There seems to be a biphasic process of bone mineral density (BMD) changes in osetoarthritis (OA). An increased bone mineral density (BMD) and a specific distribution of BMD in the cortical of the subchondral plates and below in the trabecular bone…
Bron
Aandoening
A potential chondroprotective effect of meniscal allograft transplantation (MAT) remains still unclear. Subchondral bone mineral density (BMD) and subchondral bone remodelling play important roles in the development of osteoarthritis. The purpose of our study was to determine BMD changes after MAT during a 2 year follow-up. BMD changes between the operated and the non-operated knee, as well as correlation between BMD, bone scintigraphy and Knee injury and Osteoarthritis Outcome Score (KOOS) were determined.
Onderzoeksproduct en/of interventie
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Uitkomstmaten
Primaire uitkomstmaten
Bone mineral density, semi-quantitatively bone scan scores
Achtergrond van het onderzoek
Since the first meniscal allograft transplantation (MAT) in 1984, many papers are published in literature regarding different aspects of MAT: indications and contraindications, preoperative graft sizing, methods of graft preservation, surgical techniques, fixation of the allograft, relevance of associated chondral and ligamentous damage, concomitant procedures, histologic evaluation, clinical and radiographic outcomes, and rehabilitation.
Despite all this research, a chondroprotective effect, as shown in sheep, remains still unclear in humans. This may partially because of the lack of standardized evaluation methods and the lack high-quality studies. Nonetheless, MAT seems to provide good clinical results at the short and medium term, with improvement in knee function and acceptable complication/failure rates.
Concerning the development of osteoarthritis (OA) previous studies suggest that changes in bone play a role in the development and progression of OA. Already in the 1980’s bone scintigraphy in patients with a suspected meniscal tear has shown an increased uptake, and a pattern of uptake claimed to be specific for meniscal pathology was seen in the subchondral bone of the proximal tibia, which might be the first sign of adaptive bone remodelling leading to degenerative changes of the postmeniscectomized knee.
A positive bone scintigraphy can predict subsequent loss of joint space in patients with established OA of the knee joint. The finding suggests that the activity of the subchondral bone may determine loss of cartilage. That subchondral BMD (sBMD) and subchondral bone remodelling play important roles in OA pathology was confirmed by Dore et al. It is shown that an increased bone mineral density (BMD) and a specific distribution of BMD in the cortical of the subchondral plates and below in the trabecular bone in the medial compartment after partial or total medial meniscectomy in patients with isolated medial meniscal tears. Some studies have demonstrated that knee OA was associated with lower sBMD, while another study documented that patients with high tibial sBMD had increased joint space narrowing over 1 year. These findings suggest a biphasic process of BMD changes in OA: a reduction in BMD early on followed by an increase during more advanced phases. We are interested in the effect of MAT on BMD early in the process of AO development
To our knowledge, the potential chondroprotective effect of MAT was never investigated using Dual-energy X-ray Absorptiometry (DXA) scans and bone scintigraphy. The purpose of our observational prospective cohort study was to determine BMD changes in the knee after arthroscopic MAT without bone plugs during a 2-year follow-up period and to determine BMD changes between the knee with meniscal transplant and the contralateral knee. Furthermore, we assessed the presence of interaction between BMD changes during follow-up and clinical outcome scores.
Doel van het onderzoek
There seems to be a biphasic process of bone mineral density (BMD) changes in osetoarthritis (OA). An increased bone mineral density (BMD) and a specific distribution of BMD in the cortical of the subchondral plates and below in the trabecular bone is found in the medial compartment after partial or total medial meniscectomy in patients with isolated medial meniscal tears. Other studies documented that patients with high tibial BMD had increased joint space narrowing We expect to see the same biphasic model after meniscal allograft transplantation.
Onderzoeksopzet
pre-operative (baseline)
6 months, 1 year and 2 years postoperative
Onderzoeksproduct en/of interventie
Knee injury and Osteoarthritis Outcome Score (KOOS) preopertive and postoperative after 6 months, 1 year and 2 year
Preoperatively and 6 months, 1 year and 2 years postoperative, a DXA scan and a bone scintigraphy were made
Publiek
PO Box 432
B.J.W. Thomassen
Den Haag 2501 CK
The Netherlands
+31 (0)70 3303109
b.thomassen@mchaaglanden.nl
Wetenschappelijk
PO Box 432
B.J.W. Thomassen
Den Haag 2501 CK
The Netherlands
+31 (0)70 3303109
b.thomassen@mchaaglanden.nl
Belangrijkste voorwaarden om deel te mogen nemen (Inclusiecriteria)
disabling unicompartmental pain after a (sub)total meniscectomy, patient under the age of 55 years, stable knee joint or stabilized by concomitant ACL reconstruction (ACLR) and normal knee alignment.
Belangrijkste redenen om niet deel te kunnen nemen (Exclusiecriteria)
grade IV chondropathy, PCL insufficiency, abnormal and uncorrected knee or lower limb alignment, chronic pain syndrome of the knee, arthrofibrosis, muscular atrophy and a history of knee sepsis.
Opzet
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Andere (mogelijk minder actuele) registraties in dit register
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In overige registers
Register | ID |
---|---|
NTR-new | NL5498 |
NTR-old | NTR5633 |
Ander register | : METC 15-069 |