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The aim of this work was to report the prevalence of computed tomography (CT)-detected intra-articular mineralization. We included participants from the Multicenter Osteoarthritis (MOST) Study. At the 12th year visit of the MOST study, bilateral knee CTs were first obtained. All participants also had posteroanterior and lateral radiographs of bilateral knees and completed standard questionnaires. Knee radiographs were assessed for Kellgren & Lawrence grade (KLG) and radiographic evidence of intra-articular mineralization. CT images were scored using the Boston University Calcium Knee Score (BUCKS) for cartilage, menisci, ligaments, capsule, and vasculature. Prevalence of intra-articular mineralization was computed for the total sample, and stratified by age, sex, race, Body Mass Index (BMI), presence of frequent knee pain, and KLG. We also determined distribution of mineralization in the cartilage and meniscus, and co-localization. 4140 bilateral knees from 2070 participants were included (56.7% female, mean age 61.1 years, mean BMI: 28.8 kg/m2). On radiographs 240 knees (5.8%) had intraarticular mineralization, while CT-detected mineralization was present in 9.8% of knees. Prevalence of hyaline articular and meniscus mineralization increased with age and KL grade, and was similar by sex, BMI categories, and comparable in subjects with and without frequent knee pain. Mineralization tended to be ubiquitous in the joint, most commonly involving all three (medial/lateral tibiofemoral and patellofemoral) compartments (3.1%), while the patellofemoral compartment was the most involved compartment in isolation (1.4%). CT of the knee provides greater visualization of intra-articular mineralization than radiographs and allows better localization of the crystal deposition within the joint. Further studies should focus on the co-localization of intra-articular crystal deposition and corresponding magnetic resonance imaging (MRI)-features of knee osteoarthritis (OA). [ABSTRACT FROM AUTHOR]

Background: The role of intra-articular mineralization in osteoarthritis (OA) is unclear. Its understanding may potentially advance our knowledge of knee OA pathogenesis. We describe and assess the reliability of a novel computed tomography (CT) scoring system, the Boston University Calcium Knee Score (BUCKS) for evaluating intra-articular mineralization.Methods: We included subjects from the most recent study visit of the Multicenter Osteoarthritis Study (MOST) Study, a NIH-funded longitudinal cohort of community-dwelling older adults with or at risk of knee OA. All subjects underwent CT of bilateral knees. Each knee was scored at 28 scored locations (14 for cartilage, 6 for menisci, 6 for ligaments, 1 for joint capsule, and 1 popliteal-tibial vessels). A single musculoskeletal radiologist scored cartilage and meniscus subregions, as well as vascular calcifications assigning to each a score ranging from 0 to 3. The joint capsule, medial and lateral posterior meniscal roots, anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL) and 2 collateral ligaments [medial collateral ligament (MCL)/lateral collateral ligament (LCL)] were each scored 0 or 1 for absence or presence of mineralization. To assess reliability, 31 subject CTs were reread 12 weeks later by the same reader and by a second reader and agreement was evaluated using a weighted kappa.Results: The intra-reader reliability ranged from 0.92 for ligaments to 1.0 for joint capsule. The inter-reader reliability ranged from 0.94 for cartilage and ligaments, to 1.0 for joint capsule.Conclusion: BUCKS demonstrated excellent reliability and is a potentially useful CT-based tool for studying the role of calcium crystals in knee OA. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship of meniscal damage to magnetic resonance imaging (MRI) features of compartment-specific patellofemoral joint (PFJ) osteoarthritis (OA) at baseline and 2 years later.Method: Individuals from a prospective cohort of individuals aged 50-79 with or at risk of knee OA were included. At the 60-month and 84-month study visit, Whole-Organ MRI Score (WORMS) was used to assess meniscal tears and extrusions as well as cartilage damage and bone marrow lesions (BMLs) in the medial and lateral patella and trochlea. Worsening of structural features was defined as any increase in WORMS score from 60 to 84 months. Logistic regression was used to determine the cross-sectional and longitudinal relation of meniscus damage to features of compartment-specific PFJ OA.Results: Relative to knees without lateral meniscal pathology at baseline, those with grades 3-4 lateral meniscal tear and extrusion had greater risk of worsening of cartilage damage in the lateral PFJ 2 years later (Risk ratio: 1.7 [95% CI: 1.1-2.7) and (1.7 [1.2-2.5]), respectively. Relative to those without medial meniscal pathology at baseline, those with grades 1-2 (0.6 [0.4-0.9]) and 3-4 (0.7 [0.5-1.0]) medial meniscal tears had lower risk of worsening of BMLs in the medial PFJ 2 years later.Conclusion: Meniscal tear and extrusion are associated with increased risk of medial and lateral PFJ OA and more severe meniscal pathology is associated with worsening of PFJ OA 2 years later. Lateral meniscal pathology appears to be more detrimental to the lateral PFJ. [ABSTRACT FROM AUTHOR]

