| 1. |
- Brown, Jamie S., et al.
(författare)
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Clinical, patient-reported, radiographic and magnetic resonance imaging findings 11 years after acute posterior cruciate ligament injury treated non-surgically
- 2023
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Ingår i: BMC Musculoskeletal Disorders. - 1471-2474. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Long-term consequences of posterior cruciate ligament (PCL) injury such as persistent posterior tibial translation and risk of osteoarthritis development are unclear. Additionally, little data is available describing the natural history of structural morphology of the ruptured PCL. The purpose of the study was to determine the long-term outcome after non-operatively treated PCL injury. Methods: Over 6-years, all acute knee injuries were documented by subacute MRI (median 8 days [5–15, 25th − 75th percentile] from injury to MRI). Twenty-six patients with acute PCL injury were identified of whom 18 (69%) participated in the long-term follow-up after 11 years. Follow-up included radiographic posterior tibial translation (RPTT) determined using the Puddu axial radiograph. weight-bearing knee radiographs, MRI and KOOS (Knee injury and Osteoarthritis Outcome Score). Results: On subacute MRI, 11 knees displayed total and 7 partial ruptures. At 11 (SD 1.9) years, the median RPTT was 3.7 mm (1.5–6.3, 25th − 75th percentile). Seven knees displayed radiographic osteoarthritis approximating Kellgren-Lawrence grade ≥ 2. All follow-up MRIs displayed continuity of the PCL. Patients with more severe RPTT (> 3.7 mm), had worse scores in the KOOS subscales for symptoms (mean difference 14.5, 95% CI 7–22), sport/recreation (30, 95% CI 0–65) and quality of life (25, 95% CI 13–57) than those with less severe RPTT (≤ 3.7 mm). This was also the case for the KOOS4 (22, 95% CI 9–34). Conclusion: Acute PCL injuries treated non-surgically display a high degree of PCL continuity on MR images 11 years after injury. However, there is a large variation of posterior tibial translation with higher values being associated with poorer patient-reported outcomes.
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| 2. |
- Kumm, Jaanika, et al.
(författare)
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Natural History of Intrameniscal Signal Intensity on Knee MR Images: Six Years of Data from the Osteoarthritis Initiative.
- 2015
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Ingår i: Radiology. - : Radiological Society of North America (RSNA). - 1527-1315 .- 0033-8419. ; :Jul 14
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To assess the natural history of intrameniscal signal intensity on magnetic resonance (MR) images of the medial compartment. Materials and Methods Both knees of 269 participants (55% women, aged 45-55 years) in the Osteoarthritis Initiative without radiographic knee osteoarthritis (OA) and without medial meniscal tear at baseline were studied. One radiologist assessed 3-T MR images from baseline and 24-, 48-, and 72-month follow-up for intrameniscal signal intensity and tears. A complementary log-log model with random effect was used to evaluate the risk of medial meniscal tear, adjusting for age, sex, body mass index, and knee side. Results At baseline, linear intrameniscal signal intensity in the medial compartment was present in 140 knees (26%). Once present, regression only in a single knee was observed. In 31 knees (19%) with linear intrameniscal signal intensity at any of the first three time points, the signal intensity progressed to a tear in the same segment, and in a single knee, the tear occurred in an adjacent segment. The corresponding number of tears without prior finding of intrameniscal signal intensities was 11 (3%). In the adjusted model, the hazard ratio for developing medial meniscal tear was 18.2 (95% confidence interval: 8.3, 39.8) if linear intrameniscal signal intensity was present, compared when there was no linear signal intensity. There was only one of 43 knees with injury reported in conjunction with the incident tear. Conclusion In middle-aged persons without OA, linear intrameniscal signal intensity on MR images is highly unlikely to resolve and should be considered a risk factor for medial degenerative meniscal tear. (©) RSNA, 2015 Online supplemental material is available for this article.
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| 3. |
- Kumm, Jaanika, et al.
(författare)
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Response
- 2016
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Ingår i: Radiology. - : Radiological Society of North America (RSNA). - 0033-8419 .- 1527-1315. ; 280:2, s. 649-650
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Tidskriftsartikel (refereegranskat)
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| 4. |
- Kumm, Jaanika, et al.
(författare)
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Structural abnormalities detected by knee magnetic resonance imaging are common in middle-aged subjects with and without risk factors for osteoarthritis
- 2018
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 89:5, s. 535-540
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Few data are available regarding structural changes present in knees without radiographically evident osteoarthritis (OA). We evaluated the prevalence of findings suggestive of knee OA by magnetic resonance imaging (MRI) in middle-aged subjects without radiographic OA with or without OA risk factors. Patients and methods — 340 subjects from the Osteoarthritis Initiative, aged 45–55 years (51% women) with Kellgren–Lawrence grade 0 in both knees, who had 3T knee MR images were eligible. 294 subjects had risk factors and 46 were without risk factors. MR images were assessed using the MOAKS scoring system. Results — At least 1 MR-detected feature was found in 96% (283/294) of subjects with risk factors and in 87% (40/46) of those without. Cartilage damage (82%), bone marrow lesions (60%), osteophytes (45%), meniscal body extrusion (32%), and synovitis–effusion (29%) were the most common findings in subjects with risk factors, while cartilage damage (67%), osteophytes (46%), meniscal body extrusion (37%), and bone marrow lesions (35%) were most common in subjects without. The prevalence of any abnormality was higher in subjects with OA risk factors than in subjects without (prevalence ratio adjusted for age and sex 1.3 [95% CI 1.1–1.6]), so was prevalence of subchondral cysts and bone marrow lesions. MR-detected structural changes were more frequent in patellofemoral joints. Interpretation — Our findings highlight the great challenge in distinguishing pathological features of early knee OA from what could be considered part of “normal ageing.” Bone marrow lesions were more frequently found in subjects with multiple OA risk factors.
