David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Chair, Musculoskeletal, Sydney Medical Program
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
Studying relation between sitting position and knee osteoarthritiiosrjce
Osteoarthritis (OA) of the knee is the most common form of arthritis and leads to more activity
limitations (e.g., disability in walking and stair climbing) than any other disease, especially in the elderly. The
aim of this study was to clarify the relationship between the sitting position and knee osteoarthritis. The study
involved fat males of knee pain and clinical diagnosis of early knee osteoarthritis this research is applied and
the research method is "descriptive-correlative". In order to collecting data was used questionnaire tool. Also,
in order to analyzing data was used statistical method such as Pierson coefficient and Chi-squared test. Data is
analyzed from both descriptive and inferential statistics. Descriptive statistics and graphs on the table will
describe the characteristics of the study sample. The researcher to analyze the hypotheses used Chi-square
method. The statistical society is Osteoarthritis disease males.
Prof. Jon Tobias's presentation from Osteoporosis 2016: Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude.
Find out more at: https://nos.org.uk/conference
Kate Ward's presentation from Osteoporosis 2016: Relationships between muscle function and bone microarchitecture in the Hertfordshire cohort study.
Find out more at: https://nos.org.uk/conference
The Battle 2021 Castrocaro Terme (Italy). Achilles Insertional Tendinopathy a...Nicola Taddio
The aim of this presentation is to explain the background of Achilles Insertional Tendinopathy and Haglund's Triad, the rationale of conservative treatment and finally the therapeutic exercise evidence based approach.
Studying relation between sitting position and knee osteoarthritiiosrjce
Osteoarthritis (OA) of the knee is the most common form of arthritis and leads to more activity
limitations (e.g., disability in walking and stair climbing) than any other disease, especially in the elderly. The
aim of this study was to clarify the relationship between the sitting position and knee osteoarthritis. The study
involved fat males of knee pain and clinical diagnosis of early knee osteoarthritis this research is applied and
the research method is "descriptive-correlative". In order to collecting data was used questionnaire tool. Also,
in order to analyzing data was used statistical method such as Pierson coefficient and Chi-squared test. Data is
analyzed from both descriptive and inferential statistics. Descriptive statistics and graphs on the table will
describe the characteristics of the study sample. The researcher to analyze the hypotheses used Chi-square
method. The statistical society is Osteoarthritis disease males.
Prof. Jon Tobias's presentation from Osteoporosis 2016: Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude.
Find out more at: https://nos.org.uk/conference
Kate Ward's presentation from Osteoporosis 2016: Relationships between muscle function and bone microarchitecture in the Hertfordshire cohort study.
Find out more at: https://nos.org.uk/conference
The Battle 2021 Castrocaro Terme (Italy). Achilles Insertional Tendinopathy a...Nicola Taddio
The aim of this presentation is to explain the background of Achilles Insertional Tendinopathy and Haglund's Triad, the rationale of conservative treatment and finally the therapeutic exercise evidence based approach.
In the presentation, I discussed new concepts in OA pathogenesis and identified possible targets of treatment. This was followed by a review of new treatment options for osteoarthritis. Presented during the Joint RA OA SIG Symposium at the F1 Hotel last 28 November 2014.
Dr EG Penserga discusses developments in hand osteoarthritis - from disease mechanisms to treatment propositions. Presented during the Joint RA OA SIG Symposium held at the F1 Hotel last 28 Nov 2014.
Osteoartritis (OA) adalah salah satu jenis artritis yang paling sering dialami oleh sebagian orang. Penyakit ini merupakan penyakit sendi degeneratif yang mempengaruhi tulang rawan persendian. OA terjadi akibat rusaknya kartilago yang melindungi dan memberi bantalan bagi sendi.
In the presentation, I discussed new concepts in OA pathogenesis and identified possible targets of treatment. This was followed by a review of new treatment options for osteoarthritis. Presented during the Joint RA OA SIG Symposium at the F1 Hotel last 28 November 2014.
