Delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) Shows No Change in Cartilage Structural Composition after Viscosupplementation in Patients with Early-Stage Knee Osteoarthritis

Abstract

IntroductionViscosupplementation with hyaluronic acid (HA) of osteoarthritic (OA) knee joints has a well-established positive effect on clinical symptoms. This effect, however, is only temporary and the working mechanism of HA injections is not clear. It was suggested that HA might have disease modifying properties because of its beneficial effect on cartilage sulphated glycosaminoglycan (sGAG) content. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) is a highly reproducible, non-invasive surrogate measure for sGAG content and hence composition of cartilage. The aim of this study was to assess whether improvement in cartilage structural composition is detected using dGEMRIC 14 weeks after 3 weekly injections with HA in patients with early-stage knee OA.MethodsIn 20 early-stage knee OA patients (KLG I-II), 3D dGEMRIC at 3T was acquired before and 14 weeks after 3 weekly injections with HA. To evaluate patient symptoms, the knee injury and osteoarthritis outcome score (KOOS) and a numeric rating scale (NRS) for pain were recorded. To evaluate cartilage composition, six cartilage regions in the knee were analyzed on dGEMRIC. Outcomes of dGEMRIC, KOOS and NRS before and after HA were compared using paired t-testing. Since we performed multiple t-tests, we applied a Bonferroni-Holm correction to determine statistical significance for these analyses.ResultsAll KOOS subscales (‘pain’, ‘symptoms’, ‘daily activities’, ‘sports’ and ’quality of life’) and the NRS pain improved significantly 14 weeks after Viscosupplementation with HA. Outcomes of dGEMRIC did not change significantly after HA compared to baseline in any of the cartilage regions analyzed in the knee.ConclusionsOur results confirm previous findings reported in the literature, showing persisting improvement in symptomatic outcome measures in early-stage knee OA patients 14 weeks after Viscosupplementation. Outcomes of dGEMRIC, however, did not change after Viscosupplementation, indicating no change in cartilage structural composition as an explanation for the improvement of clinical symptoms.

AMSSM scientific statement concerning viscosupplementation injections for knee osteoarthritis: importance for individual patient outcomes

“…HA-mediated chondroprotection has been demonstrated in animal, in vitro and clinical studies,56 including a recent article57 that found a decreased rate of medial and lateral tibial articular cartilage degeneration following HA injections through the use of a state-of-the-art, MRI-based assessment of cartilage integrity. Other studies of the structural impact of HA injections of similar design have, however, failed to demonstrate structural benefit to cartilage from one series of injections 58. Thus, for patients with knee OA, HA injections may offer benefits that extend beyond the issues of the statistical significance and clinical relevance of the symptomatic results that they eventuate.…”

Compositional MRI techniques for evaluation of cartilage degeneration in osteoarthritis

“…In a study of 111 obese adults, dGEMRIC showed that weight loss over the course of a year resulted in increased cartilage proteoglycan content 106 . A recently published study evaluated articular cartilage using dGEMRIC after viscosupplementation with hyaluronic acid in patients with early knee OA 107 . The study found no change in the structural composition of cartilage after 14 weeks, even though symptomatic improvement was reported.…”

High-field MRI exploration of the structural effects of cellular matrix™ on articular cartilage in knee osteoarthritis: A pilot study in 6 patients

“…Van Tiel described and used a promising reproducible methodology based on this technique to explore the potentially structural effect of HA in early stage knee OA, unsuccessfully [40].…”