Two-year prospective longitudinal study exploring the factors associated with change in femoral cartilage volume in a cohort largely without knee radiographic osteoarthritis 1

Menzies Research Institute, University of Tasmania, Hobart, Australia.
Osteoarthritis and Cartilage (Impact Factor: 4.17). 04/2008; 16(4):443-9. DOI: 10.1016/j.joca.2007.08.009
Source: PubMed


To identify factors associated with change in femoral cartilage volume over 2 years in a cohort largely without knee radiographic osteoarthritis.
A total of 252 subjects (mean 45 years, range 28-60) were used for this study. T1-weighted fat saturation magnetic resonance imaging was performed at baseline and approximately 2 years later. Knee femoral condyle cartilage volume, femoral cartilage defect (0-4 scale) and tibial bone size were determined.
The total femoral cartilage volume loss was 6.3% for the 2.3-year period. Factors associated with this annual change were female gender (females vs males: -1.69%, P<0.01), age (over vs under 40 years: -0.96%, P=0.01), smoking (beta: -0.04% per pack-years, P<0.01), as well as lower limb muscle strength (r: +0.32, P<0.01) and its change (beta: +0.34% per quartile, P<0.05). Structural factors associated with change included baseline femoral cartilage volume (beta: -0.36% per ml, P<0.01), femoral cartilage defects (beta: +1.07% per grade, P<0.01), tibial bone area (beta: +0.13% per cm(2), P<0.05), lateral osteophytes (beta: -1.91% per grade, P<0.01) and change in femoral cartilage defects (beta: -0.8% per grade, P<0.001).
This study provides evidence confirming that significant risk factors are associated with femoral cartilage loss and these include gender (female), age, smoking, and severity of lower limb muscle weakness. It also supports the hypothesis that femoral cartilage swelling reflected by an increased baseline cartilage volume could be a predictor of disease progression. Our findings also provide interesting clues to implement preventive measures that can possibly prevent or reduce knee cartilage loss.

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    • "Muscle weakness, particularly quadriceps, is common in knee OA (Bennell et al., 2011b). Although longitudinal studies provide conflicting evidence for a relationship between strength and structural changes (Segal and Glass, 2011), recent studies using magnetic resonance imaging (MRI) cartilage measures suggest higher muscle strength may be protective of structural deterioration in early knee OA (Ding et al., 2008; Segal et al., 2010). Coordination of muscle activity is a determinant of knee loading. "
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    ABSTRACT: As knee osteoarthritis (OA) cannot be cured, treatments that slow structural disease progression are a priority. Knee muscle activation has a potential role in OA pathogenesis. Although enhanced knee muscle co-contraction augments joint stability; this may speed structural disease progression by increased joint load. This study investigated the relationship between cartilage loss and duration of co-contraction of medial/lateral knee muscles in medial knee OA. Prospective cohort study. Medial (vastus medialis; semimembranosus) and lateral (vastus lateralis; biceps femoris) knee muscle myoelectric activity was recorded in 50 people with medial knee OA during natural speed walking at baseline. Medial tibial cartilage volume was measured from MRI at baseline and 12 months. Relationships between percent volume loss and duration of co-contraction of medial/lateral muscles around stance phase and ratio of duration of medial to lateral muscle co-contraction were evaluated with multiple linear regression. Greater duration of medial muscle co-contraction and greater duration of medial relative to lateral co-contraction correlated positively with annual percent loss of medial tibial cartilage volume (P = 0.003). Estimated cartilage loss was 0.14 (95% confidence interval -0.23 to -0.05) greater for each increase in medial muscle co-contraction duration of 1% of the gait cycle. Lateral muscle co-contraction inversely correlated with cartilage loss. Data support the hypothesis that augmented medial knee muscle co-contraction underpins faster progression of medial knee OA. Increased duration of lateral muscle co-contraction protected against medial cartilage loss. Exercise and biomechanical interventions to change knee muscle activation patterns provide possible candidates to slow progression of knee OA. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Manual Therapy 07/2015; DOI:10.1016/j.math.2015.07.004 · 1.71 Impact Factor
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    • "All measurements in men, but only those of RLC and RMC in women decreased with age and BMI did not correlate with any of the measurements in either group. It is well established that age and female gender are strong risk factors for OA; therefore the absence of some of the correlations in females might possibly be attributed to femoral cartilage swelling that precedes cartilage erosions in early OA [28]. "
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    ABSTRACT: Background and objectives: Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population.The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS. Methods: This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25-40 years) were recruited within the collaboration of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects' knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle). Results: A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p< 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses. Conclusion: Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.
    Journal of Back and Musculoskeletal Rehabilitation 11/2013; 27(2). DOI:10.3233/BMR-130441 · 0.71 Impact Factor
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    • "Cartilage defects at baseline (visual scoring) appeared to be associated with longitudinal measurement of quantitative cartilage loss in the same compartment in OA subjects [137, 138], although the second of the two above studies [138] only found a significant relationship in the femoro-patellar but not in the femoro-tibial joint. Other studies reported that the presence of cartilage defects predicted knee cartilage loss also in asymptomatic individuals without radiographic knee OA [139, 140]. It was hypothesized that tibial subchondral bone area expansion may lead to the development of knee cartilage defects (which are associated with future cartilage loss) and is predictive of the need for knee joint replacement in subjects with knee OA, independent of radiographic change [141]. "
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    ABSTRACT: Quantitative measures of cartilage morphology (i.e., thickness) represent potentially powerful surrogate endpoints in osteoarthritis (OA). These can be used to identify risk factors of structural disease progression and can facilitate the clinical efficacy testing of structure modifying drugs in OA. This paper focuses on quantitative imaging of articular cartilage morphology in the knee, and will specifically deal with different cartilage morphology outcome variables and regions of interest, the relative performance and relationship between cartilage morphology measures, reference values for MRI-based knee cartilage morphometry, imaging protocols for measurement of cartilage morphology (including those used in the Osteoarthritis Initiative), sensitivity to change observed in knee OA, spatial patterns of cartilage loss as derived by subregional analysis, comparison of MRI changes with radiographic changes, risk factors of MRI-based cartilage loss in knee OA, the correlation of MRI-based cartilage loss with clinical outcomes, treatment response in knee OA, and future directions of the field.
    01/2011; 2011(2090-1984):475684. DOI:10.1155/2011/475684
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