Unsupervised segmentation and quantification of anatomical knee features: data from the Osteoarthritis Initiative

This paper presents a fully automated method for segmenting articular knee cartilage and bone from in vivo 3-D dual echo steady state images. The magnetic resonance imaging (MRI) datasets were obtained from the Osteoarthritis Initiative (OAI) pilot study and include longitudinal images from controls and subjects with knee osteoarthritis (OA) scanned twice at each visit (baseline, 24 month). Initially, human experts segmented six MRI series. Five of the six resultant sets served as reference atlases for a multiatlas segmentation algorithm. The methodology created precise knee segmentations that were used to extract articular cartilage volume, surface area, and thickness as well as subchondral bone plate curvature. Comparison to manual segmentation showed Dice similarity coefficient (DSC) of 0.88 and 0.84 for the femoral and tibial cartilage. In OA subjects, thickness measurements showed test-retest precision ranging from 0.014 mm (0.6%) at the femur to 0.038 mm (1.6%) at the femoral trochlea. In the same population, the curvature test-retest precision ranged from 0.0005 mm(-1) (3.6%) at the femur to 0.0026 mm(-1) (11.7%) at the medial tibia. Thickness longitudinal changes showed OA Pearson correlation coefficient of 0.94 for the femur. In conclusion, the fully automated segmentation methodology produces reproducible cartilage volume, thickness, and shape measurements valuable for the study of OA progression.     

Vibration arthrometry in patients with knee joint disorders

Physiological patellofemoral crepitus (PPC) is the vibration signal produced by the knee joint during slow motion (less than 5 degrees per second), which can be measured by vibration arthrometry (VAM). By using the autoregressive (AR) model for the PPC signals of patients with knee osteoarthritis, the study analyzes the PPC signals to evaluate the condition of patellar-femoral joint cartilage. Accordingly, we can divide osteoarthritis into three types, type 1: the cartilage of patellar-femoral joint is intact, the osteoarthritis found in the femoral-tibial joint surface; type 2: degeneration occurs in the surface cartilage of both the femoral-tibial joint and the femoral trochlea, but not on the patellar surface; type 3: both patellar-femoral and femoral-tibial joints have osteoarthritis. For the analysis, the intraclass distance of AR coefficients and spectral power ratio of dominant poles are adopted. Based on the proposed method, two cases of type 1, six of type 2, and 28 of type 3 were found in 36 cases of knee osteoarthritis. This is in agreement with the operative findings. For comparison, the PPC signals of 10 subjects with normal knees (without pain or wound history) were also measured. The results of analysis of the 10 normal subjects were consistent and clearly differentiable from those of the osteoarthritis patients. Therefore, the proposed method is efficient for the analysis of the condition of patellar-femoral joint cartilage and VAM may become an alternative way of noninvasive diagnosis of knee osteoarthritis.     

Computer-aided method for quantification of cartilage thickness and volume changes using MRI: validation study using a synthetic model

The primary objective of this study was to develop a computer-aided method for the quantification of three-dimensional (3-D) cartilage changes over time in knees with osteoarthritis (OA). We introduced a local coordinate system (LCS) for the femoral and tibial cartilage boundaries that provides a standardized representation of cartilage geometry, thickness, and volume. The LCS can be registered in different data sets from the same patient so that results can be directly compared. Cartilage boundaries are segmented from 3-D magnetic resonance (MR) slices with a semi-automated method and transformed into offset-maps, defined by the LCS. Volumes and thickness are computed from these offset-maps. Further anatomical labeling allows focal volumes to be evaluated in predefined subregions. The accuracy of the automated behavior of the method was assessed, without any human intervention, using realistic, synthetic 3-D MR images of a human knee. The error in thickness evaluation is lower than 0.12 mm for the tibia and femur. Cartilage volumes in anatomical subregions show a coefficient of variation ranging from 0.11% to 0.32%. This method improves noninvasive 3-D analysis of cartilage thickness and volume and is well suited for in vivo follow-up clinical studies of OA knees.     

