Jones C W, Smolinski D, Willers C, Yates P J, Keogh A, Fick D, Kirk T B, Zheng M H
School of Mechanical Engineering, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
Osteoarthritis Cartilage. 2007 Dec;15(12):1388-96. doi: 10.1016/j.joca.2007.05.003. Epub 2007 Jul 9.
Osteoarthritis (OA) inflicts an enormous burden upon sufferers and healthcare systems worldwide. Continuing efforts to elucidate the aetiology of OA have indicated the need for non-destructive methods of in vivo microstructural assessment of articular cartilage (AC). In this study, we describe the first use of a recently developed laser scanning confocal arthroscope (LSCA) to image the cartilage of a fresh frozen cadaveric knee from a patient with OA.
Using an adaptation of the International Cartilage Repair Society (ICRS) joint mapping protocol, the joint was divided into three discrete regions (femoral condyle, patella and tibial plateau) for grading according to the ICRS (Outerbridge) system. The LSCA was used to generate images from each area within the three regions. Following imaging, the joint was sectioned and histology was performed on the corresponding sites with histological grading (modified-Mankin).
Quantitative results of ICRS, LSCA and histological OA assessment were compared using intraclass correlation (ICC) and Pearson correlation analysis. The LSCA enabled visualisation of chondrocyte morphology and cell density, with classical OA changes such as chondrocyte clustering, surface fibrillation and fissure formation evident. Obvious qualitative similarities between LSCA images and histology were observed, with fair to moderate agreement (P<0.05) demonstrated between modalities.
In this study, we have shown the viability of the LSCA for non-destructive imaging of the microstructure of OA knee cartilage. LSCA technology is potentially a valuable research and clinical tool for the non-destructive assessment of AC microstructure in early to late OA.
骨关节炎（OA）给全球患者和医疗系统带来了巨大负担。为阐明OA病因所做的持续努力表明，需要采用非破坏性方法对关节软骨（AC）进行体内微观结构评估。在本研究中，我们描述了首次使用最近开发的激光扫描共聚焦关节镜（LSCA）对一名OA患者新鲜冷冻尸体膝关节的软骨进行成像。
采用国际软骨修复协会（ICRS）关节映射方案的一种变体，将关节分为三个离散区域（股骨髁、髌骨和胫骨平台），根据ICRS（Outerbridge）系统进行分级。使用LSCA对三个区域内的每个区域生成图像。成像后，将关节切片，并在相应部位进行组织学检查及组织学分级（改良曼金分级）。
使用组内相关系数（ICC）和Pearson相关分析比较了ICRS、LSCA和组织学OA评估的定量结果。LSCA能够观察到软骨细胞形态和细胞密度，明显的OA典型变化如软骨细胞聚集、表面原纤维形成和裂隙形成清晰可见。观察到LSCA图像与组织学之间存在明显的定性相似性，不同方法之间显示出中等程度的一致性（P<0.05）。
在本研究中，我们证明了LSCA对OA膝关节软骨微观结构进行无损成像的可行性。LSCA技术可能是一种用于早期至晚期OA中AC微观结构无损评估的有价值的研究和临床工具。
