Publications by authors named "Ali Guermazi"

381 Publications

Wrist injuries detected on magnetic resonance imaging in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games.

Quant Imaging Med Surg 2021 Jul;11(7):3244-3251

Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.

Background: Traumatic and chronic overuse injuries of the wrist are common in athletes. The purpose of this study was to describe the frequency, anatomic distribution, and severity of MRI-detected wrist joint injuries amongst athletes who competed in the Rio de Janeiro 2016 Summer Olympics.

Methods: All sports injuries reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the 2016 Summer Olympics were analyzed. MRI was performed at the International Olympic Committee's polyclinic within the Olympic Village, using 3T and 1.5T scanners. The MRIs were interpreted by musculoskeletal radiologists with expertise in sports injuries. The distribution of wrist injuries by anatomic location and sports discipline and the severity of injuries were recorded.

Results: A total of 1,101 injuries were reported in the 11,274 athletes. Twenty-five athletes (72% male, median-age =27 years) had an MRI for wrist injuries. Fifty-six percent (N=14) of these athletes had triangular fibrocartilage pathology, 64% of which were chronic, while 36% were acute. There were scapholunate ligament injuries in 40% of the athletes. The extensor carpi ulnaris tendon was most commonly injured tendon. Fractures were seen in 32% of the athletes (N=8) and most commonly involved the scaphoid. Athletes participating in weightlifting (N=4, 16%), tennis (N=3, 12%) and gymnastics (N=3, 12%) athletes were most commonly affected.

Conclusions: MRI-detected wrist injuries during the 2016 Summer Olympics most commonly affected the scapholunate ligament, extensor carpi ulnaris tendon and triangular fibrocartilage articular disc. The highest occurrence of wrist injuries was in weightlifting, tennis and gymnastics.
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http://dx.doi.org/10.21037/qims-20-1121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250018PMC
July 2021

How to effectively utilize imaging in disease-modifying treatments for osteoarthritis clinical trials: the radiologist's perspective.

Expert Rev Mol Diagn 2021 Jul 3;21(7):673-684. Epub 2021 Jun 3.

Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.

: One of the reasons for failures of disease-modifying osteoarthritis drug clinical trials has been the radiography-based definition of structural eligibility criteria. Imaging, particularly MRI, has a critical role in planning and conducting clinical trials of osteoarthritis.: A literature search was performed using keywords including 'osteoarthritis,' 'knee,' 'MRI,' 'intra-articular injection,' 'semiquantitative scoring,' 'clinical trial,' and other specific terms where relevant. The core concepts of using MRI in osteoarthritis clinical trials are explained focusing on knee osteoarthritis, including its role in determining patient eligibility and inclusion/exclusion criteria as well as outcome measures from the expert musculoskeletal radiologist's perspective. A brief overview of statistical analyses that should be deployed in clinical trials utilizing semiquantitative MRI analyses is discussed.: In order to increase chances to detect measurable efficacy effects, investigators should consider utilizing MRI from screening to outcome assessment. Recognition of several phenotypes of osteoarthritis helps in participant stratification and will lead to more targeted clinical trials. Inclusion and exclusion criteria need to be defined using not only radiography but also MRI. Correct intra-articular injection of investigational compounds is critically important if intra-articular drug delivery is required, and such procedure should be performed and documented using appropriate imaging guidance.
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http://dx.doi.org/10.1080/14737159.2021.1933444DOI Listing
July 2021

Biochemical cartilage changes based on MRI-defined T2 relaxation times do not equal OA detection.

Proc Natl Acad Sci U S A 2021 Mar;118(11)

Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA 02118.

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http://dx.doi.org/10.1073/pnas.2023833118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980278PMC
March 2021

Deep learning approach to predict pain progression in knee osteoarthritis.

Skeletal Radiol 2021 Apr 9. Epub 2021 Apr 9.

Department of Radiology, New York University, New York, NY, USA.

Objective: To develop and evaluate deep learning (DL) risk assessment models for predicting pain progression in subjects with or at risk of knee osteoarthritis (OA).

Materials And Methods: The incidence and progression cohorts of the Osteoarthritis Initiative, a multi-center longitudinal study involving 9348 knees in 4674 subjects with or at risk of knee OA that began in 2004 and is ongoing, were used to conduct this retrospective analysis. A subset of knees without and with pain progression (defined as a 9-point or greater increase in pain score between baseline and two or more follow-up time points over the first 48 months) was randomly stratified into training (4200 knees with a mean age of 61.0 years and 60% female) and hold-out testing (500 knees with a mean age of 60.8 years and 60% female) datasets. A DL model was developed to predict pain progression using baseline knee radiographs. An artificial neural network was used to develop a traditional risk assessment model to predict pain progression using demographic, clinical, and radiographic risk factors. A combined model was developed to combine demographic, clinical, and radiographic risk factors with DL analysis of baseline knee radiographs. Area under the curve (AUC) analysis was performed using the hold-out testing dataset to evaluate model performance.

Results: The traditional model had an AUC of 0.692 (66.9% sensitivity and 64.1% specificity). The DL model had an AUC of 0.770 (76.7% sensitivity and 70.5% specificity), which was significantly higher (p < 0.001) than the traditional model. The combined model had an AUC of 0.807 (72.3% sensitivity and 80.9% specificity), which was significantly higher (p < 0.05) than the traditional and DL models.

Conclusions: DL models using baseline knee radiographs had higher diagnostic performance for predicting pain progression than traditional models using demographic, clinical, and radiographic risk factors.
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http://dx.doi.org/10.1007/s00256-021-03773-0DOI Listing
April 2021

MRI-defined Osteophyte Presence and Concomitant Cartilage Damage in Knees with Incident Tibiofemoral Osteoarthritis: Data From The Pivotal Osteoarthritis Initiative Magnetic Resonance Imaging Analyses (POMA) Study.

Arthritis Care Res (Hoboken) 2021 Mar 26. Epub 2021 Mar 26.

Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 820 Harrison Avenue, Boston, MA, 02118, USA.

Objective: To describe compartmental frequencies of MRI-defined osteophytes and co-localized cartilage damage and evaluate the associations of osteophyte (OP) size with any ipsicompartmental cartilage damage in knees with incident tibiofemoral radiographic knee osteoarthritis (ROA).

Methods: We evaluated knees from the Osteoarthritis Initiative without ROA at baseline that developed ROA during a 4-year interval. Semi-quantitative MRI scoring of osteophytes and cartilage damage was performed at the time point when ROA was diagnosed, defined as Kellgren-Lawrence grade ≥ 2, using the MOAKS instrument. The frequencies of maximum osteophyte size and maximum grade of ipsicompartmental (i.e., patellofemoral, medial tibiofemoral, lateral tibiofemoral, posterior femur) cartilage damage were assessed. Generalized estimating equations were used to determine the association of MRI-defined maximum osteophyte size with presence of any (excluding focal superficial defects) ipsicompartmental cartilage damage.

Results: 296 knees that did not have tibiofemoral ROA at the baseline visit but developed ROA during the 48- month observational period were included. In the patellofemoral, medial tibiofemoral and lateral tibiofemoral compartments, the most frequent OP grade was 1 (67.6%, 59.1% and 51.7%, respectively), and in the posterior femur it was 0 (51.7%). For all compartments except the posterior femur, a linear trend was found between increasing maximum OP size and the presence of any concomitant cartilage damage.

