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- Tjörnstrand, Jon, et al.
(författare)
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Osteoarthritis development related to cartilage quality-the prognostic value of dGEMRIC after anterior cruciate ligament injury
- 2019
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; 27:11, s. 1647-1652
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveRupture of the anterior cruciate ligament (ACL) increases the risk of developing osteoarthritis (OA). Delayed Gadolinium enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) investigates cartilage integrity through T1-analysis after intravenous contrast injection. A high dGEMRIC index represents good cartilage quality. The main purpose of this prospective cohort study was to investigate the prognostic value of the dGEMRIC index regarding future knee OA.Method31 patients with ACL injury (mean age 27 ± 6.7 (±SD) years, 19 males) were examined after 2 years with 1.5T dGEMRIC of femoral cartilage. Re-examination 14 years post-injury included weight-bearing knee radiographs, Lysholm and Knee Osteoarthritis Outcome Score (KOOS).ResultsAt the 14-year follow up radiographic OA (ROA) was present in 68% and OA symptoms (SOA) in 42% of the injured knees. The dGEMRIC index of the medial compartment was lower in knees that developed medial ROA, 325 ± 68 (ms±SD) vs 376 ± 47 (51 (7–94)) (difference of means (95% confidence interval (CI))), in patients that developed symptomatic OA (SOA), 327 ± 61 vs 399 ± 42 (52 (11–93)), and poor knee function 337 ± 54 vs 381 ± 52 (48 (7–89)) compared to those that did not develop ROA, SOA or poor function. The dGEMRIC index correlated negatively with the OARSI osteophyte score in medial (r = −0.44, P = 0.01) and lateral (r = −0.38, P = 0.03) compartments.ConclusionThe associations between a low dGEMRIC index and future ROA, as well as SOA, are in agreement with previous studies and indicate that dGEMRIC has a prognostic value for future knee OA.
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| 2. |
- Tjörnstrand, Jon, et al.
(författare)
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Poor outcome after a surgically treated chondral injury on the medial femoral condyle : early evaluation with dGEMRIC and 17-year radiographic and clinical follow-up in 16 knees
- 2018
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 89:4, s. 431-436
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — The optimal treatment for traumatic cartilage injuries remains unknown. Contrast-enhanced MRI of cartilage (dGEMRIC) evaluates cartilage quality and a low dGEMRIC index may predict radiographic osteoarthritis (OA). The purpose of this study was (a) to explore the results 17 years after surgical treatment of an isolated cartilage knee injury and (b) to evaluate the predictive value of dGEMRIC. Patients and methods — 16 knees with an isolated traumatic cartilage injury of the medial femoral condyle had cartilage repair surgery either by microfracture or autologous cartilage implantation. dGEMRIC of the injured knee was performed 2 years after surgery and radiographic examinations were performed 17 years after the operation. Results — Radiographic OA was present in 12 of 16 knees. Irrespective of surgical method, the dGEMRIC index was lower in repair tissue compared with adjacent cartilage in the medial compartment, 237 ms vs. 312 ms (p < 0.001), which in turn had lower value than in the non-injured lateral cartilage, 312 ms vs. 354 ms (p < 0.008). The dGEMRIC index in the cartilage adjacent to the repair tissue correlated negatively with radiographic osteophyte score, r = –0.75 (p = 0.03). Interpretation — A traumatic cartilage injury is associated with a high prevalence of OA after 17 years. The low dGEMRIC index in the repair tissue 2 years postoperatively indicates fibrocartilage of low quality. The negative correlation between the dGEMRIC index in the adjacent cartilage and future OA suggests that the quality of the surrounding cartilage influences outcome after cartilage repair surgery.
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| 3. |
- Tjörnstrand, Jon
(författare)
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The prognostic value of dGEMRIC regarding future knee OA Long-term assessment after traumatic chondral injury and ACL injury
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract Background: Osteoarthritis (OA) is the most common joint disorder globally and a major cause of disabiltiy with the knee joint responsible for 80% of the disease burden. Progressive degenerative changes in cartilage tissue result in deterioration and loss of articular cartilage. Cartilage has poor capacity of healing and the detection of degeneration usually occurs at a stage of progression where changes are irreversible. To improve the understanding of the degenerative process and to monitor early stage cartilage disease, new methods are needed. Delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a technique to evaluate cartilage quality by estimation of glycosaminoglycan (GAG) content, a low dGEMRIC index indicates low cartilage quality. The characteristic resistance to compressive forces of healthy cartilage relies on high GAG content. Decreasing GAG content is regarded as one of the first alterations in progression to cartilage degeneration. Aims and cohorts: 1) To validate the dGEMRIC measurement technique. 2) To monitor changes in cartilage quality in two cohorts of knee-injured patients: a) traumatic cartilage injury and b) ACL injury. To investigate the capacity of dGEMRIC to predict clinical and radiographic OA in both these cohorts. Results: For 6 investigators, the inter- and intra-observer reproducibility of dGEMRIC measurements with manual definition of different regions of interest was good with CV% of <3% at repeated measures. No difference was found related to investigator experience. A traumatic cartilage injury was associated with a high prevalence of OA after 17 years. The dGEMRIC index in the repair tissue was low already 2 years postoperatively, indicating fibrocartilage of low quality. A negative correlation between the dGEMRIC index in the adjacent cartilage and future OA suggests that the quality of the surrounding cartilage influences outcome after cartilage repair surgery. 29 patients with ACL rupture were investigated with dGEMRIC 3 weeks and 2 years after injury. dGEMRIC index was lower compared to non-injured controls. Patient that had sustained meniscectomy, or had BMI ≥25, had lower cartilage quality at 2 years. Long-term follow-up was performed in 16 patients with cartilage repair surgery and 31 patients with ACL rupture. In the cartilage repair group, the 12 knees that had developed radiographic OA had lower dGEMRIC index (p=0.07), and in the ACL group low medial dGEMRIC index was associated with both medial ROA and OA symptoms (p<0.05) after 14 years. Conclusion: Non-invasive assessment of cartilage quality with dGEMRIC is feasible and measures relevant differences in a clinical context. Cartilage quality assessed with dGEMRIC has a prognostic capacity relative knee OA development.
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