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BACKGROUND: Injuries to the articular cartilage in the knee are common in jumping athletes, particularly high-level basketball players. Unfortunately, these are often diagnosed at a late stage of the disease process, after tissue loss has already occurred. PURPOSE/HYPOTHESIS: To evaluate longitudinal changes in knee articular cartilage and knee function in National Collegiate Athletic Association (NCAA) basketball players and their evolution over the competitive season and off-season. STUDY TYPE: Longitudinal, multisite cohort study. POPULATION: Thirty-two NCAA Division 1 athletes: 22 basketball players and 10 swimmers. FIELD STRENGTH/SEQUENCE: Bilateral magnetic resonance imaging (MRI) using a combined T(1ρ) and T(2) magnetization-prepared angle-modulated portioned k-space spoiled gradient-echo snapshots (MAPSS) sequence at 3T. ASSESSMENT: We calculated T(2) and T(1ρ) relaxation times to compare compositional cartilage changes between three timepoints: preseason 1, postseason 1, and preseason 2. Knee Osteoarthritis Outcome Scores (KOOS) were used to assess knee health. STATISTICAL TESTS: One-way variance model hypothesis test, general linear model, and chi-squared test. RESULTS: In the femoral articular cartilage of all athletes, we saw a global decrease in T(2) and T(1ρ) relaxation times during the competitive season (all P < 0.05) and an increase in T(2) and T(1ρ) relaxation times during the off-season (all P < 0.05). In the basketball players’ femoral cartilage, the anterior and central compartments respectively had the highest T(2) and T(1ρ) relaxation times following the competitive season and off-season. The basketball players had significantly lower KOOS measures in every domain compared with the swimmers: Pain (P < 0.05), Symptoms (P < 0.05), Function in Daily Living (P < 0.05), Function in Sport/Recreation (P < 0.05), and Quality of Life (P < 0.05). CONCLUSION: Our results indicate that T(2) and T(1ρ) MRI can detect significant seasonal changes in the articular cartilage of basketball players and that there are regional differences in the articular cartilage that are indicative of basketball-specific stress on the femoral cartilage. This study demonstrates the potential of quantitative MRI to monitor global and regional cartilage health in athletes at risk of developing cartilage problems. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2

Cartilage transmits and redistributes biomechanical loads in the knee joint during exercise. Exercise-induced loading alters cartilage hydration and is detectable using quantitative MRI, where T2 relaxation time (T2 ) is influenced by cartilage collagen composition, fiber orientation, and changes in extracellular matrix. This study characterized short-term transient responses of healthy knee cartilage to running-induced loading using bilateral scans and image registration. Eleven healthy female recreational runners (33.73±4.22 years) and four healthy female controls (27.25±1.38 years) were scanned on a 3T GE MRI scanner with qDESS before running over-ground (runner group) or resting (control group) for 40 minutes. Subjects were scanned immediately post-activity at five-minute intervals for 60 minutes. T2 times were calculated for femoral, tibial, and patellar cartilage at each time point and analyzed using a mixed-effects model and Bonferroni post-hoc. There were immediate decreases in T2 (mean±SEM) post-run in superficial femoral cartilage of at least 3.3±0.3% (P=0.002) between baseline and Time 0 that remained for 25 minutes, a decrease in superficial tibial cartilage T2 of 2.9±0.4% (P=0.041) between baseline and Time 0, and a decrease in superficial patellar cartilage T2 of 3.6±0.3% (P=0.020) 15 minutes post-run. There were decreases in the medial posterior region of superficial femoral cartilage T2 of at least 5.3±0.2% (P=0.022) within five minutes post-run that remained at 60 minutes post-run. Clinical Significance: These results increase understanding of transient responses of healthy cartilage to repetitive, exercise-induced loading and establish preliminary recommendations for future definitive studies of cartilage response to running. This article is protected by copyright. All rights reserved.

