scholarly journals Correlation Between Synovial Fluid Biomarker Concentrations and Bone Marrow Edema Lesion Volume in Patients with Acute ACL Ruptures

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0015
Author(s):  
Utakarsh Anil ◽  
Jordan Werner ◽  
Neha Jejurikar ◽  
Lena Kenny ◽  
Hien Pham ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Acl Reconstruction ◽  
Bone Marrow Edema ◽  
Pivot Shift ◽  
Lesion Volume ◽  
Measurement Reliability ◽  
Initial Injury ◽  
Fluid Biomarker ◽  
Time From Injury ◽  
Marrow Edema

Objectives: Bone marrow edema lesions (BMELs) frequently occur following acute anterior cruciate ligament (ACL) rupture secondary to the pivot-shift mechanism of injury. The aim of the current study is to evaluate whether synovial fluid biomarker concentrations are associated with bone edema lesion volume as measured by magnetic resonance imaging (MRI) in patients undergoing ACL reconstruction. Methods: A total of 53 patients (26 females, 27 males, mean age 35.0 years [range 18-59]) undergoing ACL reconstruction with MRI knee scans available for analysis participated in the study. Synovial fluid was collected intra-operatively and analyzed for 10 biomarkers hypothesized to be involved in inflammation and post-traumatic osteoarthritis. BMELs were identified on MRI and their volumes (cm3) were quantified on two independent occasions using FireVoxel imaging software for image segmentation and region-of-interest drawing. The correlation between synovial fluid biomarker levels and BMEL volume was evaluated using Spearman’s correlation coefficient. Measurement reliability was assessed using intraclass correlation coefficient (ICC) analysis. Significance was set at p<0.05. Results: Mean time from initial injury to synovial fluid aspiration was 319 days (std. dev. 892; range 15-4320) and mean lesion volumes were: tibial=6.4 cm3 (range 0-38.6); femoral=5.8 cm3 (range 0-34.0); total=12.2 cm3 (range 0-50.5). Measurement reliability of BMEL volume was excellent [ICC(2,1)=0.968 (CI 0.945-0.981)]. Analysis of patients with MRI within 30 days of injury (n=35) showed increased tibial BMEL volume was significantly (p<0.05) correlated to decreased concentrations of interleukin (IL)-6 (ρ=-0.481), IL-1 receptor antagonist (ρ=-0.361), and vascular endothelial growth factor (VEGF) (ρ=-0.397) and increased time from injury to aspiration was correlated to decreased concentration of IL-6 (ρ=-0.463), monocyte chemotactic protein-1 (ρ=-0.453), VEGF (ρ=-0.457), IL-1Ra (ρ=-0.448), and matrix metalloproteinase (MMP)-3 (ρ=-0.426). However, among all patients, synovial fluid biomarker levels had no significant correlations to BMEL volume or time from injury to aspiration. Conclusion: Analysis of synovial fluid at the time of ACL reconstruction demonstrated that increased volume of injury-associated BMEL on MRI performed within 30 days of initial injury was significantly correlated to decreased concentrations of pro-inflammatory and growth factor cytokines. These findings suggest that the impact of the pivot-shift mechanism of injury and presence of BMEL may have an affect the local joint microenvironment. [Table: see text]

scholarly journals Ramp Lesions of the Medial Meniscus in Patients Undergoing Primary and Revision ACL Reconstruction: Prevalence and Risk Factors

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984350 ◽  
Author(s):  
George C. Balazs ◽  
Harry G. Greditzer ◽  
Dean Wang ◽  
Niv Marom ◽  
Hollis G. Potter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Acl Reconstruction ◽  
Bone Marrow Edema ◽  
Medial Meniscus ◽  
Meniscal Tear ◽  
Injury Mechanism ◽  
Posterior Horn ◽  
Ramp Lesion ◽  
Marrow Edema

