Knee

Is SPECT/CT a useful imaging tool for the identification of knee cartilage lesions: a systematic review (2024)

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Type of publication:
Journal article

Author(s):
Rix L.; *Tushingham S.; Wright K.T.; Snow M.

Citation:
Osteoarthritis and Cartilage. Conference: 2024 OARSI World Congress on Osteoarthritis. Vienna Austria. 32(Supplement 1) (pp S353), 2024. Date of Publication: April 2024.

Abstract:
Purpose (the aim of the study): Anterior knee pain (AKP) is a common orthopaedic pain which affects individuals from the young and active to the elderly and sedentary. Though multifactorial in nature, the disorder is believed to occur through muscular imbalance, structural malalignment, overuse, and trauma. Subsequently, as time passes, this can cause damage to the cartilage, resulting in chondral lesions. Currently, magnetic resonance imaging (MRI) is defined as the gold standard imaging tool for chondral lesion detection. However, MRI mis-diagnoses around 20% of chondral lesions, and therefore is not a highly sensitive tool. An emerging imaging tool is single-photon emission computerised tomography with conventional computer tomography (SPECT/CT). Important diagnostic information may be provided from SPECT/CT for AKP patients who exhibit absence of structural change on other imaging modalities, and thus holds clinical value for the detection of knee chondral lesions. This review systematically assessed the utility of SPECT/CT as an imaging modality for knee pain, and its ability to diagnose chondral lesions for those patients who present clinically with knee pain. Method(s): Under PRISMA guidelines, a systematic search of databases was conducted in PubMed, Science Direct, and Web of Knowledge, CINAHL, AMED, Ovid Emcare and Embase. Inclusion criteria comprised of any English language article which focused on the diagnostic value of SPECT/CT for knee chondral lesions and knee pain. Further, any articles which focused on animal or cadaver studies, comparator technique other than SPECT/CT or patients with a pathology other than knee chondral lesions were excluded from the study. Articles that were deemed relevant underwent QUADAS-2 bias assessment. Result(s): After database search, manuscripts were identified, and 11,982 titles were screened for relevance. Seven studies were identified as suitable for inclusion based on eligibility criteria and were subjected to QUADAS-2 assessment. All 7 articles scored low for bias. Two papers found that ICRS score at intraoperative assessment correlated with SPECT/CT tracer uptake. Two studies concluded that whilst SPECT/CT tracer uptake significantly correlated with MRI, for some patients SPECT/CT identified more chondral lesions than MRI. Two papers compared bone scintigraphy (BS) to SPECT/CT, and found that SPECT/CT was able to identify, localise and characterise more chondral lesions in the knee than BS. Conclusion(s): The evidence found in this review suggests that SPECT/CT may be a useful imaging tool to detect and localise cartilage lesions of the knee. Particularly in those patients with conflicting cases whereby there is an absence of lesions on other imaging modalities, or a lack of resemblance with patients' symptoms. More studies would be of value to strengthen the conclusions of this review.

Soft tissue extensor mechanism tendon ruptures of the knee (2021)

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Type of publication:Journal article

Author(s):Rhind J.-H.; *Lancaster P.; *Ahmed U.; *Carmont M.

Citation:British Journal of Hospital Medicine; Sep 2021; vol. 82 (no. 9); p. 1-9

Abstract:Ruptures of the extensor mechanism of the knee are serious injuries requiring prompt diagnosis and treatment. They can be divided into soft tissue and bony causes. Soft tissue tendon injuries can be either partial or complete. Rupture of the quadriceps tendon is an uncommon injury and is more frequent in patients over the age of 40 years. Patella tendon ruptures are even rarer and are more frequent in patients under the age of 40 years. Causes can be direct or indirect. Complete ruptures of the quadriceps tendon or patella tendon benefit from early surgical management, while partial ruptures may be managed non-operatively. This article gives an overview of the presentation, assessment and management of soft tissue extensor mechanism tendon ruptures for core surgical, acute care common stem and emergency medicine trainees.

Total knee arthroplasty reduces knee extension torque in-vitro and patellofemoral arthroplasty does not (2020)

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Type of publication:
Journal article

Author(s):
Joseph M.N.; Stephen J.M.; Amis A.A.; *Carmont M.R.; Tailor H.

Citation:
Journal of Biomechanics; 2020 May 7;104:109739

Abstract:
Patients often have difficulty recovering knee extension strength post total knee arthroplasty (TKA), and that may reflect alteration of the mechanics including geometry and rollback kinematics, so the purpose of this work was to explore this by comparing the knee extension torque (KET) of the native knee, TKA and patellofemoral arthroplasty (PFA) in response to quadriceps tension. Eight fresh-frozen knees were mounted in a knee extension rig with quadriceps loading and tibial extension torque measurement. Each knee was subject to four conditions: native knee, PFA, cruciate-retaining (CR) and posterior-stabilized (PS) TKA. The KET was measured from 120degree to 0degree knee flexion. Data were analyzed using one-way ANOVA and post-hoc paired t-tests. The native KET was lowest in terminal extension and 70-100degree flexion, and maximal at 20-30degree flexion. PFA produced the greatest KET (p < 0.008) compared with native, CR- and PS-TKA, at 30-40degree flexion. CR- and PS-TKA had lower KET across 0-50degree flexion (p < 0.001 across 0-30degree), falling to 25% of the native knee KET or the PFA at full extension. PFA had the highest KET in early flexion possibly due to increased trochlear offset and/or preservation of the cruciate mechanism, so PFA may be more beneficial during the functional range of motion. The claimed benefits of PS- over CR-TKA in deep flexion were not detected. Both CR- and PS-TKAs led to lower KET than the native and PFA knee states across 0-50degree flexion. This mechanical effect may help to explain clinical findings of knee extension weakness post-TKA.

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