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Thickness of Human Articular Cartilage in Joints of the Lower Limb

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Thickness of Human Articular Cartilage in Joints of the Lower Limb Ann Rheum Dis 1999;58:27–34 27 Thickness of human articular cartilage in joints of Ann Rheum Dis: first published as 10.1136/ard.58.1.27 on 1 January 1999. Downloaded from the lower limb D E T Shepherd, B B Seedhom Abstract incongruent joints such as the knee. The Objectives—(a) To determine the topo- correlations in this study imply that the graphical variations in cartilage thickness larger and heavier was a donor the thicker over the entire surfaces of cadaveric lower was the cartilage in the lower limb joints. limb joints, and (b) to examine the corre- The data further suggest the presence of lations between: cartilage thickness and an inverse relation between the mean car- its site specific modulus; cartilage thick- tilage thickness and mean compressive ness and donor age, weight, height, and modulus in each of the joints examined. body mass index. (Ann Rheum Dis 1999;58:27–34) Methods—The cartilage thickness of 11 sets of cadaveric human joints each com- prising an ankle, knee, and hip was meas- A vast array of techniques exist for measuring ured using a needle probe technique. the thickness of articular cartilage. These Statistical analysis was used to compare methods include destructive techniques where the cartilage thickness of the diVerent the thickness of plugs or slices of cartilage are lower limb joints and the diVerences in measured1–4 or using a needle probe5 and non- cartilage thickness over the surface of destructive techniques such as ultrasound.6–8 individual joints. It was further examined Jurvelin et al9 did a comparison of optical, whether cartilage had a correlation with needle probe, and ultrasonic techniques for the its stiVness, and any of the details of the measurement of articular cartilage thickness specimen donors such as age, weight, and concluded that each method had its height, and body mass index. limitations. One serious limitation was with Results—The mean cartilage thickness of ultrasound by having to assume a constant the knee was significantly greater than velocity of sound when it can vary greatly that of the ankle and hip (p<0.001) in all 11 between cartilage specimens. Yao and sets of joints, while the cartilage thickness Seedhom10 have shown that the velocityof of the hip was significantly greater than that of the ankle in 10 sets of joints sound in cartilage can vary as much as 33.6% of the average calculated from a large number (p<0.001). The mass of specimen donors http://ard.bmj.com/ was found to correlate with the mean car- of sites, leading to errors in thickness of the tilage thickness of all three lower limb same percentage when compared with data joints. A correlation was also found be- obtained by direct measurement using the nee- tween the height of donors and the mean dle probe technique. cartilage thickness of the knee and hip More recent techniques used to measure the joints, while only in the ankle joint was a thickness of articular cartilage have included correlation found between the mean carti- using magnetic resonance imaging.11 12 Kladny Rheumatology and lage thickness and the body mass index of et al11 found that the mean percentage diVer- on September 30, 2021 by guest. Protected copyright. Rehabilitation the specimen donors. A further correla- ence between cartilage thickness in magnetic Research Unit, tion was found between cartilage thickness resonance imaging and direct measurement University of Leeds, 36 Clarendon Road, and its modulus; the thinner the cartilage, from histological sections was about 10%, with Leeds LS2 9NZ the higher the modulus. the results most accurate for cartilage thicker Conclusions—The thickness of articular than 2 mm. Correspondence to: cartilage seems to be related to the Dr Seedhom. Given the vast array of techniques that exist congruance of a joint; thin cartilage is for measuring the thickness of articular cartilage Accepted for publication found in congruent joints such as the it is surprising that few studies have been 10 September 1998 ankle, whereas thick cartilage is found in published giving detailed measurements of the Table 1 Details of specimen donors relevant to the study thickness of human articular cartilage in joints of the lower limb. The thickness of articular Set number Sex Age (y) Mass (kg) Height (m) Body mass index (kg/m2) cartilage influences both the stresses and strains 1 F 62 60 1.75 19.6 arising within the cartilage matrix.13 Detailed 2 M 68 50 1.75 16.3 knowledge of cartilage thickness is also impor- 3 F 33 50 1.70 17.3 4 F 65 74 1.75 24.2 tant for finite element work on synovial joints. 