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BACKGROUND Although weight control is important in managing knee osteoarthritis (OA), it is difficult to achieve. Understanding beliefs regarding weight management in people with knee OA may improve weight control. AIMS To examine differences in bodyweight satisfaction, weight management strategies and weight-related health-beliefs in obese, overweight and normal weight people with knee OA. METHODS The beliefs and attitudes to weight in 102 people with symptomatic knee OA were ascertained. Participants were classified as being obese, overweight or of normal weight. RESULTS Although obese and overweight participants were less satisfied with their bodyweight, they were more likely to want to lose weight and to report dieting compared with normal weight participants(P

Rheumatoid arthritis (RA) is a common and debilitating disease. Expanded therapeutic options, targeting pro-inflammatory cytokines such as tumour necrosis factor (TNF) and interleukin-6 (IL-6), have revolutionised RA treatment. To date, efficacy data shows superiority of IL-6 inhibition over placebo, conventional disease modifying anti-rheumatic drugs such as methotrexate, and TNF inhibition. Moreover, while demonstrating some key differences in the safety profile compared with TNF inhibition (e.g. hyperlipidemia and neutropenia), these safety concerns have not, at least to date, been found to cause clinically significant adverse outcomes. Other safety parameters, such as infection and malignancy rates have been found to be comparable between IL-6 and TNF inhibition. This review explores the biology and clinical applications of IL-6 inhibition in the management of RA.

Purpose: The bony articular surface contributes to a joint�s congruency, and it might be a determinant of structural change. The aim of this longitudinal study was to determine (i) whether the angle of the trochlear groove is associated with the rate of loss of patella cartilage volume for 2 yr and (ii) whether this association is influenced by particular modifiable and nonmodifiable factors. Methods: A total of 297 community-based adults with no history of knee pathologic disease were recruited at baseline (2003�2004), and 271 of these subjects were reexamined at follow-up (2006�2007). Magnetic resonance imaging was performed at baseline and follow-up to determine the change in patella cartilage volume, whereas baseline images were used to assess trochlear groove angles. A baseline questionnaire determined participation in vigorous physical activity. Results: For every 1° increase in the proximal trochlear groove angle at baseline, there was an associated 1.12-mm3 (95% confidence interval (CI) = 0.00�2.24 mm3) increase in the annual rate of patella cartilage volume loss. There was a trend for this effect to occur for males, as well as people participating in vigorous physical activity (all P = 0.07). Males who exercised vigorously were more adversely affected (5.0 mm3 per annum (95% CI = 0.5�9.4 mm3 per annum)) than males who did not exercise vigorously (0.6 mm3 per annum (95% CI = -2.1 to 3.3 mm3 per annum)). Conclusions: A more flattened proximal trochlear groove is associated with increased patella cartilage volume loss, particularly for physically active men. Our results suggest that lifestyle factors, such as physical activity, may modify the association between joint incongruity and cartilage loss and can be further affected by subjects� characteristics such as gender. Understanding these complex interactions will help optimize strategies to maintain patellofemoral joint health.

Introduction Knee osteoarthritis (OA) is a major cause of pain and disability in women, becoming a major health problem in mid to later life. A better understanding of factors contributing to deleterious structural knee changes may be important for preventing OA. In men, occupations associated with frequent knee bending have been shown to be associated with damage to knee cartilage. This has not been examined in women. The aim of this study was to examine the effect of occupational specific knee activities on tibial and patella cartilage morphology among healthy females. Methods 96 females aged 26–62 years with no history of knee injury or symptoms were recruited as part of a study of community-based study of lifestyle factors on knee health. Occupational activity data examining the frequency of tasks such as heavy lifting, knee bending, stair climbing, walking and standing were obtained by questionnaire. Tibial and patella cartilage volumes and defects were measured from magnetic resonance imaging using validated methods. Results Heavy lifting/bending/squatting, knee bending, stair climbing and walking were all associated with an increased risk of patella, but not tibial, cartilage defects (odds ratio 1.8–2.9; p ≤ 0.05) after adjustment for potential confounders, including knee alignment and radiographic joint space narrowing. There was a trend towards knee bending being associated with a reduction in patella cartilage volume (p = 0.07). Conclusion Our results demonstrate that asymptomatic adult females with occupations requiring frequent knee bending have patella, but not tibial cartilage damage. These findings suggest that vocational tasks requiring knee bending are detrimental to the structure of cartilage in females and may be an area to consider in the prevention of knee OA.

Summary Objectives Identifying factors that influence the rate of cartilage loss at the knee may help to prevent or delay the progression of knee osteoarthritis (OA). Changes in knee alignment alter knee joint load and may affect the rate of cartilage loss. The aim of this study was to determine whether change in knee alignment between baseline and 2 years is associated with a change in knee cartilage volume in knee OA in the subsequent 2.5 years. Methods Seventy-eight adults with symptomatic knee OA were recruited using a combined strategy. Radiographs were performed at time 0 and 2 years to determine change in knee alignment, measured on a continuous scale. Magnetic Resonance Imaging was performed at 2 and 4.5 years to determine annual percentage change in medial and lateral tibial cartilage volumes. Results In multivariate analyses, for every 1° change toward genu valgum, there is an associated 0.44% reduction in the rate of annual medial tibial cartilage volume loss (95% CI: −0.85%, −0.04%, P =0.03). Similarly, because our measures of change in alignment and cartilage volume were continuous, these results also implied that for every 1° change toward genu varum, there was an associated 0.44% increase in the rate of annual medial tibial cartilage volume loss. Change in knee angle did not significantly affect the rate of loss of the lateral tibial cartilage volume ( P =0.95). Conclusion Our results have demonstrated that progressive change toward genu valgum reduced the annual rate of medial tibial cartilage volume loss in people with knee OA, without expediting the rate of lateral tibial cartilage volume loss. These findings suggest that methods to reduce varus alignment may delay the progression of medial tibiofemoral OA and warrant further investigation.