Automatic quantification of tibio-femoral contact area and congruity

We present methods to quantify the medial tibio- femoral (MTF) joint contact area (CA) and congruity index (CI) from low-field magnetic resonance imaging (MRI). Firstly, based on the segmented MTF cartilage compartments, we computed the contact area using the Euclidian distance transformation. The CA was defined as the area of the tibial superior surface and the femoral inferior surface that are less than a voxel width apart. Furthermore, the CI is computed point-by-point by assessing the first- and second-order general surface features over the contact area. Mathematically, it is the inverse distance between the local normal vectors (first-order features) scaled by the local normal curvatures (second-order features) along the local direction of principal knee motion in a local reference coordinate system formed by the directions of principal curvature and the surface normal vector. The abilities of the CA and the CI for diagnosing osteoarthritis (OA) at different levels (disease severity was assessed using the Kellgren and Lawrence Index, KL) were cross-validated on 288 knees at baseline. Longitudinal analysis was performed on 245 knees. The precision quantified on 31 scan-rescan pairs (RMS CV) for CA was 13.7% and for CI 7.5%. The CA increased with onset of the disease and then decreased with OA progression. The CI was highest in healthy and decreased with the onset of OA and further with disease progression. The CI showed an AUC of 0.69 (p < 0.0001) for separating KL = 0 and KL > 0. For separating KL < 1 or KL = 1 and KL > 1 knees, the AUC for CI was 0.73 (p < 0.0001). The CA demonstrated longitudinal responsiveness (SRM) at all stages of OA, whereas the CI did for advanced OA only. Eventually, the quantified CA and the CI might be suitable to help explaining OA onset, diagnosis of (early) OA, and measuring the efficacy of DMOADs in clinical trials.     

经股四头肌腱关节腔内注射玻璃酸钠治疗膝骨关节炎的疗效观察

目的观察经股四头肌腱行关节腔内注射玻璃酸钠治疗膝骨关节炎(Knee Osteoarthritis,KOA)的疗效。方法对48例KOA患者(70膝)于髌骨上缘经股四头肌腱膝关节腔穿刺注射玻璃酸钠,分别于治疗前及治疗后1月行Hss评分。结果经股四头肌腱膝关节腔穿刺可做到一针穿刺成功。治疗后Hss评分较治疗前明显升高(P<0.01),其中疼痛项、功能项差异有统计学意义。结论经股四头肌腱膝关节腔内注射玻璃酸钠对改善KOA患者临床症状疗效确切、持久,操作简便、成功率高、病人痛苦小。     

Amelioration of Osteoarthritis via Tetrahedral Framework Nucleic Acids Delivering Microrna-124 for Cartilage Regeneration

MicroRNAs (miRNAs) regulate several physiological and pathological processes involved in various diseases, including osteoarthritis (OA). OA is the most common global musculoskeletal disorder, characterized by the irreversible progressive destruction of articular cartilage. Supplementation with exogenous miRNAs may represent a promising therapeutic OA treatment, with miRNA-124 (miR-124) being a prime candidate for its anti-inflammatory ability; however, an effective drug delivery system is urgently required to enhance miR-124 stability and capacity to enter chondrocytes. To this end, tetrahedral framework nucleic acids’ (tFNAs) self-assembled 3D DNA nanostructures possess superior inherent biocompatibility, versatile functionality, unsurpassed editability, and strong cellular internalization ability. In this study, tFNAs carrying one or three miR-124 (T-miR1 or T-miR3) are successfully synthesized. T-miR3 is largely absorbed via induced inflammatory chondrocytes by IL-1β. With reactive oxygen species’ scavenging ability and inflammation-suppressive miR-124 release behavior, T-miR3 efficiently protects chondrocytes against IL-1β injury in vitro. Additionally, T-miR3 effectively prevents OA progression by inhibiting chondrocyte apoptosis, smoothing cartilage surfaces, suppressing extracellular matrix degradation, and increasing synovial thickness, effectively protecting in vivo articular cartilage, and illustrating the therapeutic ability of T-miR3 in OA treatment. This study provides experimental evidence and novel therapeutic strategies for OA treatment in the clinical setting.     

Web-Based Multilayer Viewing Interface for Knee Cartilage

Many adults suffer from osteoarthritis (OA) with the majority of people over 65 showing radiographic evidence of the disease. To carry out effective diagnosis and treatment, it is necessary to understand the progression of cartilage loss and study the effectiveness of therapeutic interventions. Hence, it is important to have accurate, fast diagnosis of the disease. In this paper, we describe a Web-based user interface that enables the direct viewing of 2-D and 3-D image data from the visceral and tissue levels of the biological continuum (i.e., the continuum comprising systems, viscera, tissue, cells, proteins, and genes)–-while preserving geometric integrity. This is achieved despite the fact that the data are from different modalities (i.e., magnetic resonance (MR) and light microscopy). The user interface was tested using image data acquired from a study of articular cartilage thickness in the porcine knee. The interface allows the clinician to view both MR and light microscopy images in an integrated manner—with the information linked geometrically.      

