The frequency of cartilage lesions in non-injured knees with symptomatic meniscus tears: results from an arthroscopic and NIR- (near-infrared) spectroscopic investigation.

INTRODUCTION: Are symptomatic tear injuries to the menisci of the knee frequently or always associated with cartilage damage to the corresponding articular surfaces and other joint surfaces, respectively? METHODS: A total of 137 patients (medial n = 127; lateral n = 10) underwent a meniscus resection. These patients showed no signs of a clear radiographic arthrosis and no MRI-detectable cartilage lesions > grade II. Traumatic injury was ruled out with a thorough medical history. The indication for operation was made exclusively on the basis of distinct, clinically apparent meniscus signs. In addition to the ICRS classification, all articular surfaces were examined spectroscopically (NIRS, near-infrared spectroscopy). RESULTS: In 76.6% (n = 105) of all knees examined, clear cartilage damage (ICRS-grade III/IV) was found. For 43.8%, these were in the area of the patella, while for 34.3% they were in the area of the medial femur, and for 17.5%, in the area of the medial tibial plateau. More rarely, this damage was localized to the area of the trochlea (8.8%) or the lateral joint compartment (femoral 2.2%, tibial 15.3%). There were no significant differences between patients with medial or lateral meniscus lesions with respect to the distribution pattern of the joint injuries. During spectroscopic examination, pathological values were demonstrated (objective evidence of cartilage degeneration) in at least one of the examined articular surfaces (media n = 6, range 1-6). CONCLUSION: Through our investigations, a high, if not complete, concomitance of degenerative cartilage lesions and degenerative meniscus damage was demonstrated. From this it can be concluded that the entity of "isolated degenerative meniscus damage" clearly does not exist in practice. It is therefore highly probable that degenerative meniscus lesions, as a part of general joint degeneration, are to be interpreted in the context of the development of arthrosis. The practical consequences still are unclear. Patients after partial meniscectomy need a longer follow-up to detect potential cartilage lesions as well as an OA progression.

Evaluation of cartilage defects with near-infrared spectroscopy (NIR): an ex vivo study.

Damaged cartilage undergoes complex changes in composition, histological structure, and mechanical properties. Near-infrared-spectroscopy (NIR spectroscopy) is an important method to measure changes in composition of complex composites. The present study was aimed at evaluating NIR spectroscopy as a means to quantitate tissue alterations in low grade cartilage defects. Fresh medial femoral condyles from female sheep were collected. Cartilage defects were graded according to the International Cartilage Repair Society (ICRS). Specimens were examined by a NIR spectroscopy device (spectral range of 1100-1700 nm). Absorption spectra were calculated from the reference and measurement spectra. As indicator for cartilage composition the ratio (absorption ratio, AR) of the two main absorption bands in this region was calculated. Mechanical stiffness was measured as Shore A. Water-, glycosaminoglycan-, and collagen content and histological grade (Mankin score) were determined. The NIR absorption in ICRS grade 1 defects (AR=2.1+/-0.1) was significantly higher than in intact cartilage (AR=1.5+/-0.1). ICRS grade 2 specimens tended to a higher NIR absorption. NIR absorption correlated significantly with Mankin score (R=0.896), water content (R=0.845), and mechanical stiffness (R=0.877). Initial cartilage degeneration correlates with changes in NIR absorption, indicating NIR spectroscopy to reflect complex structural changes in degenerated cartilage. The data suggest that NIR spectroscopy could be useful for in situ detection of early cartilage defects.

Near-infrared (NIR) spectroscopy. A new method for arthroscopic evaluation of low grade degenerated cartilage lesions. Results of a pilot study.

BACKGROUND: Arthroscopy is a highly sensitive method of evaluating high-grade cartilage lesions but the detection of low-grade lesions is often is unreliable. Objective measurements are required. A novel NIRS (near-infrared-spectroscopy) device for detection of low-grade cartilage defects was evaluated in a preliminary clinical study. METHODS: In 12 patients who had undergone arthroscopy, the cartilage lesions within the medial knee compartment were classified according to the ICRS protocol. With a NIR spectrometer system and an optical probe, similar in design to a hook used for routine arthroscopy, the optical properties of cartilage were measured during arthroscopy. RESULTS: The mean ratio of 2 NIR absorption bands of intact cartilage 3.8 (range 2.3 to 8.7).was significantly lower than that of cartilage with grade 1 lesions (12.8, range 4.8 to 19.6) and grade 2 lesions (13.4, range 10.4 to 15.4).No differences were observed between grade 1 and grade 2 lesions. CONCLUSION: NIRS can be used to distinguish between ICRS grade 1 lesions and healthy cartilage during arthroscopic surgeries. The results of this clinical study demonstrate the potential of NIRS to objectify classical arthroscopic grading systems.

Novel approach for the prediction of cell densities and viability in standardized translucent cell culture biochips with near infrared spectroscopy.