SummaryObjectivesAlthough vastus medialis and vastus lateralis are important muscular determinants of patellofemoral joint function, it is unclear how these muscles relate to the structure of the patellofemoral joint. The aim of this cross-sectional study was to determine the relationship between the vasti muscles and patella cartilage volume and defects and patella bone volume.MethodsOne hundred and seventy-five women, aged 40–67 years, with no knee pain or clinical lower-limb disease had magnetic resonance imaging (MRI) of their dominant knee. The cross-sectional areas of the distal vastus medialis and lateralis were measured 37.5mm superior to the quadriceps tendon insertion at the proximal pole of the patella. Patella cartilage volume and defects and patella bone volume were measured from these images using validated methods.ResultsThere was no significant association between the distal vastus medialis cross-sectional area and patella cartilage volume. For every 1mm2 increase in the distal vastus medialis cross-sectional area, there was an associated increased risk of patella cartilage defects [odds ratio (OR): 1.2; 95% confidence interval (CI) 1.004, 1.5; P=0.05], and an associated increase in patella bone volume (OR: 3.9; 95% CI 2.0, 5.8; P

Summary Objectives Varus–valgus alignment of the knee is increasingly becoming recognised as an important biomechanical variable in patellofemoral osteoarthritis (OA). The aim of this study was to determine the cross-sectional and longitudinal relationships between frontal plane knee alignment and patella cartilage volume in people with knee OA. Methods Ninety-nine adults with symptomatic knee OA were recruited using a combined strategy including referral from specialist centres, arthritis support groups and media advertising. Both baseline and follow-up X-rays and magnetic resonance imaging (MRI) were performed 2 years apart. Knee alignment and patella cartilage volume were determined from X-ray and MRI, respectively. Results Annual change in knee alignment was negatively associated with an annual change in the total patella cartilage volume before ( P =0.002) and after ( P =0.003) adjustment for potential confounders over an average of a 1.9-year period. For every 1° change towards valgus direction, there was a 23.4-mm 3 [95% confidence interval (CI) 8.1mm 3 –38.7mm 3 ] annual reduction in the total patella cartilage volume. Conclusion This study is the first to clearly demonstrate and quantitate the annual reduction in patella cartilage volume that occurs as knee alignment becomes increasingly valgus in an osteoarthritic cohort. Interventions that aim to minimise change towards valgus alignment may reduce the risk for the onset and progression of patellofemoral OA.

SummaryObjectivesCartilage defects are highly prevalent in subjects with knee osteoarthritis (OA). Although they are associated with increased cartilage loss and joint replacement, there is little data on the natural history of cartilage defects. The aim of this study was to examine the progression of cartilage defects over 2 years in people with knee OA and to identify factors associated with progression.MethodsOne hundred and seventeen subjects with OA underwent magnetic resonance imaging of their dominant knee at baseline and follow-up. Cartilage defects were scored (0–4) at four sites. Bone size of the medial and lateral tibial plateau was determined. Height, weight, body mass index and physical activity were measured by standard protocols.ResultsThe mean cartilage defect score increased significantly over the 2-year study period in all tibiofemoral compartments (all P

We welcome the comments from Emanuel et al. [1]. In a systematic review, Pfirrmann’s method [2] was endorsed as a valid and reliable ‘gold-standard’ for assessing intervertebral disc degeneration [3]. Nevertheless, the Pfirrmann system uses qualitative descriptors such as ‘disc height normal to slightly decreased’. This descriptor is highly subjective with confounding influences of gender, age and body habitus and the ambiguity of what represents a ‘normal’ disc height. There is no quantitative measure of disc height in the Pfirrmann grading system. This prompted us to validate disc height against the ‘gold-standard’. In our work [4], we validate that for every one-grade increase in the Pfirrmann score, there is a reduction in disc height. For example, there was a 1.60 mm reduction (95 % confidence interval –2.37 to –0.83 mm) in disc height for each Pfirrmann grade increase at the level of L3/4, independent of age, gender, body mass index and smoking history. While Emanuel et al. highlight that disc height has diurnal and joint loading variation [1], the Pfirrmann Score has the same inherent limitations [2]. Any extraneous variability from such measures would have served to cause misclassification and reduced our chances of demonstrating significant results in the current study. Moreover, contemporaneous assessment of disc height and the Pfirrmann grade was made, mitigating extraneous variability. While there was large variability around the estimated marginal means, this is probably a reflection of the modest sample size (n = 72) and is accounted for in regression analyses, with highly significant results (all p ≤ 0.009). In our study, we also demonstrated that disc height was smaller in people with high pain and/or disability, substantiating the clinical utility of the measure. While Emanuel et al. argue that factors such as high inter-subject and intra-subject variation limit the use of disc height as a clinical or epidemiological measure (e.g. from diurnal variation in water content of the disc or joint loading), this can be mitigated by standardising assessments to a particular time of the day (e.g. morning). While quantitative mapping shows promise, such techniques are highly sophisticated, expensive and not widely available. We contend that our data validate disc height as a readily available, simple and effective means of assessing intervertebral disc degeneration, but do acknowledge that disc height may not be the best singular measure for disc degeneration. We welcome further efforts to identify continuous measures that sensitively assess disc degeneration.

Although patellofemoral osteoarthritis is common and a frequent cause of disability, its aetiology remains unknown. Biomechanical factors are believed to be important in the pathogenesis of the disease. Although the patellofemoral joint bears little axial load during normal walking, retropatellar load increases during knee flexion and can exceed three times body-weight during deep knee bends. The combination of large forces being transmitted to relatively incongruent articular surfaces during activities of daily living may explain why patellofemoral osteoarthritis is so common. Other patellofemoral pathologies considered to be biomechanically mediated, such as patellofemoral pain syndrome, may provide clues to helping understand the aetiology of patellofemoral osteoarthritis. For instance, patellofemoral pain syndrome is believed to be primarily due to abnormalities in bony geometry, neuromuscular patterns and tight fibromuscular support, which ultimately contribute toward lateral patella translation, maltracking and pain. Genu valgum has also been implicated as a factor that predates lateral patella pathologies, such as the progression of patellofemoral osteoarthritis. Nevertheless, it remains unclear whether common patellofemoral pathologies that occur in early life, such as subluxation/ dislocation and patellofemoral pain syndrome, are risk factors for degenerative changes, such as patellofemoral osteoarthritis, that occur in later life. This review examines the biomechanical factors associated with patellofemoral joint pathology, using patellofemoral osteoarthritis as a disease paradigm.

