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Osteoarthritis is a condition in which low-grade inflammation results in joint pain, and it is the most common joint disease. Interactions between all of the major joint tissues, including the articular cartilage, synovium, bone marrow, subchondral bone, trabecular bone, and muscle, have been implicated in osteoarthritis. Magnetic resonance images have been used to quantify the cartilage morphology, volume and thickness, and focal defects, and may reflect changes in the biochemical composition of articular cartilage.

Objective Mechanical factors, in particular increased medial knee joint load, are believed to be important in the structural progression of knee osteoarthritis. This study evaluated the relationship of medial knee load during walking to indices of structural disease progression, measured on MRI, in people with medial knee osteoarthritis. Methods A longitudinal cohort design utilising a subset of participants (n=144, 72%) enrolled in a randomised controlled trial of lateral wedge insoles was employed. Medial knee load parameters including the peak knee adduction moment (KAM) and the KAM impulse were measured at baseline using three-dimensional gait analysis during walking. MRI at baseline and at 12 months was used to assess structural indices. Multiple regression with adjustment for covariates assessed the relationship between medial knee load parameters and the annual change in medial tibial cartilage volume. Binary logistic regression was used for the dichotomous variables of progression of medial tibiofemoral cartilage defects and bone marrow lesions (BML). Results A higher KAM impulse, but not peak KAM, at baseline was independently associated with greater loss of medial tibial cartilage volume over 12 months (β=29.9, 95% CI 6.3 to 53.5, p=0.01). No significant relationships were seen between medial knee load parameters and the progression of medial tibiofemoral cartilage defects or BML. Conclusion This study suggests knee loading, in particular the KAM impulse, may be a risk factor for loss of medial tibial cartilage volume. As knee load is modifiable, load-modifying treatments may potentially slow disease progression.

Objective To examine the association between medial meniscal extrusion and structural progression in adults with symptomatic knee osteoarthritis (OA). Methods This prospective cohort study examined 176 participants with symptomatic knee OA recruited into a randomised controlled trial. The participants underwent magnetic resonance imaging (MRI) of the study knee at baseline and approximately 2 years later. Meniscal extrusion, tibial cartilage volume, and tibiofemoral bone marrow lesions (BMLs) were measured from MRI using validated methods. Results Participants with medial meniscal extrusion ≥ 3 mm had a higher prevalence of lateral tibiofemoral BMLs at baseline (OR = 2.21, 95% CI 1.06–4.61, p  = 0.035), and those with medial meniscal extrusion 2–3 mm had a higher likelihood of lateral BML worsening over 2 years (OR = 3.76, 95% CI 1.35–10.52, p  = 0.011), compared with those with medial meniscal extrusion < 2 mm. Participants with stable medial meniscal extrusion had a lower likelihood of lateral BML worsening compared with those with regression of medial meniscal extrusion over 2 years (OR = 0.20, 95% CI 0.07–0.56, p  = 0.002). There were no associations between medial meniscal extrusion and tibial cartilage volume or medial tibiofemoral BMLs. Conclusions Our study showed associations between medial meniscal extrusion and baseline prevalence and worsening over 2 years of lateral tibiofemoral BMLs in people with symptomatic knee OA. Although the reasons for the lack of associations in the medial compartment are not clear, our results suggest a role of medial meniscal extrusion in predicting structural progression in lateral knee OA and that meniscal extrusion might be a potential target in the management of knee OA.

ObjectiveTo identify abnormalities in asymptomatic sedentary individuals using 3.0 Tesla high-resolution MRI.Materials and methodsThe cohort comprised of 230 knees of 115 uninjured sedentary adults (51 males, 64 females; median age: 44 years). All participants had bilateral knee 3.0 T MRIs. Two senior musculoskeletal radiologists graded all intraarticular knee structures using validated scoring systems. Participants completed Knee Injury and Osteoarthritis Outcome Score questionnaires at the time of the MRI scan.ResultsMRI showed abnormalities in the majority (97%) of knees. Thirty percent knees had meniscal tears: horizontal (23%), complex (3%), vertical (2%), radial (2%) and bucket handle (1%). Cartilage and bone marrow abnormalities were prevalent at the patellofemoral joint (57% knees and 48% knees, respectively). Moderate and severe cartilage lesions were common, in 19% and 31% knees, respectively, while moderate and severe bone marrow oedema in 19% and 31% knees, respectively. Moderate-intensity lesion in tendons was found in 21% knees and high-grade tendonitis in 6% knees—the patellar (11% and 2%, respectively) and quadriceps (7% and 2%, respectively) tendons being most affected. Three percent partial ligamentous ruptures were found, especially of the anterior cruciate ligament (2%).ConclusionNearly all knees of asymptomatic adults showed abnormalities in at least one knee structure on MRI. Meniscal tears, cartilage and bone marrow lesions of the patellofemoral joint were the most common pathological findings. Bucket handle and complex meniscal tears were reported for the first time in asymptomatic knees.