Purpose: To determine the relation of superolateral Hoffa's fat pad (SHFP) hyperintensity to cartilage damage and bone marrow lesions (BMLs) in the patellofemoral joint (PFJ) and tibiofemoral joint (TFJ).Methods: We used data from the 60 and 84-month study visits from the Multicenter Osteoarthritis (MOST) study. SHFP hyperintensity and Hoffa-synovitis were graded from 0 to 3. Cartilage damage and BMLs were scored in the PFJ and TFJ. Structural damage was defined as: any cartilage damage, full-thickness cartilage damage and any BML. Worsening structural damage was defined as any increase in cartilage and BML scores. Logistic regression was used to determine the relation of SHFP hyperintensity and Hoffa-synovitis (>0) to structural damage, adjusting for age, sex and body mass index (BMI).Results: 1,094 knees were included in the study. Compared to knees without SHFP hyperintensity, those with SHFP hyperintensity had 1.2 (95% Confidence Interval (CI), 1.1-1.4), 1.7 (1.3-2.3) and 1.6 (1.3-1.9) times the prevalence of any cartilage damage, full-thickness cartilage damage, and BMLs in the lateral PFJ respectively, and 1.1 (1.0-1.2), 1.3 (1.0-1.8), and 1.2 (1.0-1.4) times the prevalence of any cartilage damage, full-thickness cartilage damage, and BMLs in the medial PFJ. SHFP hyperintensity was associated with worsening BMLs in the medial PFJ (RR: 1.4 (1.0-1.9)). In general, there was no relation between SHFP hyperintensity and TFJ outcomes. Hoffa-synovitis was associated both cross-sectionally and longitudinally with structural damage, regardless of definition, in all compartments.Conclusion: SHFP hyperintensity may be a local marker of PFJ structural damage. [ABSTRACT FROM AUTHOR]

Objective: To give an illustrative overview of Hoffa's fat pad pathology with a radiologic emphasis on the anatomy, on technical considerations, and on imaging differential diagnoses in the context of osteoarthritis (OA) imaging research.Design: A PubMed database search including only English literature and covering a 20 year period was performed. The search was based on but no limited to the query terms "Hoffa", "Hoffa's fat pad" or "infrapatellar fat pad (IPFP)" in combination with "synovitis", "OA", and "magnetic resonance imaging (MRI)". The literature search yielded 289 publications that were screened for relevance; additional references were included when these were considered of importance.Results: Several anatomic variants and pathologic conditions may be encountered when assessing Hoffa's fat pad including tumors and tumor-like lesions such as osteochondroma, tenosynovial giant cell tumor (TGCT) (and pigmented nodular synovitis) and arthrofibrosis, traumatic changes including contusions and anatomic variants such as recesses. The latter may be accountable for differences in cross-sectional area or volume changes over time. Signal changes are commonly used in OA research as surrogate markers for synovitis but are non-specific findings.Conclusions: Quantitative approaches to evaluate 3D parameters of Hoffa's fat pad are increasingly applied and their role in regard to structural progression and clinical manifestations of disease needs to be further elucidated. In applying such approaches, knowledge of the detailed anatomy and potential pitfalls that may be a result of anatomical variants, inflammatory disease manifestations and additional diverse pathologies encountered seems to be paramount. [ABSTRACT FROM AUTHOR]

Purpose: To validate a novel quantitative MRI method to measure osteophyte volume.Methods: 90 subjects were selected from the Progression Cohort of the Osteoarthritis Initiative (OAI) at baseline and 48 months, and analyzed using a semi-automated software tool. Marginal osteophyte volume was calculated for four compartments of the central weight-bearing region of the tibiofemoral joint. Standardized response mean (SRM) for change in volume was used to quantify responsiveness. Concurrent validity was assessed via a comparison with MRI Osteoarthritis Knee Score (MOAKS) using Kruskal-Wallis analysis and Spearman's correlation coefficient. Intra- and inter-reader reliability was assessed on a subset of 20 knees using intra-class correlation coefficients (ICCs) and the root mean square standard deviation (RMSSD).Results: The average change in osteophyte volume (ΔV) was 196 mm(3) (SD = 272 mm(3)), and the baseline to 48-month SRM was 0.72. An increase in osteophyte volume was observed for 84% (76/90) of the subjects. Kruskal-Wallis analysis across the four MOAKS osteophyte categories was significant for medial and lateral compartments of both the tibia and femur (P < 0.001 for all). The intra-reader ICC was 0.98, and RMSSD was 82 mm(3), while inter-reader ICC was 0.97 and RMSSD was 91 mm(3). A statistically significant positive correlation was observed between osteophyte volume and several MOAKS cartilage and BML scores. The reader time was approximately 10 min per knee.Conclusions: The method is responsive, efficient, and precise, making it practical for use in large cohort studies and observational research. [ABSTRACT FROM AUTHOR]