Objective We evaluated a fully automated femoral cartilage segmentation model for measuring T2 relaxation values and longitudinal changes using multi-echo spin-echo (MESE) magnetic resonance imaging (MRI). We open sourced this model and developed a web app available at https://kl.stanford.edu into which users can drag and drop images to segment them automatically. Design We trained a neural network to segment femoral cartilage from MESE MRIs. Cartilage was divided into 12 subregions along medial-lateral, superficial-deep, and anterior-central-posterior boundaries. Subregional T2 values and four-year changes were calculated using a radiologist’s segmentations (Reader 1) and the model’s segmentations. These were compared using 28 held-out images. A subset of 14 images were also evaluated by a second expert (Reader 2) for comparison. Results Model segmentations agreed with Reader 1 segmentations with a Dice score of 0.85 ± 0.03. The model’s estimated T2 values for individual subregions agreed with those of Reader 1 with an average Spearman correlation of 0.89 and average mean absolute error (MAE) of 1.34 ms. The model’s estimated four-year change in T2 for individual subregions agreed with Reader 1 with an average correlation of 0.80 and average MAE of 1.72 ms. The model agreed with Reader 1 at least as closely as Reader 2 agreed with Reader 1 in terms of Dice score (0.85 vs. 0.75) and subregional T2 values. Conclusions Assessments of cartilage health using our fully automated segmentation model agreed with those of an expert as closely as experts agreed with one another. This has the potential to accelerate osteoarthritis research.

BACKGROUND: This study investigated the utility of a 2-dimensional watershed algorithm for identifying the cartilage surface in computed tomography (CT) arthrograms of the knee up to 33 minutes after an intra-articular iohexol injection as boundary blurring increased. METHODS: A 2D watershed algorithm was applied to CT arthrograms of 3 bovine stifle joints taken 3, 8, 18, and 33 minutes after iohexol injection and used to segment tibial cartilage. Thickness measurements were compared to a reference standard thickness measurement and the 3-minute time point scan. RESULTS: 77.2% of cartilage thickness measurements were within 0.2 mm (1 voxel) of the thickness calculated in the reference scan at the 3-minute time point. 42% fewer voxels could be segmented from the 33-minute scan than the 3-minute scan due to diffusion of the contrast agent out of the joint space and into the cartilage, leading to blurring of the cartilage boundary. The traced watershed lines were closer to the location of the cartilage surface in areas where tissues were in direct contact with each other (cartilage-cartilage or cartilage-meniscus contact). CONCLUSIONS: The use of watershed dam lines to guide cartilage segmentation shows promise for identifying cartilage boundaries from CT arthrograms in areas where soft tissues are in direct contact with each other.

Chemical exchange saturation transfer of glycosaminoglycans (GAG), gagCEST, is a quantitative MR technique that has potential for assessing cartilage proteoglycan content at field strengths of 7 Tesla (T) and higher. However, its utility at 3T remains unclear. The objective of this work was to implement a rapid volumetric gagCEST sequence with higher gagCEST asymmetry at 3T to evaluate its sensitivity to osteoarthritic changes in knee articular cartilage and in comparison to T(2) and T(1ρ) measures. We hypothesize that gagCEST asymmetry at 3T decreases with increasing severity of osteoarthritis (OA). Forty-two human volunteers, including ten healthy subjects and thirty-two subjects with medial OA, were included in the study. Knee injury and Osteoarthritis Outcome Scores (KOOS) were assessed for all subjects and Kellgren-Lawrence grading was performed for OA volunteers. Healthy subjects were scanned consecutively at 3T to assess repeatability of the volumetric gagCEST sequence at 3T. For healthy and OA subjects, gagCEST asymmetry and T(2) and T(1ρ) relaxation times were calculated for the femoral articular to assess sensitivity to OA severity. Volumetric gagCEST imaging had higher gagCEST asymmetry than single slice acquisitions (p = 0.015). Average scan-rescan coefficient of variation was 6.8%. There were no significant differences in average gagCEST asymmetry between younger and older healthy controls (p = 0.655) or between healthy controls and OA subjects (p = 0.310). T(2) and T(1ρ) relaxation times were elevated in OA subjects (p < 0.001 for both) compared to healthy controls and both were moderately correlated with total KOOS scores (rho = −0.181 and rho = −0.332 respectively). The gagCEST technique developed here, with volumetric scan times under 10 minutes and high gagCEST asymmetry at 3T, did not vary significantly between healthy subjects and those with mild-moderate osteoarthritis. This further supports a limited utility for gagCEST imaging at 3T for assessment of early changes in cartilage composition in osteoarthritis.

