Department of Medicine, Division of Rheumatology
Aged; Animals; Anterior Cruciate Ligament; Arthritis, Experimental; Blood Vessels; Bone and Bones; Cartilage, Articular; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Mice; Middle Aged; Osteoarthritis, Knee; Posterior Cruciate Ligament
Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases
OBJECTIVES: The purpose of this work was to test whether normal peri-entheseal vascular anatomy at anterior and posterior cruciate ligaments (ACL and PCL) was associated with distribution of peri-entheseal bone erosion/bone marrow lesions (BMLs) in inflammatory arthritis (IA) and osteoarthritis (OA).
METHODS: Normal microanatomy was defined histologically in mice and by 3 T MRI and histology in 21 cadaveric knees. MRI of 89 patients from the Osteoarthritis Initiative and 27 patients with IA was evaluated for BMLs at ACL and PCL entheses. Antigen-induced arthritis (AIA) in mice was evaluated to ascertain whether putative peri-entheseal vascular regions influenced osteitis and bone erosion.
RESULTS: Vascular channels penetrating cortical bone were identified in knees of non-arthritic mice adjacent to the cruciate ligaments. On MRI of normal cadavers, vascular channels adjacent to the ACL (64% of cases) and PCL (71%) entheses were observed. Histology of 10 macroscopically normal cadaveric specimens confirmed the location of vascular channels and associated subclinical changes including subchondral bone damage (80% of cases) and micro-cyst formation (50%). In the AIA model, vascular channels clearly provided a site for inflammatory tissue entry and osteoclast activation. MRI showed BMLs in the same topographic locations in both patients with early OA (41% ACL, 59% PCL) and IA (44%, 33%).
CONCLUSION: The findings show that normal ACL and PCL entheses have immediately adjacent vascular channels which are common sites of subtle bone marrow pathology in non-arthritic joints. These channels appear to be key determinants in bone damage in inflammatory and degenerative arthritis. already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Inflammation, Knee Osteoarthritis, Magnetic Resonance Imaging, Osteoarthritis, Rheumatoid Arthritis
DOI of Published Version
Ann Rheum Dis. 2015 Jan;74(1):196-203. doi: 10.1136/annrheumdis-2013-203972. Epub 2013 Oct 4. Link to article on publisher's site
Annals of the rheumatic diseases
Binks, D. A.; Gravallese, Ellen M.; Bergin, D.; Hodgson, R. J.; Tan, A. L.; Matzelle, Melissa M.; McGonagle, D.; and Radjenovic, A., "Role of vascular channels as a novel mechanism for subchondral bone damage at cruciate ligament entheses in osteoarthritis and inflammatory arthritis" (2015). Rheumatology Publications and Presentations. 47.
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