Objective: It has been shown that trabecular bone structure parameters extracted from radiographs known as fractal signature analysis (FSA) are able to predict structural outcomes such as radiographic osteoarthritis (OA) progression. Little is known about their involvement in early disease or about differences between subjects exposed to increased joint loading such as young active athletes compared to non-athletes. Aim was to compare horizontal and vertical dimensions of bone texture considering athlete status, gender, previous anterior cruciate ligament (ACL) surgery and age.Design: Included were 685 patients of which 135 consecutive athletes (82% soccer players) 18-36 years old and 550 non-athletes controls in the same age range had knee radiography for assessment of subacute or chronic knee complaints. Regions of interest (ROI) were placed in the subchondral medial and lateral tibial plateaus. Fractal signatures were calculated in the horizontal and vertical dimensions. Curve fitting algorithms were applied taking into account all four risk factors in the same model adjusting for each other.Results: For the horizontal dimensions significant differences were observed for gender (estimate (E) 0.098 (95% confidence interval(CI)) (-0.009, 0.008), P < .0001), previous ACL surgery (E -0.031, 95% CI (-0.043, -0.019), P < .0001) and highest age group (E -0.039, 95% CI (-0.048, -0.029), P < .0001). For vertical dimensions, significant differences were shown for athletes (E -0.012, 95% CI (-0.020, -0.004), P < .0001), gender (E 0.056, 95% CI (0.049, 0.062), P < .0001), and age range from 28 to 32 years (E -0.028, 95% CI (-0.037, -0.019), P < .0001).Conclusions: Trabecular bone structure differs between athletes and non-athletes, in regard to previous ACL surgery, gender and higher age. [ABSTRACT FROM AUTHOR]

Objective: Most MRI-based osteoarthritis (OA) studies have focused on a single knee per person and thus, data on bilaterality is sparse. Study aim was to describe symmetricity of MRI-detected OA features in a cohort of subjects with knee pain.Design: Participants were 169 subjects with chronic knee pain who had 3 T MRI of both knees using the same protocol as in the Osteoarthritis Initiative. Knees were read for cartilage damage, bone marrow lesions (BMLs), and meniscal damage according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system. Chi(2) tests were used to compare the proportion of knees with unilateral tissue pathology to the proportion what would be expected if both knees were independent. We further used percent agreement and linear weighted kappa statistics to describe agreement of cartilage damage and BMLs in the same articular plates.Results: 51.2% of participants were men, mean age was 52.1 (±6.2), mean BMI was 29.0 kg/m(2) (±4.1). All plates showed a significant higher degree of symmetricity for cartilage damage as evidenced by weighted kappas ranging from 0.32 to 0.59. For BMLs the degree of symmetricity was higher for the patella, trochlea, medial tibia, lateral femur, and medial femur; for meniscal damage the degree of unilaterality was lower for all medial meniscal subregions but not all lateral. Kappas ranged between 0.52 and 0.68 for cartilage and 0.30 and 0.55 for BMLs for the four subregions with highest agreement.Conclusion: A higher degree of symmetricity of tissue damage than expected by chance was observed in this cohort of subjects with knee pain. [ABSTRACT FROM AUTHOR]

Summary Objective Most MRI-based osteoarthritis (OA) studies have focused on a single knee per person and thus, data on bilaterality is sparse. Study aim was to describe symmetricity of MRI-detected OA features in a cohort of subjects with knee pain. Design Participants were 169 subjects with chronic knee pain who had 3 T MRI of both knees using the same protocol as in the Osteoarthritis Initiative. Knees were read for cartilage damage, bone marrow lesions (BMLs), and meniscal damage according to the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system. Chi 2 tests were used to compare the proportion of knees with unilateral tissue pathology to the proportion what would be expected if both knees were independent. We further used percent agreement and linear weighted kappa statistics to describe agreement of cartilage damage and BMLs in the same articular plates. Results 51.2% of participants were men, mean age was 52.1 (±6.2), mean BMI was 29.0 kg/m 2 (±4.1). All plates showed a significant higher degree of symmetricity for cartilage damage as evidenced by weighted kappas ranging from 0.32 to 0.59. For BMLs the degree of symmetricity was higher for the patella, trochlea, medial tibia, lateral femur, and medial femur; for meniscal damage the degree of unilaterality was lower for all medial meniscal subregions but not all lateral. Kappas ranged between 0.52 and 0.68 for cartilage and 0.30 and 0.55 for BMLs for the four subregions with highest agreement. Conclusion A higher degree of symmetricity of tissue damage than expected by chance was observed in this cohort of subjects with knee pain. [ABSTRACT FROM AUTHOR]