Dr EG Penserga discusses developments in hand osteoarthritis - from disease mechanisms to treatment propositions. Presented during the Joint RA OA SIG Symposium held at the F1 Hotel last 28 Nov 2014.
Osteoartritis (OA) adalah salah satu jenis artritis yang paling sering dialami oleh sebagian orang. Penyakit ini merupakan penyakit sendi degeneratif yang mempengaruhi tulang rawan persendian. OA terjadi akibat rusaknya kartilago yang melindungi dan memberi bantalan bagi sendi.
Real-life examples of manuscript reviews Comparison and contrast of useful ...OARSI
Aileen Davis, PhD
Senior Scientist and Division Head,
Health Care and Outcomes Research,
Krembil Research Institute,
University Health Network and
Professor, University of Toronto
Real-life examples of manuscript reviews Comparison and contrast of useful ...OARSI
Aileen Davis, PhD
Senior Scientist and Division Head,
Health Care and Outcomes Research,
Krembil Research Institute,
University Health Network and
Professor, University of Toronto
How to write an effective review (and help editors and authors)OARSI
Rik Lories, MD PhDProfessor of Experimental Rheumatology
Director of the Laboratory of Tissue Homeostasis and Disease
KU Leuven, Skeletal Biology and Engineering Research Centre and University Hospitals Leuven, Division of Rheumatology
Joel A Block, MD
The Willard L Wood MD Professor, and
Director, Division of Rheumatology, Rush University Medical Center
Editor in Chief, Osteoarthritis and Cartilage
Real-life examples of manuscript reviews Comparison and contrast of useful ...OARSI
Senior Scientist and Division Head,
Health Care and Outcomes Research,Krembil Research Institute,
University Health Network and
Professor, University of Toronto
Professor of Radiology and Medicine
Vice Chair, Academic Affairs
Assistant Dean of Diversity
Director, Quantitative Imaging Center (QIC)
Boston University School of Medicine, Boston, MA
Nuts & Bolts of Systematic Reviews, Meta-analyses & Network Meta-analysesOARSI
Director, Applied Health Research Centre (AHRC)
Li Ka Shing Knowledge Institute, St. Michael’s Hospital
Professor, Department of Medicine & IHPME, University of Toronto
Tier 1 Canada Research Chair in Clinical Epidemiology of Chronic Diseases
Building a translational team for impacting public policyPre-Congress Worksh...OARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Structural Targets for Prevention of Post Traumatic OA
1. Structural Targets for Prevention of
Post Traumatic OA
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Chair, Musculoskeletal, Sydney Medical Program
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
David.Hunter@sydney.edu.au
@ProfDavidHunter
2. Declaration of interest
I declare that in the past three years I have:
• Consulted for Pfizer, TLCBio, Tissuegene, Merck Serono
• Supported by an NHMRC Health Practitioner Fellowship.
3. References
• The health and structural consequences of acute knee
injuries involving rupture of the anterior cruciate ligament.
Rheum Dis Clin North Am. 2013 Feb;39(1):107-22.
• Pathogenesis of post-traumatic OA with a view to
intervention. Best Pract Res Clin Rheumatol. 2014
Feb;28(1):17-30.
• OARSI Clinical Trials Recommendations: Knee imaging in
clinical trials in osteoarthritis. Osteoarthritis Cartilage. 2015
May;23(5):698-715.
• Definition of osteoarthritis on MRI: results of a Delphi
exercise. Osteoarthritis Cartilage. 2011 Aug;19(8):963-9.
6. Natural History of OA
X-ray
Structural
changes in
bone
(i.e., joint
failure)
End-stage
Disease
(i.e., joint
death)
Initiation of
Disease
Process
MRI/Biomarkers
Changes in the
composition of bone,
cartilage,
other soft tissues
Symptoms
MRI /US
Structural changes
in bone,cartilage,
other soft tissues
Clinically detectable OA Joint
ReplacementRadiographicPre-Radiographic
Defining Disease State of Osteoarthritis
Molecular
8. Risk for Knee OA
Obesity
Injury
Occupation
Other
Arthritis Rheum. 1998, Aug;41(8):1343-55.