5 F 46 35 1.60 13.7 This paper presents the results of a study in 6 F 80 64 1.70 22.1 7 F 79 50 1.52 21.6 which the cartilage thickness was surveyed over 8 F 70 48 1.63 18.1 the entire surfaces of cadaveric lower limb joints. 9 M 63 60 1.68 21.3 10 M 74 68 1.75 22.2 It further examines whether cartilage thickness 11 F 76 40 1.60 15.6 had a correlation with its stiVness, and with any Mean 65.1 54.5 1.68 19.3 of the details of specimen donors such as age, SD 14.3 11.9 0.08 3.3 weight, height, and body mass index. 28 Shepherd, Seedhom each joint in a set would have been subjected to Ann Rheum Dis: first published as 10.1136/ard.58.1.27 on 1 January 1999. Downloaded from the same number of loading cycles. Table 1 gives details of the specimen donors. Availabil- ity was a major limiting factor on the number of this type of specimens. Displacement Cartilage thickness SPECIMEN PREPARATION Each set of joints was obtained from the Load mortuary within two to three days of death. Load and displacement The joints were sealed in plastic bags and stored at −20°C in a freezer until the time of A B Needle Time testing, when the joints were thawed overnight in a refrigerator at 4°C. Once thawed, the sur- Cartilage rounding tissue was removed from a joint so that the articular cartilage surfaces were Bone exposed. A fine felt tip pen dipped in Initial Contact with Contact with haematoxyline acid was used to draw a mesh position cartilage bone over the entire articular surface of a joint yield- Figure 1 Response of load and displacement transducers for cartilage thickness ing approximately 50 square test sites on the measurement. hip, 75 on the knee, and 35 on the ankle. Methods MATERIALS CARTILAGE THICKNESS MEASUREMENT Eleven sets of cadaveric human joints each The cartilage thickness of each square (that did comprising an ankle, knee, and hip were used not show any visible signs of degeneration) on in this study to measure the cartilage thickness the mesh of all the articular surfaces was then over the whole surface of cadaveric lower limb measured using the technique of Swann and joints. The joints within each set were obtained Seedhom.5 from the ipsilateral side and this meant that The method entails using an apparatus that allows a sharp needle to pierce the cartilage sur- face and move through the cartilage before coming to rest on the underlying bone at its interface with the cartilage. The apparatus also DD allowed simultaneous measurement to be taken EF of the displacement of the needle and of the load arising, from the moment the needle came into GG contact with the cartilage. From these measure- B ments the cartilage thickness could be deter- C mined. The apparatus and technique have been http://ard.bmj.com/ 5 A previously described and so, only a brief account of the procedure is given here. The specimen is placed approximately 0.5 mm below the needle. The needle assembly shaft is released and moves towards the cartilage before piercing the surface. Figure 1 shows a typical response of the load and displacement signals with time as the needle is allowed to on September 30, 2021 by guest. Protected copyright. move through the cartilage and into the underlying bone. Before releasing the needle, both the load and displacement signals I have zero values. Once the needle is released it moves towards the cartilage surface and the dis- placement signal thus begins to increase, but the JJ load signal remains at zero because the needle is not yet in contact with the cartilage surface. At HHKKthe moment the needle comes into contact with the cartilage surface the load signal increases above zero, thus identifying the exact position of the displacement signal that corresponds to the cartilage surface (point A in fig 1). The contact point with the underlying bone can also be determined. As the underlying bone is much stiVer than articular cartilage, LM there is a very rapid positive increase in the load signal when the needle reaches the bone inter- face with cartilage (point B). The cartilage Figure 2 Distinct areas of the lower limb joints (A, B, C: posterior, superior, and anterior thickness is the diVerence in displacement areas of the acetabulum respectively; D, E, F,G: superior, anterior, and posterior areas of the between the contact point with the bone (point femoral head respectively; H, I: patellar surface and femoral condyles respectively; J, K: tibial areas of the knee covered by the menisci and those that come into direct contact with B) and the contact point with the cartilage sur- the femur respectively; L, M: talar and tibial areas of the ankle respectively).
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