Knee osteoarthritis (OA) is characterized by joint changes, such as cartilage degradation, subchondral sclerosis and osteophyte formation around the margin of the articular surface. The knee joint has three compartments: the medial tibiofemoral, the lateral tibiofemoral and the patellofemoral. Although most epidemiological studies have predominantly examined risk factors for tibiofemoral rather than patellofemoral disease, pain associated with knee OA commonly emanates from the patellofemoral joint. Evaluating the patellofemoral joint using radiography is problematic, which may have led to the paucity of data on patellofemoral OA. However, the advent of magnetic resonance imaging has enabled direct visualization of the entire knee joint and has given new insights into the pathogenesis of joint pathologies, such as OA. This discussion aims to compare and contrast patellofemoral and tibiofemoral OA and, thus, highlight that they are independent entities and, as such, must be examined as separate pathologica...

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A333 534 A REVIEW OF MANAGEMENT OPTIONS OF FEMOROACETABULAR IMPINGEMENT J. Fairley, A. Teichtahl, Y. Wang, A. Wluka, S. Brady, F. Cicuttini. Monash Univ., Melbourne, Australia Purpose: Femoroacetabular impingement (FAI) is a common cause of hip pain treated surgically. However, the comparative efficacy of surgery versus non-surgical management is unclear. This review examines the evidence for surgical and non-surgical treatment for FAI using symptoms, hip shape and cartilage change as clinical endpoints. Methods: Electronic searches of MEDLINE and EMBASE were performed to identify relevant studies published from 2000 to July 2014.Studies that met a set of predefined criteria were included. Surgical management strategies (arthroscopy, surgical hip dislocation, combined and miniopen techniques) and non-surgical management (non-surgical, conservative) were searched with “Femoroacetabular Impingement.” Studies reporting outcomes (symptoms and anatomical change) were selected. Results: Sixteen studies comparingmanagement strategies for FAI were identified. Two studies examined non-surgical therapy prior to proceeding to surgical management. Thirteen studies examined symptom outcomes, while nine studies examined the effect on hip shape. Two studies examined impact on cartilage change. Symptom outcomes improved with both surgical and non-surgical treatment. Non-surgical management (anti-inflammatory medications, physiotherapy, activity modification) demonstrated good efficacy over 2 years with an average of 63% in the 2 studies avoiding escalation to surgery. There was no difference in symptom outcomes between surgical techniques (arthroscopy and surgical hip dislocation). Non-surgical therapy had no effect on hip shape while surgical procedures (both open and arthroscopic) resulted in improved, but not normalised, hip shape. Neither of the two studies examining cartilage effects showed any benefit of surgery. Conclusions: There are no studies that have directly compared nonsurgical and surgical treatment for FAI. When non-surgical management is used, approximately two thirds of patients do not proceed to surgery. Factors which predispose surgery have not been investigated. While with surgical intervention hip shape improves, impact on progression of joint degeneration is unclear. Further work addressing these will be needed in order to optimise patient outcome in FAI. 535 UNDERSTANDING FEAR OF MOVEMENT AND REINJURY WITH THE TAMPA SCALE OF KINESIOPHOBIA (TSK) IN INDIVIDUALS WITH MUSCULOSKELETAL KNEE PATHOLOGY: A SYSTEMATIC REVIEW L.M. Thoma y, K. Wolf y, L. Harris z, T. Best y, D. Flanigan y, L. Schmitt y. y The Ohio State Univ., Columbus, OH, USA; zOhio Univ., Columbus, OH

Knee radiography is the current gold standard for assessing the severity of knee osteoarthritis (OA) in clinical and research settings. Nevertheless, radiographic evaluation of OA is an insensitive and unreliable measure for quantifying disease severity and change over relatively short periods of time. The failure of knee radiographs to provide a sensitive outcome measure may be one factor that has contributed to the limited progress that has been achieved in developing effective treatments to slow or stop the progression of knee OA. Emerging evidence suggests that measurement of articular cartilage volume using magnetic resonance imaging (MRI) is valid, reproducible and sensitive to change in both normal subjects and those with OA. This review discusses the issues related to joint imaging using radiographs and MRI in the outcome assessment of knee OA.

Objective Although obesity is widely accepted as a risk factor for knee osteoarthritis, it is not clear whether individual components of body composition, such as the mass and distribution of muscle and fat, are associated with development of the disease. This study examined the effect of measures of body composition on the longitudinal change in tibial cartilage volume. Methods Body composition, assessed via dual x-ray absorptiometry, and tibial cartilage volume, assessed via magnetic resonance imaging, were measured in 86 healthy men and women who were mid-life in age. Change in tibial cartilage volume was assessed by imaging each knee 2 years after the baseline measurement and determining the difference from baseline in tibial cartilage volume. Correlations were determined between the muscle and fat mass of the arm, leg, and total body and the volume of the lateral- and medial-tibial cartilage, as well as the change in tibial cartilage volume over 2 years, after adjusting for confounders. Results There was a significant association between muscle mass and the medial-tibial cartilage volume, independent of age, sex, body mass index, tibial bone area, and level of physical activity. Although there was a positive association between muscle mass and the lateral-tibial cartilage volume, this did not persist after adjustment for confounders. Loss of muscle mass was associated with an increased loss of medial- and lateral-tibial cartilage over 2 years, after adjusting for confounders. No relationship was apparent between fat mass and either medial- or lateral-tibial cartilage volume, or between fat mass and change in either medial- or lateral-tibial cartilage volume over 2 years, after adjusting for confounders. Conclusion Muscle mass is an independent predictor of medial-tibial cartilage volume in healthy people in mid-life and is associated with a reduction in the rate of loss of tibial cartilage. This suggests that increased muscle mass may be protective against the onset of osteoarthritis.