Osteoarthritis Cartilage. 2009; Sep 2.
9. Defining phenotypes of osteoarthritis based on dimensions of disease
Bierma-Zeinstra, S. M. & van Middelkoop, M. (2017) In search of phenotypes
Nat. Rev. Rheumatol. doi:10.1038/nrrheum.2017.181
10.
11. Injury rates are increasing but it takes
time to develop radiographic OA
Incidence of primary anterior cruciate ligament
reconstruction in females, 2000–2015, by age
group
10 to 20 years after the diagnosis, on average,
50% of those with a diagnosed anterior
cruciate ligament or meniscus tear have
osteoarthritis
21. Accepted propositions for definition of
OA on MRI
A definition of tibiofemoral osteoarthritis on MRI would be:
The presence of both group [A] features or one group [A] feature and two or more group [B]
features
Group [A] after exclusion of joint trauma within the last 6 months (by history) and exclusion
of inflammatory arthritis (by radiographs, history and laboratory parameters):
i) Definite osteophyte formation§
ii) Full thickness cartilage loss
Group [B]:
i) Subchondral bone marrow lesion or cyst not associated with meniscal or ligamentous
attachments
ii) Meniscal subluxation, maceration or degenerative (horizontal) tear
iii) Partial thickness cartilage loss (where full thickness loss is not present)
iv) Bone attrition
Definition of PF OA requires all of the following involving the patella and/or anterior femur:
i) A definite osteophyte
ii) Partial or full thickness cartilage loss
22.
23. Early OA after ACL reconstruction
• MRI-detected OA 1 year following ACL
reconstruction is common, while being absent in
uninjured control knees.
• Patellofemoral OA is particularly affected,
especially in men (OR 6.3, 95%CI 2.4-16.2)
• Predictors of early MRI-detected OA:
• Meniscectomy (OR 6.8, 95%CI 2.0-23.3)
• BMI>25 (OR 3.0, 95%CI 1.3-6.9)
Culvenor et al. Arthritis Rheum 2015;67:946-955
24. What comes first? Multi-tissue involvement
leading to radiographic osteoarthritis
• Predictors of ROA at P-2:
• Hoffa synovitis (HR 1.76 [95% CI 1.18-2.64])
• Effusion synovitis (HR 1.81 [95% CI 1.18-2.78])
• Medial meniscal damage (HR 1.83 [95% CI 1.17-
2.89]).
• At P -1, all features but meniscal extrusion
predicted radiographic OA, with highest odds for
medial BMLs (HR 6.50 [95% CI 2.27-18.62]) and
effusion synovitis (HR 2.50 [95% CI 1.76-3.54]).
Roemer et al. Arthritis Rheumatol. 2015 May;67(8):2085-96
30. LateralMedial
Trochlea
LateralMedial
Trochlea
Femur
Tibia
Baseline
2 Year Change 5 Year Change
Raw
Change
SRM
Raw
Change
SRM
-0.1 mm-1 +0.1 mm-1
-0.1 mm-1 +0.1 mm-1
-0.01mm-1
+0.01mm-1
-1.0 z
+1.0 z
-0.01mm-1
+0.01mm-1
-1.0 z
+1.0 z
Concave Convex
Figure 2. Population Average: Left, Baseline Average. Middle, 2 year average change. Right, 5 Year average changes
0.0
34. Compositional MRI
• Initial histological and biochemical changes of cartilage
damage involve disruption of the collagen network,
decrease in proteoglycan content and increase in
permeability to water.
• Compositional MRI techniques enable detection of these
biochemical changes in the cartilage ECM before
morphological change occurs.
• Efforts toward developing MRI techniques to interrogate
cartilage macromolecules have focused on collagen and
GAG.
35. T2 mapping
• Articular cartilage T2 reflects the water content, collagen
content and collagen fiber orientation in the ECM, with longer
T2 values thought to represent cartilage degeneration
• Kijowski et al. Radiology 2013;267:503-513.
