Loaded versus unloaded magnetic resonance imaging (MRI) of the knee: Effect on meniscus extrusion in healthy volunteers and patients with osteoarthritis

Patel, Rina; Eltgroth, Matthew; Souza, Richard B.; Zhang, Chiyuan A.; Majumdar, Sharmila; Link, Thomas M.; Motamedi, Daria

doi:10.1016/j.ejro.2016.05.002

Cited by 59 publications

(61 citation statements)

References 14 publications

(23 reference statements)

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“…The values of w M and w L were measured with respect to the tibia, in order to show the relative motion between the meniscus and the bone. Thus, the external shifts were equivalent to the differences in the meniscus extrusions between the loadings and the unloadings that have been previously measured in other papers [ 15 , 40 ]. The relative displacement u between the femur and the tibia was measured in a medio-lateral direction on the mechanical axis in the centre of the knee joint.…”

Section: Methodsmentioning

confidence: 54%

“…A comparison of the values of the external shifts, between the models with free and constrained medio-lateral relative bone motion, allowed for a conclusion that the medio-lateral knee joint translation could be treated as an overriding risk factor for a meniscal extrusion process (see Fig 7 ). Patel et al investigated the impact of a knee joint loading on a meniscal extrusion in normal individuals [ 15 ]. They found in MRI study that only the medial meniscus extrusions were significantly increased during the loading.…”

Section: Discussionmentioning

confidence: 99%

“…However, a degenerative meniscal extrusion is very often connected with a change in its shape, without a disruption of the meniscus [ 13 , 14 ]. It remains unclear why menisci, without any lesions, alter their position and how a change in their shape influences this process [ 10 , 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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The influence of a change in the meniscus cross-sectional shape on the medio-lateral translation of the knee joint and meniscal extrusion

et al. 2018

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ObjectiveThe purpose of this study was to evaluate the influence of a change in the meniscus cross sectional shape on its position and on the biomechanics of a knee joint.MethodsOne main finite element model of a left knee joint was created on the basis of MRI images. The model consisted of bones, articular cartilages, menisci and ligaments. Eight variants of this model with an increased or decreased meniscus height were then prepared. Nonlinear static analyses with a fixed flexion/extension movement for a compressive load of 1000 N were performed. The additional analyses for those models with a constrained medio-lateral relative bone translation allowed for an evaluation of the influence of this translation on a meniscus external shift.ResultsIt was observed that a decrease in the meniscus height caused a decrease in the contact area, together with a decrease in the contact force between the flattened meniscus and the cartilage. For the models with an increased meniscus height, a maximal value of force acting on the meniscus in a medio-lateral direction was obtained. The results have shown that the meniscus external shift was approximately proportional to the meniscus slope angle, but that relationship was modified by a medio-lateral relative bone translation. It was found that the translation of the femur relative to the tibia may be dependent on the geometry of the menisci.ConclusionsThe results have suggested that a change in the meniscus geometry in the cross sectional plane can considerably affect not only the meniscal external shift, but also the medio-lateral translation of the knee joint as well as the congruency of the knee joint.

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Section: Methodsmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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The influence of a change in the meniscus cross-sectional shape on the medio-lateral translation of the knee joint and meniscal extrusion

et al. 2018

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“…1,8,15,42 However, few studies have dynamically investigated ME with the use of MRI. 8,9,42,48 These investigations, however, have shown some limitations regarding the reproducibility of knee positioning and consistent load application. In the present study, a newly designed nonferromagnetic pneumatic knee brace was used for standard leg positioning and load application during MRI.…”

Section: Discussionmentioning

confidence: 99%

“…Using the coronal slice in which the femoral attachment of the popliteal tendon was best visible, lateral ME was measured as the horizontal distance between the most external margin of the tibial plateau articular cartilage and the peripheral border of the lateral meniscus ( Figure 2). 11,42 The subchondral tibial plateau width (TW) was measured in the same layer and defined as the subchondral distance between the medial and lateral cartilage-bone transition. Using these values, the meniscus body extrusion ratio (MBER), which relates ME to the knee size, 52 was calculated as ME/TW and expressed as a percentage.…”

Section: Imaging Analysesmentioning

confidence: 99%

Quantitative Evaluation of Dynamic Lateral Meniscal Extrusion After Radial Tear Repair

