scholarly journals Radiographic vs. MRI vs. arthroscopic assessment and grading of knee osteoarthritis - are we using appropriate imaging?

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Samuel Newman ◽  
Huzefah Ahmed ◽  
Nader Rehmatullah

Abstract Purpose Radiographs and MRI scans are commonly used imaging techniques in the assessment of knee osteoarthritis. However, it currently remains uncertain how good a representation of the actual condition of the knee joint these investigations provide. By comparing them against arthroscopic findings the aim of our study was to conclude how accurate these imaging techniques are at grading knee osteoarthritis. Methods This was a retrospective study looking at knee arthroscopies performed at a tertiary centre over a 5 year period. The Outerbridge grade given at arthroscopy was correlated with pre-operative radiograph and MRI scores, so as to assess the reliability of these imaging techniques at predicting the actual severity of knee osteoarthritis seen. Results Kellgren-Lawrence (KL) grading of radiographs was moderately correlated with Outerbridge grades from arthroscopy for the medial compartment of the knee (Spearman’s rho (SR) 0.483, p < 0.001), with a milder correlation in the lateral compartment (SR 0.218, p = 0.003). MRI reporting of knee osteoarthritis was moderately correlated with Outerbridge grades in the medial compartment (SR 0.451, p < 0.001), mildly correlated for both the lateral (SR 0.299, p < 0.001) and patellofemoral joint compartments (SR 0.142, p = 0.054). KL and MRI grading was moderately correlated for the medial compartment (SR 0.475, p < 0.001) and mildly correlated for the lateral compartment (SR 0.277, p < 0.001). Conclusion The ability of radiographs to represent the actual condition of knee osteoarthritis is underestimated. KL grading especially best represents the disease seen in the medial compartment of the knee joint, with a moderate correlation to Outerbridge scores given on arthroscopic assessment. We suggest that whilst MRI is a useful tool in the investigation of knee symptoms, it is often unnecessarily used in patients with OA, when in fact, radiographs alone would be sufficient. Evidence level III

2020 ◽  
Vol 102-B (3) ◽  
pp. 301-309 ◽  
Author(s):  
Oisin J. F. Keenan ◽  
George Holland ◽  
Julian F. Maempel ◽  
John F. Keating ◽  
Chloe E. H. Scott

Aims Although knee osteoarthritis (OA) is diagnosed and monitored radiologically, actual full-thickness cartilage loss (FTCL) has rarely been correlated with radiological classification. This study aims to analyze which classification system correlates best with FTCL and to assess their reliability. Methods A prospective study of 300 consecutive patients undergoing unilateral total knee arthroplasty (TKA) for OA (mean age 69 years (44 to 91; standard deviation (SD) 9.5), 178 (59%) female). Two blinded examiners independently graded preoperative radiographs using five common systems: Kellgren-Lawrence (KL); International Knee Documentation Committee (IKDC); Fairbank; Brandt; and Ahlbäck. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Intraoperatively, anterior cruciate ligament (ACL) status and the presence of FTCL in 16 regions of interest were recorded. Radiological classification and FTCL were correlated using the Spearman correlation coefficient. Results Knees had a mean of 6.8 regions of FTCL (SD 3.1), most common medially. The commonest patterns of FTCL were medial ± patellofemoral (143/300, 48%) and tricompartmental (89/300, 30%). ACL status was associated with pattern of FTCL (p = 0.023). All radiological classification systems demonstrated moderate ICC, but this was highest for the IKDC: whole knee 0.68 (95% confidence interval (CI) 0.60 to 0.74); medial compartment 0.84 (95% CI 0.80 to 0.87); and lateral compartment 0.79 (95% CI 0.73 to 0.83). Correlation with actual FTCL was strongest for Ahlbäck (Spearman rho 0.27 to 0.39) and KL (0.30 to 0.33) systems, although all systems demonstrated medium correlation. The Ahlbäck score was the most discriminating in severe knee OA. Osteophyte presence in the medial compartment had high positive predictive value (PPV) for FTCL, but not in the lateral compartment. Conclusion The Ahlbäck and KL systems had the highest correlation with confirmed cartilage loss at TKA. However, the IKDC system displayed the best interobserver reliability, with favourable correlation with FTCL in medial and lateral compartments, although it was less discriminating in more severe disease. Cite this article: Bone Joint J 2020;102-B(3):301–309


2019 ◽  
Vol 6 (3) ◽  
pp. 181545 ◽  
Author(s):  
Rui Xu ◽  
Dong Ming ◽  
Ziyun Ding ◽  
Anthony M. J. Bull

