Imaging following acute knee trauma

Abstract

Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.

Towards prevention of post-traumatic osteoarthritis: report from an international expert working group on considerations for the design and conduct of interventional studies following acute knee injury

“…Imaging-based change following knee injury reflects the initial trauma but also the responses to subsequent changed dynamic knee loading after destabilizing injuries 28 . The majority of studies include X-ray and MRI cartilage outcomes, both semi-quantitative and quantitative.…”

Bone marrow edema-like lesions (BMELs) are associated with higher T1ρ and T2 values of cartilage in anterior cruciate ligament (ACL)-reconstructed knees: a longitudinal study

“…Although BMEL can be seen in other musculoskeletal disorders, it is very common in ACL injury with a prevalence of 55-98% (7,12,16,38). The specific prevalence of BMEL depends on the time between injury and BMEL, cohorts and MR machine (low field vs. high field).…”

“…In patients with knee OA, enlargement of BMELs during follow-up was associated with development of knee pain (14). Unlike BMELs in OA, post-traumatic BMELs are more likely to resolve fast (15) with a median time interval ranging between 4 months and 8 months after acute knee trauma (16).…”

Mechanically Activated Microcapsules for “On‐Demand” Drug Delivery in Dynamically Loaded Musculoskeletal Tissues

“…Musculoskeletal tissues within the body experience mechanical stimulation across multiple force magnitudes and length scales [15] . These forces not only maintain tissue integrity (through modulation of cellular activity), but can also, at supraphysiologic levels, initiate degenerative processes that require surgical intervention to restore load-bearing function [16,17] . In articular cartilage for instance, which functions to bear and distribute loads in joints, traumatic lesions on the articular surface show very little endogenous healing, and ultimately increase in size and lead to further degenerative processes in the joint causing pain and disability [18] .…”