Background: Ramp lesions are peripheral tears of the posterior horn of the medial meniscus that involve the meniscocapsular attachments or red-red zone and typically occur in conjunction with anterior cruciate ligament (ACL) ruptures. Purpose: To identify the prevalence of, and risk factors for, ramp lesions in a large cohort of patients undergoing primary and revision ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: We queried our institutional registry of patients who underwent primary or revision surgical treatment for an ACL injury. Those who underwent preoperative magnetic resonance imaging (MRI) at our facility were included in the study. Clinical details were extracted and verified using electronic records. All preoperative MRI scans were reviewed by a musculoskeletal radiologist for the presence of a ramp lesion. Stable ramp lesions were defined as a peripheral posterior horn medial meniscal tear identified on MRI but either not identifiable with viewing and probing from the anterior portals or, if identified, not displaceable with anteriorly directed probing. Unstable ramp lesions were defined as peripheral posterior horn medial meniscal tears at the meniscocapsular junction that were identifiable at the time of surgery and displaced into the medial compartment with probing. The prevalence of stable and unstable ramp lesions was calculated. Demographic, injury, and imaging parameters were determined using univariate statistics. Results: A total of 372 patients were included. The overall prevalence of ramp lesions was 42% (155/372). Unstable ramp lesions were present in 73 (20%) patients, and stable ramp lesions were present in 82 (22%) patients. The presence of any ramp lesion (stable or unstable) was associated with bone marrow edema of the posteromedial tibia on MRI (odds ratio [OR], 3.0; P < .0001), a contact injury mechanism (OR, 1.8; P = .02), and a concurrent lateral meniscal tear (OR, 1.7; P = .02). No demographic, injury, surgical, or radiological variable was associated with a stable versus unstable ramp lesion. Conclusion: The overall prevalence of a ramp lesion in patients treated for ACL ruptures at our institution was 42%. The presence of bone marrow edema of the posteromedial tibia, a contact injury mechanism, or a lateral meniscal tear should alert surgeons to the potential presence of a medial meniscal ramp lesion.

Cortical and trabecular alterations in patients with bone marrow edema of the lower limb

2013 ◽  
Author(s):  
Afrodite Zendeli ◽  
Christian Muschitz ◽  
Roland Kocijan ◽  
Lukas Fischer ◽  
Daniela Suess ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Lower Limb ◽  
Bone Marrow Edema ◽  
Marrow Edema

Calcium-Suppressed Technique in Dual-Layer Detector Computed Tomography to Evaluate Knee Articular Cartilage

2020 ◽  
Vol 16 ◽  
Author(s):  
Qinglin Meng ◽  
Mengqi Liu ◽  
Weiwei Deng ◽  
Ke Chen ◽  
Botao Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Marrow ◽  
Articular Cartilage ◽  
Bone Marrow Edema ◽  
Knee Joints ◽  
Infrapatellar Fat Pad ◽  
Proton Density ◽  
Knee Cartilage ◽  
Significant Difference ◽  
Marrow Edema

Background: Calcium-suppressed (CaSupp) technique involving spectral-based images has been used to observe bone marrow edema by removing calcium components from the image. Objective: This study aimed to evaluate the knee articular cartilage using the CaSupp technique in dual-layer detector computed tomography (DLCT). Methods: Twenty-eight healthy participants and two patients with osteoarthritis were enrolled, who underwent DLCT and magnetic resonance imaging (MRI) examination. CaSupp images were reconstructed from spectral-based images using a calcium suppression algorithm and were overlaid conventional CT images for visual evaluation. The morphology of the knee cartilage was evaluated, and the thickness of the articular cartilage was measured on sagittal proton density– weighted and CaSupp images in the patellofemoral compartment. Results: No abnormal signal or density, cartilage defect, and subjacent bone ulceration were observed in the lateral and medial femorotibial compartments and the patellofemoral compartment on MRI images and CaSupp images for the 48 normal knee joints. CaSupp images could clearly identify cartilage thinning, defect, subjacent bone marrow edema, and edema of the infrapatellar fat pad in the same way as MRI images in the three knee joints with osteoarthritis. A significant difference was found in the mean thickness of the patellar cartilage between MRI images and CaSupp images, while the femoral cartilage presented no significant difference in thickness between MRI images and CaSupp images over all 48 knee joints. Conclusion: The present study demonstrated that CaSupp images could effectively be used to perform the visual and quantitative assessment of knee cartilage.