Conclusions: In this sample of knees with incident tibiofemoral ROA, the patellofemoral joint showed more severe cartilage damage than other compartments regardless of concomitant osteophyte size. In the posterior femur, cartilage damage was rare despite the presence or size of concomitant osteophytes.
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http://dx.doi.org/10.1002/acr.24605DOI Listing
March 2021

Can MRI-defined osteoarthritis features explain anterior knee pain in individuals with, or at risk for, knee osteoarthritis? The MOST Study.

Arthritis Care Res (Hoboken) 2021 Mar 25. Epub 2021 Mar 25.

University of Delaware, (Department of Physical Therapy), Newark, USA.

Objective: The lack of strong association between knee osteoarthritis (OA) structural features and pain continues to perplex researchers and clinicians. Evaluating the patellofemoral joint in addition to the tibiofemoral joint alone has contributed to explaining this structure-pain discordance, hence justifying a more comprehensive evaluation of whole-knee OA and pain. We therefore evaluated the association between patellofemoral and tibiofemoral OA features with localized anterior knee pain (AKP) using two study designs.

Methods: Using cross-sectional data from the Multicenter Osteoarthritis Study, our first approach was a within-person, knee-matched design in which we identified participants with unilateral AKP. We then assessed MRI-derived OA features (cartilage damage, bone marrow lesions [BMLs], osteophytes, and inflammation) in both knees, and evaluated the association of patellofemoral and tibiofemoral OA features to unilateral AKP. In our second approach, MRIs from one knee per person were scored, and we evaluated the association of OA-features to AKP in participants with AKP and participants with no frequent knee pain.

Results: Using the first approach (n=71, 66% women, mean age 69 [SD 8] years), lateral patellofemoral osteophytes (odds ratio 5.0 [95% CI 1.7, 14.6]), whole-knee joint effusion-synovitis (4.7 [1.3, 16.2]), and infrapatellar synovitis (2.8 [1.0, 7.8]) were associated with AKP. Using the second approach (n=882, 59% women, mean age 69 [SD 7] years), lateral and medial patellofemoral cartilage damage (prevalence ratio 2.3 [1.3, 4.0] and 1.9 [1.1, 3.3]), and lateral patellofemoral BMLs (2.6 [1.5, 4.7]) were associated with AKP.

Conclusion: Patellofemoral but not tibiofemoral joint OA features, and inflammation were associated with AKP.
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http://dx.doi.org/10.1002/acr.24604DOI Listing
March 2021

MRI-Detected Knee Ligament Sprains and Associated Internal Derangement in Athletes Competing at the Rio de Janeiro 2016 Summer Olympics.

Open Access J Sports Med 2021 8;12:23-32. Epub 2021 Mar 8.

Department of Radiology, Boston University School of Medicine, Boston, MA, USA.

Purpose: Describe the frequency and severity of knee ligament sprains diagnosed by MRI in athletes participating at the 2016 Summer Olympic Games, their association with certain sports and assess correlations with additional knee structural injury.

Patients And Methods: All knee MRIs performed in the Olympic Village and polyclinics during the 2016 Olympics were retrospectively, blindly reviewed for ligament sprains and associated knee injuries. In addition to the absence or presence of these abnormalities, athletes were stratified by age, gender and sport.

Results: 11,274 athletes participated in the 2016 Olympic Games: 113 athletes received at least one knee MRI with some having bilateral or repeat MRI on the same knee. Anterior cruciate and medial collateral ligament (ACL/MCL) sprains were most common, accounting for 32 of the 43 sprains (74.4%). Wrestling (10), hockey (7), athletics (7), and judo (5) accounted for over half of ligament sprains. ACL sprains showed a significant positive correlation with medial, lateral meniscal tears and bone contusions. The positive correlation between posterior cruciate ligament (PCL) sprains with MCL/lateral collateral ligament sprain, and popliteus tendon tear was statistically significant with 50% of total PCL sprains occurring in hockey. When athletes were stratified by gender, ligament sprains had a similar occurrence and distribution between men and women.

Conclusion: Knee ligament sprains, at the Rio 2016 Games, were most common in wrestling, hockey, athletics and judo with ACL and MCL sprains most frequent. Meniscal tears and bone contusions occurred often with ACL sprains. PCL sprains tended to be multi-ligamentous injuries. Sustained ligament sprains had similar occurrence between genders, while men had a peak incidence of sprains at a younger age and women at an older age.
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http://dx.doi.org/10.2147/OAJSM.S292763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955024PMC
March 2021

Development of MRI-defined Structural Tissue Damage after Anterior Cruciate Ligament Injury over 5 Years: The KANON Study.

Radiology 2021 05 9;299(2):383-393. Epub 2021 Mar 9.

From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.).

Background MRI is used to evaluate structural joint changes after anterior cruciate ligament (ACL) injury, but no long-term data are available for comparing different treatment approaches. Purpose To describe structural joint damage with MRI over a 5-year period in the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) study and to compare frequencies of such tissue damage for a nonsurgical versus a surgical treatment strategy. Materials and Methods In this secondary analysis of a prospective trial (ISRCTN 84752559), 119 participants with an acute ACL injury were evaluated. Participants were enrolled from 2002 through 2006, the 2-year follow-up started in 2008, and the 5-year follow-up started in 2011. A 1.5-T MRI examination was performed at baseline and at 2- and 5-year follow-up. MRI scans were read according to a validated scoring instrument. Kruskal-Wallis tests were used to assess whether the frequencies of structural damage differed between the three as-treated groups. Results Of 119 participants (mean age, 26 years ± 5 [standard deviation]), 91 men were evaluated. At 2- and 5-year follow-up, respectively, 13% (15 of 117) and 13% (15 of 115) of knees showed incident cartilage damage in the medial tibiofemoral joint, 11% (13 of 117) and 17% (20 of 115) of knees showed incident cartilage damage in the lateral tibiofemoral joint, and 4% (five of 117) and 8% (nine of 115) of knees showed incident cartilage damage in the patellofemoral joint. Osteophyte development was seen in 23% (27 of 117) and 29% (33 of 115) of knees in the medial tibiofemoral joint, in 36% (42 of 117) and 43% (49 of 115) of knees in the lateral tibiofemoral joint, and in 35% (41 of 117) and 37% (42 of 115) of knees in the patellofemoral joint. No major differences between the groups were found for incident or worsening cartilage damage, bone marrow lesions, and osteophytes at 2 or 5 years. The rehabilitation-alone group showed less Hoffa-synovitis at 2 ( = .02) and 5 ( = .008) years. Conclusion Young adults with anterior cruciate ligament injury showed no major difference in frequency of structural tissue damage on MRI scans at 2 and 5 years regardless of treatment. However, the rehabilitation-alone group had less inflammation at 2 and 5 years. © RSNA, 2021 See also the editorial by Andreisek in this issue.
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http://dx.doi.org/10.1148/radiol.2021202954DOI Listing
May 2021

Association between Patellofemoral and medial Tibiofemoral compartment osteoarthritis progression: exploring the effect of body weight using longitudinal data from osteoarthritis initiative (OAI).