Objective. Although there is evidence for a beneficial effect of dietary antioxidants on knee joint health, the data are sparse for the hip. Our aim was to examine the relationship between dietary antioxidants and early hip structural abnormalities in community-based adults. Methods. The study included 214 participants without diagnosed hip osteoarthritis (OA) who underwent hip magnetic resonance imaging in 2009–2010. The prevalence of femoral head cartilage defects and bone marrow lesions (BML) was assessed. Intakes of antioxidant vitamins and their food sources were estimated from a food frequency questionnaire during 1990–1994. Results. Higher intakes of Vitamin E (OR 0.63, 95% CI 0.41–0.96), lutein/zeaxanthin (OR 0.58, 95% CI 0.34–0.99), and lycopene (OR 0.64, 95% CI 0.44–0.95) were associated with a reduced prevalence of femoral head cartilage defects. Higher intakes of α-carotene (OR 0.42, 95% CI 0.19–0.94), β-carotene (OR 0.31, 95% CI 0.13–0.78), and lutein/zeaxanthin (OR 0.42, 95% CI 0.18–0.98) were associated with a reduced prevalence of femoral head BML. Higher vegetable consumption was associated with a reduced prevalence of femoral head cartilage defects (OR 0.65, 95% CI 0.46–0.91) and BML (OR 0.60, 95% CI 0.37–0.97). Conclusion. Higher carotenoids intake and vegetable consumption were associated with reduced risk of hip cartilage defects and BML, and higher Vitamin E intake was associated with reduced risk of hip cartilage defects. These findings suggest a beneficial effect of dietary antioxidants on hip joint health. Although our findings need to be confirmed in other longitudinal studies, they suggest that the modification of dietary antioxidant intake may be a strategy for the prevention of hip OA.

NHMRC: 299831, 628582, 1074979, 1011975, 1063574, 1073284 Arthritis Foundation Deakin University

Introduction The infrapatellar fat pad (IPFP) is commonly resected during knee joint arthroplasty, but the ramifications of doing so are unclear. This longitudinal study determined whether the size of the IPFP (maximum cross-sectional area (CSA)) was associated with knee cartilage loss and the development of knee pain in adults without knee osteoarthritis (OA). Methods A total of 297 adults without American College of Rheumatology clinical criteria for a diagnosis of knee OA were recruited. Knee MRI was performed at baseline and an average of 2.3 years later. IPFP maximal CSA and tibial cartilage volume were measured from MRI. A large and small IPFP were defined by the median split, with a large IPFP defined by being in the highest 50 %. Body composition was performed at baseline using bio-impedance. Knee pain was assessed at follow-up using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Results A larger IPFP at baseline was associated with reduced knee pain at follow-up (OR 0.5, 95 % CI: 0.3 to 0.9, p = 0.02) and lateral tibial cartilage volume loss (β: −0.9 % (95 % CI: −1.6, −0.1 %) per annum, p = 0.03). The maximal CSA of the IPFP was predominantly located in the lateral (54.2 %), rather than the medial tibiofemoral compartment (1.7 %). Male gender (OR 12.0, 95 % CI: 6.5 to 22.0, p

OBJECTIVES: Conflicting reports of the effect of physical activity on knee cartilage may be due to the heterogeneity of populations examined and, in particular, the underlying health of the knee joint. This study examined the influence of recreational and occupational physical activity on cartilage volume loss. METHODS: A total of 250 participants with no significant musculoskeletal disease were recruited. A gender-specific median cartilage volume split was used to define people in the lowest and highest 50% of baseline cartilage volume. Baseline recreational and occupational activity was examined by questionnaire, while cartilage volume was assessed by MRI at baseline and 2.4 : years later. RESULTS: Significant interactions were demonstrable between physical activity and cartilage volume loss based on stratification of baseline cartilage volume (all P ⩽ 0.03). There was a dose-response relationship between frequently performed baseline occupational activities and medial cartilage volume loss in both the low (B = 0.2% per annum, 95% CI: 0.0, 0.04% per annum) and high (B = -0.2% per annum, 95% CI: -0.4, 0.0% per annum) baseline cartilage volume groups (P = 0.001 for interaction). Individuals with low baseline cartilage volume who were active in their occupation and/or recreational activity had greater medial cartilage volume loss than their more inactive counterparts (2.4% per annumvs1.5% per annum, P = 0.02). CONCLUSION: Whereas people with less baseline cartilage volume are more at risk of structural knee damage with either heavy occupational or recreational workloads or both, individuals with high baseline cartilage volume may advantageously modify their risk for knee OA by participating in more frequent occupational physical activities.

Summary Background There is growing interest in the role of intramuscular fat and how it may influence clinical outcomes. Vastus medialis (VM) is a functionally important quadriceps muscle that helps to stabilise the knee joint. This longitudinal study examined the determinants of VM fat infiltration and whether VM fat infiltration influenced knee cartilage volume. Methods 250 participants without any diagnosed arthropathy were assessed at baseline between 2005 and 2008, and 197 participants at follow-up between 2008 and 2010. Ambulatory and sporting activity were assessed and magnetic resonance imaging (MRI) was used to determine knee cartilage volume and VM fat infiltration. Results Age, female gender, BMI and weight were positively associated with baseline VM fat infiltration ( P ≤ 0.03), while ambulatory and sporting activity were negatively associated with VM fat infiltration ( P ≤ 0.05). After adjusting for confounders, a reduction in VM fat infiltration was associated with a reduced annual loss of medial tibial ( β = −10 mm 3 ; 95% CI −19 to 0 mm 3 ; P = 0.04) and patella ( β = −18 mm 3 ; 95% CI −36 to 0 mm 3 ; P = 0.04) cartilage volume. Conclusion This community-based study of healthy adults has shown that VM fat infiltration can be modified by lifestyle factors including weight loss and exercise, and reducing fat infiltration in VM has beneficial effect on knee cartilage preservation. The findings suggest that modifying VM fat infiltration via lifestyle interventions may have the potential to reduce the risk of knee OA.

