Chondrocyte damage and contact pressures following impact on the rabbit tibiofemoral joint

Epidemiological studies show that tibial plateau fractures comprise about 10% of all below-knee injuries in car crashes. Studies from this laboratory document that impacts to the tibiofemoral (TF) joint at 50% of the energy producing gross fracture can generate cartilage damage and microcracks at the interface between calcified cartilage and underlying subchondral bone in the tibial plateau. These injuries are suggestive of the initiation for a long term chronic disease, such as osteoarthritis. The disease process may be further encouraged by acute damage to chondrocytes in the cartilage overlying areas of occult microcracking. The hypothesis of the current study was that significant damage to chondrocytes in tibial plateau cartilage could be generated in areas of high contact pressure by a single impact delivered to the rabbit TF joint, without a gross fracture of bone. Three rabbits received a single, 13 J of energy blunt insult to the TF joint, while another three animals were used as controls. Cell viability analyses compared chondrocyte damage in impacted versus control cartilage. Two additional rabbits were impacted to document contact pressures generated in the TF joint. The study showed high contact pressures in uncovered areas of the plateau, with a trend for higher pressures in the lateral versus medial facets. A significantly higher percentage of damaged chondrocytes existed in impacted versus the opposite, nonimpacted limbs. Additionally, more chondrocyte damage was documented in the superficial zone (top 20% of cartilage thickness) of the cartilage compared to middle (middle 50% of thickness) and deep (bottom 30% of thickness) zones. This study showed that a single blunt insult to the in situ rabbit TF joint, generating large areas of contact pressure exceeding 20 MPa, produces significant chondrocyte damage in the tibial articular cartilage, especially in the superficial zone, without gross fracture of bone. Future studies will be needed to investigate the long term, chronic outcome of this blunt force joint trauma.     

Chronic softening of cartilage without thickening of underlying bone in a joint trauma model

We have recently developed a trauma model to study degradation of the rabbit patello-femoral joint. Our current working hypothesis is that alterations in retropatellar cartilage and underlying bone in our model are initiated independently by acute overstresses developed in each tissue during blunt insult to the joint, and that the processes of chronic degradation in each tissue are not related in a mechanical sense. The current study was conducted in an attempt to help validate our hypothesis by impacting the patello-femoral joint with a padded interface. Based upon earlier human cadaver experiments, we believe this would reduce the acute overstresses in patellar bone while the stresses developed in the overlying retropatellar cartilage would be sufficient enough to initiate a chronic softening of the tissue. Twenty-four animals received an impact to the patello-femoral joint and were sacrificed at either 0, 4.5, or 12 months post-insult. Three acute animals were impacted to develop a simplified computational model to estimate the stresses in joint tissues. The study showed there was a significant softening of the retropatellar cartilage at 4.5 and 12 months post-trauma, compared to unimpacted controls. However, no thickening of the underlying subchondral bone was documented at any timepoint. This was consistent with a reduction of stress in the bone compared to earlier studies, which document thickened subchondral bone post-insult at the same applied impact load. In conclusion, this study helped validate our hypothesis by documenting chronic softening of cartilage without remodeling of the underlying subchondral bone. Furthermore, this study, along with our earlier studies, suggest that impact load alone, which is currently used by the automobile industry to certify new automobiles, is not a good predictor of chronic injuries to a diarthrodial joint, and that simply the addition of padding to impact interfaces may not be adequate to protect occupants from chronic injuries.     

Enforced exercise after blunt trauma significantly affects biomechanical and histological changes in rabbit retro-patellar cartilage

