scholarly journals OSTEOCHONDRAL LESIONS OF THE TALUS: FACTORS PREDICTIVE OF CARTILAGE INTEGRITY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0026
Author(s):  
Crystal A Perkins ◽  
John Erickson ◽  
Kiery Braithwaite ◽  
Michael T Busch ◽  
S. Clifton Willimon
Keyword(s):  
Articular Cartilage ◽  
Articular Surface ◽  
Ankle Arthroscopy ◽  
Osteochondral Lesions ◽  
Mri Findings ◽  
Open Physes ◽  
Model Combining ◽  
Radiographic Grade ◽  
Operative Findings ◽  
And Cartilage

Background: The integrity of articular cartilage in patients with osteochondral lesions of the talus (OLTs) guides treatment. The ability to predict cartilage integrity in OLTs, as previously published for OCD of the knee1, would be beneficial. The purpose of this study is to evaluate the association of radiographic and MRI findings and articular cartilage integrity at the time of ankle arthroscopy for OLTs. Methods: A single-institution retrospective review identified patients 19 years of age and younger with operative treatment of OLTs from 2010 – 2017. Demographics and intra-operative findings at the time of ankle arthroscopy were identified by chart review. Radiographs were assessed for physeal status, OLT location, and Berndt and Hardy grade. MRIs were reviewed for OLT size and location, modified Kramer grade, and cartilage status. Results: 53 patients with 54 OLTs and a mean age of 13.6 years (range 7 – 19 years) were included. OLTs were located in the posteromedial talus in 39 patients (72%). Physeal status was closed/closing in 32 patients (59%) and open in 22 patients (41%). On MRI, the cartilage was predicted to be disrupted in 40 patients (74%) and intact in 14 patients (26%). At the time of ankle arthroscopy, the cartilage was found to be disrupted in 38 OLTs (70%) and intact in 16 OLTs (30%). Table 1 lists variables predictive of cartilage integrity. [Table: see text] MRI classification of cartilage integrity was 95% sensitive and 75% specific for arthroscopic integrity, with 11% misclassification. In the 16 patients less than 13 years, MRI perfectly predicted arthroscopic cartilage integrity. In patients with open physes, MRI sensitivity was 92% and specificity 100%. In patients with closing/closed physes, MRI sensitivity was 89% and specificity 50%. Receiver operator curve characteristics of a model to predict arthroscopic cartilage integrity combining MRI cartilage integrity, physeal status, and radiographic grade has an AUC of 0.955. Conclusions: Physeal status, radiographic grade, MRI grade, and cartilage integrity on MRI are independent predictors of cartilage integrity at the time of ankle arthroscopy for patients with OLTs. Overall, MRI has 95% sensitivity and 75% specificity for cartilage integrity at the time of arthroscopy, which improves to near 100% sensitivity and specificity in patients with open physes. A model combining MRI cartilage integrity, physeal status, and radiographic grade has the highest predictability of intra-operative cartilage integrity. SIegaSll E, Faust JR, Herzog MM, Marshall KW, Willimon SC, Busch MT. Age predicts disruption of the articular surface of femoral condyles in knee OCD: can we reduce usage of arthroscopy and MRI? J Pediatr Orthop 2018;38:176-180.

scholarly journals Is Magnetic Resonance Imaging (MRI) Reliable in the Diagnosis of Osteochondral Lesions (OCL’s)?

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Triin Nurm ◽  
Paulo Torres ◽  
Jayasree Ramas Ramaskandhan
Keyword(s):  
Negative Relationship ◽  
Symptomatic Patient ◽  
Ankle Arthroscopy ◽  
Osteochondral Lesions ◽  
Time Interval ◽  
Consecutive Series ◽  
Mri Findings ◽  
Arthroscopic Findings ◽  
Retrospective Clinical Study ◽  
The Stability

