Quantitative CT of the knee in the IMI-APPROACH osteoarthritis cohort:​ association of bone mineral density with radiographic disease severity, meniscal coverage and meniscal extrusion

Heiss, Rafael; Laredo, Jean-Denis; Wirth, Wolfgang; Jansen, Mylène P.; Marijnissen, Anne C.A.; Lafeber, Floris; Lalande, Agnes; Weinans, Harrie H.; Blanco, Francisco J.; Berenbaum, Francis; Kloppenburg, Margreet; Haugen, Ida K.; Engelke, Klaus; Roemer, Frank W.

Affiliations

¹Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054 Erlangen, Germany

²Service de Radiologie, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France

³Bioimagerie Ostéo-articulaires (B3OA), UMR, CNRS, 7052 INSERM U1271,10 Avenue de Verdun, 75010 Paris, France

⁴Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria

⁵Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020 Salzburg, Austria

⁶Chondrometrics GmbH, Ludwig-Zeller-Straße 12, 83395 Freilassing, Germany

⁷Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands

⁸Servier, 50 rue Carnot, 92284 Suresnes cedex, France

⁹Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.

¹⁰Grupo de Investigación de Reumatología (GIR), INIBIC – Complejo Hospitalario Universitario de A Coruña, SERGAS, Centro de Investigacion ´ CICA, Departamento de Fisioterapia y Medicina, Universidad de A Coruña, A Coruña, Spain

¹¹Servicio de Reumatologia, INIBIC- Universidade de A Coruña, As Xubias 84, 15006 A Coruña, Spain

¹²Sorbonne University, Inserm, APHP Hôpital Saint-Antoine, 75571 Paris cedex 12, France

¹³Departments of Rheumatology, Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, Netherlands

¹⁴Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway

¹⁵Department of Immunology and Rheumatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 18, Erlangen, Germany

¹⁶Institute of Medical Physics, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Henkestr. 91, 91052 Erlangen, Germany

¹⁷Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, MA, USA

Abstract and keywords

Objective Osteoarthritis (OA) is a highly prevalent chronic condition. The subchondral bone plays an important role in onset and progression of OA making it a potential treatment target for disease-modifying therapeutic approaches. However, little is known about changes of periarticular bone mineral density (BMD) in OA and its relation to meniscal coverage and meniscal extrusion at the knee. Thus, the aim of this study was to describe periarticular BMD in the Applied Public-Private Research enabling OsteoArthritis Clinical Headway (APPROACH) cohort at the knee and to analyze the association with structural disease severity, meniscal coverage and meniscal extrusion.

Design: Quantitative CT (QCT), MRI and radiographic examinations were acquired in 275 patients with knee osteoarthritis (OA). QCT was used to assess BMD at the femur and tibia, at the cortical bone plate (Cort) and at the epiphysis at three locations: subchondral (Sub), mid-epiphysis (Mid) and adjacent to the physis (Juxta). BMD was evaluated for the medial and lateral compartment separately and for subregions covered and not covered by the meniscus. Radiographs were used to determine the femorotibial angle and were evaluated according to the Kellgren and Lawrence (KL) system. Meniscal extrusion was assessed from 0 to 3.

Results: Mean BMD differed significantly between each anatomic location at both the femur and tibia (p < 0.001) in patients with KL0. Tibial regions assumed to be covered with meniscus in patients with KL0 showed lower BMD at Sub (p < 0.001), equivalent BMD at Mid (p = 0.07) and higher BMD at Juxta (p < 0.001) subregions compared to regions not covered with meniscus. Knees with KL2–4 showed lower Sub (p = 0.03), Mid (p = 0.01) and Juxta (p < 0.05) BMD at the medial femur compared to KL0/1. Meniscal extrusion grade 2 and 3 was associated with greater BMD at the tibial Cort (p < 0.001, p = 0.007). Varus malalignment is associated with significant greater BMD at the medial femur and at the medial tibia at all anatomic locations.

Conclusion: BMD within the epiphyses of the tibia and femur decreases with increasing distance from the articular surface. Knees with structural OA (KL2–4) exhibit greater cortical BMD values at the tibia and lower BMD at the femur at the subchondral level and levels beneath compared to KL0/1. BMD at the tibial cortical bone plate is greater in patients with meniscal extrusion grade 2/3.

Keywords: Osteoarthritis; Knee; Quantitative CT; Bone mineral density; Multicenter study

Links

DOI: 10.1016/j.bone.2023.116673

PubMed: 36623756

WoS: 000925034900001

History

Received: 2022-10-19

Revised: 2022-12-16

Accepted: 2023-01-4

Online: 2023-01-7

Cited Works (4)

Year	Entry
2020	Sannmann F, Laredo J-D, Chappard C, Engelke K. Impact of meniscal coverage on subchondral bone mineral density of the proximal tibia in female subjects: a cross-sectional in vivo study using QCT. Bone. May 2020;134:115292.
1957	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. December 1957;16(4):494-502.
1998	Roos H, Laurén M, Adalberth T, Roos EM, Jonsson K, Lohmander LS. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum. 1998;41(4):687-693.
2003	Patel V, Issever AS, Burghardt A, Laib A, Ries M, Majumdar S. MicroCT evaluation of normal and osteoarthritic bone structure in human knee specimens. J Orthop Res. 2003;21(1):6-13.