Our laboratory has developed an animal model to study factors leading to chronic disease in a blunt impacted joint. Studies to date indicate post trauma softening of the impacted joint cartilage, but a limited degree of histological degradation in the tissue. The model utilizes treadmill exercise of the animal post trauma. The hypothesis of the current study was that post trauma exercise helps limit histological and mechanical degradation of the impacted retro-patellar cartilage. The study involved a group of animals with enforced exercise on a treadmill and another group with cage-activity post trauma. The animals were sacrificed after 24 months. Mechanical and histological analyses were performed on the retro-patellar cartilage from each group. The impacted versus contra-lateral, non-impacted retro-patellar cartilage was mechanically softened in the exercise group, but not in the cage-activity group. Histological analyses of the tissue from the cage-activity group indicated that this cartilage had less surface integrity, more ossification/calcification, and more erosion than that in the impacted tissue from the exercise group. These tissue changes may lead to an apparent stiffening effect in the impacted cartilage from the cage-activity group at 24 months post-trauma. Potential relationships between the intensity and frequency of post trauma exercise and the mechanical character and histological degradation of the impacted cartilage need additional study. The study indicates that post-trauma exercise can significantly alter the outcome of a blunt knee joint trauma in this experimental animal model.     

Osteoarthrosis in guinea pigs: histopathologic and scanning electron microscopic features

Spontaneous cartilage degeneration of the femorotibial joint of male Hartley guinea pigs, 61 to 365 days old, was studied by light microscopy (LM) and scanning electron microscopy (SEM) to determine the incidence, age at onset, and to characterize the early changes. Knee joints of 61 day old animals were histologically and ultrastructurally normal. Focal minimal degeneration characterized by cell and proteoglycan loss with surface fibrillation was first observed by LM on the medial tibial plateau (MTP) in two of five 89 day old animals. Mild lesions characterized by focal surface disruption, primarily in the area of medial tibial plateau not covered by the meniscus, were observed in three of five 89 day old animals by SEM. Light microscopic alterations in knee joints of 4, 5, and 6 month old animals consisted of varying degrees of focal chondrocyte death, decreased toluidine blue matrix staining, and surface fibrillation. Small chondrocytic clones were first observed in medial tibial cartilage of 6 month old animals with moderate focal degeneration. Ultrastructurally, 4, 5, and 6 month old animals generally had moderate to severe fibrillation involving primarily the area of the medial tibial plateau not covered by the meniscus. Tibial osteophyte formation, mild synovial hyperplasia, medial femoral and meniscal cartilage degeneration, were first seen by LM in 9 month old animals. Lesions in 1 year old animals were similar, but more severe and included subchondral sclerosis of medial tibial and femoral bone. Bilateral fibrillation of greater than 50% of the medial tibial articular surface was observed in all 1 year old animals by SEM.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impact orientation can significantly affect the outcome of a blunt impact to the rabbit patellofemoral joint

This laboratory has developed a subfracture, joint trauma model in rabbits. Using a dropped impact mass directed onto a slightly abducted joint, chronic softening of retropatellar cartilage and thickening of underlying subchondral bone are documented in studies to 1 year post-insult. It has been hypothesized that these tissue changes are initiated by stresses developed during impact loading. A previous analytical study by this laboratory suggests that tensile strains in retropatellar cartilage can be significantly lowered, without significantly changing the intensity of stresses in the underlying subchondral bone, by reorientation of patellar impact more centrally on the joint. In the current study comparative experiments were performed on groups of animals after either an impact directed on the slightly abducted limb or a more central impact. One-year post-trauma in animals subjected to the central-oriented impact no degradation of the shear modulus for the retropatellar cartilage was documented, but the thickness of the underlying subchondral bone was significantly increased. In contrast, alterations in cartilage and underlying bone following impact on the slightly abducted limb were consistent with previous studies. The current experimental investigation showed the sensitivity of post-trauma alterations in joint tissues to slight changes in the orientation of impact load on the joint. Interestingly, for this trauma model thickening of the underlying subchondral plate occurred without mechanical degradation of the overlying articular cartilage. This supports the current laboratory hypothesis that alterations in the subchondral bone and overlying cartilage occur independently in this animal model.     