Skeletal Radiol 2021 Sep 8;50(9):1845-1854. Epub 2021 Mar 8.

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3142, Baltimore, MD, 21287, USA.

Objectives: To investigate the associations of medial and lateral patellofemoral osteoarthritis (PF-OA) at baseline with symptomatic and radiographic OA outcomes in the medial tibiofemoral compartment (MTFC) over 4 years, according to baseline overweight status.

Methods: Data and MRI images of 600 subjects in the FNIH-OA biomarkers consortium were used. Symptomatic worsening and radiographic progression of MTFC-OA were defined using Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores and MTFC joint space narrowing (JSN) from baseline to 4-year follow-up. Baseline MRIs were read to establish PF-OA diagnosis. The association between baseline regional PF-OA pattern and odds for MTFC-OA progression was evaluated using regression models (adjusted for relevant confounding covariates including body mass index (BMI), age, sex, PF alignment measurements, KL grade, and knee alignment). To evaluate the effect modifying role for overweight status, stratification analysis was performed (BMI ≥ 25 vs. < 25 kg/m).

Results: At baseline, 340 (56.7%), 255 (42.5%), and 199 (33.2%) subjects had OA in the medial, lateral, and both PF compartments. Baseline medial PF-OA was associated with WOMAC pain score and MTFC JSN progression at 4 years (Adjusted OR:1.56[95%CI:1.09-2.23] and 1.59[1.11-2.28], respectively) but not lateral PF-OA. In stratification analysis, overweight status was found to be an effect modifier for medial PF-OA and WOMAC pain (OR in overweight vs. non-overweight subjects:1.65[1.13-2.42] vs. 0.50[0.12-1.82]) as well as MTFC-JSN progression (1.63[1.12-2.4] vs. 0.75[0.19-2.81]).

Conclusions: In addition to the known confounding effect of BMI for PF-OA and MTFC-OA, the overweight status may also play an effect modifier role in the association between baseline medial PF-OA and MTFC-OA progression, which is amenable to secondary prevention.
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http://dx.doi.org/10.1007/s00256-021-03749-0DOI Listing
September 2021

Sports injuries at the Rio de Janeiro 2016 Summer Paralympic Games: use of diagnostic imaging services.

Eur Radiol 2021 Mar 3. Epub 2021 Mar 3.

Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.

Objective: To describe the occurrence of imaging-depicted sports-related injuries (bone, muscle, tendon, and ligament injuries) during the Rio 2016 Summer Paralympic Games.

Methods: Descriptive data on all imaging examinations by using radiography, ultrasonography (US), and MRI were collected and retrospectively analyzed centrally by five musculoskeletal radiologists according to imaging modality, country of origin of the athletes, type of sport, type of disability, and type and location of injury.

Results: We report 109 injuries in 4378 athletes. A total of 382 radiologic examinations were performed in 261 athletes, including 118 (31%) radiographic, 22 (6%) US, and 242 (63%) MRI examinations. Para athletes from Africa had the highest utilization rate (20.1%, 67 out of 333). Athletes from Europe underwent the most examinations with 29 radiographic, 12 US, and 66 MRI examinations. The highest utilization rate of imaging modalities by sport was among Judo para athletes (16.7%, 22 out of 132). Most injuries were reported in athletics discipline (37.6%, 41 out of 109). Most injuries were also reported among para athletes with visual impairment (40 injuries, 36.7% of all injuries). Bone stress injuries were most common among para athletes with visual impairment (6 out of 7). Para athletes with visual impairment were also more prone to bone stress injuries than traumatic fractures, unlike para athletes with neurologic and musculoskeletal impairments.

Conclusions: Imaging was used in 6.0% of para athletes. MRI comprised 63% of imaging utilization. Identification of patterns of injuries may help building future prevention programs in elite para athletes.

Key Points: • The highest imaging utilization rates were found among para athletes competing in Judo, sitting volleyball, powerlifting, and football. • Utilization of diagnostic imaging at the Rio 2016 Paralympic Games demonstrated similar trends to what was observed at the Rio 2016 Olympic Games. • Comparison of the rate of imaging-depicted injuries between Olympic and Paralympic athletes is limited due to inherent differences between the two athlete populations and the manner in which injury risk in the Paralympic athlete varies dependent on impairment type, which is not the case for the Olympic athlete.
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http://dx.doi.org/10.1007/s00330-021-07802-3DOI Listing
March 2021

Association Between Baseline "Meniscal symptoms" and Outcomes of Operative and Non-Operative Treatment of Meniscal Tear in Patients with Osteoarthritis.

Arthritis Care Res (Hoboken) 2021 Mar 1. Epub 2021 Mar 1.

Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States.

Objective: Patients with meniscal tears reporting "meniscal symptoms" such as catching or locking, have traditionally undergone arthroscopy. We investigated whether patients with meniscal tears who report "meniscal symptoms" have greater improvement with arthroscopic partial meniscectomy (APM) than physical therapy (PT).

Methods: We used data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, which randomized participants with knee osteoarthritis (OA) and meniscal tear to APM or PT. The frequency of each "meniscal symptom" (clicking, catching, popping, intermittent locking, giving way, swelling) was measured at baseline and 6-months. We used linear regression models to determine whether the difference in improvement in KOOS Pain at 6-months between those treated with APM versus PT was modified by the presence of each "meniscal symptom". We also determined the percent of participants with resolution of "meniscal symptoms" by treatment group.

Results: We included 287 participants. The presence (vs. absence) of any of the "meniscal symptoms" did not modify the improvement in KOOS Pain between APM vs. PT by more than 0.5 SD (all p-interaction >0.05). APM led to greater resolution of intermittent locking and clicking than PT (locking 70% vs 46%, clicking 41% vs 25%). No difference in resolution of the other "meniscal symptoms" was observed.

Conclusion: "Meniscal symptoms" were not associated with improved pain relief. Although symptoms of clicking and intermittent locking had a greater reduction in the APM group, the presence of "meniscal symptoms" in isolation should not inform clinical decisions surrounding APM vs. PT in patients with meniscal tear and knee OA.
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http://dx.doi.org/10.1002/acr.24588DOI Listing
March 2021

Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults With Knee Osteoarthritis: The START Randomized Clinical Trial.

JAMA 2021 02;325(7):646-657

Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill.

Importance: Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. Little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis or whether it may worsen knee symptoms.

Objective: To determine whether high-intensity strength training reduces knee pain and knee joint compressive forces more than low-intensity strength training and more than attention control in patients with knee osteoarthritis.

Design, Setting, And Participants: Assessor-blinded randomized clinical trial conducted at a university research center in North Carolina that included 377 community-dwelling adults (≥50 years) with body mass index (BMI) ranging from 20 to 45 and with knee pain and radiographic knee osteoarthritis. Enrollment occurred between July 2012 and February 2016, and follow-up was completed September 2017.

Interventions: Participants were randomized to high-intensity strength training (n = 127), low-intensity strength training (n = 126), or attention control (n = 124).

