartilage repair assessed by magnetic resonance imaging (standardized mean difference, 0.11; 95% CI, –0.51 to 0.73), WORMS (standardized mean difference, 1.68; 95% CI −14.84 to 18.21), or categorical results (odds ratio, 1.56; 95% CI, 0.32-7.59). Conclusion: Intra-articular injection of culture-expanded MSCs without adjuvant surgery can improve pain for patients experiencing knee osteoarthritis at short-term follow-up (6-12 months). However, evidence regarding function and cartilage repair remains limited.

Point-of-Care Procedure for Enhancement of Meniscal Healing in a Goat Model Utilizing Infrapatellar Fat Pad–Derived Stromal Vascular Fraction Cells Seeded in Photocrosslinkable Hydrogel

Background: Large radial tears of the meniscus involving the avascular region can compromise meniscal function and result in poor healing and subsequent osteochondral degeneration. Augmentation of surgical repairs with adipose-derived stromal vascular fraction (SVF), which contains mesenchymal stromal cells, may improve meniscal healing and preserve function (ie, chondroprotection). Purposes: (1) To develop a goat model of a radial meniscal tear with resulting osteoarthritis and (2) to explore the efficacy of a 1-step procedure utilizing infrapatellar fat pad–derived SVF cells seeded in a photocrosslinkable hydrogel to enhance meniscal healing and mitigate osteochondral degeneration. Study Design: Controlled laboratory study. Methods: A full-thickness radial tear spanning 90% of the medial meniscal width was made at the junction of the anterior and middle bodies of the goat stifle joint. Tears received 1 of 3 interventions (n = 4 per group): untreated, repair, or repair augmented with photocrosslinkable methacrylated gelatin hydrogel containing 2.0 × 106 SVF cells/mL and 2.0 µg/mL of transforming growth factor β3. The contralateral (left) joint served as a healthy control. At 6 months, meniscal healing and joint health were evaluated by magnetic resonance imaging (MRI) and assessed by histological and macroscopic scoring. The Whole-Organ Magnetic Resonance Imaging Score and the presence of a residual tear, as evaluated with T2 MRI sequences, were determined by a single blinded orthopaedic surgeon. Results: When compared with tears left untreated or repaired with suture alone, augmented repairs demonstrated increased tissue formation in the meniscal tear site, as seen on MRI and macroscopically. Likewise, the neotissue of augmented repairs possessed a histological appearance more similar, although still inferior, to healthy meniscus. Osteochondral degeneration in the medial compartment, as evaluated by the Whole-Organ Magnetic Resonance Imaging Score and Inoue (macroscopic) scale, revealed increased degeneration in the untreated and repair groups, which was mitigated in the augmented repair group. Histological evaluation with a modified Mankin score showed a similar trend. In all measures of osteochondral degeneration, the augmented repair group did not differ significantly from the uninjured control. Conclusion: A radial tear spanning 90% of the medial meniscal width in a goat stifle joint showed poor healing potential and resulted in osteochondral degeneration by 6 months, even if suture repair was performed. Augmentation of the repair with a photocrosslinkable hydrogel containing transforming growth factor β3 and SVF cells, isolated intraoperatively by rapid enzymatic digestion, improved meniscal healing and mitigated osteoarthritic changes. Clinical Relevance: Repair augmentation with an SVF cell–seeded hydrogel may support successful repair of meniscal tears previously considered irreparable.

Chondrocalcinosis is associated with increased knee joint degeneration over 4 years: data from the Osteoarthritis Initiative

To determine if presence of calcium-containing crystals (CaC) is associated with increased knee joint degeneration over 4years and assess if total number of CaCs deposited is a useful measure of disease burden. Seventy subjects with CaCs in right knees at baseline were selected from the Osteoarthritis Initiative and matched to 70 subjects without evidence of CaCs. T1-weighted gradient-echo sequences were used to confirm presence of CaCs and count the numbers of distinct circumscribed CaCs. Morphological abnormalities were assessed at baseline and 4-year follow-up using the modified semi-quantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS). Linear regression models were used to analyze the associations between presence of CaCs at baseline and changes in WORMS and to analyze the associations between numbers of circumscribed CaCs at baseline and changes in WORMS. Presence of CaCs was associated with increased cartilage degeneration in the patella (coefficient: 0.33; 95% confidence interval (CI): 0.04-0.63), the medial femur (coefficient: 0.51; 95% CI: 0.18-0.83), the lateral tibia (coefficient: 0.36; 95% CI: 0.01-0.71) as well as the medial and lateral meniscus (coefficient: 0.38; 95% CI: 0.00-0.75 and coefficient: 0.72; 95% CI: 0.12-1.32). Knees with higher numbers of CaCs had increased cartilage degeneration in the patella and medial femur (coefficient: 0.09; 95% CI: 0.05-0.14; P<0.001 and coefficient: 0.08; 95% CI: 0.02-0.14; P=0.005). CaCs were associated with increased cartilage and meniscus degeneration over a period of 4years. Assessing the number of CaC depositions may be useful to evaluate risk of onset and worsening of degenerative disease.