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| 5. |
- Kumm, Jaanika, et al.
(författare)
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Urinary osteocalcin and other markers of bone metabolism: the effect of risedronate therapy
- 2008
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Ingår i: Scandinavian Journal of Clinical & Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 68:6, s. 459-463
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Serum osteocalcin (S-OC) is widely used as an index of bone formation. However, there is evidence that some urinary fragments of OC reflect resorption and might be useful in monitoring antiresorptive therapy. Here, we report 6-month changes in urinary midfragments of osteocalcin (U-MidOC) and other bone turnover markers in response to risedronate treatment. Material and methods. The study group comprised 19 patients with postmenopausal osteoporosis, aged 49-66 years, and receiving risedronate therapy. Fifty-four premenopausal women served as controls. Osteoporosis was diagnosed by lumbal bone mineral density (BMD). Urinary osteocalcin was measured by the U-MidOC assay for midfragments. Bone formation was assessed by S-PINP and S-OC, and resorption by S-CTx-I. Results. At baseline, U-MidOC was significantly correlated only with S-OC. After the 1st month of therapy, a similar decrease was observed in the values of U-MidOC and S-CTx-I, but in formation markers S-P1NP and S-OC only after three months. The rapid decrease in U-MidOC, analogous to S-CTX-I, and the different kinetics for urinary and serum OC suggest that urinary OC midfragments are more associated with resorption than S-OC. An association was also observed between the 1-month change in U-MidOC and 12-month gain in lumbar BMD. The response in U-MidOC after only the 1st month of therapy makes it a potential marker for monitoring the effect of risedronate, presumably reflecting different aspects of bone resorption than S-CTx-I does.
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| 6. |
- Magnusson, Karin, et al.
(författare)
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Relationship Between Magnetic Resonance Imaging Features and Knee Pain Over Six Years in Knees Without Radiographic Osteoarthritis at Baseline
- 2021
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 73:11, s. 1659-1666
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore whether magnetic resonance imaging (MRI) features suggestive of knee osteoarthritis (OA) are associated with presence of knee pain in possible early-stage OA development. Methods: We included 294 participants from the Osteoarthritis Initiative (mean ± SD age 50 ± 3 years; 50% women) with baseline Kellgren/Lawrence grade of 0 in both knees, all of whom had received knee MRIs at 4 different time points over 6 years (baseline, 24, 48, and 72 months). Using a linear mixed model (knees matched within individuals), we studied whether MRI features (meniscal body extrusion [in mm], cartilage area loss [score 0–39], cartilage full thickness loss [range 0–16], osteophytes [range 0–29], meniscal integrity [range 0–10], bone marrow lesions [BMLs] including bone marrow cysts [range 0–20], Hoffa- or effusion-synovitis [absent/present], and popliteal cysts [absent/present]) were associated with knee-specific pain as reported on the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire using a 0–100 scale (worst to best). Results: The differences in KOOS knee pain score for a knee with a 1 unit higher score on MRI were the following: meniscal extrusion –1.52 (95% confidence interval [95% CI] –2.35, –0.69); cartilage area loss –0.23 (95% CI –0.48, 0.02); cartilage full thickness loss –1.04 (95% CI –1.58, –0.50); osteophytes –0.32 (95% CI –0.61, –0.03); meniscal integrity –0.28 (95% CI –0.58, 0.02); BMLs including potential cysts –0.19 (95% CI –0.55, 0.16); synovitis 0.23 (95% CI –1.14, 1.60); and popliteal cysts 0.86 (95% CI –0.56, 2.29). Conclusion: Meniscal extrusion, full thickness cartilage loss, and osteophytes are associated with having more knee pain. Although these features may be relevant targets for future trials, the clinical relevance of our findings is unclear because no feature was associated with a clinically important difference in knee pain.
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| 7. |
- Sihvonen, Raine, et al.
(författare)
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Arthroscopic partial meniscectomy for a degenerative meniscus tear : A 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial
- 2020
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Ingår i: British journal of sports medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 54:22, s. 1332-1339
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up. Design: Multicentre, randomised, participant- A nd outcome assessor-blinded, placebo-surgery controlled trial. Setting: Orthopaedic departments in five public hospitals in Finland. Participants: 146 adults, mean age 52 years (range 35-65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised. Interventions: APM or placebo surgery (diagnostic knee arthroscopy). Main outcome measures: We used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade ≥1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function (Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale). Results: There was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade ≥1 of 13%, 95% CI-2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: Adjusted absolute mean differences (APM vs placebo surgery),-1.7 (95% CI-7.7 to 4.3) in WOMET,-2.1 (95% CI-6.8 to 2.6) in Lysholm knee score, and-0.04 (95% CI-0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar. Conclusions: APM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery. Trial registration: ClinicalTrials.gov (NCT01052233 and NCT00549172).
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