Objective The patellofemoral joint is an example of an incongruent articulation commonly affected by osteoarthritis (OA). The relationship between femoral sulcus angle and the development and progression of patellofemoral OA is unclear. The aim of this study was to examine the relationship between the femoral sulcus angle at baseline and patella cartilage volume at baseline and at 2-year follow-up among community based adults with established knee OA. Methods One hundred subjects had magnetic resonance imaging of their symptomatic knee at baseline and at 2-year follow-up. From these images, patella cartilage volume was determined. Radiographic skyline views of the patellofemoral joint were taken at baseline to measure the femoral sulcus angle. Results For every 1° increase in the femoral sulcus angle (i.e., as the sulcus angle became more shallow) there was an associated 9.1 mm3 (95% CI 3.1, 15.0) increase in medial patella cartilage volume at baseline (P = 0.003). There was a similar trend that approached statistical significance between the femoral sulcus angle and the lateral patella facet cartilage volume at baseline (P = 0.09). There was no association between the femoral sulcus angle at baseline and the change in patella cartilage volume over 2 years in either patellofemoral compartment. Conclusion These results infer that the femoral sulcus angle is a cross-sectional determinant of the amount of patella cartilage, but is not a major determinant of the annual change of patella cartilage volume among people with knee OA. These data suggest that a shallower sulcus in the context of established OA may be an advantageous anatomical variant. Further longitudinal studies are required to determine the role of the femoral sulcus angle in OA.

Introduction Few data are available concerning structural changes at the hip observed by magnetic resonance imaging (MRI) in people with or without hip osteoarthritis (OA). The aim of this study was to compare cartilage volume and the presence of cartilage defects and bone marrow lesions (BMLs) in participants with and without diagnosed hip OA. Methods Femoral head cartilage volume was measured by MRI for 141 community-based persons with no diagnosed hip OA, and 19 with diagnosed hip OA. Cartilage defects and BMLs were regionally scored at the femoral head and acetabulum. Results Compared with those without diagnosed hip OA, people with diagnosed hip OA had less femoral head cartilage volume (1763 mm3 versus 3343 mm3; p

Background Whilst patellofemoral pain is one of the most common musculoskeletal disorders presenting to orthopaedic clinics, sports clinics, and general practices, factors contributing to its development in the absence of a defined arthropathy, such as osteoarthritis (OA), are unclear. The aim of this cross-sectional study was to describe the relationships between parameters of patellofemoral geometry (patella inclination, sulcus angle and patella height) and knee pain and patella cartilage volume. Methods 240 community-based adults aged 25-60 years were recruited to take part in a study of obesity and musculoskeletal health. Magnetic resonance imaging (MRI) of the dominant knee was used to determine the lateral condyle-patella angle, sulcus angle, and Insall-Salvati ratio, as well as patella cartilage and bone volumes. Pain was assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) VA pain subscale. Results Increased lateral condyle-patella angle (increased medial patella inclination) was associated with a reduction in WOMAC pain score (Regression coefficient -1.57, 95% CI -3.05, -0.09) and increased medial patella cartilage volume (Regression coefficient 51.38 mm3, 95% CI 1.68, 101.08 mm3). Higher riding patella as indicated by increased Insall-Salvati ratio was associated with decreased medial patella cartilage volume (Regression coefficient -3187 mm3, 95% CI -5510, -864 mm3). There was a trend for increased lateral patella cartilage volume associated with increased (shallower) sulcus angle (Regression coefficient 43.27 mm3, 95% CI -2.43, 88.98 mm3). Conclusion These results suggest both symptomatic and structural benefits associated with a more medially inclined patella while a high-riding patella may be detrimental to patella cartilage. This provides additional theoretical support for the current use of corrective strategies for patella malalignment that are aimed at medial patella translation, although longitudinal studies will be needed to further substantiate this.

Introduction The mechanism by which obesity increases the risk of hip osteoarthritis is unclear. One possibility may be by mediating abnormalities in bony geometry, which may in turn be associated with early structural abnormalities, such as cartilage defects and bone marrow lesions. Methods One hundred and forty one older adults with no diagnosed hip osteoarthritis had weight and body mass index measured between 1990 and 1994 and again in 2009 to 2010. Acetabular depth and lateral centre edge angle, both measures of acetabular over-coverage, as well as femoral head cartilage volume, cartilage defects and bone marrow lesions were assessed with 3.0 T magnetic resonance imaging performed in 2009 to 2010. Results Current body mass index, weight and weight gain were associated with increased acetabular depth and lateral centre edge angle (all P ≤ 0.01). For every 1 mm increase in acetabular depth, femoral head cartilage volume reduced by 59 mm3 (95% confidence interval (CI) 20 mm3 to 98 mm3, P < 0.01). Greater acetabular depth was associated with an increased risk of cartilage defects (odds ratio (OR) 1.22, 95% CI 1.03 to 1.44, P = 0.02) and bone marrow lesions (OR 1.29, 95% CI 1.01 to 1.64, P = 0.04) in the central region of the femoral head. Lateral centre edge angle was not associated with hip structure. Conclusions Obesity is associated with acetabular over-coverage. Increased acetabular depth, but not the lateral centre edge angle, is associated with reduced femoral head cartilage volume and an increased risk of cartilage defects and bone marrow lesions. Minimising any deepening of the acetabulum (for example, through weight management) might help to reduce the incidence of hip osteoarthritis.