Development of a traumatic anterior cruciate ligament and meniscal rupture model with a pilot in vivo study

The current study describes the development of a small animal, closed-joint model of traumatic anterior cruciate ligament (ACL) and meniscal rupture. This model can be used in future studies to investigate the roles of these acute damages on the long-term health of an injured knee joint. Forty-two Flemish Giant rabbits received an insult to the left tibiofemoral joint ex vivo in order to document optimal energy and joint orientation needed to generate ACL and meniscal rupture, without gross fracture of bone. Impact energies ranged from 10 J to 22 J, and joint flexion angle ranged from 60 deg to 90 deg. Three in vivo animals were impacted at 13 J with the knee flexed at 90 deg, as this was determined to be the optimal load and joint orientation for ACL and meniscal ruptures, and sacrificed at 12 weeks. Impact data from the ex vivo group revealed that 13 J of dropped-mass energy, generating approximately 1100 N of load on the knee, would cause ACL and meniscal ruptures, without gross bone fracture. Acute damage to the lateral and medial menisci was documented in numerous ex vivo specimens, with isolated lateral meniscal tears being more frequent than isolated medial tears in other cases. The in vivo animals showed no signs of ill health or other physical complications. At 12 week post-trauma these animals displayed marked degeneration of the traumatized joint including synovitis, cartilage erosion, and the formation of peripheral osteophytes. Histological microcracks at the calcified cartilage-subchondral bone interface were also evident in histological sections of these animals. A closed-joint model of traumatic ACL and meniscal rupture was produced, without gross bone fracture, and a pilot, in vivo study showed progressive joint degeneration without any other noticeable physical impairments of the animals over 12 weeks. This closed-joint, traumatic injury model may be useful in future experimental studies of joint disease and various intervention strategies.     

Dynamic contact stress patterns on the tibial plateaus during simulated gait: A novel application of normalized cross correlation

The spatial distribution and pattern of local contact stresses within the knee joint during activities of daily living have not been fully investigated. The objective of this study was to determine if common contact stress patterns exist on the tibial plateaus of human knees during simulated gait. To test this hypothesis, we developed a novel normalized cross-correlation (NCC) algorithm and applied it to the contact stresses on the tibial plateaus of 12 human cadaveric knees subjected to multi-directional loads mimicking gait. The contact stress profiles at different locations on the tibial plateaus were compared, where regions with similar contact stress patterns were identified across specimens. Three consistent regional patterns were found, among them two most prominent contact stress patterns were shared by 9–12 of all the knees and the third pattern was shared by 6–8 knees. The first pattern was located at the posterior aspect of the medial tibial plateau and had a single peak stress that occurred during the early stance phase. The second pattern was located at the central-posterior aspects of the lateral plateau and consisted of two peak stresses coincident with the timing of peak axial force at early and late stance. The third pattern was found on the anterior aspect of cartilage-to-cartilage contact region on the medial plateau consisted of double peak stresses. The differences in the location and profile of the contact stress patterns suggest that the medial and lateral menisci function to carry load at different points in the gait cycle: with the posterior aspect of the medial meniscus consistently distributing load only during the early phase of stance, and the posterior aspect of the lateral meniscus consistently distributing load during both the early and late phases of stance. This novel approach can help identify abnormalities in knee contact mechanics and provide a better understanding of the mechanical pathways leading to post-traumatic osteoarthritis.     

Rate of blunt impact loading affects changes in retropatellar cartilage and underlying bone in the rabbit patella

Our laboratory has developed a small animal model using Giant Flemish rabbits to examine chronic degradative changes in joint tissues following a blunt impact. Historically, we observe surface fissuring and decreases in the elastic modulus of retropatellar cartilage along with thickening of the underlying subchondral bone. Previous studies resulted in load insults that peaked in approximately 5ms, while loads that occur during automotive accidents or heavy exercise can produce longer rise times. The objective of the current study was to examine the influence of blunt impact loading rate using our established model. We hypothesized that the extent of fissuring and softening of retropatellar cartilage following impact would not be significantly different for a high (5ms to peak) versus low (50ms to peak) rate of loading experiment. Eight animals were impacted with a high rate of loading blunt impact, while ten animals were subjected to the same impact load at a low rate of loading. An additional eight animals served as a control population. All animals were sacrificed 12 months post-impact. The study yielded unexpected results for the first hypothesis. The high rate of loading experiments generated more surface fissuring of the retropatellar cartilage than the low rate of loading experiments. However, the degree of softening was similar for the two rates, which supported the second hypothesis. Furthermore, the study documented more thickening of bone underlying retropatellar cartilage following the high versus the low rate of loading experiments. The current study suggested that chronic injury mechanisms may be highly dependent on the rate of impact loading. These data could become extremely relevant in the development of high-velocity "safety" devices, such as knee air bags, that are needed to help position an unbelted occupant in an automobile crash.     