半导体激光照射联合透明质酸钠和运动疗法对膝关节骨性关节炎的疗效影响

目的:探讨半导体激光穴位照射联合膝关节腔注射透明质酸钠和运动疗法对膝关节骨性关节炎的的临床疗效。方法:将86例膝关节骨性关节炎患者随机分成观察组及对照组,各43例。对照组采用膝关节腔注射透明质酸钠结合运动疗法,观察组在对照组的基础上采用半导体激光穴位照射,两组患者治疗后均随访6个月。结果:采用lysholm膝关节量表在治疗前后分别对两组患者进行评价,观察组其疗效优于对照组(P﹤0.05)。结论:采取半导体激光结合运动疗法并膝关节腔注射透明质酸钠治疗膝关节骨性关节炎安全有效,能预防膝关节骨性关节炎的反复发作。     

Matrix remodeling and cytological changes during spontaneous cartilage repair

During the repair of articular cartilage, type I collagen (COL1)-based fibrous tissues change into a mixture of COL1 and type II collagen (COL2) and finally form hyaline cartilaginous tissues consisting of COL2. In order to elucidate the changes that occur in the matrix during cartilage repair and the roles of fibroblasts and chondrocytes in this process, we generated a minimal cartilage defect model that could be spontaneously repaired. Defects of 0.3?mm were created on the patellofemoral articular cartilage of rats using an Er:YAG laser and were observed histologically, ultrastructurally and histochemically. At week 2 after this operation, fibroblastic cells were found to be surrounded by COL1 throughout the area of the defect. These cells became acid phosphatase positive by week 4, both taking in and degrading collagen fibrils. Thereafter, the cells became rounded, with both COL1 and 2 evident in the matrix, and showed immunolocalized matrix metalloproteinase-1 or -9. In the region of the bone marrow, the cells became hypertrophic and were surrounded mainly by COL2 and proteoglycans. By the eighth week, the cartilaginous matrix was found to contain abundant COL2, in which collagen fibrils of various diameters were arranged irregularly. These morphological changes suggested that the fibroblastic cells both produce and resolve the matrix and undertake remodeling to become chondrocytes by converting from a COL1- into a COL2-dominant matrix. This process eventually forms new articular cartilage, but this is not completely identical to normal articular cartilage at the ultrastructural level.     

Quantitative and morphological observations on the ultrastructure of articular tissue generated from free periosteal grafts.

This study investigates the ultrastructure of articular tissue generated on osteochondral defects in skeletally immature rabbits from free reversed periosteal allografts after 50 and 100 days of post-operative intermittent active motion. Tissue samples prepared for transmission electron microscopy were compared with normal cartilage and periosteum in terms of cell morphology and the pattern of intercellular collagen deposition. Well-differentiated tissue demonstrated many ultrastructural features of normal articular cartilage while poorly differentiated samples contained cells and intercellular collagen profiles which were somewhat similar to those observed in periosteum.     

Euryale Ferox Seed‐Inspired Superlubricated Nanoparticles for Treatment of Osteoarthritis

Osteoarthritis has been regarded as a typical lubrication deficiency related joint disease, which is characterized by the breakdown of articular cartilage at the joint surface and the inflammation of the joint capsule. Here, inspired by the structure of the fresh euryale ferox seed that possesses a slippery aril and a hard coat containing starchy kernel, a novel superlubricated nanoparticle, namely poly (3‐sulfopropyl methacrylate potassium salt)‐grafted mesoporous silica nanoparticles (MSNs‐NH₂@PSPMK), is biomimicked and synthesized via a one‐step photopolymerization method. The nanoparticles are endowed with enhanced lubrication by the grafted PSPMK polyelectrolyte polymer due to the formation of tenacious hydration layers surrounding the negative charges, and simultaneously are featured with effective drug loading and release behavior as a result of the sufficient mesoporous channels in the MSNs. When encapsulated with an anti‐inflammatory drug diclofenac sodium (DS), the lubrication capability of the superlubricated nanoparticles is improved, while the drug release rate is sustained by increasing the thickness of PSPMK layer, which is simply achieved via adjustment of the precursor monomer concentration in the photopolymerization process. Additionally, the in vitro and in vivo experimental results show that the DS‐loaded MSNs‐NH₂@PSPMK nanoparticles effectively protect the chondrocytes from degeneration, and thus, inhibit the development of osteoarthritis.     