Main Outcomes And Measures: Primary outcomes at the 18-month follow-up were Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) knee pain (0 best-20 worst; minimally clinically important difference [MCID, 2]) and knee joint compressive force, defined as the maximal tibiofemoral contact force exerted along the long axis of the tibia during walking (MCID, unknown).

Results: Among 377 randomized participants (mean age, 65 years; 151 women [40%]), 320 (85%) completed the trial. Mean adjusted (sex, baseline BMI, baseline outcome values) WOMAC pain scores at the 18-month follow-up were not statistically significantly different between the high-intensity group and the control group (5.1 vs 4.9; adjusted difference, 0.2; 95% CI, -0.6 to 1.1; P = .61) or between the high-intensity and low-intensity groups (5.1 vs 4.4; adjusted difference, 0.7; 95% CI, -0.1 to 1.6; P = .08). Mean knee joint compressive forces were not statistically significantly different between the high-intensity group and the control group (2453 N vs 2512 N; adjusted difference, -58; 95% CI, -282 to 165 N; P = .61), or between the high-intensity and low-intensity groups (2453 N vs 2475 N; adjusted difference, -21; 95% CI, -235 to 193 N; P = .85). There were 87 nonserious adverse events (high-intensity, 53; low-intensity, 30; control, 4) and 13 serious adverse events unrelated to the study (high-intensity, 5; low-intensity, 3; control, 5).

Conclusions And Relevance: Among patients with knee osteoarthritis, high-intensity strength training compared with low-intensity strength training or an attention control did not significantly reduce knee pain or knee joint compressive forces at 18 months. The findings do not support the use of high-intensity strength training over low-intensity strength training or an attention control in adults with knee osteoarthritis.

Trial Registration: ClinicalTrials.gov Identifier: NCT01489462.
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http://dx.doi.org/10.1001/jama.2021.0411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887656PMC
February 2021

Long-Term Safety and Efficacy of Subcutaneous Tanezumab Versus Nonsteroidal Antiinflammatory Drugs for Hip or Knee Osteoarthritis: A Randomized Trial.

Arthritis Rheumatol 2021 Jul 7;73(7):1167-1177. Epub 2021 Jun 7.

Pfizer, Inc., Groton, Connecticut.

Objective: To assess the long-term safety and 16-week efficacy of subcutaneous tanezumab in patients with hip or knee osteoarthritis (OA).

Methods: This was a phase III randomized, double-blind, active treatment-controlled (using nonsteroidal antiinflammatory drugs [NSAIDs] as the active treatment control) safety trial of tanezumab (56-week treatment/24-week posttreatment follow-up) in adults who were receiving stable-dose NSAID therapy at the time of screening and who had Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function scores of ≥5; patient global assessment (PtGA) of OA of fair, poor, or very poor; history of inadequate pain relief with standard analgesics; and no history or radiographic evidence of prespecified bone/joint conditions beyond OA. Patients received oral naproxen, celecoxib, or diclofenac twice daily (NSAID group; n = 996) or tanezumab 2.5 mg (n = 1,002) or 5 mg (n = 998) subcutaneously every 8 weeks. Coprimary efficacy end points at week 16 were changes in WOMAC pain and physical function scores and changes in PtGA. The primary joint safety end point over 80 weeks comprised adjudicated rapidly progressive OA type 1 or 2, primary osteonecrosis, subchondral insufficiency fracture, or pathologic fracture. Mean values, least squares mean values, and least squares mean differences between groups (with 95% confidence intervals [95% CIs]) were calculated.

Results: Of 3,021 randomized patients, 2,996 received ≥1 treatment dose. Adverse events (AEs) were similar between patients treated with tanezumab 2.5 mg and those treated with NSAIDs, and were more prevalent in those treated with tanezumab 5 mg. Composite joint safety events were significantly more prevalent with tanezumab 2.5 mg and tanezumab 5 mg than with NSAIDs (observation time-adjusted rate/1,000 patient-years 38.3 [95% CI 28.0, 52.5] and 71.5 [95% CI 56.7, 90.2], respectively, versus 14.8 [95% CI 8.9, 24.6]; P = 0.001 for tanezumab 2.5 mg versus NSAIDs; P < 0.001 for tanezumab 5 mg versus NSAIDs). Tanezumab 5 mg significantly improved pain and physical function but did not improve PtGA at week 16 when compared to NSAIDs; corresponding differences between the tanezumab 2.5 mg and NSAID groups were not statistically significant.

Conclusion: In patients previously receiving a stable dose of NSAIDs, tanezumab administered subcutaneously resulted in more joint safety events than continued NSAIDs, with differences being dose dependent. Pain and physical function improved with both doses of tanezumab compared to NSAIDs, reaching statistical significance with tanezumab 5 mg at 16 weeks.
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http://dx.doi.org/10.1002/art.41674DOI Listing
July 2021

Presence of MRI-defined inflammation particularly in overweight and obese women increases risk of radiographic knee osteoarthritis: the POMA Study.

Arthritis Care Res (Hoboken) 2021 Feb 2. Epub 2021 Feb 2.

Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, S700 Biomedical Science Tower, 3500 Terrace Street, Pittsburgh, PA, 15261, USA.

Objective: Aims were to assess 1.) whether odds for incident radiographic osteoarthritis (ROA) differ between men and women in regard to body mass index (BMI) and inflammatory magnetic resonance imaging (MRI) markers one and two years prior and 2.) whether presence of inflammation on MRI differs between normal-weight, and overweight/obese persons that develop ROA up to four years prior.

Methods: We studied 355 knees from the Osteoarthritis Initiative study that developed incident ROA and 355 matched controls. MRIs were read for effusion-synovitis and Hoffa-synovitis for up to four consecutive annual time points. Subjects were classified as normal-weight (BMI < 25), overweight (BMI ≥25/<30) or obese (BMI ≥30). Conditional logistic regression was used to assess odds of incident ROA for effusion-synovitis and Hoffa-synovitis at one and two years prior ROA incidence (i.e. "P-1" and "P-2") considering BMI category. Bivariate logistic regression was used to assess odds of inflammation for cases only.

Results: 178 (25.1%) participants were normal-weight, 283 (39.9%) overweight and 249 (35.1%) obese. At P-2 being overweight with Hoffa-synovitis (OR 3.26, 95%CI 1.39,7.65) or effusion-synovitis (3.56, 95%CI 1.45,8.75) was associated with greater odds of incident ROA in women. For those with incident ROA there were no increased odds of synovitis in the overweight/obese subgroup for most time points but increased odds for effusion-synovitis were observed at P-2 (OR 2.21, 95%CI 1.11,4.43).

Conclusions: Presence of inflammatory markers seems to play a role especially in overweight women while obese women have increased odds for ROA also in the absence of these markers.
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http://dx.doi.org/10.1002/acr.24568DOI Listing
February 2021

Beirut port explosion: unusual presentation of bilateral blast-related extensor mechanism rupture.

Skeletal Radiol 2021 Jul 27;50(7):1479-1483. Epub 2021 Jan 27.

Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 32 Fruit Street, YAW-6044, Boston, MA, 02114, USA.