Material properties of articular cartilage in the rabbit tibial plateau

The material properties of articular cartilage in the rabbit tibial plateau were determined using biphasic indentation creep tests. Cartilage specimens from matched-pair hind limbs of rabbits approximately 4 months of age and greater than 12 months of age were tested on two locations within each compartment using a custom built materials testing apparatus. A three-way ANOVA was used to determine the effect of leg, compartment, and test location on the material properties (aggregate modulus, permeability, and Poisson's ratio) and thickness of the cartilage for each set of specimens. While no differences were observed in cartilage properties between the left and right legs, differences between compartments were found in each set of specimens. For cartilage from the adolescent group, values for aggregate modulus were 40% less in the medial compartment compared to the lateral compartment, while values for permeability and thickness were greater in the medial compartment compared to the lateral compartment (57% and 30%, respectively). Values for Poisson's ratio were 19% less in the medial compartment compared to the lateral compartment. There was also a strong trend for thickness to differ between test locations. Similar findings were observed for cartilage from the mature group with values for permeability and thickness being greater in the medial compartment compared to the lateral compartment (66% and 34%, respectively). Values for Poisson's ratio were 22% less in the medial compartment compared to the lateral compartment.     

兔后交叉韧带断裂后外侧胫骨平台退变的组织学研究

目的：探讨兔后交叉韧带（Posterior cruciate ligament,PCL）断裂对外侧胫骨平台组织学的影响。方法：48只家兔膝关节随机配对为实验侧和对照侧造模,造模后第4、8、16、24周各随机处死12只,行外侧胫骨平台大体观察、HE染色、免疫组化检测基质金属蛋白酶13（matrix metalloproteinase-13,MMP-13）、基质金属蛋白酶抑制剂1（Tisse inhibitor-1 of matrix metalloproteinasel,TIMP-1）表达。结果：①大体观察,随时间延长,实验组外侧胫骨平台软骨出现磨损,呈灰黄色,弹性差,骨赘形成。②组织学观察,随时间延长,胫骨平台软骨纤维化,细胞排列紊乱,簇聚细胞出现频率增加。⑧实验组MMP-13、TIMP—1表达均高于对照组,有显著性差异。P〈0．05。④实验组MMP-13、TIMP-1表达阳性率第4、8、16周逐渐升高,24周下降,各组比较有显著性差异,P〈0．05。结论：①兔膝关节PCL断裂会引起外侧胫骨平台软骨退行性变,且该退变随着时间的推移逐渐加重。②MMP-13与TIMP-1在PCL断裂膝关节外侧胫骨平台中的表达呈现先高后低的变化规律,造成MMP-13与T1MP-1的失衡,加速软骨退变。⑨MMP-13与T／MP-1表达增高提示MMP-13与TIMP—1可能参与了PCL断裂后外侧胫骨平台软骨的退变过程。     

兔后交叉韧带断裂后外侧胫骨平台退变的组织学研究

目的:探讨兔后交叉韧带(Posterior cruciate ligament,PCL)断裂对外侧胫骨平台组织学的影响。方法:48只家兔膝关节随机配对为实验侧和对照侧造模,造模后第4、8、16、24周各随机处死12只,行外侧胫骨平台大体观察、HE染色、免疫组化检测基质金属蛋白酶13(matrix metalloproteinase-13,MMP-13)、基质金属蛋白酶抑制剂1(Tisse inhibitor-1 of matrix metalloproteinase1,TIMP-1)表达。结果:①大体观察,随时间延长,实验组外侧胫骨平台软骨出现磨损,呈灰黄色,弹性差,骨赘形成。②组织学观察,随时间延长,胫骨平台软骨纤维化,细胞排列紊乱,簇聚细胞出现频率增加。③实验组MMP-13、TIMP-1表达均高于对照组,有显著性差异,P<0.05。④实验组MMP-13、TIMP-1表达阳性率第4、8、16周逐渐升高,24周下降,各组比较有显著性差异,P<0.05。结论:①兔膝关节PCL断裂会引起外侧胫骨平台软骨退行性变,且该退变随着时间的推移逐渐加重。②MMP-13与TIMP-1在PCL断裂膝关节外侧胫骨平台中的表达呈现先高后低的变化规律,造成MMP-13与TIMP-1的失衡,加速软骨退变。③MMP-13与TIMP-1表达增高提示MMP-13与TIMP-1可能参与了PCL断裂后外侧胫骨平台软骨的退变过程。     