Medial knee joint osteoarthritis (OA) is a debilitating and prevalent condition. Surgical treatment consists of redistributing the forces from the medial to the lateral compartment through osteotomy, or replacing the joint surfaces. As the mediolateral load distribution is related to the action of the musculature around the knee, the aim of this study was to devise a technique to redistribute these forces non-surgically through changes in muscle excitation. Eight healthy subjects participated in the experiment, and neuromuscular electrical stimulation was used to change the muscle forces around the knee. A musculoskeletal model was used to quantify the loading on the medial compartment of the knee, and a novel algorithm devised and implemented to simulate neuromuscular electrical stimulation. The forces and moments at the knee, ground reaction forces, walking velocity and step length were quantified before and after stimulation. Stimulation of the biceps femoris resulted in a significant decrease in the second peak of the medial knee joint loading by up to 0.17 body weight ( p = 0.016). Kinematic parameters were not significantly affected. Neuromuscular electrical stimulation can decrease the peak loads on the medial compartment of the knee, and thus offers a promising therapy for medial knee joint OA.


Author(s):  
Zahra Trad ◽  
Abdelwahed Barkaoui ◽  
Moez Chafra ◽  
João Manuel RS Tavares

Osteoarthritis is a globally common disease that imposes a considerable ongoing health and economic burden on the socioeconomic system. As more and more biomechanical factors have been explored, malalignment of the lower limb has been found to influence the load distribution across the articular surface of the knee joint substantially. In this work, a three-dimensional finite element analysis was carried out to investigate the effect of varying the high tibial osteotomy correction angle on the stress distribution in both compartments of the human knee joint. Thereafter, determine the optimal correction angle to achieve a balanced loading between these two compartments. The developed finite element model was validated against experimental and numerical results. The findings of this work suggest that by changing the correction angle from 0° to 10° valgus, high tibial osteotomy shifted the mechanical load from the affected medial compartment to the lateral compartment with intact cartilage. The Von Mises and the shear stresses decreased in the medial compartment and increased in the lateral compartment. Moreover, a balanced stress distribution between the two compartments as well as the desired alignment were achieved under a valgus hypercorrection of 4.5° that significantly unloads the medial compartment, loads the lateral compartment and arrests the progression of osteoarthritis. After comparing the achieved results against the ones of previous studies that explored the effects of the high tibial osteotomy correction angle on either clinical outcomes or biomechanical outcomes, one can conclude that the findings of this study agree well with the related clinical data and recommendations found in the literature.


2013 ◽  
Vol 6 (1) ◽  
Author(s):  
Pazit Levinger ◽  
Hylton B Menz ◽  
Adam D Morrow ◽  
John R Bartlett ◽  
Julian A Feller ◽  
...  

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 550
Author(s):  
Takashi Fukaya ◽  
Hirotaka Mutsuzaki ◽  
Toshiyuki Aoyama ◽  
Kunihiro Watanabe ◽  
Koichi Mori

Background and Objectives: Medial knee osteoarthritis is known to increase the mechanical load on the medial compartment of the knee joint during walking; however, it is not visually understood how much the mechanical load increases nor where in the medial compartment of the knee joint that load is focused. Therefore, we conducted a simulation study to determine the location and amount of the mechanical load in the medial compartment of the knee joint during the stance phase. Materials and Methods: Subject was a patient with right medial knee osteoarthritis. Computed tomography imaging and gait analysis were performed on subject. The CT image of the right knee was calculated using finite element analysis software. Since this software can set the flexion angle arbitrarily while maintaining the nonuniform material properties of the bone region, the model is constructed by matching the knee joint extension image obtained by CT to the loading response phase of gait analysis. The data of muscle exertion tension and vertical ground reaction force were inserted into the knee joint model created from the computed tomography-based finite element method, and the knee joint compressive stress was calculated. Results: With regard to compressive stress, the tibia showed high stress at 4.10 to 5.36 N/mm2. The femur showed high stress at 4.00 to 6.48 N/mm2. The joint compressive stress on the medial compartment of the knee joint was found to concentrate on the edge of the medial tibial condyle in the medial knee osteoarthritis subject. Conclusions: The measurement method of knee joint compressive stress by computed tomography-based finite element method can visually be a reliable method of measuring joint compressive stress in the medial knee osteoarthritis. This reflects the clinical findings because concentration of stress on the medial knee joint was observed at the medial osteophyte.


2008 ◽  
Vol 16 (5) ◽  
pp. 591-599 ◽  
Author(s):  
M.A. Hunt ◽  
T.B. Birmingham ◽  
D. Bryant ◽  
I. Jones ◽  
J.R. Giffin ◽  
...  

2018 ◽  
Vol 36 (9) ◽  
pp. 2373-2379 ◽  
Author(s):  
Jessica L. Asay ◽  
Jennifer C. Erhart-Hledik ◽  
Thomas P. Andriacchi

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