Background It has been suggested that knee height is a determinant of knee joint load. Nonetheless, no study has directly examined the relationship between anthropometric measures of height and knee joint structures, such as cartilage. Methods 89 asymptomatic community-based adults aged 25-62 with no diagnosed history of knee arthropathy were recruited. Anthropometric data (knee height and body height) were obtained by standard protocol, while tibial cartilage volume and defects, as well as bone area were determined from magnetic resonance imaging. Static knee alignment was measured from the joint radiograph. Results All anthropometric height measures were associated with increasing compartmental tibial bone area (p ≤ 0.05). Although knee height was associated with tibial cartilage volume (e.g. β = 27 mm3 95% CI 7- 48; p = 0.009 for the medial compartment), these relationship no longer remained significant when knee height as a percentage of body height was analysed. Knee height as a percentage of body height was associated with a reduced risk of medial tibial cartilage defects (odds ratio 0.6; 95% confidence interval 0.4 - 1.0; p = 0.05). Conclusion The association between increased anthropometric height measures and increased tibial bone area may reflect inherently larger bony structures. However the beneficial associations demonstrated with cartilage morphology suggest that an increased knee height may confer a beneficial biomechanical environment to the chondrocyte of asymptomatic adults.

Meniscus Meniscal osteophyte Grade 3-5 Yes Outer part Chondrogenesis Grade 4 Yes Yes Outer part Ossification Grade 3-6 Yes Yes Attachment hypertrophy Grade 4-6 Yes Erosion Grade 6* Yes* Cruciate ligament Strong ECM staining Grade 3-6 Yes Yes Cell hypertrophy Grade 3-6 Yes Yes Cell clustering Grades 4-6 Yes Yes Loss of alignment Grade 3-4 Yes Yes Collateral ligament Chondroplasia Grade 4-5 Ossification Grade 4-5

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A207 Physical activity was assessed between 2006 and 2008 by questionnaire, while low back pain and disability were assessed by the Chronic Pain Grade Scale at the time of MRI. Intervertebral disc height and cross-sectional area and fat content of multifidus and erector spinae were assessed from MRI. Results: Lower physical activity levels were associated with reduced average intervertebral disc height (b -0.63mm, 95% CI -1.17mm to -0.08mm, p 1⁄4 0.026) after adjusting for age, gender and BMI. There were no significant associations between physical activity levels and the cross-sectional area of multifidus or erector spinae. Lower levels of physical activity were associated with an increased risk of high fat content in multifidus (OR 2.7, 95% CI 1.1 to 6.7, p 1⁄4 0.04) and high intensity pain/disability (OR 1⁄4 5.0, 95% CI 1.5 to 16.4, p 1⁄4 0.008) after adjustment for age, gender and BMI. Conclusions: Physical inactivity is associated with reduced intervertebral disc height, high fat content of multifidus and high intensity low back pain and disability in a dose-dependent manner. These data provide evidence that among community-based adults, physical inactivity is associated with deleterious changes in lumbosacral spine structure. 331 THE ASSOCIATIONS BETWEEN DISC DEGENERATION AND COEXISTENT STRUCTURAL ABNORMALITIES IN THE LUMBOSACRAL SPINE e A 3.0T MRI STUDY OF COMMUNITY-BASED ADULTS A. Teichtahl y, D. Urquhart z, Y. Wang z, A. Wluka z, R. O'Sullivan z, F. Cicuttini z. yBaker IDI/Monash Univ., Melbourne, Australia; zMonash Univ., Melbourne, Australia Purpose: Degenerative disc disease of the lumbar spine is common, with severe disease increasing the risk for back pain. This cross-sectional study examined whether disc degeneration was associated with structural pathology in the lumbosacral spine. Methods: 72 community-based individuals not selected for low back pain had MRI to determine lumbosacral disc degeneration via the Pfirrmann grading system, intervertebral disc height, Modic change and paraspinal muscle fat content. Results: With reducing intervertebral disc height, there was an increased prevalence of degenerative disc disease from L3 through to S1 (OR range 1.3 to 1.5; 95% CI range 1.1 to 2.1; all p 0.01). Modic change from L2 to L4 was associated with an increased prevalence of disc degeneration at each corresponding level (OR range 5.5 to 31.3, p 0.04). High fat (>50%) content of multifidus and erector spinae were associated with an increased prevalence of intervertebral disc degeneration at L5/S1 (OR 4.5, 95% CI 1.3 to 15.2, p 1⁄4 0.016) and L3/4 (OR 6.4, 95% CI 1.3 to 31.8, p 1⁄4 0.02) respectively, with a non-significant, but similar direction for all other lumbosacral levels. Conclusions: This cross-sectional study has demonstrated that reduced intervertebral disc height, Modic change and high fat content of the paraspinal muscles are associated with an increased prevalence of severe degenerative disc disease in the lumbosacral spine. Longitudinal studies are required to help determine whether degenerative disc disease is a cause or result of these structural abnormalities. 332 MODIC CHANGES IN THE LUMBAR SPINE AND THEIR ASSOCIATION WITH BODY COMPOSITION, FAT DISTRIBUTION AND INTERVERTEBRAL DISC HEIGHT e A 3.0T-MRI STUDY OF COMMUNITY-BASED ADULTS A. Teichtahl y, D. Urquhart z, Y. Wang z, A. Wluka z, R. O'Sullivan z, F. Cicuttini z. yBaker IDI/Monash Univ., Melbourne, Australia; zMonash Univ., Melbourne, Australia Purpose: Vertebral endplate and bone marrow (Modic) change are being recognised in the pathogenesis of non-specific low back pain. Although obesity, measured by the Bodymass index (BMI), has not been found to be associated with Modic change, body composition and fat distribution have not been examined. Moreover, no study has examined whether Modic change are related to other structural features of low back pain, such as reduced intervertebral disc height. Methods: 72 community-based individuals not selected for low back pain had lumbar vertebral Modic change and intervertebral disc height assessed from MRI. Dual energy x-ray absorptiometry measured body composition and fat distribution. Results: The predominance of Modic change was type 2, with only 1 participant demonstrating Modic type 1 change. Modic change was associated with an increased fat mass index (OR 1.20, 95% CI 1.01 to 1.43), and tended to be associated with a reduced fat-free mass index (OR 0.62, 95% CI 0.37 to 1.03, p1⁄4 0.07).While an increased percentage of gynoid fat was associated with a reduced risk (OR 0.62, 95% CI 0.43 to 0.89), an increased percentage of android fat was associated with an increased risk of Modic change (OR 2.11, 95% CI 1.18 to 3.76). Modic change was also associated with reduced intervertebral disc height at L2/3, L4/5 and L5/S1 (OR range 1.4 to 1.8; all p 0.03). Conclusions: Modic type 2 change is associated with reduced intervertebral disc height and an increased fat mass index. Whereas gynoid fat distribution protected against Modic type 2 change, an android pattern increased the risk of this lesion. Modic type 2 change, which histologically represent fat replacement, might have a metabolic component to its aetiology. Imaging: Joint Morphometry 333 BONE MARROW LESIONS QUANTITATIVELY EVALUATED ON FLUID SENSITIVE SEQUENCES, NOT CARTILAGE SEQUENCES, CORRELATE WITH PAIN: DATA FROM THE OSTEOARTHRITIS INITIATIVE M. Zhang y, J.B. Driban y, L. Price y, G.H. Lo z, T.E. McAlindon y. y Tufts Med. Ctr., Boston, MA, USA; zMichael E. DeBakey VA Med. Ctr./Baylor Coll. of Med., Houston, TX, USA Purpose: Subchondral bone marrow lesions (BMLs) are common findings on magnetic resonance (MR) images of knees with osteoarthritis (OA) and relate to structural and symptomatic progression of OA. While BMLs are often assessed on intermediate-weighted fat suppressed (IW FS) turbo spin echo sequences some researchers have also evaluated BMLs on 3-dimensional dual echo steady state (3D DESS) sequences or other similar sequences that are used for cartilage measurements. This latter approach would enable an efficient method to assess changes in BMLs and cartilage on the same sequence. Prior head-to-head comparisons have demonstrated that IW FS sequences may be more sensitive to detecting BMLs but have not determined if BMLs on the different sequences have similar construct validity. The purpose of this study was to compare quantitative assessment of BMLs on IW FS and 3D DESS sequences and to assess the construct validity of BML volumes on each sequence by calculating the correlations between BML volumes and knee Methods: We randomly chose 30 knees from the Osteoarthritis Initiative (OAI) with 24and 48-month MR images as well as complete data from the OAI Bone Ancillary Study (i.e., subchondral bone mineral density, MR-based trabecular morphometry, meniscal readings, and cartilage damage). Fifteen of these were randomly selected among those with medial joint space narrowing (OARSI score) between the 24and 48-month OAI visits and 15 knees had no medial joint space narrowing during this observation period. All of the knees had both IW FS and 3D DESS MRI images. The IW FS turbo spin echo and 3D DESS sequences were acquired using the OAI MR imaging protocol. We designed a semi-automatic software to measure BMLs on both sequences (Figure 1). One reader used customized software to place a large region of interest around a BML and the software generated the BML boundaries based on image morphology algorithms (image normalization, filtering, dilation, noise removal, and thresholding). We decided one threshold for IW FS and one threshold for 3D DESS based on 4 sample MRIs from each sequence. We summed the femur and tibia BMLs to generate a whole knee BML volume. We calculated the Spearman correlations of 24-month BML volume and BML volume change (48-month BMLsminus 24-month BMLs) between IW FS and 3D DESS sequences. We also calculated the association of BMLs on both sequences with Western Ontario and McMaster universities Arthritis index (WOMAC) pain score. Results: The IW FS sequence has larger BML volumes than 3D DESS sequence (24-month BMLs mean: IW FS 1⁄4 3507mm3, SD 1⁄4 5130mm3; 3D DESS 1⁄4 564.9mm3, SD 1⁄4 692.80mm3; Figures 2a and 2b). The difference in BML volumes between sequences is greater among knees with larger BMLs than knees with smaller BMLs (Figure 2b). The IW FS sequence generally demonstrates more BMLs volume change than 3D DESS sequence (Figure 2c and 2d). Furthermore, the difference between BML volume change between sequences is greater among knees with larger BML volume changes. The 24-month BML volume on IW FS is correlated with the 24-month BMLs volume on 3D DESS (r 1⁄4 0.90, p <