Winkler

Wierer

Csapo

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Radial tears of the lateral meniscus frequently accompany acute anterior cruciate ligament (ACL) injuries and lead to increased joint stress and pathological meniscal extrusion (ME). The dynamic behavior of the lateral meniscus after radial tear repair with respect to ME has not been described. Purpose: To quantitatively assess dynamic lateral ME after all-inside radial tear repair. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ACL reconstruction and all-inside radial tear repair of the lateral meniscus and had no history of contralateral knee injuries were included. Magnetic resonance imaging scans were acquired in loaded (50% of body weight) and unloaded conditions of both the injured and noninjured knees. A custom-made pneumatically driven knee brace was used for standardized knee positioning in 10° of flexion and with axial load application. Quantitative measures included the absolute lateral ME, meniscal body extrusion ratio, and Δ extrusion. Preoperative and postoperative unloaded extrusion data were compared by paired t tests. For postoperative data, the concomitant influence of the factors “leg” and “condition” were assessed through factorial analyses of variance. Results: A total of 10 patients with a mean follow-up of 47.9 months were enrolled. The intraclass correlation coefficient (ICC) confirmed good interrater reliability (ICC, 0.898) and excellent intrarater reliability (ICC, 0.976). In the unloaded injured leg, all-inside repair reduced ME from 3.15 ± 1.07 mm to 2.13 ± 0.61 mm (–32.4%; P = .033). Overall, load application led to a significant increase in ME (+0.34 mm [+21.8%]; P = .029). Significantly greater ME was observed in the injured knee (+1.10 mm [+93.2%]; P = .001) than in the noninjured knee. The condition × leg interaction was not significant ( P = .795), suggesting that the compression-associated increase in ME did not differ significantly between the injured and noninjured knees. Conclusion: Lateral ME depends on the knee status and loading condition. All-inside repair of radial meniscal tears led to a reduction of extrusion with no alteration in dynamic lateral ME. Meniscus-preserving therapy is recommended in the case of a radial lateral meniscal tear to preserve its dynamic behavior.

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Diagnostic accuracy of a novel ultrasound imaging index for knee osteoarthritis: Evaluation of sensitivity, specificity, and predictive values

Kiso,

Okada,

Kawata

et al. 2024

J of Clinical Ultrasound

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PurposeWe aimed to develop and validate a new ultrasonography (US) index for the diagnosis of primary medial‐type knee osteoarthritis (OA).MethodsIn total, 156 patients (203 limbs) underwent standing knee radiography and the US for suspected knee OA. Total osteophyte height (TOH) and distance between bones (DBB) aided diagnosis. Logistic regression identified optimal cutoff values. Thresholds from logistic regression informed recipient operating characteristic curve (ROC) analysis, balancing sensitivity and specificity. These thresholds were then applied in the differential thermal analysis (DTA) to construct a 2 × 2 table.ResultsThe TOH‐DBB index showed that a DBB of 5.6 mm or less was required to diagnose primary medial‐type knee arthropathy. The results in the 2 × 2 table were 41 true‐positive (TP), 10 false negative (FN), 22 true‐negative (TN), and 7 false positive (FP). A DBB of 5.6 mm or less and TOH of 4.7 mm or more were necessary to diagnose severe deformity. The results in the 2 × 2 table were 10 TP, 4 FN, 23 TN, and 4 FP.ConclusionThe TOH‐DBB index was confirmed to capture changes in primary medial‐type knee OA across various stages.

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Loaded versus unloaded magnetic resonance imaging (MRI) of the knee: Effect on meniscus extrusion in healthy volunteers and patients with osteoarthritis

Abstract: HighlightsIncreased extrusion of the medial meniscus with loaded MRI compared to unloaded.No change in lateral meniscus extrusion between loaded and unloaded MRI.Increased extrusion of the medial meniscus with loaded MRI in those with tears.

Cited by 59 publications

References 14 publications

The influence of a change in the meniscus cross-sectional shape on the medio-lateral translation of the knee joint and meniscal extrusion

The influence of a change in the meniscus cross-sectional shape on the medio-lateral translation of the knee joint and meniscal extrusion

Quantitative Evaluation of Dynamic Lateral Meniscal Extrusion After Radial Tear Repair

Diagnostic accuracy of a novel ultrasound imaging index for knee osteoarthritis: Evaluation of sensitivity, specificity, and predictive values

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