Industrial disasters related to high-order explosives result in characteristic injuries that are seldom seen among civilians. Survivors of these disasters often present with injuries of the musculoskeletal system. Awareness of explosion and blast injuries for healthcare providers who care for civilians is important considering the possibility of such events as demonstrated in the past two decades, including the Boston Marathon bombing in 2013 and the explosion of the port of Tianjin, China, in 2015. We report an unusual presentation of isolated bilateral rupture of the knee extensor mechanism in a 46-year-old healthy male, with history of anabolic androgen steroid (AAS) use. He was standing 1.5 miles from the site of the site of explosion of the port of Beirut on August 4, 2020. We discuss the imaging appearance of this injury, the different mechanisms of blast-related injuries, the role of possible underlying pathology, and the management of this patient.
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http://dx.doi.org/10.1007/s00256-020-03707-2DOI Listing
July 2021

Serum uric acid and knee osteoarthritis in community residents without gout: a longitudinal study.

Rheumatology (Oxford) 2021 Jan 25. Epub 2021 Jan 25.

Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.

Objectives: Emerging evidence suggests a potential link between osteoarthritis (OA) and gout; however, the association between serum uric acid (UA) itself and knee OA remains uncertain due to a lack of longitudinal studies. Here, we investigated the association between serum UA and knee OA according to cartilage status in elderly community residents without gout.

Methods: In this longitudinal study, participants without a history of gout were recruited from among the Korean cohort of the Hallym Aging Study (n = 296 for radiography study and n = 223 for MRI study). Weight-bearing knee radiographs and 1.5-T MRI scans, along with blood collection for analysis of serum UA, were performed at baseline and after 3 years. The severity and structural progression of knee OA were evaluated using the Kellgren-Lawrence grading system and the Whole-Organ MRI Score (WORMS) cartilage scoring method. Multivariable logistic regression analysis was conducted using generalized estimating equation (GEE) models.

Results: Serum UA levels were not associated with radiographic progression after adjusting for age, sex, and body mass index (BMI). There was no significant association between serum UA and tibiofemoral cartilage loss on MRI. However, baseline serum UA levels were negatively associated with patellofemoral cartilage loss over 3 years (adjusted odd ratio 0.70, 95% confidence interval 0.49-0.98).

Conclusion: In this population-based cohort, serum UA was not a risk factor for knee OA progression. Further large-scale longitudinal studies in other populations are needed to validate the effects of UA on cartilage damage.
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http://dx.doi.org/10.1093/rheumatology/keab048DOI Listing
January 2021

Infrapatellar fat pad volume and Hoffa-synovitis after ACL reconstruction: Association with early osteoarthritis features and pain over 5 years.

J Orthop Res 2021 Jan 17. Epub 2021 Jan 17.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.

Infrapatellar fat pad (IPFP) morphology and Hoffa-synovitis may be relevant to the development and progression of post-traumatic osteoarthritis (OA). We aimed to compare IPFP volume and Hoffa-synovitis in participants with anterior cruciate ligament reconstruction (ACLR) and uninjured controls, and to determine their association with prevalent and worsening early knee OA features and pain in participants post-ACLR. We assessed IPFP volume and Hoffa-synovitis from magnetic resonance imaging (MRI) in 111 participants 1-year post-ACLR and 20 uninjured controls. Patellofemoral and tibiofemoral cartilage and bone marrow lesions (BMLs) were assessed from MRIs at 1 and 5 years post-ACLR, and worsening defined as any longitudinal increase in lesion size/severity. IPFP volume and Hoffa-synovitis prevalence were compared between groups with analysis of covariance and χ tests, respectively. Generalized linear models assessed the relation of IPFP volume and Hoffa-synovitis to prevalent and worsening features of OA and knee pain (Knee injury and Osteoarthritis Outcome Score-Pain Subscale, Anterior Knee Pain Scale). No significant between-group differences were observed in IPFP volume (ACLR 34.39 ± 7.29cm , Control 34.27 ± 7.56cm ) and Hoffa-synovitis (ACLR 61%, Control 80%). Greater IPFP volume at 1-year post-ACLR was associated with greater odds of patellofemoral BMLs at 1-year (odds ratio [OR] [95% confidence intervals]: 1.104 [1.016, 1.200]) and worsening tibiofemoral cartilage lesions at 5-year post-ACLR (OR: 1.234 [1.026, 1.483]). Hoffa-synovitis at 1-year post-ACLR was associated with greater odds of worsening patellofemoral BMLs at 5-year post-ACLR (OR: 7.465 [1.291, 43.169]). In conclusion, IPFP volume and Hoffa-synovitis prevalence are similar between individuals 1-year post-ACLR and controls. Greater IPFP volume and Hoffa-synovitis appear to be associated with the presence and worsening of some early OA features in those post-ACLR, but not pain.
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http://dx.doi.org/10.1002/jor.24987DOI Listing
January 2021

Bone Structure Analysis of the Radius Using Ultrahigh Field (7T) MRI: Relevance of Technical Parameters and Comparison with 3T MRI and Radiography.

Diagnostics (Basel) 2021 Jan 12;11(1). Epub 2021 Jan 12.

Department of Radiology, Friedrich Alexander University Erlangen-Nürnberg (FAU) & Universitätsklinikum Erlangen, 91054 Erlangen, Germany.

Bone fractal signature analysis (FSA-also termed bone texture analysis) is a tool that assesses structural changes that may relate to clinical outcomes and functions. Our aim was to compare bone texture analysis of the distal radius in patients and volunteers using radiography and 3T and 7T magnetic resonance imaging (MRI)-a patient group ( = 25) and a volunteer group ( = 25) were included. Participants in the patient group had a history of chronic wrist pain with suspected or confirmed osteoarthritis and/or ligament instability. All participants had 3T and 7T MRI including T1-weighted turbo spin echo (TSE) sequences. The 7T MRI examination included an additional high-resolution (HR) T1 TSE sequence. Radiographs of the wrist were acquired for the patient group. When comparing patients and volunteers (unadjusted for gender and age), we found a statistically significant difference of horizontal and vertical fractal dimensions (FDs) using 7T T1 TSE-HR images in low-resolution mode (horizontal: = 0.04, vertical: = 0.01). When comparing radiography to the different MRI sequences, we found a statistically significant difference for low- and high-resolution horizontal FDs between radiography and 3T T1 TSE and 7T T1 TSE-HR. Vertical FDs were significantly different only between radiographs and 3T T1 TSE in the high-resolution mode; FSA measures obtained from 3T and 7T MRI are highly dependent on the sequence and reconstruction resolution used, and thus are not easily comparable between MRI systems and applied sequences.
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http://dx.doi.org/10.3390/diagnostics11010110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826934PMC
January 2021

Multivariable modeling of biomarker data from the phase 1 Foundation for the NIH Osteoarthritis Biomarkers Consortium.

Arthritis Care Res (Hoboken) 2021 Jan 9. Epub 2021 Jan 9.

Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.

Objective: To determine the optimal combination of imaging and biochemical biomarkers to predict knee osteoarthritis (OA) progression.

