Understanding the Implications of the Meniscal Ossicle: Patient Presentation, Treatment, and Outcomes.

The meniscal ossicle is observed in clinical practice, yet there currently is limited information on its potential clinical significance. The purpose of this study was to assess the clinical presentation, imaging findings, and clinical treatment and outcomes of a series of patients identified as having a meniscal ossicle. An institutional database was reviewed to identify knees with a meniscal ossicle. Clinical presentation, magnetic resonance imaging (MRI), treatment, and outcomes were analyzed. Radiographs were graded using Kellgren-Lawrence (KL) scores. MRIs were reviewed for the presence and location of meniscal ossicles and additional knee pathology. Knee arthroplasty rates were recorded with the remaining patients contacted to obtain final International Knee Documentation Committee (IKDC) and Tegner's scores. Failure was defined as conversion to arthroplasty or failing IKDC score (< 75.4). Forty-five meniscal ossicles in 45 patients (26 males and 19 females) with a mean age of 51 years (standard deviation [SD] = 19.0) were included. Pain was the most common presenting symptom (89%). Forty-two patients (93%) had an associated meniscus root tear on MRI. Eighteen percent of patients that did not have an ossicle on initial imaging subsequently developed an ossicle. Mean KL grades progressed significantly from baseline of 1.84 (SD = 1.0) to 2.55 (SD = 0.93 p < 0.01) on final follow-up. Thirty-nine percent of baseline radiographs showed KL grades of less than 2 compared with only 15% of follow-up radiographs (p = 0.04). Mean IKDC score obtained for patients ≤ 60 at an average follow-up of 3.1 years (SD = 3.2) was 65.2 (SD = 19.0). Eight out of 45 patients (18%) had progressed to total knee arthroplasty (TKA) by latest available follow-up. Sixty-two percent of patients met failure criteria at latest available follow-up. The meniscal ossicle is most commonly found in the posterior horn or root of the medial meniscus and is highly suggestive to be sequelae of a posterior root tear. Therefore, the presence of a meniscal ossicle should alert the orthopaedic surgeon to the high likelihood of the patient having a meniscus root tear. These patients have shown to have poor clinical outcomes and worsening arthritis.

Noninvasive visualization of human dopamine dynamics from PET images.

We recently introduced strategies for extracting temporal patterns of brain dopamine fluctuations from dynamic positron emission tomography (PET) data using the tracer [11C]-raclopride. Each of our methods yields a collection of time-concentration curves for endogenous dopamine. Given a spatially dense collection of curves (i.e., one at every voxel in a region of interest), we produce image volumes of dopamine (DA) concentration, DA(X, t), at multiple voxel locations and each time-frame. The volume over time-frames constitutes a 4D dataset that can be thought of as a DA "movie". There are a number of ways to visualize such data. Viewing cine loops of a slice through the DA volume is one way. Creating images of dopamine peak-time, Tpeak(X), derived from a movie, is another. Each visualization may reveal spatio-temporal patterns of neurotransmitter activity heretofore unobservable. We conducted an initial validation experiment in which identical DA responses were induced by an identical task, initiated at different times by the same subject, in two separate PET scans. A comparison of the resulting Tpeak(X) images revealed a large contiguous cluster of striatal voxels, on each side, whose DA timing was consistent with the relative timing of the tasks. Hence, the DA movies and their respective peak-time images were shown to be new types of functional images that contain bonafide timing information about a neurotransmitter's response to a stimulus.