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Ann Rheum Dis. 2015 Jan;74(1):196-203. doi: 10.1136/annrheumdis-2013-203972. Epub 2013 Oct 4.

Role of vascular channels as a novel mechanism for subchondral bone damage at cruciate ligament entheses in osteoarthritis and inflammatory arthritis.

Author information

1
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK Leeds Musculoskeletal Biomedical Research Unit, National Institute for Health Research, Chapel Allerton Hospital, University of Leeds, Leeds, UK.
2
Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
3
Department of Radiology, Galway University Hospitals, Galway, Ireland.

Abstract

OBJECTIVES:

The purpose of this work was to test whether normal peri-entheseal vascular anatomy at anterior and posterior cruciate ligaments (ACL and PCL) was associated with distribution of peri-entheseal bone erosion/bone marrow lesions (BMLs) in inflammatory arthritis (IA) and osteoarthritis (OA).

METHODS:

Normal microanatomy was defined histologically in mice and by 3 T MRI and histology in 21 cadaveric knees. MRI of 89 patients from the Osteoarthritis Initiative and 27 patients with IA was evaluated for BMLs at ACL and PCL entheses. Antigen-induced arthritis (AIA) in mice was evaluated to ascertain whether putative peri-entheseal vascular regions influenced osteitis and bone erosion.

RESULTS:

Vascular channels penetrating cortical bone were identified in knees of non-arthritic mice adjacent to the cruciate ligaments. On MRI of normal cadavers, vascular channels adjacent to the ACL (64% of cases) and PCL (71%) entheses were observed. Histology of 10 macroscopically normal cadaveric specimens confirmed the location of vascular channels and associated subclinical changes including subchondral bone damage (80% of cases) and micro-cyst formation (50%). In the AIA model, vascular channels clearly provided a site for inflammatory tissue entry and osteoclast activation. MRI showed BMLs in the same topographic locations in both patients with early OA (41% ACL, 59% PCL) and IA (44%, 33%).

CONCLUSION:

The findings show that normal ACL and PCL entheses have immediately adjacent vascular channels which are common sites of subtle bone marrow pathology in non-arthritic joints. These channels appear to be key determinants in bone damage in inflammatory and degenerative arthritis.

KEYWORDS:

Inflammation; Knee Osteoarthritis; Magnetic Resonance Imaging; Osteoarthritis; Rheumatoid Arthritis

Comment in

PMID:
24095939
PMCID:
PMC4283693
DOI:
10.1136/annrheumdis-2013-203972
[Indexed for MEDLINE]
Free PMC Article
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