Knee osteoarthritis (KOA) represents a well-documented degenerative arthropathy prevalent among the elderly population. KOA is a persistent condition, also referred to as progressive joint Disease, stemming from the continual deterioration of cartilage. Predominantly afflicting individuals aged 45 and above, this ailment is commonly labeled as a “wear and tear” joint disorder, targeting joints such as the knee, hand, hips, and spine. Osteoarthritis symptoms typically increase gradually, contributing to the deterioration of articular cartilage. Prominent indicators encompass pain, stiffness, tenderness, swelling, and the development of bone spurs. Diagnosis typically involves the utilization of Radiographic X-ray images, Magnetic Resonance Imaging (MRI), and Computed Tomography (CT) Scan by medical professionals and experts. However, this conventional approach is time-consuming, and also sometimes tedious for medical professionals. In order to address the limitation of time and expedite the diagnostic process, deep learning algorithms have been implemented in the medical field. In the present investigation, four pre-trained models, specifically CNN, AlexNet, ResNet34 and ResNet-50, were utilized to predict the severity of KOA. Further, a Deep stack ensemble technique was employed to achieve optimal performance resulting to the accuracy of 99.71%.

ObjectivesPeripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement).Methods and resultsAfter literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging.ConclusionsOverall, white blood cell scintigraphy and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities for the diagnosis of PBI and PJI. However, the choice of which advanced diagnostic modality to use first depends on several factors, such as the benefit for the patient, local experience of imaging specialists, costs, and availability. Since robust, comparative studies among most tests do not exist, the proposed flowcharts are based not only on existing literature but also on the opinion of multiple experts involved on these topics.Key Points• For peripheral bone infection and prosthetic joint infection, white blood cell and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities.• Two evidence- and expert-based diagnostic flowcharts involving variable combination of laboratory tests, biopsy methods, and radiological and nuclear medicine imaging modalities are proposed by a multi-society expert panel.• Clinical application of these flowcharts depends on several factors, such as the benefit for the patient, local experience, costs, and availability.

Various types of cellular injection have become a popular and costly treatment option for patients with knee osteoarthritis despite a paucity of literature establishing relative efficacy to each other or corticosteroid injections. Here we aimed to identify the safety and efficacy of cell injections from autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction and allogeneic human umbilical cord tissue-derived mesenchymal stromal cells, in comparison to corticosteroid injection (CSI). The study was a phase 2/3, four-arm parallel, multicenter, single-blind, randomized, controlled clinical trial with 480 patients with a diagnosis of knee osteoarthritis (Kellgren–Lawrence II–IV). Participants were randomized to the three different arms with a 3:1 distribution. Arm 1: autologous bone marrow aspirate concentrate ( n  = 120), CSI ( n  = 40); arm 2: umbilical cord tissue-derived mesenchymal stromal cells ( n  = 120), CSI ( n  = 40); arm 3: stromal vascular fraction ( n  = 120), CSI ( n  = 40). The co-primary endpoints were the visual analog scale pain score and Knee injury and Osteoarthritis Outcome Score pain score at 12 months versus baseline. Analyses of our primary endpoints, with 440 patients, revealed that at 1 year post injection, none of the three orthobiologic injections was superior to another, or to the CSI control. In addition, none of the four groups showed a significant change in magnetic resonance imaging osteoarthritis score compared to baseline. No procedure-related serious adverse events were reported during the study period. In summary, this study shows that at 1 year post injection, there was no superior orthobiologic as compared to CSI for knee osteoarthritis. ClinicalTrials.gov Identifier: NCT03818737 The multicenter phase 3 trial of stem cell therapy for osteoarthritis (MILES) for knee pain revealed that cell therapies showed no significant difference in knee pain outcomes, compared to corticosteroid injections, 1 year following treatment.