scholarly journals Detection of Bone Marrow Edema in Patients with Osteoid Osteoma Using Three-Material Decomposition with Dual-Layer Spectral CT

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 953
Author(s):  
Florian T. Gassert ◽  
Johannes Hammel ◽  
Felix C. Hofmann ◽  
Jan Neumann ◽  
Claudio E. von Schacky ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Osteoid Osteoma ◽  
Bone Marrow Edema ◽  
Volume Fraction ◽  
Imaging Findings ◽  
Spectral Ct ◽  
Material Decomposition ◽  
Negative Imaging ◽  
Interreader Agreement ◽  
Marrow Edema

The aim of this study is to assess whether perifocal bone marrow edema (BME) in patients with osteoid osteoma (OO) can be accurately detected on dual-layer spectral CT (DLCT) with three-material decomposition. To that end, 18 patients with OO (25.33 ± 12.44 years; 7 females) were pairwise-matched with 18 patients (26.72 ± 9.65 years; 9 females) admitted for suspected pathologies other than OO in the same anatomic location but negative imaging findings. All patients were examined with DLCT and MRI. DLCT data was decomposed into hydroxyapatite and water- and fat-equivalent volume fraction maps. Two radiologists assessed DLCT-based volume fraction maps for the presence of perifocal BME, using a Likert scale (1 = no edema; 2 = likely no edema; 3 = likely edema; 4 = edema). Accuracy, sensitivity, and specificity for the detection of BME on DLCT were analyzed using MR findings as standard of reference. For the detection of BME in patients with OO, DLCT showed a sensitivity of 0.92, a specificity of 0.94, and an accuracy of 0.92 for both radiologists. Interreader agreement for the assessment of BME with DLCT was substantial (weighted κ = 0.78; 95% CI, 0.59, 0.94). DLCT with material-specific volume fraction maps allowed accurate detection of BME in patients with OO. This may spare patients additional examinations and facilitate the diagnosis of OO.

scholarly journals THU0484 FIBROMYALGIA AND MULTIPLE SWITCHING OF BIOLOGICS IN SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 479.2-480
Author(s):  
A. Negm ◽  
J. Alsaleh
Keyword(s):  
Bone Marrow ◽  
Disease Activity ◽  
Bone Marrow Edema ◽  
Disease Duration ◽  
Hla B27 ◽  
Tender Points ◽  
Conventional Dmards ◽  
Likelihood Ratio Testing ◽  
Multiple Switching ◽  
Marrow Edema