Methods: Nested case-control study from the FNIH OA Biomarkers Consortium of participants with Kellgren-Lawrence grade 1-3 and complete biomarker data (n=539 to 550). Cases were knees with radiographic and pain progression between 24-48 months from baseline. Radiographic progression only was assessed in secondary analyses. Biomarkers (baseline and 24-month changes) with p<0.10 in univariate analysis were selected, including MRI (quantitative (Q) cartilage thickness and volume; semi-quantitative (SQ) MRI markers; bone shape and area; Q meniscal volume), radiographic (trabecular bone texture (TBT)), and serum and/or urine biochemical markers. Multivariable logistic regression models were built using three different step-wise selection methods (complex vs. parsimonious models).

Results: Among baseline biomarkers, the number of locations affected by osteophytes (SQ), Q central medial femoral and central lateral femoral cartilage thickness, patellar bone shape, and SQ Hoffa-synovitis predicted progression in most models (C-statistics 0.641-0.671). 24-month changes in SQ MRI markers (effusion-synovitis, meniscal morphology, and cartilage damage), Q central medial femoral cartilage thickness, Q medial tibial cartilage volume, Q lateral patellofemoral bone area, horizontal TBT (intercept term), and urine NTX-I predicted progression in most models (C-statistics 0.680-0.724). A different combination of imaging and biochemical biomarkers (baseline and 24-month change) predicted radiographic progression only, with higher C-statistics (0.716-0.832).

Conclusion: This study highlights the combination of biomarkers with potential prognostic utility in OA disease-modifying trials. Properly qualified, these biomarkers could be used to enrich future trials with participants likely to progress.
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http://dx.doi.org/10.1002/acr.24557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267050PMC
January 2021

Lateral patellar tilt and its longitudinal association with patellofemoral osteoarthritis-related structural damage: Analysis of the osteoarthritis initiative data.

Knee 2020 Dec 25;27(6):1971-1979. Epub 2020 Nov 25.

Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.

Background: Increase in lateral patellar tilt-(LPT) can cause increased pressure on the lateral facet of the knee and can lead to patellar or femoral cartilage damage and further osseous changes. This study aims to test the hypothesis whether there is an association between increased LPT and MRI-based patellofemoral osteoarthritis-(OA) features at baseline and their worsening over a 2-year follow-up in participants of the Osteoarthritis Initiative-(OAI).

Methods: Recorded clinical and imaging data of 600 participants in the FNIH-OA biomarkers consortium was extracted from its database. The LPT-(as the angle betweenthe longest patella diameter and posterior aspect of condyles) was measured using theaxial knee MRI. Associations of LPT (every 5° increase) with MRI OA Knee Scoring-(MOAKS) for OA-related features, including cartilage and bone marrow lesions (BMLs) in addition to knee cartilage volume at baseline and their worsening after 2-year follow-up were assessed using regression models adjusted for several possible confounders.

Results: The mean LPT angle in this sample was 8.84° ± 5.19. In baseline, higher LPT was associated with lower cartilage volumes and higher cartilage lesions and BMLs MOAKS scores in the lateral trochlear and patellar subregions. Over the follow-ups, subjects with higher LPT measures in the baseline showed higher odds of experiencing BML score worsening in the lateral trochlear subregion-(OR:1.25[1.01-1.56]) over the 2-year follow-ups.

Conclusions: Increase in LPT measures may be associated with OA-related features in the trochlear subregion. Therefore, aside from its use as an indicator of patellofemoral instability syndrome, LPT may be associated with longitudinal progression of patellofemoral OA.
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http://dx.doi.org/10.1016/j.knee.2020.11.002DOI Listing
December 2020

Conventional MRI-based subchondral trabecular biomarkers as predictors of knee osteoarthritis progression: data from the Osteoarthritis Initiative.

Eur Radiol 2021 Jun 25;31(6):3564-3573. Epub 2020 Nov 25.

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC, Baltimore, MD, 21287, USA.

Objectives: To evaluate the reliability and validity of measuring subchondral trabecular biomarkers in "conventional" intermediate-weighted (IW) MRI sequences and to assess the predictive value of biomarker changes for predicting near-term symptomatic and structural progressions in knee osteoarthritis (OA).

Methods: For this study, a framework for measuring trabecular biomarkers in the proximal medial tibia in the "conventional" IW MRI sequence was developed. The reliability of measuring these biomarkers (trabecular thickness [cTbTh], spacing [cTbSp], connectivity density [cConnD], and bone-to-total volume ratio [cBV/TV]) was evaluated in the Bone Ancillary Study (within the Osteoarthritis Initiative [OAI]). The validity of these measurements was assessed by comparing to "apparent" biomarkers (from high-resolution steady-state MRI sequence) and peri-articular bone marrow density (BMD, from dual-energy X-ray absorptiometry). The association of these biomarker changes from baseline to 24 months (using the Reliable Change Index) with knee OA progression was studied in the FNIH OA Biomarkers Consortium (within the OAI). Pain and radiographic progression were evaluated by comparing baseline WOMAC pain score and radiographic joint space width with the 24-to-48-month scores/measurements. Associations between biomarker changes and these outcomes were studied using logistic regression adjusted for the relevant covariates.

Results: With acceptable reliability, the cTbTh and cBV/TV, but not cTbSp or cConnD, were modestly associated with the "apparent" biomarkers and peri-articular BMD (β: 1.10 [95% CI: 0.45-1.75], p value: 0.001 and β: 3.69 [95% CI: 2.56-4.83], p value: < 0.001, respectively). Knees with increased cTbTh had higher (OR: 1.44 [95% CI: 1.03-2.02], p value: 0.035) and knees with decreased cTbTh (OR: 0.69 [95% CI: 0.49-0.95], p value: 0.026) or decreased cBV/TV (OR: 0.67 [95% CI: 0.48-0.93], p value: 0.018) had lower odds of experiencing OA pain progression over the follow-ups.

Conclusions: Measurement of certain "conventional" MRI-based subchondral trabecular biomarkers has high reliability and modest validity. Though modest, there are significant associations between these biomarker changes and knee OA pain progression up to 48-month follow-up.

Key Points: • Despite the lower spatial resolution than what is required to accurately study the subchondral trabecular microstructures, the "conventional" IW MRI sequences may retain adequate information that allows quantification of trabecular microstructure biomarkers. • Subchondral trabecular biomarkers obtained from "conventional" IW MRI sequences (i.e., cTbTh, cTbSp, and cBV/TV) are reliable and valid measures of trabecular microstructure changes compared to those from "apparent" trabecular biomarkers (from the FISP MRI sequence) and peri-articular BMD (from DXA). • Increased trabecular thickness and bone-to-total ratio (cTbTh and cBV/TV, obtained from "conventional" IW MRI sequences) from baseline to 24-month visits may be associated with higher odds of knee OA pain progression over 48 months of follow-up.
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http://dx.doi.org/10.1007/s00330-020-07512-2DOI Listing
June 2021

Quantifying varus thrust in knee osteoarthritis using wearable inertial sensors: A proof of concept.

Clin Biomech (Bristol, Avon) 2020 12 11;80:105232. Epub 2020 Nov 11.

