Role of vascular channels as a novel mechanism for subchondral bone damage at cruciate ligament entheses in osteoarthritis and inflammatory arthritis. Issue 1 (4th October 2013)

• Record Type: Journal Article
• Authors: Binks, D A; Gravallese, E M; Bergin, D; Hodgson, R J; Tan, A L; Matzelle, M M; McGonagle, D; Radjenovic, A
• Is Part Of: Annals of the rheumatic diseases. Volume 74:Issue 1(2015)
• Page Start: 196
• Page End: 203
• Publication Date: 2013-10-04
• Subjects: Osteoarthritis -- Inflammation -- Magnetic Resonance Imaging -- Rheumatoid Arthritis -- Knee Osteoarthritis; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2013-203972
• Languages: English
• ISSNs: 0003-4967

Abstract

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.