Temporal in vivo assessment of fresh osteochondral allograft transplants to the distal aspect of the femur by dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) and zonal T2 mapping MRI

Dawson S. Brown, Michael G. Durkan, Erik Foss, Jerzy Szumowski, Dennis Crawford

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Zonal T2 mapping and dGEMRIC (delayed gadolinium-enhanced magnetic resonance imaging of cartilage) are diagnostic quantitative techniques to evaluate the biochemical health of articular cartilage. We adapted these techniques to investigate the results of osteochondral allograft transplantation and correlated the findings with patient-reported outcomes. Methods: Nine patients with contained ICRS (International Cartilage Repair Society) grade-4 defects of the articular portion of a femoral condyle were treated with fresh osteochondral allografts and were evaluated prospectively with dGEMRIC and T2 mapping before and after gadolinium administration. The KOOS (Knee Injury Osteoarthritis Outcome Score) and IKDC (International Knee Documentation Committee) subjective scores were obtained at baseline and at one and two years postoperatively. For quantitative T2 mapping, regions of interest were drawn in the deep and superficial layers of allograft and control cartilage. For dGEMRIC analyses, the relaxation rate, post-gadolinium change in relaxation rate, and ratio between changes in the allograft and control regions of interest were calculated from T1 values. Results: The mean ratio between the post-gadolinium changes in the allograft and control cartilage was 1.13 at one year and 1.55 at two years, and the ratio increased in eight of nine patients from one to two years. There was no difference between the mean T2 values in the deep zone of the allograft and control cartilage at one or two years (p > 0.05), but mean T2 values were higher in the superficial zone of the allograft cartilage at one (p <0.0001) and two (p <0.028) years. The mean improvement from baseline was significant at one and two years for the IKDC and all five KOOS subdomains (p <0.05). All or nearly all patients showed improvements in all clinical outcomes scores at one year. Conclusions: Functional MRI techniques can be applied to noninvasively assess the biochemical health of cartilage after osteochondral allograft transplantation. The MRI findings correlated with certain patient-reported outcomes in the early postoperative period. Relative glycosaminoglycan content and the collagen structure of allograft cartilage may undergo time-dependent degeneration. A patient's perception of clinical outcome and quality of life is likely multifactorial and is impacted by more than the health of the allograft cartilage. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)564-572
Number of pages9
JournalJournal of Bone and Joint Surgery - Series A
Volume96
Issue number7
DOIs
StatePublished - Apr 2 2014

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Gadolinium
Femur
Cartilage
Allografts
Transplants
Knee Injuries
Knee Osteoarthritis
Documentation
Knee
Health
Transplantation
Magnetic Resonance Imaging
Articular Cartilage
Thigh
Glycosaminoglycans
Postoperative Period
Collagen
Joints
Quality of Life
Bone and Bones

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Temporal in vivo assessment of fresh osteochondral allograft transplants to the distal aspect of the femur by dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) and zonal T2 mapping MRI. / Brown, Dawson S.; Durkan, Michael G.; Foss, Erik; Szumowski, Jerzy; Crawford, Dennis.

In: Journal of Bone and Joint Surgery - Series A, Vol. 96, No. 7, 02.04.2014, p. 564-572.

Research output: Contribution to journalArticle

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abstract = "Background: Zonal T2 mapping and dGEMRIC (delayed gadolinium-enhanced magnetic resonance imaging of cartilage) are diagnostic quantitative techniques to evaluate the biochemical health of articular cartilage. We adapted these techniques to investigate the results of osteochondral allograft transplantation and correlated the findings with patient-reported outcomes. Methods: Nine patients with contained ICRS (International Cartilage Repair Society) grade-4 defects of the articular portion of a femoral condyle were treated with fresh osteochondral allografts and were evaluated prospectively with dGEMRIC and T2 mapping before and after gadolinium administration. The KOOS (Knee Injury Osteoarthritis Outcome Score) and IKDC (International Knee Documentation Committee) subjective scores were obtained at baseline and at one and two years postoperatively. For quantitative T2 mapping, regions of interest were drawn in the deep and superficial layers of allograft and control cartilage. For dGEMRIC analyses, the relaxation rate, post-gadolinium change in relaxation rate, and ratio between changes in the allograft and control regions of interest were calculated from T1 values. Results: The mean ratio between the post-gadolinium changes in the allograft and control cartilage was 1.13 at one year and 1.55 at two years, and the ratio increased in eight of nine patients from one to two years. There was no difference between the mean T2 values in the deep zone of the allograft and control cartilage at one or two years (p > 0.05), but mean T2 values were higher in the superficial zone of the allograft cartilage at one (p <0.0001) and two (p <0.028) years. The mean improvement from baseline was significant at one and two years for the IKDC and all five KOOS subdomains (p <0.05). All or nearly all patients showed improvements in all clinical outcomes scores at one year. Conclusions: Functional MRI techniques can be applied to noninvasively assess the biochemical health of cartilage after osteochondral allograft transplantation. The MRI findings correlated with certain patient-reported outcomes in the early postoperative period. Relative glycosaminoglycan content and the collagen structure of allograft cartilage may undergo time-dependent degeneration. A patient's perception of clinical outcome and quality of life is likely multifactorial and is impacted by more than the health of the allograft cartilage. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.",
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