Department of Physical Therapy & Athletic Training, Boston University College of Health & Rehabilitation Sciences: Sargent College, Boston, MA, USA; Division of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA. Electronic address:

Background: Varus thrust during walking, visualized as excessive frontal plane knee motion during weight acceptance, is a modifiable risk factor for progression of knee osteoarthritis. However, visual assessment does not capture thrust severity and quantification with optical motion capture is often not feasible. Inertial sensors may provide a convenient alternative to optical motion capture. This proof-of-concept study sought to compare wearable inertial sensors to optical motion capture for the quantification of varus thrust.

Methods: Twenty-six participants with medial knee osteoarthritis underwent gait analysis at self-selected and fast speeds. Linear regression with generalized estimating equations assessed associations between peak knee adduction velocity or knee adduction excursion from optical motion capture and peak thigh or shank adduction velocity from two inertial sensors on the lower limb. Relationships between inertial measures and peak external knee adduction moment were assessed as a secondary aim.

Findings: Both thigh and shank inertial sensor measures were associated with the optical motion capture measures for both speeds (P < 0.001 to P = 0.020), with the thigh measures having less variability than the shank. After accounting for age, sex, body mass index, radiographic severity, and limb alignment, thigh adduction velocity was also associated with knee adduction moment at both speeds (both P < 0.001).

Interpretation: An inertial sensor placed on the mid-thigh can quantify varus thrust in people with medial knee osteoarthritis without the need for optical motion capture. This single sensor may be useful for risk screening or evaluating the effects of interventions in large samples.
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http://dx.doi.org/10.1016/j.clinbiomech.2020.105232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749075PMC
December 2020

Emerging Technologies and Platforms for the Immunodetection of Multiple Biochemical Markers in Osteoarthritis Research and Therapy.

Front Med (Lausanne) 2020 21;7:572977. Epub 2020 Oct 21.

Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania.

Biomarkers, especially biochemical markers, are important in osteoarthritis (OA) research, clinical trials, and drug development and have potential for more extensive use in therapeutic monitoring. However, they have not yet had any significant impact on disease diagnosis and follow-up in a clinical context. Nevertheless, the development of immunoassays for the detection and measurement of biochemical markers in OA research and therapy is an active area of research and development. The evaluation of biochemical markers representing low-grade inflammation or extracellular matrix turnover may permit OA prognosis and expedite the development of personalized treatment tailored to fit particular disease severities. However, currently detection methods have failed to overcome specific hurdles such as low biochemical marker concentrations, patient-specific variation, and limited utility of single biochemical markers for definitive characterization of disease status. These challenges require new and innovative approaches for development of detection and quantification systems that incorporate clinically relevant biochemical marker panels. Emerging platforms and technologies that are already on the way to implementation in routine diagnostics and monitoring of other diseases could potentially serve as good technological and strategic examples for better assessment of OA. State-of-the-art technologies such as advanced multiplex assays, enhanced immunoassays, and biosensors ensure simultaneous screening of a range of biochemical marker targets, the expansion of detection limits, low costs, and rapid analysis. This paper explores the implementation of such technologies in OA research and therapy. Application of novel immunoassay-based technologies may shed light on poorly understood mechanisms in disease pathogenesis and lead to the development of clinically relevant biochemical marker panels. More sensitive and specific biochemical marker immunodetection will complement imaging biomarkers and ensure evidence-based comparisons of intervention efficacy. We discuss the challenges hindering the development, testing, and implementation of new OA biochemical marker assays utilizing emerging multiplexing technologies and biosensors.
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http://dx.doi.org/10.3389/fmed.2020.572977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609858PMC
October 2020

Intra-articular Corticosteroid Injections for the Treatment of Hip and Knee Osteoarthritis-related Pain: Considerations and Controversies with a Focus on Imaging- Scientific Expert Panel.

Radiology 2020 12 20;297(3):503-512. Epub 2020 Oct 20.

From the Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Pkwy, Suite 1B105, West Roxbury, MA 02132 (A.G., T.N., D.T.F., F.W.R.); Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard University, Boston, Mass (J.N.K.); Department of Medicine, University of Arizona Health Sciences Center, Tucson, Ariz (C.K.K.); Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England (P.G.C.); and Department of Radiology, University of Erlangen, Erlangen, Germany (F.W.R.).

Current management of osteoarthritis (OA) is primarily focused on symptom control. Intra-articular corticosteroid (IACS) injections are often used for pain management of hip and knee OA in patients who have not responded to oral or topical analgesics. Recent case series suggested that negative structural outcomes including accelerated OA progression, subchondral insufficiency fracture, complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received IACS injections. This expert panel report reviews the current understanding of pain in OA, summarizes current international guidelines regarding indications for IACS injection, and considers preinterventional safety measures, including imaging. Potential profiles of those who would likely benefit from IACS injection and a suggestion for an updated patient consent form are presented. As of today, there is no established recommendation or consensus regarding imaging, clinical, or laboratory markers before an IACS injection to screen for OA-related imaging abnormalities. Repeating radiographs before each subsequent IACS injection remains controversial. The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of accelerated OA or joint destruction after IACS injections are needed. However, given the relatively rare incidence of these adverse outcomes, any clinical trial would be challenging in design and a large number of patients would need to be included.
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http://dx.doi.org/10.1148/radiol.2020200771DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706887PMC
December 2020

Kneeling as a risk factor of patellofemoral joint cartilage damage worsening: an exploratory analysis on the Osteoarthritis Initiative.

Eur Radiol 2021 Apr 2;31(4):2601-2609. Epub 2020 Oct 2.

Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.

Objectives: To determine whether kneeling activity is associated with the MRI measures of patellofemoral (PF) joint cartilage damage worsening in subjects with/without patella alta (PA).

Methods: Baseline and 24-month 3-T MR images and semi-quantitative MRI Osteoarthritis Knee Score (MOAKS) of PF joint of 600 subjects from the FNIH study, a nested study within the Osteoarthritis Initiative (OAI), were extracted. At baseline visit, subjects were asked how many days per week they participated in kneeling activities lasted ≥ 30 min. Insall-Salvati ratio (ISR) (patellar tendon/patellar height) was measured on baseline MRIs by a musculoskeletal radiologist; ISR ≥ 1.3 was considered PA. Regression analysis adjusted for confounding variables was used to assess the impact of kneeling on worsening of MOAKS cartilage over 24 months. The potential moderating effect of PA was evaluated using adjusted regression analysis.

Results: Six hundred subjects (58.8% female, years, BMI = 30.7 ± 4.8 kg/m) were included; 13.7%, 6.2%, and 5.5% of participants reported 1 day, 2-5 days, and ≥ 6 days of kneeling activities per week. A higher frequency of kneeling activity was associated with the increased risk of MOAKS cartilage score worsening (adjusted OR (95% CI): 2.33 (1.08-5.06)). Stratification analysis showed that only ≥ 6 days/week of kneeling activities was associated with the worsening of MOAKS cartilage scores (2.74 (1.03-7.27)). When we included the presence of PA in regression models, the OR (95% CI) for the association between kneeling and PF cartilage damage will decrease to 1.26 (0.78-2.04), suggesting the potential role of PA as the moderator variable.

Conclusion: Extensive kneeling activity (≥ 6 days/week) may be associated with the MRI-based worsening of PF cartilage damage, specifically in subjects with an underlying patella alta.