Near infrared spectroscopy is a rapid and nondestructive method for compositional analysis of biological material. The technology is widely used within bioreactors and possesses potential as a standardized method for quality control in miniaturized microfluidic cell culture systems. Here, we established a method for quantification of cell density and viability of adherent HepaRG cells cultured in a translucent, miniaturized cell culture biochip. The newly developed statistical models for interpretation of near infrared spectroscopy from biochips are the basis for a novel method of fast, continuous, and contact-free analysis of cell viability and real-time monitoring of cell growth. The technique thus paves the way for a robust and reliable high-throughput analysis of biochip-embedded cell cultures.

Karl Fischer titration and coulometry for measurement of water content in small cartilage specimens.

This study evaluated the efficiency of Karl Fischer titration and coulometry for measurement of water content in small intact and defective cartilage specimens. Cartilage from the main weight-bearing zone of the medial condyle of 38 fresh sheep knees was used. Of these, 20 condyles had an intact cartilage, while defects (14 grade I and 4 grade II) were found in the rest. The mechanical hardness was determined as Shore A. Cartilage specimens of approximately 5 mg were analyzed in special devices for moisture measurement and then continuously heated up to 105 degrees C. The actual measurement was performed in an electric cell (coulometry). An electrode was laminated with hygroscopic phosphorus pentoxide. In the electrochemical reaction, H and O are liberated from the electrode. The requirement for electric energy correlates with the amount of water in the specimen. The water content in intact cartilage was 66.9%. Grade I (72.6%) and grade II (77.8%) defects had significantly higher water content. Significantly higher and faster spontaneous evaporation was observed in cartilage defects at room temperature. The water content and spontaneous water evaporation correlated with significantly lower mechanical hardness. The experimental design (combined method of thermogravimetry, Karl Fischer titration, and coulometry) was sufficient for evaluating the water content in small cartilage specimens. It is also possible to measure the temperature-dependent water liberation from cartilage specimens.

Is there a correlation between biophotonical, biochemical, histological, and visual changes in the cartilage of osteoarthritic knee-joints?

The aim of this study was to detect characteristic structural changes in the cartilage composition of osteoarthritis (OA), hereby improving the arthroscopic identification of cartilage pathology by the use of a non-destructive technique - NIRS (Near-Infrared Spectroscopy). 682 cartilage samples out of 25 knees with OA were classified visually, using the ICRS system, biophotonically, histologically (n = 66), using the Score of Mankin and the Score of Otte, and biochemically (n = 616), determining the content of glycosaminoglycan (GAG) and hydroxyproline (HP). Significant correlations were found between biophotonical, histological, biochemical and visual characteristics of cartilage lesions. NIRS values corresponded to the content of GAG, HP and to the Score of Mankin and Otte. The data show that changes in the composition and structure of articular cartilage influence the optical properties and can be measured objectively by NIRS. The ease of use during arthroscopy, the quick response and the non-destructive nature of NIRS make it a promising addition to the assessment of disease intervention in OA.

Near-infrared spectroscopy for arthroscopic evaluation of cartilage lesions: results of a blinded, prospective, interobserver study.

BACKGROUND: Mechanical tests to grade cartilage damage are limited by the instruments used and by the ability to access all areas of cartilage within a joint. Better methods to diagnose cartilage injury or degeneration are needed. Purpose/ HYPOTHESIS: To detect the interobserver variance of arthroscopic cartilage grading by subjective judgment using the International Cartilage Repair Society (ICRS) score and by objective measurement using near-infrared (NIR) spectroscopy. We hypothesized that objective measurement of cartilage lesions by NIR spectroscopy will yield more valid results than routine grading using the ICRS score. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Fifteen patients undergoing arthroscopic knee operations were evaluated by 4 experienced arthroscopists independently. The cartilage lesions within the medial knee compartment were estimated by each observer using the ICRS grade and by measurements with a special arthroscopic NIR spectroscopy probe. RESULTS: The ICRS grading had a poor interobserver agreement, with a mean Fleiss kappa index of κ = 0.173. Only in 10% (6 of 60) of judged cartilage areas did all 4 surgeons grade the cartilage areas with the same result. In 17 areas (28.3%), the surgeons had a variance of 2 or more grades. In the remaining cases, the surgeons varied within 1 grade. The objective NIR spectroscopy-obtained measurements of cartilage resulted in a significant correlation within the observers of R = 0.885 ± 0.036 (P < .001). CONCLUSION: Our results of interobserver evaluation in real-time arthroscopic cartilage grading suggest that this subjective grading is not satisfactory. This study emphasizes the need for objective measurement techniques for arthroscopic cartilage grading. Near-infrared spectroscopy has a good interobserver correlation. Thus, this method could be developed in the future as a precise method of measuring cartilage lesions.

How do visual, spectroscopic and biomechanical changes of cartilage correlate in osteoarthritic knee joints?