BackgroundKnee MRI is increasingly used to inform clinical management. Features associated with osteoarthritis are often present in asymptomatic uninjured knees; however, the estimated prevalence varies substantially between studies. We performed a systematic review with meta-analysis to provide summary estimates of the prevalence of MRI features of osteoarthritis in asymptomatic uninjured knees.MethodsWe searched six electronic databases for studies reporting MRI osteoarthritis feature prevalence (ie, cartilage defects, meniscal tears, bone marrow lesions and osteophytes) in asymptomatic uninjured knees. Summary estimates were calculated using random-effects meta-analysis (and stratified by mean age: <40 vs ≥40 years). Meta-regression explored heterogeneity.ResultsWe included 63 studies (5397 knees of 4751 adults). The overall pooled prevalence of cartilage defects was 24% (95% CI 15% to 34%) and meniscal tears was 10% (7% to 13%), with significantly higher prevalence with age: cartilage defect <40 years 11% (6%to 17%) and ≥40 years 43% (29% to 57%); meniscal tear <40 years 4% (2% to 7%) and ≥40 years 19% (13% to 26%). The overall pooled estimate of bone marrow lesions and osteophytes was 18% (12% to 24%) and 25% (14% to 38%), respectively, with prevalence of osteophytes (but not bone marrow lesions) increasing with age. Significant associations were found between prevalence estimates and MRI sequences used, physical activity, radiographic osteoarthritis and risk of bias.ConclusionsSummary estimates of MRI osteoarthritis feature prevalence among asymptomatic uninjured knees were 4%–14% in adults aged <40 years to 19%–43% in adults ≥40 years. These imaging findings should be interpreted in the context of clinical presentations and considered in clinical decision-making.

Mesenchymal stem cells (MSCs) have been the focus of an emerging treatment for osteoarthritis. However, few studies reported about outcomes of an intra‐articular injection of autologous adipose‐derived mesenchymal stem cells (AD‐MSCs). This study aimed to assess the efficacy and safety of a single intra‐articular injection of AD‐MSCs for patients with knee osteoarthritis. It was a prospective double‐blinded, randomized controlled, phase IIb clinical trial. AD‐MSCs were administered for 12 patients (MSC group), and the group was compared with 12 knees with injection of normal saline (control group) up to 6 months. All procedures were performed in the outpatient clinic. Primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score. Secondary outcome measure included various clinical and radiologic examination, and safety after injection. Change of cartilage defect after injection was evaluated using magnetic resonance imaging (MRI). Single injection of AD‐MSCs led to a significant improvement of the WOMAC score at 6 months. In the control group, there was no significant change in the WOMAC score at 6 months. No serious adverse events were observed in both groups during the follow‐up period. In MRI, there was no significant change of cartilage defect at 6 months in MSC group whereas the defect in the control group was increased. An intra‐articular injection of autologous AD‐MSCs provided satisfactory functional improvement and pain relief for patients with knee osteoarthritis in the outpatient setting, without causing adverse events at 6 months' follow‐up. Larger sample size and long‐term follow‐up are required. Stem Cells Translational Medicine 2019;8:504–511 Autologous adipose‐derived mesenchymal stem cells (AD‐MSCs) were administered for 12 patients, and the group was compared with 12 knees with injection of normal saline up to 6 months. The procedures were performed in an outpatient clinic. An intra‐articular injection of autologous AD‐MSCs provided satisfactory functional improvement and pain relief in patients with knee osteoarthritis without causing adverse events at 6 months' follow‐up.

ObjectivesTo evaluate the diagnostic accuracy of dual-energy computed tomography (CT) virtual non-calcium (VNCa) reconstructions for the depiction of traumatic knee bone marrow edema.MethodsFifty-seven patients (mean age, 50 years; range, 20–82 years) with acute knee trauma further divided into 30 women and 27 men, who had undergone third-generation dual-source dual-energy CT and 3-T magnetic resonance imaging (MRI) within 7 days between January 2017 and May 2018, were retrospectively analyzed. Six radiologists, blinded to clinical and MRI information, independently analyzed conventional grayscale dual-energy CT series for fractures; after 8 weeks, readers evaluated color-coded VNCa reconstructions for the presence of bone marrow edema in six femoral and six tibial regions. Quantitative analysis of CT numbers on VNCa reconstructions was performed by a seventh radiologist. Two additional radiologists, blinded to clinical and CT information, analyzed MRI series in consensus to define the reference standard. Sensitivity, specificity, and the area under the curve (AUC) were the primary metrics of diagnostic accuracy.ResultsMRI revealed 197 areas with bone marrow edema (91/342 femoral, 106/342 tibial). In the qualitative analysis, VNCa showed high overall sensitivity (1108/1182 [94%]) and specificity (2789/2922 [95%]) for depicting bone marrow edema. The AUC was 0.96 (femur) and 0.97 (tibia). A cutoff value of − 51 Hounsfield units (HU) provided high sensitivity (102/106 [96%]) and specificity (229/236 [97%]) for differentiating tibial bone marrow edema.ConclusionsIn both quantitative and qualitative analyses, dual-energy CT VNCa reconstructions yielded excellent diagnostic accuracy for depicting traumatic knee bone marrow edema compared with MRI.Key Points• Dual-energy CT (DECT) virtual non-calcium (VNCa) reconstructions are highly accurate in depicting bone marrow edema of the femur and tibia.• Diagnostic confidence, image noise, and image quality were rated as equivalent in VNCa reconstructions and MRI (magnetic resonance imaging) series.• VNCa images may serve as an alternative imaging approach to MRI.