Martin S, Rashidifard C, Norris D, Goncalves A, Vercollone C, Brezinski M E
Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Osteoarthr Cartil Open. 2022 Dec;4(4). doi: 10.1016/j.ocarto.2022.100313. Epub 2022 Sep 23.
Efforts to develop chondroprotective approaches to halt osteoarthritis (OA) progression have recently increased. Current imaging techniques are critical in managing advanced OA, but greater resolution is needed to identify reversible stages (pre-OA). Optical coherence tomography (OCT) is a micron scale imaging technology widely used in ophthalmology, cardiology, and neurology. We previously demonstrated that polarization sensitive OCT (PS-OCT) can identify pre-OA in vitro, in animals, and in open surgical fields. This feasibility study examines performing intraarticular PS-OCT using a flexible endocatheter introduced through a stiff 18-gauge spinal needle. Results are critical for designing larger clinical trials examining minimally invasive PS-OCT's ability to identify pre-OA.
Fifteen patients undergoing arthroscopic partial medial meniscectomy were selected to confirm their risk for rapid progression to OA. Magnetic resonance imaging (MRI) was obtained at time 0 and at 2.5 years to determine if significant OA developed over this short period and for correlation with time zero PS-OCT results.
Over half of the patients developed frank OA by 2.65 ± 0.28 years. All cartilage surfaces were successfully imaged by PS-OCT, but endocatheter redesign is needed. Normal to severely abnormal areas by PS-OCT (all normal by MRI) were successfully identified. PS-OCT assessments were promising for predicting OA progression (p < 0.008). However, the study's low power prevented definite conclusions regarding predictive value.
This pilot study produced at least two outcomes critical for future larger trial designs: medial meniscectomy patients are well-suited for studying PS-OCT's ability to predict future OA and substantial endocatheter redesign is needed.
近年来，为开发软骨保护方法以阻止骨关节炎（OA）进展所做的努力有所增加。当前的成像技术对晚期OA的管理至关重要，但需要更高的分辨率来识别可逆阶段（OA前期）。光学相干断层扫描（OCT）是一种微米级成像技术，广泛应用于眼科、心脏病学和神经病学。我们之前证明了偏振敏感OCT（PS-OCT）能够在体外、动物以及开放手术视野中识别OA前期。本可行性研究探讨了使用通过硬18号脊麻针引入的柔性心内导管进行关节内PS-OCT检查。研究结果对于设计更大规模的临床试验以检验微创PS-OCT识别OA前期的能力至关重要。
选择15例接受关节镜下部分内侧半月板切除术的患者，以确认他们快速进展为OA的风险。在0时间点和2.5年时进行磁共振成像（MRI），以确定在此短时间内是否发生了显著的OA，并与0时间点的PS-OCT结果进行相关性分析。
超过一半的患者在2.65±0.28年时发展为明显的OA。所有软骨表面均通过PS-OCT成功成像，但需要重新设计心内导管。成功识别出PS-OCT显示的正常至严重异常区域（MRI显示均正常）。PS-OCT评估对于预测OA进展很有前景（p<0.008）。然而，该研究的低效能阻碍了就预测价值得出明确结论。
这项初步研究产生了至少两个对未来更大规模试验设计至关重要的结果：内侧半月板切除术患者非常适合用于研究PS-OCT预测未来OA的能力，并且需要对心内导管进行大量重新设计。