Category: Ankle, Arthroscopy Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. Musculoskeletal radiologists aim to determine and report both chondral and/or osseous stability/instability of each lesion. The aim of this study was to specifically analyse the reliability of MRI reported findings in predicting the stability of OCL’s in symptomatic patients. Methods: A single centre, single surgeon consecutive series of patients who had undergone an ankle arthroscopy procedure preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and arthroscopic findings were extracted and analysed. Arthroscopy findings were taken as the gold standard. Results: Between April 2012 and July 2016, 48 patients who fulfilled the criteria were included. There were 27 male and 21 female patients, the average age was 43.4. Average time interval between MRI and arthroscopy was 9 months. There was a significant negative relationship between OCL’s reported as stable on MRI to arthroscopic findings, r=-.31, p=0.03. Of the 21 patients who had OCL’s reported as stable on the MRI, all had unstable lesions on arthroscopic evaluation (100%). One patient had an unstable OCL reported on the MRI and it was also unstable arthroscopically. In 27 patients, there was no mention of the stability of the reported OCL on the MRI, 22 patients (81.5%) had unstable lesions and 5 patients (18.5%) had stable lesions on arthroscopic findings. Conclusion: This study demonstrates that MRI has a poor predictive value for the stability of OCL’s of the ankle. Therefore we recommend that in the symptomatic patient an arthroscopy is indicated irrespective of MRI findings.

scholarly journals MRI evaluation with severity of ankle osteoarthritis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Hiroyuki Mitsui ◽  
Takaaki Hirano ◽  
Akiyama Yui ◽  
Shingo Maeda ◽  
Hisateru Niki
Keyword(s):  
Articular Cartilage ◽  
Evaluation Method ◽  
Articular Surface ◽  
Medial Malleolus ◽  
Mri Findings ◽  
Ankle Osteoarthritis ◽  
Talocrural Joint ◽  
X Ray ◽  
Ankle Joints ◽  
The Relationship

Category: Ankle Arthritis Introduction/Purpose: Takakura-Tanaka classification is effective as an X-ray evaluation method for determining the severity of and treatment strategy for ankle osteoarthritis (OA). Concerning OA, MRI is gaining attention as a tool for examining the condition of the articular cartilage over X-ray findings. However, there are few reports on the relationship between MRI and X- ray findings in ankle joints. We assessed MRI findings of ankle OA at each stage of Takakura-Tanaka classification to investigate the effects of bone and articular cartilage. Methods: We studied the localization of Bone Marrow Edema (BME) partitioned articular surface by MRI in 22 regions at the talocrural, talocalcaneal, talonavicular, and calcaneocuboid joints of 46 feet of 45 patients who had a diagnosis of ankle OA in our hospital. Furthermore, we compared the radiological findings with the localization of BME. Results: By MRI, the area where BME was seen is located in the anterior medial part of the talocrural joint. Pointedly, 60% of BME was confirmed on the tibial side of the talocrural joint. In addition, as the Takakura-Tanaka classification advanced, the identification of BME tended to increase on the anterior of the talus and the medial malleolus articular surface. Conclusion: We found on MRI that the localization of BME was identified by Takakura-Tanaka classification in osteoarthritis of the foot. On the other hand, there are some cases of OA without BME that were identified by X-ray in this study. In the future, there is a possibility that the severity of OA can be classified into more inclusive classifications by MRI. We intend to combine the severity of ankle OA with MRI findings and Takakura-Tanaka classification together.

scholarly journals Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142097570
Author(s):  
Mossub Qatu ◽  
George Borrelli ◽  
Christopher Traynor ◽  
Joseph Weistroffer ◽  
James Jastifer
Keyword(s):  
Articular Cartilage ◽  
Digital Imaging ◽  
Articular Surface ◽  
Implant Design ◽  
Joint Surface ◽  
Fracture Classification ◽  
Articular Damage ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
The Mean

Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

scholarly journals A case report of femoral head fracture with osteochondral lesion treated by osteosynthesis and biomimetic scaffold: 2-year clinical and radiological follow-up

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Alessandro Casiraghi ◽  
Claudio Galante ◽  
Marco Domenicucci ◽  
Stefano Cattaneo ◽  
Andrea Achille Spreafico ◽  
...  
Keyword(s):  
Case Report ◽  
Femoral Head ◽  
Articular Surface ◽  
Osteochondral Lesion ◽  
Hip Dislocation ◽  
Fracture Dislocation ◽  
Osteochondral Lesions ◽  
Femoral Head Fracture ◽  
Osteochondral Scaffold