Objective: Prevalence data on radiographic osteoarthritis (ROA) in young active athletes is sparse. Aim was to assess in a matched case-control design the frequency of ROA in an athlete population and whether athlete status, gender, previous anterior cruciate ligament (ACL) surgery and age increase the odds for ROA.Design: 135 consecutive athletes (82% soccer players) 18-36 years old and 550 non-athletes aged-matched controls had knee radiography (Lyon-Schuss protocol) for assessment of subacute or chronic knee complaints. Patients with acute trauma or fractures were excluded. Radiographs were graded according to the Kellgren-Lawrence and OARSI grading schemes. In addition, medial and lateral intercondylar notch osteophytes were scored. We used logistic regression model to assess the association of ROA and specific radiographic OA features with athlete status, prior ACL surgery, gender and age, adjusting for each other.Results: 19.4% of patients were 18-22 years old, 26.4% were 23-27, 22.6% were 28-32, and 31.5% were 33-36 years old. 18.7% were female and 8.8% had previous ACL surgery. 8.5% had ROA and 6.0% had evidence of JSN. The adjusted odds ratios (aOR) for ROA were 2.8 (95% confidence interval 1.4, 5.5) for athletes, 7.0 (3.5, 13.9) for previous ACL surgery and 3.3 (1.2, 9.0) for age range 32-36. Athlete status significantly increased odds for tibiofemoral osteophytes [aOR 2.9 (1.6, 5.4)] and comparably for notch osteophytes [aOR 2.3 (1.1, 4.7)].Conclusions: Athlete status, higher age and previous ACL surgery increase the risk of ROA with surgery being the strongest risk factor. [ABSTRACT FROM AUTHOR]

Summary Objective Prevalence data on radiographic osteoarthritis (ROA) in young active athletes is sparse. Aim was to assess in a matched case–control design the frequency of ROA in an athlete population and whether athlete status, gender, previous anterior cruciate ligament (ACL) surgery and age increase the odds for ROA. Design 135 consecutive athletes (82% soccer players) 18–36 years old and 550 non-athletes aged-matched controls had knee radiography (Lyon-Schuss protocol) for assessment of subacute or chronic knee complaints. Patients with acute trauma or fractures were excluded. Radiographs were graded according to the Kellgren–Lawrence and OARSI grading schemes. In addition, medial and lateral intercondylar notch osteophytes were scored. We used logistic regression model to assess the association of ROA and specific radiographic OA features with athlete status, prior ACL surgery, gender and age, adjusting for each other. Results 19.4% of patients were 18–22 years old, 26.4% were 23–27, 22.6% were 28–32, and 31.5% were 33–36 years old. 18.7% were female and 8.8% had previous ACL surgery. 8.5% had ROA and 6.0% had evidence of JSN. The adjusted odds ratios (aOR) for ROA were 2.8 (95% confidence interval 1.4, 5.5) for athletes, 7.0 (3.5, 13.9) for previous ACL surgery and 3.3 (1.2, 9.0) for age range 32–36. Athlete status significantly increased odds for tibiofemoral osteophytes [aOR 2.9 (1.6, 5.4)] and comparably for notch osteophytes [aOR 2.3 (1.1, 4.7)]. Conclusions Athlete status, higher age and previous ACL surgery increase the risk of ROA with surgery being the strongest risk factor. [ABSTRACT FROM AUTHOR]

Summary Objective To determine the prevalence of intraarticular susceptibility artifacts and to detect longitudinal changes in the artifacts, on 3T magnetic resonance imaging (MRI) of the knee in a cohort of patients with knee pain, and to assess the association of susceptibility artifacts with radiographic intraarticular calcifications. Design Three hundred and forty-six knees of 177 subjects aged 35–65 were included. 3T MRI was performed at baseline and at 6 months. Baseline radiographs were assessed for presence/absence of linear/punctate calcifications within the tibiofemoral joint (TFJ) space. Corresponding MRIs were assessed for susceptibility artifacts (i.e., linear/punctate hypointensities) in the TFJ space on coronal dual-echo steady-state (DESS) sequences. Kappa statistics were applied to determine agreement between findings on baseline DESS and radiography. Changes in artifacts over time were recorded. Results In the medial compartment, 13 (4%) of the knees showed susceptibility artifacts at baseline. Six knees had persistent artifacts and six knees had incident artifacts at follow-up. Agreement between DESS and radiography was κ = 0.18 (−0.15, 0.51) in the medial compartment. Frequency of artifacts in the lateral compartment was low (2%). Conclusion Susceptibility artifacts detected on knee MRI are not frequent, and likely correspond to vacuum phenomena as they commonly change over time and are not associated with intraarticular calcifications. Radiologists should be aware of these artifacts as they can interfere with cartilage segmentation. [ABSTRACT FROM AUTHOR]