Structure-symptom relationship with wide-area ultrasound scanning of knee osteoarthritis

Abstract

The aetiology of knee pain in osteoarthritis (OA) is heterogeneous and its relationship with structural changes and function is unclear. Our goal was to determine the prevalence of wide-area scanned ultrasound-defined knee OA structural features and their association with pain and functional impairment in 79 symptomatic and 63 asymptomatic subjects. All subjects underwent ultrasound knee wide-area scanning and the severity of articular cartilage degeneration, the presence and size of osteophytes, and meniscal extrusion were evaluated. Subjects filled in a self-administrated questionnaire on present knee pain, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) on clinical symptoms and function over the past week. Cartilage changes were the most prevalent followed by lateral meniscal extrusion, osteophytes and medial meniscal extrusion. The global femoral cartilage grade associated strongly with pain and the WOMAC index. Site-specifically, early medial cartilage changes and thinning in sulcus and lateral site were associated with symptoms. The presence of femoral lateral osteophytes was also associated with both outcomes. Using the novel wide-area ultrasound scanning technique, we were able to confirm the negative impact of femoral cartilage OA changes on clinical symptoms. Presence, not necessarily size, of lateral femoral osteophytes was also associated with increased pain and disability.

Evaluation of clinical symptoms and sonographic characteristics of femoral trochlear cartilage in primary knee osteoarthritis

“…In this study, there was a relationship between meniscal extrusion and WOMAC indices, which was also reported in a study by Malas et al (20). However, in a study by Podlipska, there was no significant relationship with the cartilage grade after adjustments; therefore, this finding was only considered as a concomitant presentation (21). In the current study, after adjusting for the cartilage grade, there was a significant relationship with all WOMAC indices, indicating their independent role in the development of clinical symptoms.…”

“…This lack of relationship has been also noted in some of previous studies (20). However, in some other studies, examination of this relationship was considered unnecessary due to varying degrees of cartilage thickness in different individuals (21). However, this finding can be attributed to the type of patient selection (all of whom had OA with some degree of cartilage damage) and differences in measurements.…”

“…Moreover, there was no reference or evidence (such as MRI or arthroscopy findings) to confirm the ultrasonographic findings in our study. Furthermore, various factors can contribute to the clinical symptoms of patients including osteophytes, erosion, alignment, and even psychological issues (3,21), which were not considered in the present study. In fact, lack of cartilage grade changes in 7.4% of patients, despite having symptoms, can indicate the role of other factors in the clinical symptoms of patients.…”

Femoral Cartilage Ultrasound Echo Intensity Associates with Arthroscopic Cartilage Damage

“…In addition to measuring cartilage size, an assessment of the cartilage ultrasound echo intensity ( i.e., brightness of the image) quantifies the integrity of the superficial cartilage collagen matrix ( Kuroki et al 2008 ). While cartilage breakdown appears on ultrasound as a loss of a sharp contour and alterations in the cartilage echo intensity ( Möller et al 2008 ), previous qualitative assessments indicate that it may lead to either a decrease or an increase of the ultrasound echo intensity ( Finucci et al 2015 ; Podlipská et al 2017 ). This highlights the need for assessments that directly quantify the magnitude and heterogeneity of the cartilage echo intensity.…”

“…We hypothesized that thinner ultrasound-assessed cartilage would be associated with arthroscopic femoral cartilage damage because the presence of cartilage defects may be detected as cartilage thinning. Since there is qualitative evidence that a decline in cartilage health may result in lesser or greater cartilage echo intensity ( Möller et al 2008 ; Finucci et al 2015 ; Podlipská et al 2017 ), we hypothesized that altered quantitative ultrasound metrics of echo-intensity mean and heterogeneity would be associated with arthroscopic femoral cartilage damage. This study would provide preliminary evidence of which non-invasive quantitative cartilage ultrasound metrics may detect a decline in cartilage health.…”