Cartilage Quality (dGEMRIC Index) Following Knee Joint Distraction or High Tibial Osteotomy

Abstract

Objective High tibial osteotomy (HTO) and knee joint distraction (KJD) are treatments to unload the osteoarthritic (OA) joint with proven success in postponing a total knee arthroplasty (TKA). While both treatments demonstrate joint repair, there is limited information about the quality of the regenerated tissue. Therefore, the change in quality of the repaired cartilaginous tissue after KJD and HTO was studied using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). Design Forty patients (20 KJD and 20 HTO), treated for medial tibiofemoral OA, were included in this study. Radiographic outcomes, clinical characteristics, and cartilage quality were evaluated at baseline, and at 1- and 2-year follow-up. Results Two years after KJD treatment, clear clinical improvement was observed. Moreover, a statistically significant increased medial (Δ 0.99 mm), minimal (Δ 1.04 mm), and mean (Δ 0.68 mm) radiographic joint space width (JSW) was demonstrated. Likewise, medial (Δ 1.03 mm), minimal (Δ 0.72 mm), and mean (Δ 0.46 mm) JSW were statistically significantly increased on radiographs after HTO. There was on average no statistically significant change in dGEMRIC indices over two years and no difference between treatments. Yet there seemed to be a clinically relevant, positive relation between increase in cartilage quality and patients' experienced clinical benefit. Conclusions Treatment of knee OA by either HTO or KJD leads to clinical benefit, and an increase in cartilage thickness on weightbearing radiographs for over 2 years posttreatment. This cartilaginous tissue was on average not different from baseline, as determined by dGEMRIC, whereas changes in quality at the individual level correlated with clinical benefit.

Humeral head histopathological changes in cuff tear arthropathy

“…19 In patients treated with high tibial osteotomy Journal of Orthopaedic Surgery 27(1) (HTO) or knee joint distraction, median joint cartilage width was increased on radiographs due to median decompression. 20 As the process continues, the subchondral blood vessels enter the calcified zone and progress toward the joint's surface, which is consistent with our data, showing that the duplication of the tidemark and ossification in the deep layer of the cartilage appeared in the CTA group.…”

“…19 In patients treated with high tibial osteotomy (HTO) or knee joint distraction, median joint cartilage width was increased on radiographs due to median decompression. 20…”

Knee Joint Distraction Compared with High Tibial Osteotomy and Total Knee Arthroplasty: Two-Year Clinical, Radiographic, and Biochemical Marker Outcomes of Two Randomized Controlled Trials

“… 24 Moreover, beneficial changes regarding proteoglycan content in these canine studies is supported by recent dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) evaluation in clinical KJD studies. 25 …”

Enhanced Extracellular Matrix Breakdown Characterizes the Early Distraction Phase of Canine Knee Joint Distraction

“…The strongest tissue repair is observed at 1 and 2 years after distraction by radiographic and magnetic resonance imaging evaluation (both quantitative and qualitative, such as dGEMRIC and T2 relaxation), the latter demonstrating the presence of hyaline cartilage. 11,12,15 In addition, increased serum levels of the collagen type II synthesis marker, PIIANP (N-propeptide of collagen IIA), and decreased levels of the collagen type II breakdown marker, CTXII (C-Telopeptide of type II collagen), at 1 and 2 years post distraction treatment, show an increased ratio of synthesis over breakdown in this period. 11,16 After this period, the degenerative, progressive nature of OA takes over again, and this results in a gradual waning of the effect.…”