The addition of a T2 mapping sequence to
a routine MR protocol at 3.0 T improved sensitivity in the
detection of cartilage lesions within the knee joint from
74.6% to 88.9%, with only a small reduction in specificity.
The greatest improvement in sensitivity with use of
the T2 maps was in the identification of
early cartilage degeneration.
36. • Prospective, observational analysis of 42
knees in 40 patients
with acute, isolated ACL injury with
imaging at the time of injury and
yearly follow-up for a max of 11 years.
• All patients sustained chondral damage at
initial injury.
• There was increased risk
of cartilage degeneration over the medial
tibial plateau (MTP) (P = .047; OR 6.23;
95% CI 1.03-37.90) and patella (P = .032;
OR = 4.88; 95% CI, 1.14-20.80) in
nonsurgical patients compared with
surgically treated patients.
T2 mapping
Potter et al. Am J Sport s Med. 2012 ;40:276-85
37. T1 rho mapping
• T1rho probes the slow motion interactions between
motion-restricted water molecules and their local
macromolecular environment.
• Regatte et al. J Magn Reson Imaging
2006; 23: 547-553
Sensitive imaging marker for
quantitative monitoring of
macromolecules in early OA.
• Stahl et al. Eur Radiol 2009; 19: 132-
143.
More sensitive than T2 mapping for
differentiating between normal
cartilage and early-stage OA.
38. Cartilage Morphology and T1ρ and T2 Quantification in
ACL-reconstructed Knees: A 2-year Follow-up
Osteoarthritis Cartilage. 2013 Aug;21(8):1058-67
39. Fig. 2
Osteoarthritis and Cartilage 2017 25, 513-520DOI: (10.1016/j.joca.2016.09.015)
Integration of T2 and T1Rho
40. dGEMRIC
High-grade damage of the medial meniscus showed significant associations
with lower dGEMRIC indices. The dGEMRIC technique may be a useful tool in
detecting early changes of cartilage when meniscal function is lost.
Crema et al. Arthritis Rheum 2014;66:1517-24.
41. Summary of compositional MRI
• Compositional MRI techniques seem to have the
potential to supplement clinical MRI sequences in
identifying cartilage degeneration at an earlier stage
than is possible today
• Different techniques are complementary, in that some
focus on isotropy or the collagen network (e.g., T2
mapping and T1rho) while others focus on tissue
composition, e.g., dGEMRIC, that conveys information
on the GAG concentration
• While some, such as T2 mapping, are easily applied on
standard clinical platforms using 1.5 or 3T systems,
others require dedicated hardware or software
Guermazi et al. J Rheum 2016;43:7-11
42. Cartilage adaptation after anterior cruciate ligament injury and
reconstruction: implications for clinical management and
research? A systematic review of longitudinal MRI studies.
Clinical management
Chondral defects are commonly detected in ACL-injured
and reconstructed knees
Gross MRI-detected morphological change requires
approximately 2 years
Prevention should focus on ultra-structural deterioration
accelerating cartilage loss
In the lateral compartment, morphological and/or ultra-
structural damage most likely progresses from blunt
trauma onwards. Medially, changes presumably start
during the first year, hitherto recorded the soonest at 3
weeks follow-up
Moderate-to-strong evidence exist for baseline factors
meniscal lesion/meniscectomy, BML, time from injury
and persistent altered biomechanics as influencing rate
of cartilage change after ACL reconstruction
(Late) post-operative rehabilitation should also consider
cartilage status in return to play decisions
ACL-reconstructed knees may benefit from longer
recovery than non-surgically treated knees. After 1 year,
treatment effects disappear and, so far, no treatment
option appears convincingly superior in view of structural
longevity of the knee
Future research directions
Longitudinal follow-up studies of cartilage ultra-
structural changes during the first year(s)
following injury or reconstruction. UTE and UTE-
T2* and T1rho imaging may be more sensitive
than standard T2 mapping in this respect
Validation of MRI biomarkers in long-term studies
in view of the prediction of future radiographic
and/or symptomatic OA
Prospective risk factor studies to support
identification of patients treated with ACL
reconstruction at risk for accelerated cartilage
degeneration
High quality (multi-center) Randomized
Controlled Trials (RCT's) on the efficacy and safety
of biological, surgical, and rehabilitation
techniques in mediating cartilage morphological
and ultra-structural deterioration following ACL
injury and reconstruction both in the short- and
long-term
Osteoarthritis Cartilage. 2013 Aug;21(8):1009-24.