Whilst arthroscopic surgery for the treatment of meniscal tears is the most commonly performed orthopaedic surgery, meniscal tears at the knee are frequently identified on magnetic resonance imaging in adults with and without knee pain. The evidence for arthroscopic treatment of meniscal tears is controversial and lacks a supporting evidence base; it may be no more efficacious than conservative therapies. Surgical approaches to the treatment of meniscal pathology can be broadly categorised into those in which partial menisectomy or repair are performed. This review highlights that the major factor determining the choice of operative approach is age: meniscal repair is performed exclusively on younger populations, while older populations are subject to partial menisectomy procedures. This is probably because the meniscus is less amenable to repair in the older population where other degenerative changes co-exist. In middle-aged to older adults, arthroscopic partial menisectomy (APM) may treat the meniscus tear, but does not address the degenerative whole organ disease of knee osteoarthritis. Thus far, there is no convincing evidence that operative approaches are superior to conservative measures as the first-line treatment of older people with knee pain and meniscal tears. However, in two randomised controlled trials (RCTs) approximately one-third of subjects in the exercise groups had persisting knee pain with some evidence of improvement following APM, although the characteristics of this subgroup are unclear. From the available data, a first-line trial of conservative therapy, which includes weight loss, is recommended for the treatment of degenerative meniscal tears in older adults. The exception to this may be when mechanical symptoms, such as knee locking, predominate. Although requiring corroboration by RCTs, there is accumulating evidence from cohort studies and case series that meniscal repair rather than APM may improve function and reduce the long-term risk of knee osteoarthritis in young adults. There is no clear evidence from RCTs that one surgical method of meniscal repair is superior to another.