AbstractThe aim of the present study was to present clinical and radiological outcome of a hip fracture-dislocation of the femoral head treated with biomimetic osteochondral scaffold.An 18-year-old male was admitted to the hospital after a motorcycle-accident. He presented with an obturator hip dislocation with a type IVA femoral head fracture according to Brumback classification system. The patient underwent surgery 5 days after accident. The largest osteochondral fragment was reduced and stabilized with 2 screws, and the small fragments were removed. The residual osteochondral area was replaced by a biomimetic nanostructured osteochondral scaffold. At 1-year follow-up the patient did not complain of hip pain and could walk without limp. At 2-year follow-up he was able to run with no pain and he returned to practice sports. Repeated radiographs and magnetic resonance imaging studies of the hip showed no signs of osteoarthritis or evidence of avascular necrosis. A hyaline-like signal on the surface of the scaffold was observed with restoration of the articular surface and progressive decrease of the subchondral edema.The results of the present study showed that the biomimetic nanostructured osteochondral scaffold could be a promising and safe option for the treatment of traumatic osteochondral lesions of the femoral head.Study Design: Case report.

Overlapping Allografts Provide Superior and More Reliable Surface Topography Matching Than Oblong Allografts: A Computer-Simulated Model Study

2021 ◽  
pp. 036354652110030
Author(s):  
Hailey P. Huddleston ◽  
Atsushi Urita ◽  
William M. Cregar ◽  
Theodore M. Wolfson ◽  
Brian J. Cole ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Surface Topography ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Radius Of Curvature ◽  
Cartilage Surface ◽  
3 Dimensional ◽  
Cloud Models ◽  
And Cartilage ◽  
Osteochondral Allografts

Background: Osteochondral allograft transplantation is 1 treatment option for focal articular cartilage defects of the knee. Large irregular defects, which can be treated using an oblong allograft or multiple overlapping allografts, increase the procedure’s technical complexity and may provide suboptimal cartilage and subchondral surface matching between donor grafts and recipient sites. Purpose: To quantify and compare cartilage and subchondral surface topography mismatch and cartilage step-off for oblong and overlapping allografts using a 3-dimensional simulation model. Study Design: Controlled laboratory study. Methods: Human cadaveric medial femoral hemicondyles (n = 12) underwent computed tomography and were segmented into cartilage and bone components using 3-dimensional reconstruction and modeling software. Segments were then exported into point-cloud models. Modeled defect sizes of 17 × 30 mm were created on each recipient hemicondyle. There were 2 types of donor allografts from each condyle utilized: overlapping and oblong. Grafts were virtually harvested and implanted to optimally align with the defect to provide minimal cartilage surface topography mismatch. Least mean squares distances were used to measure cartilage and subchondral surface topography mismatch and cartilage step-off. Results: Cartilage and subchondral topography mismatch for the overlapping allograft group was 0.27 ± 0.02 mm and 0.80 ± 0.19 mm, respectively. In comparison, the oblong allograft group had significantly increased cartilage (0.62 ± 0.43 mm; P < .001) and subchondral (1.49 ± 1.10 mm; P < .001) mismatch. Cartilage step-off was also found to be significantly increased in the oblong group compared with the overlapping group ( P < .001). In addition, overlapping allografts more reliably provided a significantly higher percentage of clinically acceptable (0.5- and 1-mm thresholds) cartilage surface topography matching (overlapping: 100% for both 0.5 and 1 mm; oblong: 90% for 1 mm and 56% for 0.5 mm; P < .001) and cartilage step-off (overlapping: 100% for both 0.5 and 1 mm; oblong: 86% for 1 mm and 12% for 0.5 mm; P < .001). Conclusion: This computer simulation study demonstrated improved topography matching and decreased cartilage step-off with overlapping osteochondral allografts compared with oblong osteochondral allografts when using grafts from donors that were not matched to the recipient condyle by size or radius of curvature. These findings suggest that overlapping allografts may be superior in treating large, irregular osteochondral defects involving the femoral condyles with regard to technique. Clinical Relevance: This study suggests that overlapping allografts may provide superior articular cartilage surface topography matching compared with oblong allografts and do so in a more reliable fashion. Surgeons may consider overlapping allografts over oblong allografts because of the increased ease of topography matching during placement.