43. Summary of the current and future strategies for
the management of ankle and knee joint injuries
Joint Primary prevention Secondary prevention Current treatments
Ankle Braces101,102,
proprioceptive
training103,104,
breakaway bases105
Braces106,107, disease-
modifying PTOA drugs,
CT-guided
reconstruction108
‘Rest, ice, compression,
elevation’104,
anatomical
reconstruction109,110
Knee Exercise programs
(neuromuscular,
aerobic, strength
and plyometric
training)13,111-115
Disease-modifying PTOA
drugs (targeting gene
products, inflammatory
processes and specific
biomarkers)
ACL reconstruction116,
meniscal repair117
Best Pract Res Clin Rheumatol. 2014 Feb;28(1):17-30.
44. Summary Slide
Baseline imaging prognostic
markers
Short term change (within 6-
12 months) markers
Meniscal injury Bone shape
Osteochondral injury/
depression fracture
Cartilage composition- T2,
T1Rho
Synovitis/Reinjury/ surgery
More speculative
Alignment, tibial slope, muscle
volume and quality
Bone histomorphometry
46. Conclusions
Conventional MRI can show “pre-radiographic”
changes
Morphologic changes that are not seen on radiography
Validity and reliability well established now
Compositional MRI shows “pre-morphologic”
physiologic changes
e.g. morphologically normal cartilage with changes in
dGEMRIC index, T2 or T1rho values
Promising future, but needs more longitudinal studies for
validation
47. Recommendations
• The utility of plain radiography in early OA is limited due to
inability to detect early structural changes.
• MRI has superior sensitivity to change and validity in the
context of early OA.
• Further MRI research on the predictive validity (related to
longer term development of OA) and utility in clinical trials
(both as a prognostic but also as efficacy of intervention
markers) is required before making defined
recommendations about one MRI measure over another.
• Features that do appear to be worthy of focusing on are:
meniscal morphology, synovitis, bone shape, compositional
imaging
49. What's happening at IWOAI 2019?
• Clinical & Imaging Parameters for DMOAD Trials & Update on DMOAD
Developments
• Pre-workshop on Machine Learning Segmentation Challenge
• Novel Analytics and Computational Approaches
• Linking Imaging with Tissue and Joint Function
• Imaging Early Osteoarthritis
• Phenotypes/Subgroups of Osteoarthritis
• Updates & Insight from APPROACH / OAI / MOST
• Pre-Congress Boat Trip (June 25th) & Post-Congress Bike/Beach Trip (June 29th)
June 26-28
Charlottetown, Prince Edward Island, Canada
50. Acknowledgements
• Chris Little, USYD
• Kim Bennell, Univ Melb
• Paul Hodges, UQ
• Bill Vicenzino, UQ
• Manuela Ferreira, USYD
• Rana Hinman, Univ Melb
• Changhai Ding, UTAS
• James Linklater, USYD
• Peter Choong, Univ Melb
• Michelle Dowsey, Univ
Melb
• Justin Roe, UNSW
• David Lloyd, Griffith
• Stefan Lohmander, Lund
• Yuqing Zhang, MGH
• Steve Messier, Wake Forest
• Felix Eckstein, PMU
• Nigel Arden, Oxford
• Kent Kwoh, Arizona
• Virginia Kraus, Duke
• Ali Guermazi, Boston Univ
• Frank Roemer, Erlangen
• Grace Lo, Baylor
• Elena Losina, Harvard
• Jeff Katz, Harvard
• Michael Nevitt, UCSF
• Richard Loeser, UNC
• Tim McAlindon, Tufts
• David Wilson, UBC
• Young Jo Kim, Harvard