Femoroacetabular impingement (FAI) is a disorder that causes hip pain and disability in young patients, particularly athletes. Increased stress on the hip during development has been associated with increased risk of cam morphology. The specific forces involved are unclear, but may be due to continued rotational motion, like the eggbeater kick. The goal of this prospective cohort study was to use magnetic resonance imaging (MRI) to identify the prevalence of FAI anatomy in athletes who tread water and compare it to the literature on other sports. With university IRB approval, 20 Division 1 water polo players and synchronized swimmers (15 female, 5 male), ages 18–23 years (mean age 20.7 ± 1.4), completed the 33-item International Hip Outcome Tool and underwent non-contrast MRI scans of both hips using a 3 Tesla scanner. Recruitment was based on sport, with both symptomatic and asymptomatic individuals included. Cam and pincer morphology were identified. The Wilcoxon Signed-Rank/Rank Sum tests were used to assess outcomes. Seventy per cent (14/20) of subjects reported pain in their hips yet only 15% (3/20) sought clinical evaluation. Cam morphology was present in 67.5% (27/40) of hips, while 22.5% (9/40) demonstrated pincer morphology. The prevalence of cam morphology in water polo players and synchronized swimmers is greater than that reported for the general population and at a similar level as some other sports. From a clinical perspective, acknowledgment of the high prevalence of cam morphology in water polo players and synchronized swimmers should be considered when these athletes present with hip pain.

Background: High tibial osteotomy is a surgical procedure to treat medial compartment osteoarthritis in varus knees. The reported success rates of the procedure are inconsistent, which may be due to sagittal plane alignment of the osteotomy. The objective of this study was to determine the effect of changing tibial slope, for a range of tibial wedge angles in high tibial osteotomy, on knee joint contact pressure location and kinematics during continuous loaded flexion/extension. Methods: Seven cadaveric knee specimens were cycled through flexion and extension in an Oxford knee-loading rig. The osteotomy on each specimen was adjusted to seven clinically relevant wedge and slope combinations. We used pressure sensors to determine the position of the centre of pressure in each compartment of the tibial plateau and infrared motion capture markers to determine tibiofemoral and patellofemoral kinematics. Findings: In early knee flexion, a 5 degree increase in tibial slope shifted the centre of pressure in the medial compartment anteriorly by 7mm for a 15 degree wedge (p

Osteoarthritis is a degenerative disease affecting bones and cartilage especially in the human knee. In this context, cartilage thickness is an indicator for knee cartilage health. Thickness measurements are performed on medical images acquired in-vivo. Currently, there is no standard method agreed upon that defines a distance measure in articular cartilage. In this work, we present a comparison of different methods commonly used in literature. These methods are based on nearest neighbors, surface normal vectors, local thickness and potential field lines. All approaches were applied to manual segmentations of tibia and lateral and medial tibial cartilage performed by experienced raters. The underlying data were contrast agent-enhanced cone-beam C-arm CT reconstructions of one healthy subject’s knee. The subject was scanned three times, once in supine position and two times in a standing weight-bearing position. A comparison of the resulting thickness maps shows similar distributions and high correlation coefficients between the approaches above 0.90. The nearest neighbor method results on average in the lowest cartilage thickness values, while the local thickness approach assigns the highest values. We showed that the different methods agree in their thickness distribution. The results will be used for a future evaluation of cartilage change under weight-bearing conditions.

Many surgeons in low-resource settings do not have access to safe, affordable, or reliable surgical drilling tools. Surgeons often resort to nonsterile hardware drills because they are affordable, robust, and efficient, but they are impossible to sterilize using steam. A promising alternative is to use a Drill Cover system (a sterilizable fabric bag plus surgical chuck adapter) so that a nonsterile hardware drill can be used safely for surgical bone drilling. Our objective was to design a safe, effective, affordable Drill Cover system for scale in low-resource settings. We designed our device based on feedback from users at Mulago Hospital (Kampala, Uganda) and focused on 3 main aspects. First, the design included a sealed barrier between the surgical field and hardware drill that withstands pressurized fluid. Second, the selected hardware drill had a maximum speed of 1050 rpm to match common surgical drills and reduce risk of necrosis. Third, the fabric cover was optimized for ease of assembly while maintaining a sterile technique. Furthermore, with the Drill Cover approach, multiple Drill Covers can be provided with a single battery-powered drill in a "kit," so that the drill can be used in back-to-back surgeries without requiring immediate sterilization. The Drill Cover design presented here provides a proof-of-concept for a product that can be commercialized, produced at scale, and used in low-resource settings globally to improve access to safe surgery.