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A320 intra-articular injection of monoiodoacetate (MIA), and the joint degeneration was assessed with the OARSI cartilage degeneration score in histological assessments of the joints of the rats. Results: The MCP-1 itself enhanced the autocrine of MCP-1 in OA and normal human cartilage and the Expression of collagen I, V, IX, XI and Matrix metalloproteinases (MMP) increased after Stimulation of MCP-1. The MCP-1 also induced the apoptosis of normal and OA chondrocytes. The CCR-2 antagonist retarded the establishment of a monoiodoacetate (MIA)-induced animal model of OA in rats. Conclusions: The results of this study prove that the MCP-1-CCR2 ligand-receptor axis plays an important role in the progress of the OA's pathology. Inhibition of the MCP-1-CCR2 ligand-receptor axis may retard the pathological progress of human OA. And, we speculate that lots of OA patients that etiology is unclear can gain some cues from the MCP-1-CCR2 ligand-receptor axis, according to our present study. 506 BONE GEOMETRY OF THE HIP IS ASSOCIATED WITH OBESITY AND EARLY STRUCTURAL DAMAGE e A 3.0T MRI STUDY OF COMMUNITY-BASED ADULTS A. Teichtahl y, Y. Wang z, S. Smith z, A. Wluka z, M. Zhu z, D. Urquhart z, G. Giles x, R. O'Sullivan z, F. Cicuttini z. yBaker IDI/Monash Univ., Melbourne, Australia; zMonash Univ., Melbourne, Australia; xCancer Council Victoria, Melbourne, Australia Purpose: The mechanism by which obesity increases the risk of hip osteoarthritis (OA) is unclear. One mechanism may be by mediating abnormalities in bony geometry, which may in turn be associated with early structural abnormalities, such as cartilage defects and bone marrow lesions (BMLs). Methods: 141 older adults with no diagnosed hip OA had weight and body mass index (BMI) measured between 1990 and 1994 and again in 2009-10. Acetabular depth and lateral centre edge angle (LCEA), both measures of acetabular over-coverage, as well as femoral head cartilage volume, cartilage defects and BMLs were assessed with 3.0T MRI performed in 2009-10. Results: Current BMI, weight and weight gain were associated with increased acetabular depth and LCEA (all p 0.01). For every one millimetre increase in acetabular depth, femoral head cartilage volume reduced by 59mm3 (95% CI 98mm3 to 20mm3, p < 0.01). Greater acetabular depth was associated with an increased risk of cartilage defects (OR 1.22, 95% CI 1.03e1.44, p 1⁄4 0.02) and BMLs (OR 1.29, 95% CI 1.01e1.64, p 1⁄4 0.04) in the central region of the femoral head. LCEAwas not associated with hip structure. Conclusions: Obesity is associated with acetabular over-coverage. Increased acetabular depth, but not the LCEA, is associated with reduced femoral head cartilage volume and an increased risk of cartilage defects and BMLs. Minimising any deepening of the acetabulum, for example through weight management, might help to reduce the incidence of hip OA. 507 THE BENEFICIAL ROLE OF PAI-1 IN BONE-CARTILAGE INTERACTION M.F. Pustjens y, S.C. Mastbergen y, W.H. Noort-Van der Laan zy, R.J. Van Heerwaarden z, F.P. Lafeber y. yUniv. Med. Ctr. Utrecht, Utrecht, Netherlands; z St. Maartenskliniek, Woerden, Netherlands Purpose: In osteoarthritis (OA) subchondral bone changes are seen in addition to cartilage changes. In treatments targeted at bone, such as treatment with strontium ranelate (Reginster, 2013), or treatments with bone involvement such as osteotomy (Jung et al, 2014) or joint distraction (Intema et al, 2012) cartilage repair has been demonstrated. These studies support the hypothesis that a reset of bone can lead to cartilage repair. However, the exact biochemical interactions and how this contributes to repair and degradation processes is less well known. Plasminogen activator inhibitor (PAI)-1, inhibits plasmin which accounts for higher levels of MMPs in OA. It is expressed in subchondral bone and cartilage. The present study evaluates the role of plasminogen activator inhibitor 1 (PAI-1) in bone-cartilage interaction and its direct effects on osteoarthritic cartilage. Methods: Osteoblast culture supernatant from healthy (n1⁄414) and OA (n1⁄416) donors was tested on both healthy and OA cartilage and proteoglycan (PG) synthesis was studied. Expression levels of mediators were assessed in the osteoblast culture supernatants by Luminex analysis. Subsequently, OA cartilage (n1⁄411 donors) was cultured in absence/presence of PAI-1 and PG synthesis changes were studied. Results: PG synthesis of OA cartilage was increased (þ34%, p1⁄40.036) upon addition of healthy osteoblast supernatant. Importantly, a decrease was seen when OA osteoblast supernatant was added to healthy cartilage (-31% PG synthesis, p1⁄40.001). PAI-1 was expressed at significant higher levels in healthy osteoblasts compared to OA osteoblasts (184ng/ml vs 91ng/ml, resp.p1⁄40.015). Moreover, osteoblast PAI-1 levels were positively correlated with PG synthesis (r1⁄40.595, p1⁄40.042) influenced by the osteoblasts. Culturing OA cartilage in direct presence of PAI-1 (2000ng/ml) revealed 33% (p1⁄40.026) increase of PG synthesis confirming the beneficial role of PAI-1 in the osteoblast cultures. Conclusions: Healthy osteoblast derivedmediators lead to PG synthesis increase in OA cartilage, while it has no effect on healthy cartilage. Moreover, OA osteoblast derived mediators lead to a decrease in PG synthesis in healthy cartilage, but not in OA cartilage. Higher PAI-1 levels in these osteoblasts cultures are clearly correlated with higher PG synthesis in cartilage, which hints at a role for PAI-1 in cartilage repair. Its direct effects on OA cartilage, increasing PG synthesis, further confirmed the relevance of PAI-1. This supports that targeting bone directly or involvement of bone might be feasible as treatment for OA. 508 INVOLVEMENT OF TGFs1 IN THE INITIAL PHASE OF TMJ AND KNEE OSTEOARTHRITIS E.M. Long, R.E. Seegmiller, P. Reynolds. Brigham Young Univ., Provo, UT