Impact-induced osteochondral fracture in the tibial plateau

In this study, human tibia plateaus with the meniscus removed were impacted on various regions of the plateau surface via a drop test using a 5mm indenter. Osteochondral blocks containing the failure site were then extracted, chemically fixed, dehydrated, gold-particle coated, and sent for X-ray micro-CT imaging to obtain 3-D image reconstructions of the cartilage and underlying bone. Cartilage failure upon impact appeared to be characteristically brittle in nature. Impacted cartilage from the region not protected by the meniscus showed a relatively large cavernous disruption with microcrack propagation extending radially into the subchondral bone, while impacted cartilage from beneath the meniscus showed less dramatic surface disruption and with no underlying bone failure.     

Crushed bone grafts and a collagen membrane are not suitable for enhancing cartilage quality in the regeneration of osteochondral defects--an in vivo study in sheep

Hyaline joint cartilage has only a limited potential for self-repair. Some of the published techniques for osteochondral defect therapy try to improve that potential. In this study, it was hypothesised that one of those surgical techniques, the crushed transplanted bone graft together with a collagen membrane, accelerates significantly the reconstruction of the subchondral bone plate and improves the mechanical and histological quality of repaired cartilage in osteochondral defects compared to an empty control defect. In order to test this hypothesis, defects were created in the left knee of 12 sheep and filled either with autologous crushed bone graft or left empty. The animals were sacrificed after 3 (n = 6) and 6 (n = 6) months. No differences were found either macroscopically or histomorphometrically between the bone graft and empty control defects. The biomechanical as well as the histological results of the bone graft defects were inferior to the control defects with inflammatory processes caused either by bone graft or membrane remnants. Based on the results in this sheep model, the filling of subchondral bone defects with compacted cancellous bone should be carefully reconsidered.     

Cleft formations between the body and the greater horn of the hyoid bone

Clefts between the body and the greater horn of the hyoid bone are reconstructed graphically from histological sections of hyoid bones from children aged 5 months up to 7 a. In 3 cases, the cleft cranially is enclosed by perichondrium at the lateral and medial sides; caudally the perichondral tissue is continued by cartilage on the medial side. On the lateral side, the perichondrium reaches more caudally. In 1 case, the cleft is enclosed on its medial side by cartilage only. In all cases examined, the medial wall is thicker than the lateral. The formation of a joint cleft between the body and the greater horn of the hyoid bone seems to be predominant in the lateral and caudal parts of that diarthrosis.     

Topographical variation of the elastic properties of articular cartilage in the canine knee

Equilibrium response of articular cartilage to indentation loading is controlled by the thickness (h) and elastic properties (shear modulus, mu, and Poisson's ratio, nu) of the tissue. In this study, we characterized topographical variation of Poisson's ratio of the articular cartilage in the canine knee joint (N=6). Poisson's ratio was measured using a microscopic technique. In this technique, the shape change of the cartilage disk was visualized while the cartilage was immersed in physiological solution and compressed in unconfined geometry. After a constant 5% axial strain, the lateral strain was measured during stress relaxation. At equilibrium, the lateral-to-axial strain ratio indicates the Poisson's ratio of the tissue. Indentation (equilibrium) data from our prior study (Arokoski et al., 1994. International Journal of Sports Medicine 15, 254-260) was re-analyzed using the Poisson's ratio results at the test site to derive values for shear and aggregate moduli. The lowest Poisson's ratio (0.070+/-0.016) located at the patellar surface of femur (FPI) and the highest (0.236+/-0.026) at the medial tibial plateau (TMI). The stiffest cartilage was found at the patellar groove of femur (micro=0.964+/-0.189MPa, H(a)=2.084+/-0. 409MPa) and the softest at the tibial plateaus (micro=0.385+/-0. 062MPa, H(a)=1.113+/-0.141MPa). Comparison of the mechanical results and the biochemical composition of the tissue (Jurvelin et al., 1988. Engineering in Medicine 17, 157-162) at the matched sites of the canine knee joint indicated a negative correlation between the Poisson's ratio and collagen-to-PG content ratio. This is in harmony with our previous findings which suggested that, in unconfined compression, the degree of lateral expansion in different tissue zones is related to collagen-to-PG ratio of the zone.     