Key Points: • Frequent daily kneeling activity is associated with a higher risk of patellofemoral cartilage damage resulting in patellofemoral osteoarthritis. • The cartilage damage associated with extensive kneeling activity may be worse in subjects with an underlying patella alta (i.e., high-riding patella).
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http://dx.doi.org/10.1007/s00330-020-07337-zDOI Listing
April 2021

Knee cartilage damage and concomitant internal derangement on MRI in athletes competing at the Rio de Janeiro 2016 Summer Olympics.

Eur J Radiol Open 2020 11;7:100258. Epub 2020 Sep 11.

Department of Radiology, Boston University School of Medicine, Boston, MA, United States.

Purpose: To report the MRI patterns of knee cartilage damage and concomitant internal derangement in athletes participating at the Rio de Janeiro 2016 Olympic Games.

Methods: Knee MRIs obtained at the core imaging facility of the International Olympic Committee were blindly, retrospectively reviewed by a board-certified musculoskeletal radiologist for meniscal, ligamentous, and tendon abnormalities. Cartilage assessment was based on the modified Outerbridge criteria.

Results: Of 122 athletes who received a knee MRI, 64 (52.4 %) had cartilage damage. Cartilage damage was more prevalent in the patellofemoral compartment (52 athletes, 42.6 %), followed by lateral (23 athletes, 18.9 %) and medial tibiofemoral compartments (12 athletes, 9.8 %). Patellofemoral cartilage damage was most prevalent in beach-volleyball (100 %), followed by volleyball (8 athletes, 66.7 %) and weightlifting (7 athletes, 70 %). Patellofemoral cartilage damage was most prevalent with quadriceps (8 athletes, 72.7 %) and patellar tendinosis (11 athletes, 61.1 %). Medial and lateral tibiofemoral cartilage damage was significantly associated with medial (8 athletes, 29.6 %) and lateral meniscal tears (16 athletes, 55.2 %), respectively. There was a trend for the percentage of athletes with cartilage damage to increase with age.

Conclusion: The majority of athletes at the 2016 Rio Summer Olympics who had a knee MRI showed cartilage damage. Patellofemoral compartment cartilage damage was most common and frequently observed in certain sports including volleyball, beach volleyball, and weightlifting. Overuse in these sports can contribute to patellofemoral cartilage damage and subsequent development of anterior knee pain. Cartilage damage was also observed with concomitant meniscal tears and older age.
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http://dx.doi.org/10.1016/j.ejro.2020.100258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495057PMC
September 2020

Imaging of OA - From disease modification to clinical utility.

Best Pract Res Clin Rheumatol 2020 12 15;34(6):101588. Epub 2020 Sep 15.

Department of Radiology, Boston University School of Medicine, Boston, United States; Department of Radiology, VA Boston Healthcare System, West Roxbury Medical Center, Boston, United States. Electronic address:

Multiple disease-modifying osteoarthritis drug (DMOAD) trials were done in the last two decades, but no pharmacological agent has yet been approved by regulatory agencies as an effective therapy to date. Given the fact that we have seen the recent discontinuation of several late-stage drug development trials, a careful strategy is needed in formulating a plan for a successful DMOAD trial - including the various roles of imaging. This narrative review article will summarize how imaging is utilized in osteoarthritis from the perspective of disease modification to clinical utility. We will describe how semi-quantitative and quantitative magnetic resonance imaging approaches have been deployed in DMOAD trials. We will then review the utility of musculoskeletal ultrasound in research and clinical settings. Finally, novel hybrid positron emission tomography/MRI techniques and current research using artificial intelligence will be discussed, focusing on original research. Older publications are included for the discussion of the previous DMOAD trials and other relevant topics where deemed appropriate.
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http://dx.doi.org/10.1016/j.berh.2020.101588DOI Listing
December 2020

PET/Computed Tomography Scans and PET/MR Imaging in the Diagnosis and Management of Musculoskeletal Diseases.

PET Clin 2020 Oct 16;15(4):535-545. Epub 2020 Jul 16.

Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033, USA.

PET/computed tomography scans and PET/MR imaging have been applied in imaging tumors of the musculoskeletal system for their ability to provide information about metabolic activity. However, applications of these imaging modalities are now being extended to nononcologic musculoskeletal pathologies, such as osteoarthritis, rheumatoid arthritis, and osteoporosis. This article aims to explore the alternative uses of these imaging modalities in oncologic and nononcologic musculoskeletal pathologies. It also discusses the various strengths and some weaknesses that are seen in particular situations.
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http://dx.doi.org/10.1016/j.cpet.2020.06.005DOI Listing
October 2020

Correction to: Assessment of knee pain from MR imaging using a convolutional Siamese network.

Eur Radiol 2020 Dec;30(12):6968

Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.

The original version of this article, published on 13 February 2020, unfortunately contained a mistake.
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http://dx.doi.org/10.1007/s00330-020-07073-4DOI Listing
December 2020

Specific manifestations of knee osteoarthritis predict depression and anxiety years in the future: Vancouver Longitudinal Study of Early Knee Osteoarthritis.

BMC Musculoskelet Disord 2020 Jul 16;21(1):467. Epub 2020 Jul 16.

Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.

Background: To evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models.

Methods: A population-based cohort (n = 122) with knee pain, aged 40-79, was evaluated at baseline, 3 and 7 years. Baseline predictors were: age decade; sex; BMI ≥ 25; physical exam knee effusion; crepitus; malalignment; quadriceps atrophy; flexion; flexion contracture; Kellgren-Lawrence (KL) x-ray grade (0/1/2/3+); WOMAC pain ≥25; WOMAC stiffness ≥25; self-reported knee swelling; and knee OA diagnosis (no/probable/definite). Depression and anxiety, cutoffs 5+ and 7+ respectively, were measured via the Hospital Anxiety and Depression Scale. We fit logistic models at each cycle using multivariable models selected via lowest Akaike's information criterion.

Results: Baseline depression model: sex (female OR = 0.27; 0.10, 0.76) and KL grade (KL 1 OR = 4.21; 1.31, 13.48). Three-year depression model: KL grade (KL 1 OR = 18.92; 1.73, 206.25). Seven-year depression model: WOMAC stiffness ≥25 (OR = 3.49; 1.02, 11.94) and flexion contracture ≥1 degree (OR = 0.23; 0.07, 0.81). Baseline anxiety model: knee swelling (OR = 4.11; 1.51, 11.13) and age (50-59 vs. 40-49 OR = 0.31 [0.11, 0.85]; 60-69 OR = 0.07 [0.01, 0.42]). Three-year anxiety model: WOMAC stiffness ≥25 (OR = 5.80; 1.23, 27.29) and KL grade (KL 1 OR = 6.25; 1.04, 37.65). Seven-year anxiety model: sex (female OR = 2.71; 0.87, 8.46).

Conclusion: Specific knee OA-related manifestations predict depression and anxiety cross-sectionally, 3 years in the future, and for depression, 7 years in the future. This information may prove useful to clinicians in helping to identify patients most at risk of present or future depression and anxiety, thus facilitating preemptive discussions that may help counter that risk.
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http://dx.doi.org/10.1186/s12891-020-03496-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367326PMC
July 2020