Does meniscal injury increase the likelihood that osteoarthritis (OA) of the knee will develop and if so, how? A University of California, San Francisco research team led by Christina R. Allen, MD, associate clinical professor of orthopaedic surgery, is grappling with that question.
A 1-year research study, made possible by a 2012 Orthopaedic Research and Education Foundation (OREF)/Goldberg Arthritis Research Grant funded by the Dr. Victor and Mrs. Harriet Goldberg Endowment Fund, will help determine how meniscal tears and meniscectomies contribute to early cartilage damage and lead to OA. The investigation will provide critical pilot data for a larger, longitudinal study that Dr. Allen hopes will have funding from the National Institutes of Health.
Understanding the damage
Meniscal tears are among the most common orthopaedic injuries and usually result in swelling, joint-line pain, and compromised mobility. Arthroscopic partial meniscectomy, the most common treatment, is generally successful; yet negative consequences, both biochemical and clinical, have been widely documented.
“Currently, osteoarthritis is not diagnosed until it is well advanced and is most likely irreversible,” Dr. Allen explained. “Outcomes from our study could potentially allow clinicians to see subclinical early OA following meniscus injury or meniscectomy and provide a way to measure the positive or negative effects of therapeutic interventions before the condition (OA) is irreversible.”
Taking a closer look
The study will follow 15 patients with acute posterior horn medial meniscal tears. Using quantitative high-resolution 3D magnetic resonance imaging (MRI) and statistical analysis, the team will assess and document knee health and functionality before and after the patients undergo partial meniscectomy surgery. The same surgery group will perform all the procedures and use a single technique to minimize any potential confounding effects.
Specifically, the team will monitor alterations in the contact area and in meniscal kinematics when the knee is loaded at 0- and 30-degree flexion angles. Looking at biochemical markers, the team will also evaluate changes in cartilage tissue.
The main advantage of using MRI methodology, Dr. Allen said, is that it is noninvasive, so that human studies can be more easily performed. Still, the approach has at least one drawback. “MRIs don’t grow on trees, unfortunately, and they’re expensive,” she said, especially given that the study depends on nonstandard MRI sequences that typically take an hour to complete. “That’s an hour of radiology time. These MRIs cost $500 a pop,” she said. “The OREF grant is very important in getting this study done. Without it, we wouldn’t be able to do the MRIs.”
How things work
An engineer before going to medical school, Dr. Allen’s first experience with biomedical research explored the use of sensory biofeedback with prosthetic limbs. That sparked her interest in clinically relevant scientific research, which Dr. Allen said “blossomed” during her residency at the University of Pittsburgh, particularly after being selected for the school’s 6-year track, pioneered by Carl T. Brighton, MD, PhD, which requires a full year devoted to basic science research.
How things might work better
With results from this study, Dr. Allen looks forward to conducting further research to explore remedies to mitigate the inevitability of OA for more patients. Depending on study outcomes, Dr. Allen posited, future investigations might explore transplant or repair strategies to restore the meniscus to its native state or pharmacologic strategies that offer chondroprotective effects following meniscal débridement.
Grateful for grant support
Dr. Allen described the OREF grant as “huge” in moving her research forward, pragmatically and otherwise, and suggested colleagues join her in contributing to help ensure future grants are available to other orthopaedic surgeons.
“We still need to keep advancing and there are a lot of unsolved questions and problems in orthopaedics,” she said. “If the government’s funding is declining, we have to make up the slack. We need to support each other in doing research. I’ve been contributing to OREF for more than 10 years, but the money is not going to come out of thin air.”
Sharon Johnson is a contributing writer for OREF and can be reached at firstname.lastname@example.org