Quantitative MR imaging evaluation of chondropathy in osteoarthritic knees.

208

Objective. To evaluate the rate of progression of cartilage loss in the knee joint using magnetic resonance imaging (MRI) and to evaluate potential risk factors for more rapid cartilage loss.Methods. We evaluated baseline and followup MRIs of the knees in 43 patients (minimum time interval of 1 year, mean 1.8 years, range 52-285 weeks). Cartilage loss was graded in the anterior, central, and posterior regions of the medial and lateral knee compartments. Knee joints were also evaluated for other pathology. Data were analyzed using analysis of variance models.Results. Patients who had sustained meniscal tears showed a higher average rate of progression of cartilage loss (22%) than that seen in those who had intact menisci (14.9%) (P < 0.018). Anterior cruciate ligament (ACL) tears had a borderline significant influence (P < 0.06) on the progression of cartilage pathology. Lesions located in the central region of the medial compartment were more likely to progress to more advanced cartilage pathology (progression rate 28%; P < 0.003) than lesions in the anterior (19%; P < 0.564) and posterior (17%; P < 0.957) regions or lesions located in the lateral compartment (average progression rate 15%; P < 0.707). Lesions located in the anterior region of the lateral compartment showed less progression of cartilage degradation (6%; P < 0.001). No specific grade of lesion identified at baseline had a predilection for more rapid cartilage loss (P < 0.93).Conclusion. MRI can detect interval cartilage loss in patients over a short period (<2 years). The presence of meniscal and ACL tears was associated with more rapid cartilage loss. Cartilage lesions located in the central region of the medial compartment showed more rapid progression of cartilage loss than cartilage lesions in the anterior and posterior portions of the medial compartment. The findings in this study suggest that patients entering clinical trials investigating antiarthritis regimens may need to be randomized based on location of the lesion.

Section: Discussionmentioning

confidence: 99%

Risk factors for progressive cartilage loss in the knee

Biswal¹,

Hastie²,

Andriacchi³

et al. 2002

208

“…The cartilage defects were graded on the MR images with a modification of a previous classification system (10)(11)(12) at medial tibial, medial femoral, lateral tibial, and lateral femoral sites as follows: grade 0 ϭ normal cartilage; grade 1 ϭ focal blistering and intracartilaginous low-signal intensity area with an intact surface and bottom; grade 2 ϭ irregularities on the surface or bottom and loss of thickness of Ͻ50%; grade 3 ϭ deep ulceration with loss of thickness of Ͼ50%; grade 4 ϭ full-thickness cartilage wear with exposure of subchondral bone ( Figure 1). We found that the cartilage surface in some images was still regular but that cartilage adjacent to subchondral bone became irregular, so we included this in the classification system.…”

Section: Methodsmentioning

confidence: 99%

Association of cartilage defects with loss of knee cartilage in healthy, middle‐age adults: A prospective study

Cicuttini¹,

Ding²,

Wluka³

et al. 2005

239

203

Objective. The significance of asymptomatic knee cartilage defects in healthy individuals is not known. The aim of this study was to examine the association between cartilage defects in the knee and cartilage volume both cross-sectionally and longitudinally in healthy, middle-age adults.Methods. Eighty-six healthy men and women (mean ؎ SD age 53.8 ؎ 8.8 years) underwent T1-weighted fat-suppressed magnetic resonance imaging of their dominant knees at baseline and at the 2-year followup visit. Knee cartilage volume was measured. Cartilage defects were scored according to a grading system (0-4) and as present (a defect score of >2) or absent in the medial and lateral tibiofemoral compartments.Results. Cartilage defects in the medial and lateral tibiofemoral compartments were very common (in 61% and 43% of subjects, respectively). Those with cartilage defects had a 25% reduction in medial tibial cartilage volume, a 15% reduction in lateral tibial cartilage volume, and a 19% reduction in total femoral cartilage volume relative to those with no cartilage defects in cross-sectional analyses (all P < 0.05). In the medial tibiofemoral compartment, the annual loss of tibial cartilage in those with cartilage defects was 2.5% (95% confidence interval [95% CI] 2.2%, 3.1%) compared with an annual loss of tibial cartilage of 1.3% (95% CI 0.5%, 2.0%) in those with no defects (P ‫؍‬ 0.028), independent of other known risk factors for osteoarthritis (OA).Conclusion. These data suggest that the presence of asymptomatic, non-full-thickness medial tibiofemoral cartilage defects identifies healthy individuals most likely to lose knee cartilage in the absence of radiographic knee OA. Thus, interventions aimed at reducing or reversing cartilage defects may reduce the risk of subsequent knee OA.