A Review of the Collagen Orientation in the Articular Cartilage

Cartilage ◽  
2021 ◽  
pp. 194760352098877
Author(s):  
Roy D. Bloebaum ◽  
Andrew S. Wilson ◽  
William N. Martin
Keyword(s):  
Surface Layer ◽  
Articular Cartilage ◽  
Fiber Orientation ◽  
Collagen Fiber ◽  
Articular Surface ◽  
Imaging Techniques ◽  
Collagen Fibers ◽  
Deep Zone ◽  
Collagen Fiber Orientation ◽  
Critical Point Drying

Objective There has been a debate as to the alignment of the collagen fibers. Using a hand lens, Sir William Hunter demonstrated that the collagen fibers ran perpendicular and later aspects were supported by Benninghoff. Despite these 2 historical studies, modern technology has conflicting data on the collagen alignment. Design Ten mature New Zealand rabbits were used to obtain 40 condyle specimens. The specimens were passed through ascending grades of alcohol, subjected to critical point drying (CPD), and viewed in the scanning electron microscope. Specimens revealed splits from the dehydration process. When observing the fibers exposed within the opening of the splits, parallel fibers were observed to run in a radial direction, normal to the surface of the articular cartilage, radiating from the deep zone and arcading as they approach the surface layer. After these observations, the same samples were mechanically fractured and damaged by scalpel. Results The splits in the articular surface created deep fissures, exposing parallel bundles of collagen fibers, radiating from the deep zone and arcading as they approach the surface layer. On higher magnification, individual fibers were observed to run parallel to one another, traversing radially toward the surface of the articular cartilage and arcading. Mechanical fracturing and scalpel damage induced on the same specimens with the splits showed randomly oriented fibers. Conclusion Collagen fiber orientation corroborates aspects of Hunter’s findings and compliments Benninghoff. Investigators must be aware of the limits of their processing and imaging techniques in order to interpret collagen fiber orientation in cartilage.

scholarly journals The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

2021 ◽  
Author(s):  
Anne-Sophie van der Post ◽  
Sjoerd Jens ◽  
Frank F. Smithuis ◽  
Miryam C. Obdeijn ◽  
Roelof-Jan Oostra ◽  
...  
Keyword(s):  
Signal Intensity ◽  
Sagittal Plane ◽  
Articular Surface ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Variance ◽  
Observer Agreement ◽  
Mri Findings ◽  
Mri Features ◽  
Triangular Fibrocartilage ◽  
The Individual

Abstract Objective The objective of the study is to provide a reference for morphology, homogeneity, and signal intensity of triangular fibrocartilage complex (TFCC) and TFCC-related MRI features in adolescents. Materials and methods Prospectively collected data on asymptomatic participants aged 12–18 years, between June 2015 and November 2017, were retrospectively analyzed. A radiograph was performed in all participants to determine skeletal age and ulnar variance. A 3-T MRI followed to assess TFCC components and TFCC-related features. A standardized scoring form, based on MRI definitions used in literature on adults, was used for individual assessment of all participants by four observers. Results per item were expressed as frequencies (percentages) of observations by all observers for all participants combined (n = 92). Inter-observer agreement was determined by the unweighted Fleiss’ kappa with 95% confidence intervals (95% CI). Results The cohort consisted of 23 asymptomatic adolescents (12 girls and 11 boys). Median age was 13.5 years (range 12.0–17.0). Median ulnar variance was −0.7 mm (range − 2.7–1.4). Median triangular fibrocartilage (TFC) thickness was 1.4 mm (range 0.1–2.9). Diffuse increased TFC signal intensity not reaching the articular surface was observed in 30 (33%) observations and a vertical linear increased signal intensity with TFC discontinuation in 19 (20%) observations. Discontinuation between the volar radioulnar ligament and the TFC in the sagittal plane was seen in 23 (25%) observations. The extensor carpi ulnaris was completely dislocated in 10 (11%) observations, more frequent in supinated wrists (p = 0.031). Inter-observer agreement ranged from poor to fair for scoring items on the individual TFCC components. Conclusion MRI findings, whether normal variation or asymptomatic abnormality, can be observed in TFCC and TFCC-related features of asymptomatic adolescents. The rather low inter-observer agreement underscores the challenges in interpreting these small structures on MRI. This should be taken into consideration when interpreting clinical MRIs and deciding upon arthroscopy.

