Iordache Sergiu, Cursaru Adrian, Marinescu Andreea, Cretu Bogdan, Popa Mihnea, Costache Mihai Aurel, Serban Bogdan, Cirstoiu Catalin
Orthopaedics and Traumatology, University Emergency Hospital, Bucharest, ROU.
Radiology and Imaging, University Emergency Hospital, Bucharest, ROU.
Cureus. 2024 Sep 4;16(9):e68595. doi: 10.7759/cureus.68595. eCollection 2024 Sep.
Introduction Knee osteoarthritis (KOA) is a progressive degenerative disease, with an increasing prevalence among the population. The degenerative changes in KOA affect the cartilage, menisci, synovial tissue, and subchondral bone. The treatment for patients in advanced stages of the disease is total knee arthroplasty (TKA). The purpose of this descriptive study is to identify the MRI features in the case of patients with KOA who did not obtain an improvement in symptoms and joint function after the non-surgical treatments and who applied for surgical treatment, i.e. TKA. Also, we aimed to identify the correlations between the MRI changes and the functional score of the patients, as well as the inter-variable correlations. Materials and methods The study was conducted in the Department of Orthopedics and Traumatology at the University Emergency Hospital of Bucharest between January 1, 2023, and January 31, 2024. It included 50 patients who required TKA. This study is a prospective, observational, and descriptive analysis focusing on patients scheduled for TKA. Results The patients in the study group who required TKA had a Knee Society Score (KSS) ranging from 35 to 70 and a KSS function score between 24 and 60. Among them, 98% had tricompartmental lesions of the articular cartilage, and 100% presented with osteophytes, even when they were not identifiable radiologically. Additionally, 58% of the patients had changes in the infrapatellar fat pad, 66% presented with joint effusion without any traumatic history, and 86% of the patients had partial or complete lesions of the anterior cruciate ligament. Conclusion The MRI pattern of the patient who requires TKA consists of the presence of articular cartilage lesions in more than two compartments with exposure of the subchondral bone and diameter greater than 1 cm, meniscus lesions (>grade 2), meniscus extrusion (>grade 1), the presence of bone marrow lesions (BMLs) in the medial or lateral compartment of the femur or tibia, hyperintense signal of the infrapatellar fat pad, anterior cruciate ligament (ACL) lesions (>grade 2), and the presence of osteophytes together with the presence of effusion in the suprapatellar bursa. BMLs and changes in the infrapatellar fat pad may lead to the opening of new research perspectives explaining the complex changes in KOA in relation to the inflammatory process and gene expression.
引言
膝关节骨关节炎（KOA）是一种进行性退行性疾病，在人群中的患病率呈上升趋势。KOA的退行性改变会影响软骨、半月板、滑膜组织和软骨下骨。对于疾病晚期患者的治疗方法是全膝关节置换术（TKA）。本描述性研究的目的是确定在接受非手术治疗后症状和关节功能未得到改善且申请手术治疗（即TKA）的KOA患者的MRI特征。此外，我们旨在确定MRI变化与患者功能评分之间的相关性以及变量间的相关性。
材料与方法
该研究于2023年1月1日至2024年1月31日在布加勒斯特大学急诊医院骨科进行。研究纳入了50例需要进行TKA的患者。本研究是一项针对计划进行TKA的患者的前瞻性、观察性和描述性分析。
结果
研究组中需要进行TKA的患者膝关节协会评分（KSS）在35至70分之间，KSS功能评分在24至60分之间。其中，98%的患者存在关节软骨的三部分损伤，100%的患者存在骨赘，即使在放射学上无法识别。此外，58%的患者髌下脂肪垫有改变，66%的患者在无任何创伤史的情况下出现关节积液，86%的患者存在前交叉韧带部分或完全损伤。
结论
需要进行TKA的患者的MRI表现包括两个以上关节软骨损伤伴软骨下骨暴露且直径大于1 cm、半月板损伤（>2级）、半月板挤压（>1级）、股骨或胫骨内侧或外侧骨髓损伤（BMLs）、髌下脂肪垫高信号、前交叉韧带（ACL）损伤（>2级）、骨赘的存在以及髌上囊积液。BMLs和髌下脂肪垫的改变可能会开启新的研究视角，以解释KOA在炎症过程和基因表达方面的复杂变化。