BACKGROUND: Characteristic changes in cartilage of human knee joints with different degrees of osteoarthritis (OA) have been investigated by visual, biophotonical and biomechanical examination. Knowledge about the cartilage composition and changes during the development of OA is important for diagnostic decisions and understanding the pathogenesis of OA. METHODS: Thirty two patients with severe knee OA received endoprosthetic replacement. During surgical intervention cartilage specimen were harvested from defined surface areas of the joints. The degree of cartilage defects was classified visually (ICRS Grade: International Cartilage Repair Society), biophotonically (NIRS: near infrared spectroscopy) and biomechanically (Young's Modulus). To characterise links between the investigated parameters the Spearman's rank correlation coefficient was used. FINDINGS: Significant negative correlations were found between visual macroscopic degree of degeneration (ICRS Grade) and biophotonic characteristics (NIRS) (rho=-0.467) or cartilage stiffness (Young's Modulus) (rho=-0.501). Between NIRS and Young's Modulus significant positive correlation of rho=0.535 was detected. INTERPRETATION: Visual, biophotonic and biomechanical properties of cartilage reveal strong correlations in all degrees of cartilage defects in patients with severe OA. According to these results, we indicate that an objective, non-invasive and non-destructive measurement of cartilage properties during open and arthroscopic knee surgery is possible by NIRS and provide a novel tool to evaluate disease intervention and treatment.

Detection and evaluation of initial cartilage pathology in man: A comparison between MRT, arthroscopy and near-infrared spectroscopy (NIR) in their relation to initial knee pain.

BACKGROUND AND AIMS: MRI and arthroscopy are important methods in the evaluation of cartilage pathology. But frequently initial changes of cartilage in combination with chronic knee pain cannot be detected by employing these two methods. Better diagnostic tools for the detection of the early stages of osteoarthritis (OA) are required. The objective of this study was to show that near-infrared spectroscopy (NIRS) can be incorporated into routine arthroscopy to improve detection and assessment of the initial cartilage pathology. Furthermore correlations between findings in MRI, arthroscopy and NIRS in patients with initial symptoms of OA have studied. METHODS: Patients (n=21, 12 women, 9 men, age: 15-59 years, mean 34.19 years) with knee pain lasting for at least half a year without any trauma of the knee in their history were interviewed (body weight, smoking behaviour) and clinically evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Also serum parameters (cholesterol, lipids) were analysed, conventional X-rays in three directions (evaluated according to Kellgren and Lawrence) and MRI (evaluation of cartilage damage according to the ICRS-score) were performed preoperatively in all patients. During subsequent arthroscopy cartilage damage was evaluated according to the ICRS-score. In addition the spectral reflection of cartilage was investigated in all knees using a special micro-glass-fiber probe in the near-infrared light region (spectral range between 1150 and 1475nm). To characterize relations between the investigated parameters the Spearman's rank correlation coefficient was used. Inter-observer variance was calculated employing the Cohens-Kappa-test. RESULTS: MRI demonstrated a strong inter-observer variance with no significant correlations to other parameters. The same was observed for arthroscopic findings. Only NIRS showed significant correlations with three out of five KOOS subscores. Within the general parameters only smoking behaviour showed a significant correlation with two of the KOOS-scores. NIRS therefore seemed to be a sensitive diagnostic tool in detection of initial pathology in human cartilage. The additional necessary time for the spectroscopic investigation as part of the routine arthroscopy ranged between 3 and 7min (mean: 4min 18s). CONCLUSION: Particularly for early-stage cartilage lesions (ICRS 0/I) MRI and arthroscopy have rather low predictive value. The inter-observer variance is very high (Cohens-Kappa<0.4). Correlations found between NIRS and KOOS suggest that NIRS potentially can be used for detection of initial cartilage pathology and may be helpful in the evaluation of the benefit of different medical or surgical interventions at early-stage of articular cartilage damage.

Visual processing in the ketamine-anesthetized monkey. Optokinetic and blood oxygenation level-dependent responses.

We used optokinetic responses and functional magnetic resonance imaging (fMRI) to examine visual processing in monkeys whose conscious state was modulated by low doses (1-2 mg/kg) of the dissociative anesthetic ketamine. We found that, despite the animal's dissociated state and despite specific influences of ketamine on the oculomotor system, optokinetic nystagmus (OKN) could be reliably elicited with large, moving visual patterns. Responses were horizontally bidirectional for monocular stimulation, indicating that ketamine did not eliminate cortical processing of the motion stimulus. Also, results from fMRI directly demonstrated that the cortical blood oxygenation level-dependent (BOLD) response to visual patterns was preserved at the same ketamine doses used to elicit OKN. Finally, in the ketamine-anesthetized state, perceptually bistable motion stimuli produced patterns of spontaneously alternating OKN that normally would be tightly coupled to perceptual changes. These results, taken together, demonstrate that after ketamine administration cortical circuits continue to processes visual patterns in a dose-dependent manner despite the animal's behavioral dissociation. While perceptual experience is difficult to evaluate under these conditions, oculomotor patterns revealed that the brain not only registers but also acts upon its sensory input, employing it to drive a sensorimotor loop and even responding to a sensory conflict by engaging in spontaneous perception-related state changes. The ketamine-anesthetized monkey preparation thereby offers a safe and viable paradigm for the behavioral and electrophysiological investigation of issues related to conscious perception and anesthesia, as well as neural mechanisms of basic sensory processing.