A technique for regional analysis of femorotibial cartilage thickness based on quantitative magnetic resonance imaging

The objective of this work was to develop a methodology for measuring cartilage thickness in anatomically based subregions in the tibial and in the central weight-bearing femoral cartilage from magnetic resonance (MR) images. The tibial plateau was divided into a central area of the total subchondral bone area (tAB), and anterior, posterior, internal, and external subregions surrounding it. In the weight-bearing femoral condyles, central, internal, and external subregions were determined. The Euclidean distance between the tAB and cartilage surface was used for determining cartilage thickness. The reproducibility of the method was evaluated on test-retest data sets of 12 participants (six healthy, six with osteoarthritis). The subregion size was varied systematically to study the influence on the reproducibility. The size of the subregions was highly consistent under conditions of repositioning (standard deviation 0.0%-0.3%). The precision errors for regional mean cartilage thickness measurements ranged from 19 mum (1.5%) to 84 mum (4.7%). The computation of regional cartilage thickness values from segmented MR images is shown to be highly reproducible and robust under conditions of joint repositioning. In longitudinal studies, this technique may substantially enhance the ability of quantitative MRI to monitor structural changes in osteoarthritis at narrow time intervals.     

Adaptive cancellation of muscle contraction interference invibroarthrographic signals

Vibroarthrography (VAG) is an innovative, objective, noninvasive technique for obtaining diagnostic information concerning the articular cartilage of a joint. Knee VAG signals can be detected using a contact sensor over the skin surface of the knee joint during knee movement such as flexion and/or extension. These measured signals. However, contain significant interference caused by muscle contraction that is required for knee movement. Quality improvement of VAG signals is an important subject, and crucial in computer-aided diagnosis of cartilage pathology. While simple frequency domain high-pass (or band-pass) filtering could be used for minimizing muscle contraction interference (MCI), it could eliminate possible overlapping spectral components of the VAG signals. In this work, an adaptive MCI cancellation technique is presented as an alternative technique for filtering VAG signals. Methods of measuring the VAG and reference signals (MCI) are described, with details on MCI identification. Characterization, and step size optimization for the adaptive filter. The performance of the method is evaluated by simulated signals as well as signals obtained from human subjects under isotonic contraction     

Design of patient-specific gait modifications for knee osteoarthritis rehabilitation

Abstract-Gait modification is a nonsurgical approach for reducing the external knee adduction torque in patients with knee osteoarthritis (OA). The magnitude of the first adduction torque peak in particular is strongly associated with knee OA progression. While toeing out has been shown to reduce the second peak, no clinically realistic gait modifications have been identified that effectively reduce both peaks simultaneously. This study predicts novel patient-specific gait modifications that achieve this goal without changing the foot path. The modified gait motion was designed for a single patient with knee OA using dynamic optimization of a patient-specific, full-body gait model. The cost function minimized the knee adduction torque subject to constraints limiting how much the new gait motion could deviate from the patient's normal gait motion. The optimizations predicted a "medial-thrust" gait pattern that reduced the first adduction torque peak between 32% and 54% and the second peak between 34% and 56%. The new motion involved three synergistic kinematic changes: slightly decreased pelvis obliquity, slightly increased leg flexion, and slightly increased pelvis axial rotation. After gait retraining, the patient achieved adduction torque reductions of 39% to 50% in the first peak and 37% to 55% in the second one. These reductions are comparable to those reported after high tibial osteotomy surgery. The associated kinematic changes were consistent with the predictions except for pelvis obliquity, which showed little change. This study demonstrates that it is feasible to design novel patient-specific gait modifications with potential clinical benefit using dynamic optimization of patient-specific, full-body gait models. Further investigation is needed to assess the extent to which similar gait modifications may be effective for other patients with knee OA.     