“…Medication regimens and any changes in them were closely monitored and recorded. The use of indomethacin was not permitted because of its potential to promote degeneration of OA cartilage (13,(51)(52)(53). Likewise, the use of glucosamine sulfate was not permitted because of its potential to affect OA progression (54).…”

Section: Methodsmentioning

confidence: 99%

“…The validity of measurements of JSW in knee OA has been demonstrated by correlations between the medial tibiofemoral JSW and the sum of the thickness of both the femoral and the tibial articular cartilage (11). The use of arthroscopy to assess cartilage appears to be reliable and sensitive to change at 1 year (12,13). However, only the cartilage surface can be evaluated, and the method is both semiquantitative and, most importantly, invasive, which is problematic for multicenter studies.…”

mentioning

confidence: 99%

Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over two years and correlation with clinical symptoms and radiologic changes

Raynauld¹,

Martel‐Pelletier²,

Berthiaume³

et al. 2004

239

Objective. To evaluate the change in osteoarthritic (OA) knee cartilage volume over a two-year period with the use of magnetic resonance imaging (MRI) and to correlate the MRI changes with radiologic changes.Methods. Thirty-two patients with symptomatic knee OA underwent MRI of the knee at baseline and at 6, 12, 18, and 24 months. Loss of cartilage volumes were computed and contrasted with changes in clinical variables for OA and with standardized semiflexed knee radiographs at baseline at 1 and 2 years.Results. Progression of cartilage loss at all followup points was statistically significant (P < 0.0001), with a mean ؎ SD of 3.8 ؎ 5.1% for global cartilage loss and 4.3 ؎ 6.5% for medial compartment cartilage loss at 6 months, 3.6 ؎ 5.1% and 4.2 ؎ 7.5% at 12 months, and 6.1 ؎ 7.2% and 7.6 ؎ 8.6% at 24 months. Discriminant function analysis identified 2 groups of patients, those who progressed slowly (<2% of global cartilage loss; n ‫؍‬ 21) and those who progressed rapidly (>15% of global cartilage loss; n ‫؍‬ 11) over the 2 years of study. At baseline, there was a greater proportion of women (P ‫؍‬ 0.001), a lower range of motion (P ‫؍‬ 0.01), a greater circumference and higher level of pain (P ‫؍‬ 0.05) and stiffness in the study knee, and a higher body mass index in the fast progressor group compared with the slow progressor group. No statistical correlation between loss of cartilage volume and radiographic changes was seen.Conclusion. Quantitative MRI can measure the progression of knee OA precisely and can help to identify patients with rapidly progressing disease. These findings indicate that MRI could be helpful in assessing the effects of treatment with structure-modifying agents in OA.In people over the age of 60 years, osteoarthritis (OA) is a common cause of disability. Assessment of cartilage damage is important for monitoring disease progression and evaluating therapeutic response in OA. For many years, clinical studies of drug interventions in symptomatic knee OA have focused specifically on clinical parameters, such as pain and joint function, without assessing the effect of treatment on structural changes caused by the disease or the role of treatment in preventing cartilage degradation. Serial radiographs of affected joints appear to be a logical means of documenting the progression of OA over time (1), provided that a validated, reliable, and easily reproducible technique is used (2-5).