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Eshnazarov Kamolhuja Eshnazarovich, Republican Clinical Hospital № 1, Uzbekistan E-mail: kamolhuja77@mail.ru
MRT FEATURES OF THE ARTICULAR SURFACE OF THE FEMUR IN OSTEOARTHROSIS OF THE KNEE JOINT
Abstract:
Goal: To study the importance of the results of MRI studies for the correct formation of a clinical diagnosis and choice the tactics for the treatment of arthrosis of the knee joint.
Methods and materials: In the research, 80 patients with a diagnosis of knee osteoartritis (OA) were examined. The age of the patients was from 18 to 75 years. Of the 80 patients, 47 (58.75%) were women and 33 were men (41.25%). In all 80 patients, the MRI scan was performed. The role of degenerative changes center on the articular surfaces of the femur in the MRI examinations was studied by using Cahill - Berg and Harding classifications.
Results: In the results, according to the Cahill - Berg's classification, pathological outbreak located in 56 patients (70%) in the external medial condylus, in 24 patients (30%) in the internal medial condylus. In 6 patients (7.5%) OA identified in the lateral and medial condylus. According to the Harding OA located in 2 patients (2.5%) - A area, in 16 patients (6.25%) - A and B, in 29 patients (48.75%) - B, in 19 patients (21.25%) - B and C, and in 14 patients (18.75%) - C area.
Conclusion: In main group of patients with knee joint osteoarthrosis in MRI imaging identified early stages of the damage of joint cartilage. In all patients the outbreaks of OA located on the knee surface of femur, possibility to study their features in all positions may help to put correct diagnosis.
Keywords: Knee joint, osteoarthritis, magnetic resonance tomography, diagnosis.
Introduction Methods and materials
The widespread use of magnetic resonance imag- In the research, 80 patients with a diagnosis of knee
ing in practice, like noninvasive method, helps to assess OA were examined. Of these, 40 patients were treated the changes in cartilage, under cartilage tissue and bone at the Barunsang Hospital of the Republic of Korea be-of the knee joint [1; 2]. In modern orthopedics, early tween 2012 and 2015, and 40 patients were treated at diagnosis of osteoarthritis became available with mag- the Department of Traumatology and Orthopedics of netic resonance imaging. At the same time, it became the Republican Clinical Hospital No. 1 of the Ministry of possible to analyze changes in joints after surgical inter- Health of the Republic of Uzbekistan from 2016 to 2017. vention and to study the effectiveness of the procedures The age of the patients was from 18 to 75 years. Of
performed [3; 4]. MRI helps to detect early changes the 80 patients, 47 (58.75%) were women and 33 were not only in ligaments, tendons and muscles, also allows men (41.25%). In all 80 patients, the MRI scan was per-diagnosing and determining treatment tactics in the formed in devices MAGNETOM Area - Siemens 1.5T early stages by studying the size, properties and loca- (Germany) and SIGNA Explorer - General Electrics tion of hyaline cartilage defects in osteoarthritis of the 1.5T (USA). During the examination, the knee joint knee j oint [5; 6]. was fixed with a flexion up to 5 degree and with the pos-
Purpose sibility of rotation around the free axis of the legs up to
To study the importance the results of MRI for the 15 degree and the internal rotation did not exceed 5 de-correct formation of a clinical diagnosis and choice the gree and the external rotation was 10 degree. The images tactics for the treatment of arthrosis of the knee joint. were taken with cuts of 3 to 4 mm in standard sizes of
axial and coronal T1WI, T2WI, sagittal T1WI and T2BI cuts. The role of degenerative changes center on the articular surfaces of the femur in the MRI examinations
was studied by using Cahill cations (Diagram 1).
Berg and Harding classifi-
Diagram 1. Classification of Cahill-Berg and Harding for the definition of the OA outbreak of the knee joint. Cahill - Berg classification: 1 - medial condylus outer area, 2 - medial condylus internal area, 3 - femoral incision, 4 - medial area of lateral condylus and 5 - lateral area of lateral condylus. Harding classification: The A - Blumensaat line (the figure above the upper backside of the intercondylar carcase image) corresponds to the lower area of the knee lid, B - A and C spheres, C - Tangential line from the posterior cortex of the femoral diaphysis to the knee joint
The features of outbreaks of knee joint osteoarthro- and in the 5th stage there severe low intensity in dam-
sis, its volume, depth of damage, MRI stages and other changes justified by the P. A. Lotke and M. L. Ecker's classification which is recommended in 1985. According to this classification in the 1st stage in T2W1 view damaged area is intensified and in T1W1 low intensity. In the 2nd stage in T1W1 limited low intensity damaged area, in the 3rd stage the damaged area intensity is decreased than the moderate intensity, in the 4th stage in both T1 and
aged area and narrowed joint range [7; 8].
Results and discussions
Through the MRI investigation for knowing more information about disease and planning surgical treatment by the classification of P. A. Lotke and M. L. Ecker, in the main group of patients identified depletion of cartilage and subchondral tissue of the medial tibiofemoral joint surface of knee joint (Table 1).
T2W1 views damaged area is in low limited intensity
Table 1. - Distribution of patients by stages of MRI classification P. A. Lotke and M. L. Ecker
MRI stages Patients number Percent
Stage - 1 24 30
Stage - 2 27 33.75
Stage - 3 17 21.25
Stage - 4 12 15
Total 80 100
In the MRI investigations identified wound and degenerative changes in 51 patients (63.75%) internal, in 7 patients (5.6%) both meniscus and in 10 patients (12.5%) only external meniscus. The damage of adjacent joint cartilage of damaged meniscus occurred in 57 pa-
tients (71.25%). In 11 patients (13.75%) identified intraarticular foreign body, in 7 patients (8.75%) partial rupture of crossing ligament and in 8 patients (10%) Becker's cyst.
r,
i
Picture 1. Location of osteoarthritis zones in 1 A and 2 C by Harding
In the results, according to the Cahill - Berg's classification, pathological outbreak located in 56 patients (70%) in the external medial condylus, in 24 patients (30%) in the internal medial condylus. In 6 patients (7.5%) OA identified in the lateral and medial condylus. According to the Harding OA located in 2 patients (2.5%) - A area, in 16 patients (6.25%) - A and B, in 29 patients (48.75%) - B, in 19 patients (21.25%) - B and C, and in 14 patients (18.75%) - C area (Picture 1).
The results of MRI investigation showed that in the patients with knee OA pathological process located more on the medial joint surface. Permanent impact of damaged meniscus to the joint surface called degenerative and destructive changes. In all patients identified degenerative changes on the femoral condylus surface of knee joint in MRI investigation. In 45 patients (56.25%) pathological process located on the tibial joint surface and in 7 patient (5%) on the patellar joint surface (2-diagram).
Diagram 2. Distribution outbreak of osteoarthritis on the articular surface
Conclusion
In main group of patients with knee joint osteoarthrosis in MRI imaging identified early stages of the damage of joint cartilage.
In all patients the outbreaks of OA located on the knee surface of femur, possibility to study their features in all positions may help to put correct diagnosis.
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