The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year

Background Dual-energy computer tomography (DECT) can detect post-traumatic bone marrow lesions. Prospective studies of the knee with large numbers of participants and intra-observer agreement assessment are limited. Purpose To investigate the diagnostic accuracy of DECT in detecting bone marrow lesions as well as estimating the bone marrow lesion volume in patients with suspected anterior cruciate ligament trauma with magnetic resonance imaging (MRI) as reference standard. Material and Methods Forty-eight consecutive patients with suspected anterior cruciate ligament injury were imaged bilaterally with DECT within a mean of 25 days (range 4–55 days) following injury and MRI within seven days of DECT. Two readers analyzed DECT virtual non-calcium-blinded images. Consensus MRI was reference standard. Intra- and inter-observer agreement were determined using weighted kappa statistics. Sensitivity, specificity, and negative and positive predictive values were calculated. Bone marrow lesion volumes were measured; for comparison, intra-class correlation coefficient was used. Results The 48 patients (26 men, 22 women; mean age 23 years, age range 15–37 years) were imaged bilaterally yielding 52 knees with bone marrow lesions, of which 44 were in the femur and 41 were in the tibia. Intra- and inter-observer agreement to detect bone marrow lesions was moderate and fair to moderate (κ 0.54–0.66, 95% confidence interval [CI] 0.39–0.80 and 0.37–0.41, 95% CI 0.20–0.57) and overall sensitivity and specificity were 70.1% and 69.1%, respectively. Positive and negative predictive values were 72.9% and 66.1%, respectively. Bone marrow lesion volumes showed excellent intra- and inter-observer agreement (0.83–0.91, 95% CI 0.74–0.94 and 0.76–0.78, 95% CI 0.57–0.87). Conclusion The diagnostic performance of DECT to detect bone marrow lesions in the subacutely injured knee was moderate with intra- and inter-observer agreement ranging from moderate to substantial and fair to moderate. Bone marrow lesion volume correlation was excellent.

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P279 THE ACUTELY ACL INJURED KNEE ASSESSED BY MRI-NATURAL HISTORY OF POST TRAUMATIC BONE MARROW LESIONS IN AN RCT OF SURGICAL VS. NON-SURGICAL TREATMENT

Osteoarthritis and Cartilage ◽

10.1016/s1063-4584(07)60727-4 ◽

2006 ◽

Vol 14 ◽

pp. S152-S153

Author(s):

R.B. Frobell ◽

H.P. Roos ◽

E.M. Roos ◽

M-P. Hellio Le Graverand-Gastineau ◽

R.J. Buck ◽

...

Keyword(s):

Bone Marrow ◽

Surgical Treatment ◽

Natural History ◽

Bone Marrow Lesions ◽

History Of ◽

Post Traumatic ◽

Injured Knee ◽

Non Surgical Treatment

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Relationship between bone marrow lesions, cartilage loss and pain in knee osteoarthritis: results from a randomised controlled clinical trial using MRI

Annals of the Rheumatic Diseases ◽

10.1136/ard.2009.127993 ◽

2010 ◽

Vol 69 (12) ◽

pp. 2118-2124 ◽

Cited By ~ 45

Author(s):

Lukas Martin Wildi ◽

Jean-Pierre Raynauld ◽

Johanne Martel-Pelletier ◽

François Abram ◽

Marc Dorais ◽

...

Keyword(s):

Clinical Trial ◽

Bone Marrow ◽

Knee Osteoarthritis ◽

Tibial Plateau ◽

Cartilage Volume ◽

Medial Tibial Plateau ◽

Bone Marrow Lesions ◽

Randomised Controlled ◽

And Cartilage ◽

Over Time

ObjectiveTo assess in a multicentre randomised double-blind phase III clinical trial evaluating the effect of licofelone in comparison with naproxen on knee osteoarthritis (OA) the presence of, and change in, bone marrow lesions (BML) over time, their relationship to cartilage volume loss, meniscal extrusion and pain.MethodsPatients with knee OA were selected from the dataset of a recently published randomised controlled trial. MRI was performed at baseline, 6, 12 and 24 months to assess BML score (modified Whole-Organ MRI Score) and cartilage volume changes over time. Pain levels were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire.ResultsOne hundred and sixty-one patients completed the study according to protocol. The global knee and all subregions showed increased BML scores over time (p <0.001, 24 months) except for the medial tibial plateau in the licofelone group. In multivariate regression analysis, licofelone treatment predicted reduction in BML score in the medial tibial plateau (β= −0.280, p = 0.026). BML scores at baseline correlated with cartilage volume over time; however, correlation was limited to 12 months. No positive correlation was found between BML and WOMAC scores.ConclusionsBML scores were found to increase over time, probably owing to accumulation of chronic structural changes. Correlation between BML and cartilage volume was strong at baseline but not over time, probably due to the study drug. Licofelone reduced the BML score in the medial tibial plateau. In contrast to previous reports, no positive relationship was found between BML score (baseline or change over time) and pain, probably an effect of the selected population.

