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Scientific Articles   |    
Localized Cartilage Assessment with Three-Dimensional dGEMRIC in Asymptomatic Hips with Normal Morphology and Cam Deformity
T.C.B. Pollard, FRCS(Tr&Orth)1; E.G. McNally, FRCR1; D.C. Wilson, PEng2; D.R. Wilson, DPhil2; B. Mädler, PhD3; M. Watson, MSc1; H.S. Gill, DPhil1; A.J. Carr, FRCS1
1 Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMs), Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, United Kingdom. E-mail address for T.C.B. Pollard: Tom.Pollard@ndorms.ox.ac.uk
2 Department of Orthopaedic Surgery and Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
3 MRI Research Centre, Department of Physics and Astronomy, University of British Columbia Hospital, Purdy Pavilion, Room M10, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the British National Institute for Health Research, Botnar Research Foundation, Canadian Institutes of Health Research, and Michael Smith Foundation for Health Research. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences and the National Institute for Health Research Biomedical Research Unit, University of Oxford, Oxford, United Kingdom, and the Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Nov 03;92(15):2557-2569. doi: 10.2106/JBJS.I.01200
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Abstract

Background: 

Cam deformities cause femoroacetabular impingement and damage the acetabular labral-chondral complex. The aims of this study were to investigate the potential of delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) to detect cartilage disease in asymptomatic hips with cam deformities compared with morphologically normal hips, establish whether dGEMRIC could identify advanced disease in hips with positive clinical findings, and establish whether cartilage damage correlated with the severity of the cam deformity.

Methods: 

Subjects were recruited from a prospective study of individuals with a family history of osteoarthritis and their spouses who served as control subjects. Their symptoms and impingement test results were recorded. Asymptomatic hips with normal radiographic joint-space width were placed in a subgroup according to the presence of a cam deformity and the impingement test result. dGEMRIC was performed on a 3-T system, studying two regions of interest: the anterosuperior aspect of the acetabular cartilage (T1acet) and the total femoral and acetabular cartilage (T1total). The ratio T1acet/T1total gave the relative glycosaminoglycan content in the anterosuperior aspect of the acetabular cartilage. The cohort was placed in subgroups by joint morphology, impingement test status, and genetic predisposition; the mean T1 scores were compared, and the alpha angle and T1 were correlated.

Results: 

Of thirty-two subjects (mean age, fifty-two years), nineteen had cam deformities. Hips with a cam deformity had reduced acetabular glycosaminoglycan content compared with normal hips (mean T1acet/T1total, 0.949 and 1.093, respectively; p = 0.0008). Hips with a positive impingement test result had global depletion of glycosaminoglycan compared with hips with a negative result (mean T1total, 625 ms versus 710 ms; p = 0.0152). T1acet inversely correlated with the magnitude of the alpha angle (r = -0.483, p = 0.0038), suggesting that the severity of cartilage damage correlates with the magnitude of the cam deformity. All of these differences occurred irrespective of genetic predisposition.

Conclusions: 

The dGEMRIC technique can detect cartilage damage in asymptomatic hips with cam deformities and no radiographic evidence of joint space narrowing. This damage correlates with cam deformity severity. Further study of the application of dGEMRIC as an imaging biomarker of early osteoarthritis is justified to validate its prognostic accuracy, identify subjects for clinical trials, and evaluate the effectiveness of surgical procedures.

Level of Evidence: 

Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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