scholarly journals Early patellofemoral articular cartilage degeneration in a rat model of patellar instability is associated with activation of the NF-κB signaling pathway

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wei Lin ◽  
Huijun Kang ◽  
Yike Dai ◽  
Yingzhen Niu ◽  
Guangmin Yang ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Signaling Pathway ◽  
Subchondral Bone ◽  
Patellofemoral Joint ◽  
Patellar Instability ◽  
Cartilage Degeneration ◽  
Control Group ◽  
And Control ◽  
Articular Cartilage Degeneration ◽  
And Cartilage

Abstract Background Patellar instability (PI) often increases the possibility of lateral patellar dislocation and early osteoarthritis. The molecular mechanism of early articular cartilage degeneration during patellofemoral osteoarthritis (PFOA) still requires further investigation. However, it is known that the NF-κB signaling pathway plays an important role in articular cartilage degeneration. The aim of this study was to investigate the relationship between the NF-κB signaling pathway and patellofemoral joint cartilage degeneration. Methods We established a rat model of PI-induced PFOA. Female 4-week-old Sprague-Dawley rats (n = 120) were randomly divided into two groups: the PI (n = 60) and control group (n = 60). The distal femurs of the PI and control group were isolated and compared 4, 8, and 12 weeks after surgery. The morphological structure of the trochlear cartilage and subchondral bone were evaluated by micro-computed tomography and histology. The expression of NF-κB, matrix metalloproteinase (MMP)-13, collagen X, and TNF-ɑ were evaluated by immunohistochemistry and quantitative polymerase chain reaction. Results In the PI group, subchondral bone loss and cartilage degeneration were found 4 weeks after surgery. Compared with the control group, the protein and mRNA expression of NF-κB and TNF-ɑ were significantly increased 4, 8, and 12 weeks after surgery in the PI group. In addition, the markers of cartilage degeneration MMP-13 and collagen X were more highly expressed in the PI group compared with the control group at different time points after surgery. Conclusions This study has demonstrated that early patellofemoral joint cartilage degeneration can be caused by PI in growing rats, accompanied by significant subchondral bone loss and cartilage degeneration. In addition, the degeneration of articular cartilage may be associated with the activation of the NF-κB signaling pathway and can deteriorate with time as a result of PI.

On the Natural Lubrication of Synovial Joints: Normal and Degenerate

1977 ◽  
Vol 99 (2) ◽  
pp. 163-172 ◽  
Author(s):  
Joseph M. Mansour ◽  
Van C. Mow
Keyword(s):  
Articular Cartilage ◽  
Solid Phase ◽  
Articular Surface ◽  
Moving Load ◽  
Frictional Resistance ◽  
Elastic Solid ◽  
Surface Load ◽  
Two Phase ◽  
Tissue Properties ◽  
Synovial Joints

Fluid flow and mass transport mechanisms associated with articular cartilage function are important biomechanical processes of normal and pathological synovial joints. A three-layer permeable, two-phase medium of an incompressible fluid and a linear elastic solid are used to model the flow and deformational behavior of articular cartilage. The frictional resistance of the relative motion of the fluid phase with respect to the solid phase is given by a linear diffusive dissipation term. The subchondral bony substrate is represented by an elastic solid. The three-layer model of articular cartilage is chosen because of the known histological, ultrastructural, and biomechanical variations of the tissue properties. The calculated flow field shows that for material properties of normal healthy articular cartilage the tissue creates a naturally lubricated surface. The movement of the interstitial fluid at the surface is circulatory in manner, being exuded in front and near the leading half of the moving surface load and imbibed behind and near the trailing half of the moving load. The flow fields of healthy tissues are capable of sustaining a film of fluid at the articular surface whereas pathological tissues cannot.

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