A comparison of the influence of global functional loads vs. local contact anatomy on articular cartilage thickness at the knee

Cartilage contact geometry, along with joint loading, can play an important role in determining local articular cartilage tissue stress. Thus individual variations in cartilage thickness can be associated with both individual variations in joint loading associated with activities of daily living as well as individual differences in the anatomy of the contacting surfaces of the joint. The purpose of this study was to isolate the relationship between cartilage thickness predicted by individual variations in contact surface geometry based on the radii of the femur and tibia vs. cartilage thickness predicted by individual variations in joint loading. Knee magnetic resonance (MR) images and the peak knee adduction moments during walking were obtained from 11 young healthy male subjects (age 30.5+/-5.1 years). The cartilage thicknesses and surface radii of the femoral and tibial cartilage were measured in the weight-bearing regions of the medial and lateral compartments of three-dimensional models from the MR images. The ratio of contact pressure between the medial and lateral compartments was calculated from the radii of tibiofemoral contact surface geometries. The results showed that the medial to lateral pressure ratios were not correlated with the medial to lateral cartilage thickness ratios. However, in general, pressure was higher in the lateral than medial compartments and cartilage was thicker in the lateral than medial compartments. The peak knee adduction moment showed a significant positive linear correlation with medial to lateral thickness ratio in both femur (R(2)=0.43,P<0.01) and tibia (R(2)=0.32,P<0.01). The results of this study suggest that the dynamics of walking is an important factor to describe individual differences in cartilage thickness for normal subjects.     

Quantification of subchondral bone changes in a murine osteoarthritis model using micro-CT

In the past few years there has been a considerable interest in the role of bone in osteoarthritis. Despite the increasing evidence of the involvement of bone in osteoarthritis, it remains very difficult to attribute the cause or effect of changes in subchondral bone to the process of osteoarthritis. Although osteoarthritis in mice provides a useful model to study changes in the subchondral bone, detailed quantification of these changes is lacking. Therefore, the goal of this study was to quantify subchondral bone changes in a murine osteoarthritis model by use of micro-computed tomography (micro-CT). We induced osteoarthritis-like characteristics in the knee joints of mice using collagenase injections, and after four weeks we calculated various 3D morphometric parameters in the epiphysis of the proximal tibia. The collagenase injections caused cartilage damage, visible in histological sections, particularly on the medial tibial plateau. Micro-CT analysis revealed that the thickness of the subchondral bone plate was decreased both at the lateral and the medial side. The trabecular compartment demonstrated a small but significant reduction in bone volume fraction compared to the contralateral control joints. Trabeculae in the collagenase-injected joints were thinner but their shape remained rod-like. Furthermore, the connectivity between trabeculae was reduced and the trabecular spacing was increased. In conclusion, four weeks after induction of osteoarthritis in the murine knee subtle but significant changes in subchondral bone architecture could be detected and quantified in 3D with micro-CT analysis.     