Background:Fibromyalgia (FM) is a condition characterized by chronic widespread pain, tender points, fatigue and disturbed sleep rhythm. Some of these symptoms such as fatigue, tender points and diffuse pain seen in patients with spondylarthritis (SpA). Moreover, FM and SpA can coexist creating a diagnostic challenge, particularly in early disease course and influence clinical disease activity assessment.Objectives:With this cross-sectional study, we aim to estimate the prevalence of FM in SpA and to elaborate its effect on biological treatments.Methods:FM was identified according to the ACR 2010 diagnostic criteria. SpA patients identified according to rheumatologist using various SpA subsets criteria. A review of the electronic medical files for SpA patients attending the rheumatology outpatient clinic and infusion unit at a major tertiary hospital during the period from June to December 2018 were included. Patients’ demographics, socioeconomics, disease characteristics, activity, HLA status and abnormal MRI sacroiliac were explored. Regarding SpA medications, number, frequency and dose of DMARDs and biological agents were obtained.Continuous variables were reported by their mean and standard deviation (SD) and qualitative variables by frequency and percentage. Statistical significance was set at p <0.05. Statistical analysis was performed using SPSS version 23.Results:Of the 305 enrolled SpA patients, 43 (14.1%) had FM. Females represents 57.4% of the patients, mean age was 44.07 ± 11.85 years. Arab ethnicity represents most of our cohort 84.9%, the majority were Emirati 64.6%. Smokers were 8.2% and ex-smokers were 3.3%. Axial SpA represents 38.4% while peripheral SpA 61.6% of our cohort according to ASAS classification.HLA B27 tested in a sample of 180 patients; it was positive in only 17.8%. CRP found to be elevated in 20.3% of the patients at baseline. Abnormal MRI SIJ bone marrow edema changes were found in 10.8%, while other SIJ changes was seen in additional 20.6%. The prevalence of FM showed no statistically significant difference between axial and peripheral SpA. Patients SpA and FM have longer disease duration than SpA alone, P= 0.034. Table.1 show demographics, socioeconomics and clinical data of our cohort.Regarding medication, the use of biologics among SpA patients with FM is more frequent than SpA patients without FM (74.4% vs 51.5 % respectively), P= 0.005. Interestingly, the likelihood ratio testing showed that SpA patient with Fibromyalgia switch more frequently to another biologics than SpA without fibromyalgia, P= 0.015.Cramer’s V test showed that there is a high statistically significant (P= 0.002) and very strong association (> 0.25) between presence of Fibromyalgia and multiple switching of biologics in SpA.There was no difference in the exposure to prednisolone nor conventional DMARDs between SpA patients with or without FM, P= 0.64 & 1 respectively.Gender, Female, n (%)175 (57.4)Age, mean ± SD (min- max), years44.07 ± 11.85 (18- 78)Type of A, n (%)AxialPeripheral117 (38.4)188 (61.6)Fibromyalgia, n (%)FM in axial SpAFM in Peripheral SpA43 (14.1)18 (41.9)25 (58.1)SpA Disease duration (months)FM+, mean ±SDFM-, mean ±SD107.7± 50.486± 57.9Elevated CRP, n (%)62 (20.3)HLA B27 in180 patients, n (%)PositiveNegative32 (17.8)148 (82.2)Abnormal MRI SIJ, n (%)Bone marrow edemaSubchondral sclerosisFatty transformation of bone marrowErosion92 (30.2)33 (10.8)21 (6.9)5 (1.6)2 (0.7)Number of conventional DMARDs ever tired, n (%)NoneOneTwoThree81 (26.6)166 (54.4)46 (15.1)12 (3.9)Frequency of DMARDs usage, n, (%)Conventional DMARDsPrednisoloneBiologic DNARDs224 (73.4)56 (18.4)164 (53.8)Conclusion:FM coexistence with SpA might impact clinical evaluation of disease activity and possibly negatively affect self-measurement of treatment response. In our study, SPA patients exposed to more biologics if they have coexisting FM; Moreover, they are more frequent switchers among biologics including TNFi and IL17i.Acknowledgments:N Elsidig, A Al Marzooqi, N Zamani, A HossainiDisclosure of Interests: :None declared

scholarly journals DELAY TO ACL RECONSTRUCTION IN PEDIATRIC AND ADOLESCENT PATIENTS IS ASSOCIATED WITH A LINEAR INCREASE IN THE RISK OF MEDIAL MENISCAL TEARS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
David A. Kolin ◽  
Brody Dawkins ◽  
Joshua Park ◽  
Peter D. Fabricant ◽  
Allison Gilmore ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Linear Increase ◽  
Meniscal Injury ◽  
Meniscal Tears ◽  
Increased Risk ◽  
Text Figure ◽  
Time From Injury

Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal tears. Previous studies have shown that secondary meniscal tears—occurring after the initial ACL injury—are associated with greater delays from injury to ACL reconstruction (ACLR), but frequently use dichotomous categories of acute versus delayed ACLR. Purpose: As meniscal damage is likely accrued constantly over time, we investigated the variability of concurrent meniscal injuries as a function of time from injury to ACLR in a pediatric and adolescent population. Methods: We performed a retrospective review of all patients ≤18 years who underwent an ACLR between 2014 and 2018 at one of two tertiary academic hospitals. Outliers were excluded if time from injury to ACLR was greater than 78 weeks. Records were reviewed to assess patients’ dates of injury and surgery. The prevalence of concurrent medial and/or lateral meniscal injury was evaluated at the time of surgery for each patient. Adjusted relative risks (ARRs) of meniscal injury were calculated using Poisson regression models adjusted for age, sex, and body-mass index. Logistic regression was used to model the predicted probability of medial meniscal tears. Results: 546 patients met inclusion criteria. The mean age of participants was 15.3 years (S.D., 1.6), and 277 (50.7%) patients were male. Overall, 344 (63.0%) patients had a meniscal tear. 169 (49.1%) tears occurred at the medial meniscus, and 257 (74.7%) occurred at the lateral meniscus (Table 1). Compared to females, males had a greater risk of lateral meniscal injury (ARR, 1.46; 95% CI, 1.20-1.77) but not medial meniscal injury (ARR, 1.01; 95% CI, 0.77-1.31) (Figure 1). When considering all meniscal tears, time from injury to ACLR was not associated with increased risk of a tear (ARR, 1.01; 95% CI, 1.00-1.01). However, for medial meniscal tears, there was a significant association between time from injury to ACLR, in weeks, and meniscal tears (ARR, 1.02; 95% CI, 1.01-1.03, P = 0.003). A ten-week delay was associated with a 20% increased risk of medial meniscal injury (Figure 2). Conclusion: In pediatric and adolescent ACLR patients, the risk of any meniscal injury was not associated with delay from injury to surgery. However, the risk of medial meniscal injury increased by 2% each week from injury to surgery. [Table: see text][Figure: see text][Figure: see text]

There is an Association of Synovial Interleukin-6 Levels With Chondral Damage in Anterior Cruciate Ligament–Deficient Knees

2021 ◽  
pp. 155633162199200
Author(s):  
Ravi Gupta ◽  
Anil Kapoor ◽  
Sourabh Khatri ◽  
Dinesh Sandal ◽  
Gladson David Masih
Keyword(s):  
Anterior Cruciate Ligament ◽  
Synovial Fluid ◽  
Acl Reconstruction ◽  
Inflammatory Cytokines ◽  
Interleukin 6 ◽  
Cruciate Ligament ◽  
Interleukin 1 ◽  
Chondral Damage ◽  
Anterior Cruciate ◽  
Acl Deficient

Background: Osteoarthritis (OA) in the anterior cruciate ligament (ACL)–deficient knee is seen in approximately 50% of affected patients. Possible causes include biochemical or biomechanical changes. Purpose: We sought to study the correlation between inflammatory cytokines and chondral damage in ACL-deficient knees. Methods: Seventy-six male patients who underwent ACL reconstruction were enrolled in a cross-sectional study. Synovial fluid was aspirated before surgery and analyzed for levels of the inflammatory cytokines tumor necrosis factor-α, interleukin-1 (IL-1), and interleukin-6 (IL-6). At the time of ACL reconstruction, the severity of chondral damage was documented as described by the Outerbridge classification. Results: Patients with grade 2 or higher chondral damage were observed to have elevated IL-6 levels when compared to patients who had no chondral damage. Interleukin-6 levels had no correlation with the duration of injury. Conclusion: Elevated levels of IL-6 in synovial fluid were associated with chondral damage in ACL-deficient knees. Further study is warranted to determine whether inflammatory cytokines contribute to the development of OA of the knee after ACL injury.

MR Imaging of Bone Marrow Edema and Joint Effusion in Patients with Osteonecrosis of the Femoral Head: Relationship to Pain

2003 ◽  
Vol 181 (2) ◽  
pp. 545-549 ◽  
Author(s):  
Guo-Shu Huang ◽  
Wing P. Chan ◽  
Yue-Cune Chang ◽  
Cheng-Yen Chang ◽  
Cheng-Yu Chen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Mr Imaging ◽  
Bone Marrow Edema ◽  
Joint Effusion ◽  
Marrow Edema
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