声发射信号诊断的膝盖骨性关节炎

针对目前膝盖骨性关节炎(OA)发病率高,传统的诊断方法缺乏便携性,价格贵,存在放射性危害等局限性。该文提出了一种基于遗传算法优化BP神经网络的膝盖OA诊断。该方法以健康组和患病组为研究对象,将采集到的声发射(AE)信号通过遗传优化算法得到BP网络的最佳初始权值和阈值,利用BP神经网络对AE信号进行诊断分类。经实验室建立的膝盖OA声发射数据库的实验结果表明,该诊断方法效果好,误差小,能对膝盖OA患者进行实时检测和早期预测,具有临床价值。     

红光治疗仪治疗78例膝关节炎患者的效果分析

目的:探讨红光治疗仪治疗膝关节炎的临床效果。方法:选择我院自2013年3月至2014年3月期间收治的膝关节炎患者78例,将其平均分为观察组(n=39)和对照组(n=39)。观察组采用红光治疗仪进行治疗,对照组采用双氯芬酸钠进行治疗,观察和统计患者接受治疗后的临床效果及生活质量改善情况。结果:观察组患者接受治疗后的临床效果明显优于对照组患者(P0.05);观察组患者生活质量改善情况明显优于对照组患者(P0.05)。结论:红光治疗仪治疗膝关节炎效果显著,改善了患者的生活质量,值得推广。     

Structural analysis of articular cartilage using multiphoton microscopy: input for biomechanical modeling

The 3-D morphology of chicken articular cartilage was quantified using multiphoton microscopy (MPM) for use in continuum-mechanical modeling. To motivate this morphological study we propose aspects of a new, 3-D finite strain constitutive model for articular cartilage focusing on the essential load-bearing morphology: an inhomogeneous, poro-(visco)elastic solid matrix reinforced by an anisotropic, (visco)elastic dispersed fiber fabric which is saturated by an incompressible fluid residing in strain-dependent pores. Samples of fresh chicken cartilage were sectioned in three orthogonal planes and imaged using MPM, specifically imaging the collagen fibers using second harmonic generation. Employing image analysis techniques based on Fourier analysis, we derived the principal directionality and dispersion of the collagen fiber fabric in the superficial layer. In the middle layer, objective thresholding techniques were used to extract the volume fraction occupied by extracellular collagen matrix. In conjunction with information available in the literature, or additional experimental testing, we show how this data can be used to derive a 3-D map of the initial solid volume fraction and Darcy permeability.     

Analysis of knee vibration signals using linear prediction

Clinical methods used at present for the diagnosis of cartilage pathology in the knee are invasive in nature, and carry some risks. There exists a need for the development of a safe, objective, noninvasive method for early detection, localization, and quantification of cartilage pathology in the knee. This paper investigates the possibility of developing such a method based on an analysis of vibrations produced by joint surfaces rubbing against one another during normal movement. In particular, the method of modeling by linear prediction is used for adaptive segmentation and parameterization of knee vibration signals. Dominant poles are extracted from the model system function for each segment based on their energy contributions and bandwidths. These dominant poles represent the dominant features of the signal segments in the spectral domain. Two-dimensional feature vectors are then constructed using the first dominant pole and the ratio of power in the 40-120 Hz band to the total power of the segment. The potential use of this method to distinguish between vibrations produced by normal volunteers and patients known to have cartilage pathology (chondromalacia) is discussed.     

Surface extraction and thickness measurement of the articular cartilage from MR images using directional gradient vector flow snakes

The accuracy of the surface extraction of magnetic resonance images of highly congruent joints with thin articular cartilage layers has a significant effect on the percentage errors and reproducibility of quantitative measurements (e.g., thickness and volume) of the articular cartilage. Traditional techniques such as gradient-based edge detection are not suitable for the extraction of these surfaces. This paper studies the extraction of articular cartilage surfaces using snakes, and a gradient vector flow (GVF)-based external force is proposed for this application. In order to make the GVF snake more stable and converge to the correct surfaces, directional gradient is used to produce the gradient vector flow. Experimental results show that the directional GVF snake is more robust than the traditional GVF snake for this application. Based on the newly developed snake model, an articular cartilage surface extraction algorithm is developed. Thickness is computed based on the surfaces extracted using the proposed algorithm. In order to make the thickness measurement more reproducible, a new thickness computation approach, which is called T-norm, is introduced. Experimental results show that the thickness measurement obtained by the new thickness computation approach has better reproducibility than that obtained by the existing thickness computation approaches.