Quantitative proteomics at different depths in human articular cartilage reveals unique patterns of protein distribution

The articular cartilage of synovial joints ensures friction-free mobility and attenuates mechanical impact on the joint during movement. These functions are mediated by the complex network of extracellular molecules characteristic for articular cartilage. Zonal differences in the extracellular matrix (ECM) are well recognized. However, knowledge about the precise molecular composition in the different zones remains limited. In the present study, we investigated the distribution of ECM molecules along the surface-to-bone axis, using quantitative non-targeted as well as targeted proteomics.\In a discovery approach, iTRAQ mass spectrometry was used to identify all extractable ECM proteins in the different layers of a human lateral tibial plateau full thickness cartilage sample. A targeted MRM mass spectrometry approach was then applied to verify these findings and to extend the analysis to four medial tibial plateau samples.In the lateral tibial plateau sample, the unique distribution patterns of 70 ECM proteins were identified, revealing groups of proteins with a preferential distribution to the superficial, intermediate or deep regions of articular cartilage. The detailed analysis of selected 29 proteins confirmed these findings and revealed similar distribution patterns in the four medial tibial plateau samples.The results of this study allow, for the first time, an overview of the zonal distribution of a broad range of cartilage ECM proteins and open up further investigations of the functional roles of matrix proteins in the different zones of articular cartilage in health and disease.     

Knee cartilage loss in symptomatic knee osteoarthritis over 4.5 years

The objective of this study was to describe the rate of change in knee cartilage volume over 4.5 years in subjects with symptomatic knee osteoarthritis (OA) and to determine factors associated with cartilage loss. One hundred and five subjects were eligible for this longitudinal study. Subjects' tibial cartilage volume was assessed by magnetic resonance imaging (MRI) at baseline, at 2 years and at 4.5 years. Of 105 subjects, 78 (74%) completed the study. The annual percentage losses of medial and lateral tibial cartilage over 4.5 years were 3.7 ± 4.7% (mean ± SD; 95% confidence interval 2.7 to 4.8%) and 4.4 ± 4.7% (mean ± SD; 95% confidence interval 3.4 to 5.5%), respectively. Cartilage volume in each individual seemed to track over the study period, relative to other study participants. After multivariate adjustment, annual medial tibial cartilage loss was predicted by lesser severity of baseline knee pain but was independent of age, body mass index and structural factors. No factors specified a priori were associated with lateral cartilage volume rates of change. Tibial cartilage declines at an average rate of 4% per year in subjects with symptomatic knee OA. There was evidence to support the concept that tracking occurs in OA. This may enable the prediction of cartilage change in an individual. The only significant factor affecting the loss of medial tibial cartilage was baseline knee pain, possibly through altered joint loading.     

Knee meniscal extrusion in a largely non-osteoarthritic cohort: association with greater loss of cartilage volume

We conducted a longitudinal study (duration 2 years), including 294 individuals (mean age 45 years, 58% female), in order to examine associations between meniscal extrusion, knee structure, radiographic changes and risk factors for osteoarthritis (OA) in a largely non-osteoarthritic cohort. Meniscal extrusion, tibiofemoral cartilage defect score and cartilage volume, and tibial plateau bone area were determined using T1-weighted fat-saturated magnetic resonance imaging. At baseline the presence of medial meniscal extrusion was significantly associated with body mass index (odds ratio [OR] per kg/m2 = 1.13, 95% confidence interval [CI] = 1.02-1.25), past knee injury (positive versus negative history: OR = 3.73, 95% CI = 1.16-11.97), medial tibial bone area (OR per cm2 = 1.37, 95% CI = 1.02-1.85), and osteophytes (OR per grade = 4.89, 95% CI = 1.59-15.02). Two-year longitudinal data revealed that medial meniscal extrusion at baseline was associated with a greater rate of loss of medial tibiofemoral cartilage volume (extrusion versus no extrusion: -1.4%/year; P < 0.05) and greater risk for increased medial femoral cartilage defects (OR = 2.59, 95% CI = 1.14-5.86) and lateral tibial cartilage defects (OR = 2.64, 95% CI = 1.03-6.76). However, the latter two associations became nonsignificant after adjustment for tibial bone area and osteophytes. This study suggests that increasing body mass index and bone size, past knee injury, and osteophytes may be causally related to meniscal extrusion. Most importantly, meniscal extrusion at baseline is associated with greater loss of knee cartilage over 2 years, and this seems to be mediated mostly by subchondral bone changes, suggesting extrusion represents one pathway between bone expansion and cartilage loss.