Do Cartilage Repair Procedures Prevent Degenerative Meniscus Changes?: Longitudinal T1 and Morphological Evaluation With 3.0-T MRI

Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California.
The American Journal of Sports Medicine (Impact Factor: 4.36). 10/2012; 40(12). DOI: 10.1177/0363546512461594
Source: PubMed


BACKGROUND:Cartilage repair (CR) procedures are widely accepted for treatment of isolated cartilage defects in the knee joint. However, it is not well known whether these procedures prevent degenerative joint disease. HYPOTHESIS:Cartilage repair procedures prevent accelerated qualitative and quantitative progression of meniscus degeneration in individuals with focal cartilage defects. STUDY DESIGN:Cohort study; Level of evidence, 2. METHODS:Ninety-four subjects were studied. Cartilage repair procedures were performed on 34 patients (osteochondral transplantation, n = 16; microfracture, n = 18); 34 controls were matched. An additional 13 patients received CR and anterior cruciate ligament (ACL) reconstruction (CR&ACL), and 13 patients received only ACL reconstruction. Magnetic resonance imaging at 3.0-tesla with T(1ρ) mapping and sagittal fat-saturated intermediate-weighted fast spin echo (FSE) sequences was performed to quantitatively and qualitatively analyze menisci (Whole-Organ Magnetic Resonance Imaging Score [WORMS] assessment). Patients in the CR and CR&ACL groups were examined 4 months (n = 34; n = 13), 1 year (n = 21; n = 8), and 2 years (n = 9; n = 5) after CR. Control subjects were scanned at baseline and after 1 and 2 years, ACL patients after 1 and 2 years. RESULTS:At baseline, global meniscus T(1ρ) values (mean ± SEM) were higher in individuals with CR (14.2 ± 0.5 ms; P = .004) and in individuals with CR&ACL (17.1 ± 0.9 ms; P < .001) when compared with controls (12.8 ± 0.6 ms). After 2 years, there was a statistical difference between T(1ρ) at the overlying meniscus above cartilage defects (16.4 ± 1.0 ms) and T(1ρ) of the subgroup of control knees without cartilage defects (12.1 ± 0.8 ms; P < .001) and a statistical trend to the CR group (13.3 ± 1.0 ms; P = .09). At baseline, 35% of subjects with CR showed morphological meniscus tears at the overlying meniscus; 10% of CR subjects showed an increase in the WORMS meniscus score within the first year, and none progressed in the second year. Control subjects with (without) cartilage defects showed meniscus tears in 30% (5%) at baseline; 38% (19%) increased within the first year, and 15% (10%) within the second year. CONCLUSION:This study demonstrated more severe meniscus degeneration after CR surgery compared with controls. However, progression of T(1ρ) values was not observed from 1 to 2 years after surgery. These results suggest that CR may prevent degenerative meniscus changes.

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Available from: Karupppasamy Subburaj, Oct 06, 2015
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    • "First efforts have been made to apply T1rho relaxation times for assessment of cartilage repair tissue [139, 140, 172]. A differentiation between different tissue types after cartilage repair procedures was possible by applying T1rho mapping, in particular, in combination with T2 mapping [139]. "
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    ABSTRACT: Background. New quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as outcome measures after cartilage repair. Objective. To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. Methods. Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. Results. Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), and diffusion weighted imaging (DWI) are applicable on most clinical 1.5 T and 3 T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. Conclusions. A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair.
    BioMed Research International 05/2014; 2014:840170. DOI:10.1155/2014/840170 · 3.17 Impact Factor
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    ABSTRACT: To review recent original research publications related to imaging of osteoarthritis and identify emerging trends and significant advances. Relevant articles were identified through a search of the PubMed database using the query terms "osteoarthritis" in combination with "imaging", "radiography", "MRI", "ultrasound", "computed tomography",and "nuclear medicine"; either published or in press between March 2012 and March 2013. Abstracts were reviewed to exclude review articles, case reports, and studies not focused on imaging using routine clinical imaging measures. Initial query yielded 932 references, which were reduced to 328 citations following the initial review. MRI (118 references) and radiography (129 refs) remain the primary imaging modalities in OA studies, with fewer reports using CT (35 refs) and ultrasound (23 refs). MRI parametric mapping techniques remain an active research area (33 refs) with growth in T2*- and T1rho mapping publications compared to prior years. Although the knee is the major joint studied (210 refs) there is interest in the hip (106 refs) and hand (29 refs). Imaging continues to focus on evaluation of cartilage (173 refs) and bone (119 refs). Imaging plays a major role in osteoarthritis research with publications continuing along traditional lines of investigation. Translational and clinical research application of compositional MRI techniques is becoming more common driven in part by the availability of T2 mapping data from the OAI. New imaging techniques continue to be developed with a goal of identifying methods with greater specificity and responsiveness to changes in the joint, and novel functional neuroimaging techniques to study central pain. Publications related to imaging of OA continue to be heavily focused on quantitative and semiquantitative MRI evaluation of the knee with increasing applicationof compositional MRI techniques in the hip.
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    ABSTRACT: Purpose The purpose of this study was to assess the clinical and radiographic outcomes after revision meniscal allograft transplantation (RMAT). Methods Eleven patients underwent RMAT performed by the senior author (B.J.C.). These patients were studied prospectively and completed standardized outcome surveys (including International Knee Documentation Committee [IKDC], Cincinnati Knee-Rating System, Tegner score, Lysholm score, Short Form-12, Knee Injury and Osteoarthritis Outcome Score [KOOS], and overall satisfaction) preoperatively and annually thereafter for a minimum of 2 years. Radiographic analysis before surgery and at the most recent follow-up included anteroposterior, Rosenberg, lateral, and sunrise views graded by the Kellgren and Lawrence (K & L) scale. The status of the articular cartilage was graded intraoperatively using the Outerbridge classification. Two patients were lost to follow-up and one declined further participation. Results The average time to RMAT from the index procedure was 3.45 ± 2.52 years, with a mean follow-up after RMAT of 3.83 ± 1.3 years. One patient progressed to arthroplasty during follow-up and was not included in subjective outcome score follow-up. Clinical outcome scores that demonstrated significant improvements included IKDC (43 ± 12 to 61 ± 16; P = .03) and KOOS pain score (66 ± 12 to 79 ± 11; P = .047). Along with this, the subjective symptom rate significantly improved from 5.0 ± 0.9 preoperatively to 6.7 ± 1.8 postoperatively (P = .011). Radiographic (P = .7) and Outerbridge (P = .809) grading did not show progression. Seven of 8 patients would have surgery again, and satisfaction at final follow-up was 7.6 ± 2.6. Conclusions In this small series with short-term follow-up, RMAT resulted in high patient satisfaction and significant symptom reduction on validated outcome scores (IKDC and KOOS pain score), proving the original hypothesis that outcomes after RMAT would be improved compared with preoperative conditions. Identifiable causes of MAT failure may help predict response to RMAT. Because arthroplasty is still not favored in young active patients, a thorough discussion with the patient is necessary to best align their goals with those of the surgery when considering revision meniscus transplantation. Level of Evidence Level IV, therapeutic case series.
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