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Correlation between the subchondral bone marrow lesions and cartilage repair tissue after matrix-associated autologous chondrocyte implantation in the knee: a cross-sectional study

Acta Radiologica ◽

10.1177/0284185120969955 ◽

2020 ◽

pp. 028418512096995

Author(s):

Jialing Lyu ◽

Yindi Zhang ◽

Weimin Zhu ◽

Dingfu Li ◽

Weiqiang Lin ◽

...

Keyword(s):

Bone Marrow ◽

Relaxation Time ◽

Cartilage Repair ◽

Subchondral Bone ◽

Autologous Chondrocyte Implantation ◽

Repair Tissue ◽

Bone Marrow Lesions ◽

Chondrocyte Implantation ◽

And Cartilage ◽

Autologous Chondrocyte

Background The contribution of the subchondral bone in the development and progression of osteoarthritis (OA) has long been recognized, but its role in cartilage repair procedures has only recently attracted more attention. Purpose To explore the correlation between the cartilage repair tissue (RT) and the subchondral bone marrow lesions (BMLs) after matrix-associated autologous chondrocyte implantation (MACI) in the knee joint. Material and Methods A total of 30 patients who underwent MACI in the knee from January 2015 to June 2018 and follow-up magnetic resonance imaging (MRI) scan were recruited in this study. The MRI results of cartilage RT were evaluated using T2* relaxation time. Subchondral BMLs were also qualitatively evaluated by use of the two-dimensional proton density-weighted fat-suppressed (2D-PD-FS) and three-dimensional dual-echo steady-state (3D-DESS) sequences. Results The univariate analysis displayed a significant negative correlation between subchondral BMLs and cartilage RT ( P < 0.01). In the minimally adjusted model (only age, sex, and body mass index [BMI] adjusted), the results did not show obvious changes (β = –6.54, 95% confidence interval [CI] = –10.99 to –2.09; P = 0.008). After adjustment for the full models (age, sex, BMI, defect size, combined injury, and preoperative duration of symptoms adjusted), the connection was also detected (β = –6.66, 95% CI –11.82 to –1.50; P = 0.019). Conclusion After MACI, the subchondral BMLs are significantly correlated with cartilage RT-T2* relaxation time. The role of subchondral bone in cartilage repair procedures should not be underestimated.

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Acromegalic arthropathy in various stages of the disease: an MRI study

Acta Endocrinologica ◽

10.1530/eje-16-1073 ◽

2017 ◽

Vol 176 (6) ◽

pp. 779-790 ◽

Cited By ~ 8

Author(s):

K M J A Claessen ◽

A Navas Canete ◽

P W de Bruin ◽

A M Pereira ◽

M Kloppenburg ◽

...

Keyword(s):

Bone Marrow ◽

Water Content ◽

Relaxation Times ◽

Cartilage Defects ◽

Joint Cartilage ◽

T2 Relaxation ◽

Bone Marrow Lesions ◽

Active Patients ◽

And Cartilage ◽

Acromegalic Arthropathy

Background Arthropathy is a prevalent and invalidating complication of acromegaly with a characteristic radiographic phenotype. We aimed to further characterize cartilage and bone abnormalities associated with acromegalic arthropathy using magnetic resonance imaging (MRI). Methods Twenty-six patients (23% women, mean age 56.8 ± 13.4 years), with active (n = 10) and controlled acromegaly (n = 16) underwent a 3.0 T MRI of the right knee. Osteophytes, cartilage defects, bone marrow lesions and subchondral cysts were assessed by the Knee Osteoarthritis Scoring System (KOSS) method. Cartilage thickness and cartilage T2 relaxation times, in which higher values reflect increased water content and/or structural changes, were measured. Twenty-five controls (52% women, mean age: 59.6 ± 8.0 years) with primary knee OA were included for comparison. Results Both in active and controlled acromegaly, structural OA defects were highly prevalent, with thickest cartilage and highest cartilage T2 relaxation times in the active patients. When compared to primary OA subjects, patients with acromegaly seem to have less cysts (12% vs 48%, P = 0.001) and bone marrow lesions (15% vs 80%, P = 0.006), but comparable prevalence of osteophytosis and cartilage defects. Patients with acromegaly had 31% thicker total joint cartilage (P < 0.001) with higher cartilage T2 relaxation times at all measured sites than primary OA subjects (P < 0.01). Conclusions Patients with active acromegaly have a high prevalence of structural OA abnormalities in combination with thick joint cartilage. In addition, T2 relaxation times of cartilage are high in active patients, indicating unhealthy cartilage with increased water content, which is (partially) reversible by adequate treatment. Patients with acromegaly have a different distribution of structural OA abnormalities visualized by MRI than primary OA subjects, especially of cartilage defects.

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